Cluster randomised controlled trial of an m-health intervention in centre-based childcare services to reduce the packing of discretionary foods in children’s lunchboxes: study protocol for the ’SWAP IT Childcare' trial

Abstract

IntroductionIn many developed nations, including Australia, a substantial number of children aged under 5 years attend centre-based childcare services that require parents to pack food in lunchboxes. These lunchboxes often contain excessive amounts of unhealthy (‘discretionary’) foods. This study aims to assess the impact of a mobile health (m-health) intervention on reducing the packing of discretionary foods in children’s childcare lunchboxes.Methods and analysisA cluster randomised controlled trial will be undertaken with parents from 18 centre-based childcare services in the Hunter New England region of New South Wales, Australia. Services will be randomised to receive either a 4-month m-health intervention called ‘SWAP IT Childcare’ or usual care. The development of the intervention was informed by the Behaviour Change Wheel model and will consist primarily of the provision of targeted information, lunchbox food guidelines and website links addressing parent barriers to packing healthy lunchboxes delivered through push notifications via an existing app used by childcare services to communicate with parents and carers. The primary outcomes of the trial will be energy (kilojoules) from discretionary foods packed in lunchboxes and the total energy (kilojoules), saturated fat (grams), total and added sugars (grams) and sodium (milligrams) from all foods packed in lunchboxes. Outcomes will be assessed by weighing and photographing all lunchbox food items at baseline and at the end of the intervention.Ethics and disseminationThe study was approved by the Hunter New England Local Health District Human Ethics Committee (06/07/26/4.04) and ratified by the University of Newcastle, Human Research Ethics Committee (H-2008–0343). Evaluation and process data collected as part of the study will be disseminated in peer-reviewed publications and local, national and international presentations and will form part of PhD student theses.Trial registration numberACTRN12618000133235; Pre-results.

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

“…Childcare centres will be randomly allocated following a block randomisation procedure in a 1:1 ratio to either intervention or control using a computerised random number function in Microsoft Excel 2013. Due to the demographic and socioeconomic diversity of the HNE region, randomisation will be stratified by centres with a high number of Aboriginal child enrolments (> 10%) and by centre socioeconomic status (SES), as determined by Socio-Economic Indexes for Areas categorisation using centre postcodes [ 35 , 36 ]. Randomisation will be completed following baseline data collection by a statistician not otherwise involved in the trial.…”

“…Specifically, childcare centres will be asked to implement the following targeted healthy eating practices within the 6-month intervention period: Supporting families to provide healthier foods consistent with dietary guidelines: Childcare centres will be asked to monitor children’s lunchboxes for consistency with dietary guidelines on a daily basis and distribute nutrition-focused messages to parents that promote the packing of healthy lunchboxes at least twice during the intervention period. Messages will offer advice to address parents’ commonly reported barriers to providing healthy foods, including overcoming fussy eating, improving food acceptance, providing healthy foods on a budget and quick and healthy options [ 36 ]. Provision of intentional learning experiences about healthy eating to children: Childcare centre staff will be asked to provide children with intentional learning experiences at least twice per week aimed to support children’s development of healthy eating behaviours [ 40 ].…”

“…Supporting families to provide healthier foods consistent with dietary guidelines: Childcare centres will be asked to monitor children’s lunchboxes for consistency with dietary guidelines on a daily basis and distribute nutrition-focused messages to parents that promote the packing of healthy lunchboxes at least twice during the intervention period. Messages will offer advice to address parents’ commonly reported barriers to providing healthy foods, including overcoming fussy eating, improving food acceptance, providing healthy foods on a budget and quick and healthy options [ 36 ].…”

“…Per EPAO protocol, a trained RA will undertake a one-day observation and review of childcare centre documentation. The EPAO has been previously used by the research team in 18 childcare centres [ 36 ] and has demonstrated high inter-observer agreement. The tool is considered to be gold standard for environmental observations in the childcare setting [ 61 ].…”

“…All food wastage will be collected by the research team during the second measurement and factored into child consumption measurements. The weighed plate method with photographs has been previously used by the research team [ 36 ] and has proven to be a precise measure of dietary intake in previous studies [ 62 ]. This weighed food record data will be entered into a nutrient analysis database (FoodWorks) [ 63 ] by a trained dietitian blinded to centre allocation.…”