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

Abstract

Objective: To inform a package of initiatives to increase children’s vegetable intake while in long day care (LDC) by evaluating the independent and combined effects of three initiatives targeting food provision, the mealtime environment, and the curriculum. Design: Using the Multiphase Optimisation Strategy (MOST) framework, a 12-week, eight-condition (n=7 intervention, n=1 control) randomised factorial experiment was conducted. Children’s dietary intake data was measured pre- and post-initiative implementation using the weighed plate waste method (1x meal and 2x between-meal snacks). Vegetable intake (grams/day) was calculated from vegetable provision and waste. The optimal combination of initiatives was determined using a linear mixed-effects model comparing between-group vegetable intake at follow up, while considering initiative fidelity and acceptability. Setting: LDC centres in metropolitan Adelaide, South Australia Participants: 32 centres, 276 staff, and 1039 children aged 2-5 years Results: There were no statistically significant differences between any of the intervention groups and the control group for vegetable intake (all p>0.05). The Curriculum with Mealtime environment group consumed 26.7g more vegetables/child/day than control [GMR (95% CI), 3.29 (0.96, 11.27), p=0.06]. Completion rates for the curriculum (>93%) and mealtime environment (61%) initiatives were high, and acceptability was good (4/5 would recommend), compared to the Food provision initiative (0-50% completed the menu assessment, 3/5 would recommend). Conclusion: A program targeting the curriculum and mealtime environment in LDC may be useful to increase children’s vegetable intake. Determining the effectiveness of this optimised package in a randomised controlled trial is required, as per the evaluation phase of the MOST framework.

Evaluation of a long day care intervention targeting the mealtime environment and curriculum to increase children’s vegetable intake: a cluster randomised controlled trial using the multiphase optimisation strategy framework

“…Centres were eligible to participate if they were: (1) LDC centres located in Australia who operate for at least 8 hours per weekday (Monday to Friday), (2) care for children aged 2–5 years, (3) are responsible for the centre menu planning and (4) prepare food onsite serving lunch and two between-meal snacks each day (morning and afternoon). Centres were excluded if they catered exclusively to children with special needs or if they participated in the previous optimisation study ( 20 ) . Within centres, children aged 2–5 years were eligible.…”

“…The MOST framework uses a cyclic approach and comprises three phases: (1) Preparation, (2) Optimisation and (3) Evaluation ( 18 ) . Using this framework, we previously developed three initiatives to increase children’s vegetable intake in LDC: (1) Food provision, (2) Mealtime environment and (3) Curriculum ( 19 ) (preparation phase) and tested them using an eight-group factorial trial to determine the most efficient intervention (optimisation phase) ( 20 ) . We found that the Mealtime environment with Curriculum initiative combination had the most promise for increasing children’s vegetable intake ( 20 ) .…”

“…Using this framework, we previously developed three initiatives to increase children’s vegetable intake in LDC: (1) Food provision, (2) Mealtime environment and (3) Curriculum ( 19 ) (preparation phase) and tested them using an eight-group factorial trial to determine the most efficient intervention (optimisation phase) ( 20 ) . We found that the Mealtime environment with Curriculum initiative combination had the most promise for increasing children’s vegetable intake ( 20 ) . Using a weighed plate waste method, a non-significant and clinically meaningful increase of 0·36 serves of vegetables per day was observed compared with the control group ( 20 ) .…”

“…We found that the Mealtime environment with Curriculum initiative combination had the most promise for increasing children’s vegetable intake ( 20 ) . Using a weighed plate waste method, a non-significant and clinically meaningful increase of 0·36 serves of vegetables per day was observed compared with the control group ( 20 ) . Initiative fidelity was also greatest for the Curriculum initiative (>90 % completion rates), and good acceptability was reported for both the Curriculum and Mealtime environment initiatives (4/5 educators would recommend to others).…”

“…Thus, the current paper reports on the evaluation phase of the MOST framework to determine the effectiveness of the optimised intervention (Mealtime environment with Curriculum initiatives) ( 20 ) on children’s vegetable intake in LDC. The RE-AIM framework has been employed to understand the potential of the intervention to be upscaled into LDC settings nationally ( 21 ) .…”