Multistrategy childcare-based intervention to improve compliance with nutrition guidelines versus usual care in long day care services: a study protocol for a randomised controlled trial

Abstract

IntroductionInterventions to improve child diet are recommended as dietary patterns developed in childhood track into adulthood and influence the risk of chronic disease. For child health, childcare services are required to provide foods to children consistent with nutrition guidelines. Research suggests that foods and beverages provided by services to children are often inconsistent with nutrition guidelines. The primary aim of this study is to assess, relative to a usual care control group, the effectiveness of a multistrategy childcare-based intervention in improving compliance with nutrition guidelines in long day care services.Methods and analysisThe study will employ a parallel group randomised controlled trial design. A sample of 58 long day care services that provide all meals (typically includes 1 main and 2 mid-meals) to children while they are in care, in the Hunter New England region of New South Wales, Australia, will be randomly allocated to a 6-month intervention to support implementation of nutrition guidelines or a usual care control group in a 1:1 ratio. The intervention was designed to overcome barriers to the implementation of nutrition guidelines assessed using the theoretical domains framework. Intervention strategies will include the provision of staff training and resources, audit and feedback, ongoing support and securing executive support. The primary outcome of the trial will be the change in the proportion of long day care services that have a 2-week menu compliant with childcare nutrition guidelines, measured by comprehensive menu assessments. As a secondary outcome, child dietary intake while in care will also be assessed. To assess the effectiveness of the intervention, the measures will be undertaken at baseline and ∼6 months postbaseline.Ethics and disseminationThe study was approved by the Hunter New England Human Research Ethics Committee. Study findings will be disseminated widely through peer-reviewed publications.

Menu planning practices in early childhood education and care – factors associated with menu compliance with sector dietary guidelines

“…A cross‐sectional baseline survey was undertaken with centre‐based LDC services as part of a randomised controlled trial conducted in the Hunter New England region of New South Wales (NSW), Australia. Ethical approval to conduct the study was obtained from the Hunter New England Human Research Ethics Committee (reference 12/08/15/5.01) and the University of Newcastle Human Research Ethics Committee (reference H‐2012‐0321).…”

“…The recommendations specific to children aged 2‐5 years within the Caring for Children guidelines was chosen as this age range covers 77.2% of all children attending LDC services within Australia . Menu compliance assessments were undertaken by an independent Dietitian, consistent with best practice protocols for menu audits . Menu planners were contacted for additional information (for example brands of foods, ingredients of recipes and approximate quantities provided) via telephone or face‐to‐face contact if the menu did not provide sufficient information to enable food group categorisation and serve size calculation.…”

Parental work status and children's dietary consumption: Australian evidence

“…Some studies have found that children attending child care centres consumed more fruit, vegetables and low‐fat dairy (Chang‐Martinez, Ahmed, Natale, & Messiah, ; Gubbels, Raaijmakers, Gerards, & Kremers, ; Robson, Khoury, Kalkwarf, & Copeland, ; Sisson et al, ). In Australia, child care services do not receive a support from the government for the provision of foods to children that adhered to nutrition guidelines (Seward et al, ). One study found that long‐day care services in NSW provided most of the core food groups consistent with the guidelines except for vegetables (Yoong, Skelton, Jones, & Wolfenden, ).…”

Improving the impact of obesity prevention interventions in the childcare setting: The need for a systematic application of implementation science

“…A number of implementation science theoretical frameworks and tools are being used to better understand implementation processes and guide the development of strategies to improve intervention implementation . In addition to Damschroder's Consolidated Framework for Implementation Research, the Theoretical Domains Framework, informed by 128 explanatory constructs from 33 theories of behaviour change has recently been applied in the childcare setting to improve the implementation of dietary guidelines . The Theoretical Domains Framework can also be used to identify the most pertinent barriers to implementation.…”

“…Importantly tools have also been developed to assist researchers and practitioners using the framework to select the most appropriate strategies to address these . While such frameworks have typically been used to assess factors that may impede recommended professional practice in clinical settings, their application in childcare settings is increasing . Systematic review protocols, recently registered with PROSPERO, also suggest that an up‐to‐date systematic synthesis of barriers and facilitators of fruit and vegetable consumption in pre‐school‐aged children, together with factors that influence the implementation of dietary guidelines in childcare serviceswill soon be available.…”