In Portugal, early childhood education (ECE) services for children ages 0-3 were the first education services to reopen, following periods of mandatory closure due to the Covid-19 pandemic. Covid-19 prevention and control measures (PCMs) were issued by the Ministry of Health to be implemented nationwide, but no knowledge is yet available on their implementation and impact. International research suggests that younger children appear to be less susceptible to infection and that transmission within childcare centres is low. Hence, the social and educational benefits of maintaining educational settings open were considered to outweigh the health benefits of closing them (assuming that PCMs were in place). This cross-sectional study maps the extent to which PCMs were implemented in ECE services for children ages 0-3 and examines perceived changes in pedagogical practices, children’s and teachers’ well-being and their relation to professionals’ digital health literacy.

An online survey was carried out, comprising three questionnaires developed under this study (implementation of PCMs, pedagogical practices and children's well-being), two validated scales (professionals’ well-being and digital health literacy), three questions on overall appraisal, and a sociodemographic profile. A total of 2,908 centres from all country districts were contacted by e-mail, and 853 ECE teachers completed the survey. Of this sample, 77% were private non-profit centres and 23% were private for-profit centres.

Results indicated that PCMs were widely implemented across the country (graph 1), with teachers reporting that the majority of PCMs were always or often implemented. Teachers extensively reported the use of personal protective equipment; the use of toys/materials provided exclusively by the centres; the restriction of parents’ entry to centres; the disinfection of surfaces, materials and children’s hands; and ventilation. Two PCMs registered higher variation in teachers’ responses. Thus, the reduction of the number of children per room was the least-reported measure, with 57% of teachers stating that it was never implemented. Implementing measures to avoid children sharing toys also showed variation, ranging from never (17%) to always (14%). Although 97% of teachers acknowledged that information on PCMs was always or often available, 34% reported that training opportunities for professionals were never or rarely available.

Items concerning changes in pedagogical practices and PCMs were explored, and three components were identified for each of them. The pedagogical components were adult-child interaction, emotional climate, and interaction with families. Teachers were asked how their pedagogical practices had changed since the start of the pandemic, and teachers reporting frequency of use above the median were considered to have “reinforced” the practice in question. The PCM components were disinfection and ventilation, social distancing, and centre/classroom organisation – including reduced class size. Associations between pedagogical practice components and PCM components are shown in graph 2. When asked about changes to pedagogical practices throughout the pandemic, when compared to pre-pandemic practices, teachers who reported that they had reinforced their pedagogical practices in adult-child interaction and interaction with families reported implementing the three PCM components more often. Perceived reinforcement of positive emotional climate was more likely to be reported by teachers who reported implementing disinfection and ventilation measures and centre/classroom organisation measures more frequently.

Overall, the results suggest that teachers who reported more frequent implementation of PCMs were more likely to report having reinforced their pedagogical practices, even after adjusting for teachers’ age, teachers’ years of experience, childcare centre location, number of children in the room, number of children in the centre and children’s age. However, when asked for an overall appraisal concerning the pandemic's impact on pedagogical practices, 56% of teachers agreed that the pandemic might have contributed to reducing their quality.

When asked about the proportion of children from their room that showed signs of physical or emotional well-being, teachers overall reported that all or almost all children exhibited such signs (graph 3). Teachers who reported more frequent implementation of disinfection and ventilation measures were more likely to perceive positive indicators of children’s well-being. However, there were no significant associations between the reported implementation of PCMs related to social distancing and centre/classroom organisation and perceived children’s well-being.

Teachers who reported to have reinforced their pedagogical practices during the pandemic, particularly by increasing the quality of adult-child interaction and the positive emotional climate in the classroom, were more likely to report positive indicators of children’s well-being. Despite these results, when asked for an overall appraisal of the pandemic's impact on children’s well-being in childcare, 29% of teachers considered that the pandemic might have contributed to a decrease in children’s well-being.

Most ECE teachers reported that they felt positive levels of subjective well-being very often during the last two weeks of on-site work (graph 4). Yet, a complete analysis of the scale shows that nearly 14% of the teachers reported low well-being. The overall appraisal emphasised that 55% of participants agreed that the pandemic had contributed to a decrease in adults’ well-being.

ECE teachers who implemented disinfection, ventilation and centre/classroom organisation measures more frequently were more likely to report high well-being. No significant associations were found between social distancing and well-being. Teachers who reported higher levels of subjective well-being were more likely to perceive that they had reinforced their pedagogical practices in adult-child interaction, emotional climate, and interaction with families, during the pandemic. Finally, teachers with higher subjective well-being scores were more likely to indicate a higher proportion of children with signs of well-being in their classrooms.

Teachers assessed their own digital health literacy on four dimensions adapted to the Covid-19 context: information searching (e.g., search the Internet for information about the coronavirus and make a choice from all the information found), self-generated content (e.g., clearly formulate a question or health-related concern), evaluating reliability (e.g., decide whether the information is reliable or not) and determining relevance (e.g., decide if the information is applicable). For each dimension, two subgroups were created using the median split (limited versus adequate digital health literacy). ECE teachers who reported adequate information searching tended to report implementing disinfection, ventilation and classroom organisation measures more frequently. ECE teachers who reported adequate self-generated content also reported implementing classroom organisation measures more often. ECE teachers who perceived themselves as having adequate evaluating reliability reported implementing disinfection, ventilation and organisational measures more frequently. Finally, adequate determining relevance was significantly associated with more frequent implementation of all three PCMs. These results suggest that ECE teachers’ digital health literacy concerning Covid-19 is associated with their implementation of PCMs. Teachers who believed that they were well equipped to find and appraise information about Covid-19 were more likely to implement PCMs.  This finding calls for community-wide approaches to improve digital health literacy among ECE teachers and more broadly.

This is a cross-sectional study, based on teachers’ own reports of their practices and behaviours and those of the children in their classrooms. Therefore, no claims can be made about cause and effect. Secondly, because the data was self-reported, it is not possible to exclude the influence of social desirability (that is, the possibility that social pressure led teachers to inflate their responses). However, the fact that teachers responded anonymously offers some protection from this potential drawback. Although this is a convenience sample, which advises a cautious approach to results, the high number of participants from all the districts of Portugal improves the trustworthiness of the results. Despite these limitations, this study adds to research on the pandemic by focusing on an understudied age group in Covid-19-related research. Moreover, it offers data not only on health issues, but also on the pandemic’s possible effects on pedagogical practices, as perceived by teachers.

ECE services for children ages 0-3 were the first educational services to reopen and were operating continuously from 18 May 2020 to 21 January 2021. Results suggest that PCMs are being widely implemented in services for children ages 0-3 in Portugal. Moreover, ECE teachers who reported implementing PCMs with greater frequency were more likely to perceive themselves as having reinforced their pedagogical practices, reported higher levels of subjective well-being and indicated higher proportions of children showing well-being indicators in their classrooms.  The results also suggest that teachers who reported implementing PCMs more often were more likely to report adequate digital health literacy.

It can be hypothesised that throughout this period, the professionals have built capacity and confidence in the implementation of PCMs while trying to safeguard the quality of their pedagogical practices. The perceived reinforcement of these practices, namely at the level of adult-child interaction and emotional climate, appears to be associated with perceived child well-being. Future educational and social initiatives directed towards mitigating the effects of the Covid-19 pandemic in ECE services should consider the potential protective effect of pedagogical practices. Hence, the quality of pedagogical practices should be emphasised so that the well-being of children and adults is safeguarded. In a context of global challenges to health and education, positive signs are given by ECE teachers, who seem to be confident that ECE centres in Portugal are implementing the measures to tackle the pandemic and protecting children’s well-being by reinforcing the quality of education and care.

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