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Kirkegaard A, Irwin C, Byrne R, Sambell R, Vincze L. Barriers and enablers to a healthy food environment in Australian childcare services: Exploring directors' perspectives. Health Promot J Austr 2024; 35:122-133. [PMID: 36998156 DOI: 10.1002/hpja.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/07/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023] Open
Abstract
ISSUE ADDRESSED Early childhood education and care (ECEC) settings are ideal environments to optimise nutrition and positively influence children's food behaviours. However, recent research has identified the need to improve nutrition policies, food provision, and mealtime environments in Australian ECEC settings. This study explored the perceptions of ECEC directors regarding barriers and enablers to a health-promoting food environment within ECEC services. METHODS Eleven directors from ECEC services in Nerang, Queensland, and surrounding areas, participated in qualitative interviews between March and May 2021. Transcripts were analysed using qualitative content analysis that followed a deductive-inductive approach employing nutrition-related domains from the Wellness Child Care Assessment Tool, these being: (i) nutrition policy; (ii) nutrition education; (iii) food provision; and (iv) mealtimes. Transcripts were coded independently by two researchers in NVivo and consensus for barriers and enablers was achieved through discussion. RESULTS Barriers and enablers were reported across four domains (nutrition policy, nutrition education, food provision, and mealtimes). Comprehensive nutrition-related policies were an enabler to a healthy nutrition environment but were sometimes described as lacking detail or customisation to the service. Nutrition education for children was described as competing with other activities for time and resources in an already-crowded curriculum. Financial and time pressures faced by families were a barrier to healthy food provision in services where families provided food for children. The ability of staff to sit with children and engage in conversation during mealtimes was an enabler; however, competing demands on time and the unavailability of food for staff were cited as barriers to health-promoting mealtimes. CONCLUSIONS Directors in ECEC services report both barriers and enablers to a healthy food environment. Nutrition policies were an enabler when comprehensive and relevant but a barrier when vague and not tailored to the service environment. ECEC services should be supported to develop and implement service-specific nutrition policies and practices by engaging with parents and staff. SO WHAT?: The barriers and enablers reported in this study should be considered when designing and implementing future evidence-based interventions to improve the nutrition environment in ECEC services.
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Affiliation(s)
- Amy Kirkegaard
- Centre for Community Health and Wellbeing, University of Queensland, Springfield, QLD, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Chris Irwin
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
| | - Rebecca Byrne
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Ros Sambell
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Lisa Vincze
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD, Australia
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Kashef S, Bell LK, Brown V, Gardner C, Zarnowiecki D, Morgillo S, Arguelles JC, Cox DN, Golley RK. Evaluation of a menu box delivery service for Australian long-day care services to improve food provision and child intake: a cluster randomised controlled trial. Public Health Nutr 2023; 26:3122-3133. [PMID: 37830292 PMCID: PMC10755420 DOI: 10.1017/s1368980023002136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 08/06/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE To evaluate the impact of a menu box delivery service tailored to the long-day care (LDC) setting on improving menu compliance with recommendations, children's diet quality and dietary intake while in care. DESIGN A cluster randomised controlled trial in LDC centres randomly assigned to an intervention (menu box delivery) or comparison (menu planning training) group. The primary outcome was child food provision and dietary intake. Secondary outcomes include menu compliance and process evaluation, including acceptability, fidelity and menu cost (per child, per day). SETTING South Australian LDC centres. PARTICIPANTS Eight LDC centres (n 224 children) provided data. RESULTS No differences were observed in serves/d between intervention and comparison centres, for provision (intervention, 0·9 inter-quartile range (IQR) 0·7-1·2; comparison, 0·8 IQR 0·5-1·3) or consumption (intervention, 0·5 IQR 0·2-0·8; comparison, 0·5 IQR 0·3-0·9) of vegetables. Child food provision and dietary intake were similar across both groups for all food groups (P < 0·05). At follow-up, all intervention centres met menu planning guidelines for vegetables, whereas only one comparison centre met guidelines. Intervention centre directors found the menu box delivery more acceptable than cooks. Cost of the intervention was AUD$2·34 greater than comparison centres (intervention, AUD$4·62 (95 % CI ($4·58, $4·67)); comparison, AUD$2·28 (95 % CI ($2·27, $2·30)) per child, per day). CONCLUSIONS Menu compliance can be improved via a menu delivery service, delivering equivalent impacts on child food provision and dietary intake compared with an online training programme. Further exploration of cooks acceptability and cost is essential before scaling up to implementation.
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Affiliation(s)
- Shabnam Kashef
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park South Australia, GPO Box 2100, Adelaide, SA5001, Australia
| | - Lucinda K Bell
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park South Australia, GPO Box 2100, Adelaide, SA5001, Australia
| | - Victoria Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Claire Gardner
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park South Australia, GPO Box 2100, Adelaide, SA5001, Australia
| | - Dorota Zarnowiecki
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park South Australia, GPO Box 2100, Adelaide, SA5001, Australia
| | - Samantha Morgillo
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park South Australia, GPO Box 2100, Adelaide, SA5001, Australia
| | | | - David N Cox
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, Adelaide, SA, Australia
| | - Rebecca K Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park South Australia, GPO Box 2100, Adelaide, SA5001, Australia
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Yoong SL, Turon H, Wong CK, Bayles L, Finch M, Barnes C, Doherty E, Wolfenden L. An audit of the dissemination strategies and plan included in international food-based dietary guidelines. Public Health Nutr 2023; 26:2586-2594. [PMID: 37565494 DOI: 10.1017/s1368980023001714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Food-based dietary guidelines (FBDG) are an important resource to improve population health; however, little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDG. DESIGN A cross-sectional audit of FBDG with a published English-language version sourced from the United Nations FAO repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel and message). For guidelines with a dissemination plan, we described goals, audience, strategies and expertise and resources according to the Canadian Institute for Health Research guidance. SETTING FBDG from fifty-three countries mostly from high-income (n 28, 52·8 %), and upper-middle income (n 18, 34 %) areas were included. PARTICIPANTS n/a. RESULTS The source of guidelines was most frequently health departments (79·2 %). The message included quantities and types of foods, physical activity recommendations and 88·7 % included summarised versions of main messages. The most common channels were infographics and information booklets, and the main end-users were the public. For twelve countries (22·6 %), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the Canadian Institute for Health Research. CONCLUSIONS The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDG had formal dissemination plans and of those there was limited detailed provided.
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Affiliation(s)
- Sze Lin Yoong
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Heidi Turon
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Carrie K Wong
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Lyndal Bayles
- School of Health Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Meghan Finch
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Courtney Barnes
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Emma Doherty
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
| | - Luke Wolfenden
- College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, NSW, Australia
- Hunter Medical Research Institute, Population Health Research Program, New Lambton, NSW, Australia
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Kempler JV, Love P, Bolton KA, Rozman M, Spence AC. Exploring the Use of a Web-Based Menu Planning Tool in Childcare Services: Qualitative Cross-sectional Survey Study. JMIR Form Res 2022; 6:e35553. [PMID: 35849438 PMCID: PMC9345012 DOI: 10.2196/35553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022] Open
Abstract
Background Early childhood is a critical period for supporting the development of healthy eating habits, which may affect lifelong health. Childcare services are important settings for promoting early childhood nutrition; however, food provision in childcare frequently does not align with dietary guidelines. Web-based menu planning tools are well suited to support healthy food provision in childcare, although little is known about their use. Research is needed to understand how web-based menu planning tools are used in the childcare setting and how they can effectively support healthy menu planning and food provision for children in childcare. Objective We aimed to explore the use of a web-based menu planning tool called FoodChecker, which is available to childcare services in Victoria, Australia. We also aimed to gain insights and perspectives from childcare staff involved in menu planning about their use of the tool to plan healthy menus and guide healthy food provision for children. Methods We conducted a qualitative descriptive study using a cross-sectional web-based survey completed by the staff involved in menu planning in childcare services. Thematic analysis was performed using NVivo software. Emergent themes were mapped against constructs of the Technology Acceptance Model regarding perceived usefulness, perceived ease of use, and external variables influencing perceptions and use. Results The participants included 30 cooks and 34 directors from 53 childcare services. Participants perceived the web-based menu planning tool as useful for supporting child nutrition and health, improving organizational processes, and aiding the menu planner role. Perceptions regarding ease of use were mixed. External variables influencing perceptions and use included awareness of the tool, perceived need, time, resources, organizational support, and the food budget. Participants made recommendations to improve the tool, particularly the need to integrate functionality to make it easier and faster to use or to include more links to resources to support healthy menu planning. Conclusions The web-based menu planning tool was perceived as useful for cooks and directors in childcare services. Areas for improvement were identified; for example, the need for integrated digital features to make the tool easier and faster to use. As the first qualitative study to explore childcare staff experiences with a web-based menu planning tool, these findings inform future research and development of such tools to aid scalable and sustainable support for healthier food provision in the childcare sector.
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Affiliation(s)
- Jessica V Kempler
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Kristy A Bolton
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
| | - Margaret Rozman
- Healthy Eating Advisory Service, Nutrition Australia Victorian Division, Docklands, Australia
| | - Alison C Spence
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
- Institute for Physical Activity and Nutrition (IPAN), Deakin University, Geelong, Australia
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Elford A, Spence A, Wakem A, Campbell KJ, Love P. Barriers and enablers to menu planning guideline implementation in Australian childcare centres and the role of government support services. Public Health Nutr 2022; 25:1-10. [PMID: 35641313 PMCID: PMC9991762 DOI: 10.1017/s1368980022001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/11/2022] [Accepted: 05/30/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To explore government support service access, perceived barriers/enablers to menu planning and menu compliance in long day care (LDC) centres in Victoria, Australia, where the Victorian Government-funded Healthy Eating Advisory Service (HEAS) is available to provide free LDC menu planning support. DESIGN This is a cross-sectional study design. Data were collected from online surveys with the option of uploading 2 weeks of menus and recipes. Menu compliance was scored for quantity, quality and variety. Barriers/enablers to menu planning guideline implementation were determined using the Theoretical Domains Framework (TDF). Independent t tests, one-way ANOVA and chi-square tests assessed relationships between characteristics, barriers/enablers and menu scores. SETTING Eighty-nine LDC centres that prepare food onsite. PARTICIPANTS LDC staff responsible for menu planning (n 89) and menus from eighteen centres. RESULTS Fifty-five per cent of centres had accessed HEAS. Of eighteen provided menus, only one menu was compliant with menu planning guidelines. HEAS access was associated with higher average scores in four of seven TDF domains, namely knowledge/awareness, skills/role, reinforcement/influence and optimism/intent. There were no correlations between menu score and barriers/enablers; however, menu quality scores were higher for those accessing HEAS. CONCLUSIONS Childcare-specific government support services may be an important public health nutrition strategy and may improve menu planning guideline implementation as well as menu quality; however, this does not necessarily translate into menu compliance. Research should confirm these findings in larger studies to ascertain uptake of these services. Public health efforts should focus on exploring barriers and enablers to uptake of government support services to increase reach and acceptability.
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Affiliation(s)
- Audrey Elford
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University Geelong Waurn Ponds Campus, 75 Pigdons Road, Geelong, VIC3216, Australia
| | - Alison Spence
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University Geelong Waurn Ponds Campus, 75 Pigdons Road, Geelong, VIC3216, Australia
| | - Amy Wakem
- Healthy Eating Advisory Service, Nutrition Australia, VIC, Australia
| | - Karen J Campbell
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University Geelong Waurn Ponds Campus, 75 Pigdons Road, Geelong, VIC3216, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences (SENS), Deakin University Geelong Waurn Ponds Campus, 75 Pigdons Road, Geelong, VIC3216, Australia
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Elford A, Gwee C, Veal M, Jani R, Sambell R, Kashef S, Love P. Identification and Evaluation of Tools Utilised for Measuring Food Provision in Childcare Centres and Primary Schools: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4096. [PMID: 35409781 PMCID: PMC8998327 DOI: 10.3390/ijerph19074096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Children aged 2-11 years spend significant hours per week in early childhood education and care (ECEC) and primary schools. Whilst considered important environments to influence children's food intake, there is heterogeneity in the tools utilised to assess food provision in these settings. This systematic review aimed to identify and evaluate tools used to measure food provision in ECEC and primary schools. METHODS The Preferred Reporting Items for Systematic Reviews (PRISMA) was followed. Publications (2003-2020) that implemented, validated, or developed measurement tools to assess food provision within ECEC or primary schools were included. Two reviewers extracted and evaluated studies, cross checked by a third reviewer and verified by all authors. The Academy of Nutrition and Dietetics Quality Criteria Checklist (QCC) was used to critically appraise each study. RESULTS Eighty-two studies were included in the review. Seven measurement tools were identified, namely, Menu review; Observation; Weighed food protocol; Questionnaire/survey; Digital photography; Quick menu audit; and Web-based menu assessment. An evidence-based evaluation was conducted for each tool. CONCLUSIONS The weighed food protocol was found to be the most popular and accurate measurement tool to assess individual-level intake. Future research is recommended to develop and validate a tool to assess service-level food provision.
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Affiliation(s)
- Audrey Elford
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
| | - Cherice Gwee
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (C.G.); (M.V.)
| | - Maliney Veal
- Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia; (C.G.); (M.V.)
| | - Rati Jani
- School of Health Sciences and Social Work, Griffith University, Gold Coast, QLD 4222, Australia;
| | - Ros Sambell
- School of Medical and Health Sciences, Nutrition and Health Innovation Research Institute, Edith Cowan University, Perth, WA 6027, Australia;
| | - Shabnam Kashef
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia;
| | - Penelope Love
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3216, Australia;
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Crowe RK, Probst YC, Norman JA, Furber SE, Stanley RM, Ryan ST, Vuong C, Hammersley ML, Wardle K, Franco L, Beets MW, Weaver RG, Davis M, Innes-Hughes C, Okely AD. Foods and beverages provided in out of school hours care services: an observational study. BMC Public Health 2022; 22:277. [PMID: 35144567 PMCID: PMC8832650 DOI: 10.1186/s12889-022-12652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/25/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Out of school hours care (OSHC) is a fast-growing childcare setting in Australia, however the types of foods and beverages offered are relatively unknown. This study describes the food and beverages offered and investigates sector-level and setting-level factors which may impact OSHC in meeting the Australian Dietary Guidelines (ADG). Methods This cross-sectional, observational study was conducted in 89 OSHC services (between 2018 and 2019). Food and beverages offered, kitchen facilities and menus were captured via direct observation. Foods were categorised into five food groups or discretionary foods, based on the ADG, and frequencies determined. Short interviews with OSHC directors ascertained healthy eating policies, staff training, food quality assessment methods and food budgets. Fisher’s exact test explored the influence of sector-level and setting-level factors on food provision behaviours. Results Discretionary foods (1.5 ± 0.68) were offered more frequently than vegetables (0.82 ± 0.80) (p < .001), dairy (0.97 ± 0.81) (p = .013) and lean meats (0.22 ± 0.54) (p < .001). OSHC associated with long day care and reported using valid food quality assessment methods offered more lean meats (p= .002, and p= .004). Larger organisations offered more vegetables (p = .015) and discretionary foods (p= .007). Menus with clearly worded instructions to provide fruits and vegetables daily offered more fruit (p= .009), vegetables (p < .001) and whole grains (p= .003). No other sector or setting-level factors were associated with services aligning with the ADG. Conclusion Future interventions could benefit from trialling menu planning training and tools to assist OSHC services in NSW meet the ADG requirements.
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Affiliation(s)
- Ruth K Crowe
- School of Medicine, Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia. .,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.
| | - Yasmine C Probst
- School of Medicine, Science Medicine and Health, University of Wollongong, Wollongong, NSW, Australia.,Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jennifer A Norman
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia.,Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Susan E Furber
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Rebecca M Stanley
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Sarah T Ryan
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Cecilia Vuong
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Megan L Hammersley
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
| | - Karen Wardle
- Health Promotion Service, South Western Sydney Local Health District, Liverpool, NSW, Australia
| | - Lisa Franco
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Health Promotion Service, Illawarra Shoalhaven Local Health District, Warrawong, NSW, Australia
| | - Michael W Beets
- Exercise Science, Arnold School of Public Health University of South Carolina, Columbia, SC, USA
| | - R Glenn Weaver
- Exercise Science, Arnold School of Public Health University of South Carolina, Columbia, SC, USA
| | - Marc Davis
- Centre for Population Health, St Leonards, NSW, Australia
| | | | - Anthony D Okely
- Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, NSW, Australia.,Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
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Grady A, Barnes C, Lum M, Jones J, Yoong SL. Impact of Nudge Strategies on Nutrition Education Participation in Child Care: Randomized Controlled Trial. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:151-156. [PMID: 33573767 DOI: 10.1016/j.jneb.2020.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the impact of incorporating nudge strategies in the design of a nutrition education workshop invitation on workshop registration among early childhood education and care centers. METHODS A parallel-group randomized controlled trial was conducted with 88 centers. Centers received nudge strategies embedded within an enhanced invitation (intervention) or a generic invitation (control) to attend a nutrition education workshop. Center workshop registration and invitation recall and acceptability were compared between the 2 arms. RESULTS No statistically significant differences in workshop registration (25% vs 20%; P = 0.61), invitation recall (69% vs 62%; P = 0.58) or acceptability (mean: 8.38 vs 8.06; P = 0.50) were found between intervention and control centers, respectively. CONCLUSIONS AND IMPLICATIONS Low-intensity behavioral strategies embedded in the design of an invitation were insufficient to increase workshop registration significantly. Investigation and application of alternate evidence-based nudge strategies to encourage staff participation in nutrition education in early childhood education and care setting are recommended.
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Affiliation(s)
- Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter New England Population Health, Wallsend, New South Wales, Australia; Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia.
| | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter New England Population Health, Wallsend, New South Wales, Australia; Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Melanie Lum
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter New England Population Health, Wallsend, New South Wales, Australia; Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jannah Jones
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter New England Population Health, Wallsend, New South Wales, Australia; Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia; Hunter New England Population Health, Wallsend, New South Wales, Australia; Hunter Medical Research Institute, University of Newcastle, Callaghan, New South Wales, Australia; Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia; Swinburne University of Technology, Hawthorn, Victoria, Australia
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Reeves P, Edmunds K, Szewczyk Z, Grady A, Yoong SL, Wolfenden L, Wyse R, Finch M, Stacey F, Wiggers J, Searles A. Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines. Implement Sci 2021; 16:1. [PMID: 33413491 PMCID: PMC7789335 DOI: 10.1186/s13012-020-01068-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 12/01/2020] [Indexed: 12/14/2022] Open
Abstract
Background Despite the known benefits of healthy eating in childhood, few Australian childcare services provide food that is consistent with dietary guidelines. The effectiveness of a web-based menu planning intervention to increase childcare service provision of healthy foods and decrease provision of discretionary foods in long day-care services in Australia was assessed in a randomised controlled trial. Here we consider the costs, consequences, cost-effectiveness and budget impact of the intervention using data collected within the trial. Methods The prospective trial-based economic evaluation involved 54 childcare services across New South Wales (NSW), Australia. Services were randomised to a 12-month intervention or usual care. The intervention involved access to a web-based menu planning and decision support tool and online resources. Effectiveness measures included mean number of food groups, overall menu and individual food group compliance with dietary guidelines, and mean servings of food groups at 12 months. Costs (reported in $AUD, 2017/18) were evaluated from both health sector and societal perspectives. The direct cost to support uptake of the intervention was calculated, as were costs to each childcare service. The incremental cost of the intervention was calculated as the net difference in the cost to undertake menu planning and review plus the direct cost of the intervention. Incremental cost-effectiveness ratios (ICERs) including uncertainty intervals were estimated for differences in costs and effects between intervention and control groups. A relative value index was calculated to determine overall value for money. Results Over the 12 months of the trial, we calculated a difference in cost between usual practice and intervention groups of − $482 (95% UI − $859, − $56). While the measured increase in menu and food group compliance within the trial did not reach statistical significance, there were significant improvements in mean servings of fruit and discretionary food, represented in the cost-consequence analysis. The calculated relative value index of 1.1 suggests that the intervention returns acceptable value for money for the outcomes generated. Conclusion Compared to usual practice, web-based programmes may offer an efficient and sustainable alternative for childcare services to improve the provision of healthy foods to children in their care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12616000974404
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Affiliation(s)
- Penny Reeves
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia. .,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.
| | - Kim Edmunds
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Zoe Szewczyk
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Alice Grady
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Sze Lin Yoong
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Luke Wolfenden
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Rebecca Wyse
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
| | - Meghan Finch
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Fiona Stacey
- Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia
| | - John Wiggers
- School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia.,Hunter New England Population Health, Wallsend, New South Wales, 2287, Australia.,Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
| | - Andrew Searles
- Hunter Medical Research Institute (HMRI), New Lambton, New South Wales, Australia.,School of Medicine and Public health, University of Newcastle, Callaghan, New South Wales, 2308, Australia
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Grady A, Wolfenden L, Wiggers J, Rissel C, Finch M, Flood V, Salajan D, O'Rourke R, Stacey F, Wyse R, Lecathelinais C, Barnes C, Green S, Herrmann V, Yoong SL. Effectiveness of a Web-Based Menu-Planning Intervention to Improve Childcare Service Compliance With Dietary Guidelines: Randomized Controlled Trial. J Med Internet Res 2020; 22:e13401. [PMID: 32014843 PMCID: PMC7055768 DOI: 10.2196/13401] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/04/2019] [Accepted: 11/29/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines. OBJECTIVE This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups; (2) individual food groups; and (3) mean servings of individual food groups. Childcare service use and acceptability of the Web-based program were also assessed. METHODS A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up. RESULTS No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for individual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P<.001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable. CONCLUSIONS Although improvements in childcare service overall menu and individual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted. TRIAL REGISTRATION Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404; http://www.anzctr.org.au/ACTRN12616000974404.aspx.
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Affiliation(s)
- Alice Grady
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - John Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Chris Rissel
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia
- New South Wales Office of Preventive Health, Liverpool, Australia
| | - Meghan Finch
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Victoria Flood
- Westmead Hospital, Western Sydney Local Health District, Westmead, Australia
- Faculty of Health Sciences and Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | | | | | - Fiona Stacey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | | | - Courtney Barnes
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
| | - Sue Green
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
| | - Vanessa Herrmann
- Population Health, Hunter New England Local Health District, Wallsend, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Population Health, Hunter New England Local Health District, Wallsend, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, Australia
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