A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres

Abstract

Background As dietary behaviours developed during early childhood are known to track into adulthood, interventions that aim to improve child nutrition at a population level are recommended. Whilst early childhood education and care (ECEC) is a promising setting for interventions targeting children’s nutrition behaviours, previous interventions have largely used high intensity, face-to-face approaches, limiting their reach, implementation and potential impact at a population level. Web-based modalities represent a promising means of supporting the delivery of childcare-based interventions whilst overcoming challenges of previous approaches; however, the feasibility of using such modalities to support implementation is largely unknown. As such, this study sought to collect feasibility and pilot data to inform the design of a web-based intervention together with health promotion officer support within childcare centres. Child dietary intake will also be assessed to provide an estimate of the impact of the implementation intervention. Methods A superiority cluster randomised controlled trial with repeat cross-sectional data collection employing an effectiveness-implementation type-II hybrid design will be conducted with childcare centres within the Hunter New England region of New South Wales, Australia. Type-II hybrid designs provide the opportunity to assess intervention efficacy whilst piloting the feasibility of the implementation strategies. Centres allocated to the intervention group will receive access to a web-based program together with health promotion officer support to implement targeted healthy eating practices to improve child diet in care. A number of outcomes will be assessed to inform the feasibility to conduct a larger trial, including childcare centre and parent recruitment and consent rates for each component of data collection, uptake of the implementation strategies, acceptability of the intervention and implementation strategies, appropriateness of the implementation strategies and the contextual factors influencing implementation. Discussion This study will provide high-quality evidence regarding the potential feasibility of a web-based intervention and the impact of healthy eating practices on child diet in care. Web-based modalities provide a promising approach for population-wide implementation support to childcare centres given their potential reach and consistency with existing infrastructure. Trial registration Prospectively registered with Australian New Zealand Clinical Trial Registry (ACTRN12619001158156).

An Overview of Research Opportunities to Increase the Impact of Nutrition Intervention Research in Early Childhood and Education Care Settings According to the RE-AIM Framework

“…Further, there is opportunity for the use of adaptive designs to understand the effective components of digital interventions. Additionally, designing digital health interventions that can be embedded into existing structures within ECEC [33,34] or are closely aligned with reporting requirements for the sector [35] may be a way of delivering nutrition interventions, while addressing potential barriers to engagement with such technology.…”

“…In addition to this trial, at least three recent protocols specifying the use of Hybrid designs for ECEC nutrition research have been published [35,102]. Firstly a protocol by Barnes and colleagues describes a Hybrid Type 2 design, which aims to pilot the feasibility of a web-based intervention as a strategy to improve implementation of recommended nutrition policies and practices while also testing the effectiveness of the intervention on child dietary intake [35]. The remaining two protocols describe Hybrid type 3 trials.…”

Parent Website Engagement and Health Equity Implications in a Child Care–Based Wellness Intervention

“…At least 2 such studies are currently underway. 39,40 Vroom's Expectancy Theory of Motivation, which posits that the likelihood of a behavior depends on the expectation that the behavior will result in an outcome that is valued, 41 could help explain the positive correlation between passive components (Connect and Attend) and application of behavior (Participate and Enact). Parents who completed the Connect and Attend interventions may have been sufficiently motivated by the material to expect that the outcome of the Practice and Enact interventions would be of value to them.…”

The Association between Australian Childcare Centre Healthy Eating Practices and Children’s Healthy Eating Behaviours: A Cross-Sectional Study within Lunchbox Centres

“…ECEC centres included long day care and preschools, typically enrolling children between 0 and 6 years old, prior to compulsory schooling [ 19 ]. ECEC centres within the study region currently participating in a cluster randomised controlled trial (RCT) to improve child dietary intake in care served as the sampling frame for the study, with baseline data from the trial presented within this paper [ 20 ]. The sample size of 440 children and 22 ECEC centres (estimating 20 children per centre) was calculated to enable the detection of clinically meaningful differences in the trial outcomes [ 20 ].…”

“…All food wastage, including packaging, partially consumed items and food items dropped on the floor, were collected by the RAs throughout the day and were factored into child intake measurements. Weighed food record data is considered gold standard for measuring child dietary intake in the setting [ 20 , 22 , 24 ].…”