Application of the multiphase optimisation strategy to develop, optimise and evaluate the effectiveness of a multicomponent initiative package to increase 2-to-5-year-old children’s vegetable intake in long day care centres: a study protocol

Abstract

IntroductionGlobally, children do not eat enough core foods, with vegetable intakes persistently low. Early life is critical for establishing vegetable acceptance and intake. Increased usage of formal childcare has led to the importance of childcare settings shaping children’s food intake. This study will use the multiphase optimisation strategy to develop, optimise and evaluate the effectiveness of a multicomponent initiative package to increase 2-to-5-year-old children’s vegetable intake in long day care centres.Methods and analysisThe preparation phase will use existing literature and best practice guidelines to develop three initiatives aiming to: (1) increase vegetable provision at mealtimes, (2) deliver a vegetable-focused sensory curriculum and (3) use supportive mealtime practices encouraging children’s tasting of vegetables. The optimisation phase (N=32 centres) will use a 12-week, eight-condition factorial experiment to test main and synergistic effects of the initiatives. The optimum combination of initiatives producing the largest increase in vegetable intake will be identified. The evaluation phase (N=20 centres) will test the effectiveness of the optimised package using a 12-week waitlist randomised controlled trial. Primary outcomes are children’s vegetable intake and food group intake at long day care. Secondary outcomes are menu guideline compliance, cook and educator knowledge and skills, and reach. Process evaluation will include fidelity, acceptability, barriers and facilitators, and compatibility with practice. Repeated measures ANOVA with interaction effects (optimisation phase) and linear mixed modelling (evaluation phase) will test effects of the initiatives on vegetable intake.Ethics and disseminationThis study has received ethics approval from the Flinders University Research Ethics Committee (Project No: 1873) for the optimisation phase. Approval for the evaluation phase will be obtained following completion of optimisation phase. Findings will be disseminated to stakeholders, including long day care centres and childcare organisations; and to researchers via peer-reviewed journals and conferences.Trial registration numbersACTRN12620001301954, ACTRN12620001323910p.

Development of an initiatives package to increase children’s vegetable intake in long day care centres using the Multiphase Optimisation Strategy (MOST) randomised factorial experiment

“…Findings from this study suggest that interventions simultaneously targeting a combination of the curriculum and mealtime environment are the most efficient and effective targets for increasing children’s vegetable intake as opposed to a more complex intervention with all three initiatives. This combination will be taken forward to the next stage (evaluation phase) of the MOST framework to be evaluated in a randomised controlled trial design (27) .…”

“…This study used the MOST framework to develop a package of initiatives to increase children's vegetable intake in LDC centres. Details are outlined in a study protocol paper (27) (•https://doi.org/10•1136/bmjopen-2020-047618). This article reports Phase 2 of the MOST framework, the optimisation phase.…”

“…The preparation phase enabled staff to complete the online trainings, prepare for the curriculum implementation and complete the menu assessment (described below). The implementation phase involved delivery of the initiatives, described in detail in the protocol paper (27) and in brief below.…”

“…staff mealtime practices) and (3) curriculum, to identify a package of initiatives that delivers an optimal increase children’s vegetable intake while in LDC and (2) undertake a process evaluation to understand acceptability and factors that influence adoption of the initiatives. The optimisation criterion was defined as the initiative package with the greatest meaningful effect on vegetable intake, taking into consideration process evaluation findings (27) . It was hypothesised that an intervention utilising all three initiatives would have the largest effect on vegetable intake, with a target average increase of 0·5 serves/d (37·5 g).…”

Working together to increase Australian children’s liking of vegetables: a position statement by the Vegetable Intake Strategic Alliance (VISA)

“…Provide support at the organisational level through policy (food supply/distribution included). Incentivise and reward the inclusion of vegetables and vegetable products in menus at schools, hospitals and ECEC through recognition and award, for example, five-star food service (analogous to health star ratings of foods). Optimise the taste, flavour and texture qualities of vegetables and vegetable products according to children’s preferences through product development and preparation. Provide guidance, training and support to industry and food service for the development of vegetable-based products with high sensory appeal (9,27) . Involve children in preparation and cultivation of vegetables at home, in school (28,29) and in childcare centres (30) so that they have experiential familiarity of vegetables. Initiate ‘incursions’ from growers into childcare and schools to increase children’s familiarity with the origins of vegetables and leverage children’s love of nature (31) . …”