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Wiggins S, Cromdal J, Willemsen A. Daring to taste: The organisation of children's tasting practices during preschool lunches. Appetite 2024; 198:107378. [PMID: 38692513 DOI: 10.1016/j.appet.2024.107378] [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: 02/27/2024] [Revised: 04/23/2024] [Accepted: 04/25/2024] [Indexed: 05/03/2024]
Abstract
Tasting food is the first step toward diversifying eating habits, and studies with children have typically focused on their sensory education and willingness to try new foods. While very little is known about how children taste foods during everyday mealtimes, EMCA (ethnomethodological and conversation analytic) research on adult tasting in naturalistic settings has demonstrated regular organisational patterns. This paper brings these two research areas together, using the insights of EMCA research on adult tasting to inform our understanding of how young children taste food during preschool lunches. Data are taken from a large corpus of video-recorded lunches in Sweden, in which children (3- to 6-year-olds) were eating with staff members. Discursive Psychology and multimodal Conversation Analysis were used to analyse the data. The analysis demonstrates how the sequential organisation of child tasting is similar to adult tasting, and how tasting practices are a collaborative, multisensory activity involving various embodied practices: from the orientation to food as 'to be tasted', the withdrawal of mutual gaze and exaggerated mouth movements, to the re-establishment of gaze accompanying the food assessment. In contrast to adult tasting, however, tasting during preschool lunches is often framed in terms of personal development of the child and of the individualising of taste within the framework of the institution. The findings thus provide further support for EMCA research on sensory practices and contribute to psychological research on children's eating by evidencing the importance of the interactional and institutional context on tasting as a sensory practice.
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Helland SH, Vejrup K, Overby NC. "I'm not sure whether I will implement it": exploring barriers and facilitators to implementing a digital "healthy eating" resource in early education and care settings - teachers' perspectives. BMC Public Health 2024; 24:1499. [PMID: 38835020 DOI: 10.1186/s12889-024-19014-7] [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: 01/25/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Scaling up effective interventions to promote healthy eating habits in children in real-world settings is a pressing need. The success of implementation hinges crucially on engaging end-users and tailoring interventions to meet their specific needs. Building on our prior evaluation of a digital "healthy eating" resource for early childhood education and care (ECEC) staff; this qualitative study aims to pinpoint the barriers and facilitators that influence the successful implementation of such interventions. METHODS We conducted twelve semi-structured interviews with ECEC teachers in a Norwegian municipality. Interview participants were later invited to participate in focus groups where two discussions were conducted with five of the participants to reflect on the initial interview findings. Thematic analysis, facilitated by NVivo software, was employed to analyse the data, aiming to identify and summarize teachers' subjective experiences and perspectives. RESULTS Teachers' perceptions of barriers to the implementation of an upcoming digital "healthy eating" resource included: (1) No established tradition of using digital resources at work; (2) Uncertainty regarding the achievable outcomes of implementation; (3) Perception of the new "healthy eating" resource as cooking-focused and unnecessary; and (4) Hectic everyday life serving as a barrier to the long-term use of a digital resource. Facilitators for implementation included: (1) A user-friendly format; (2) Newsletters featuring seasonal tips inspire and serve as effective reminders; (3) Emphasis on research and legislation; and (4) Structuring the resource as a series and an idea bank. CONCLUSIONS The findings underscore the essential need for tailored strategies and comprehensive support structures to successfully implement a culturally appropriate digital "healthy eating" resource for ECEC staff, ensuring effectiveness and feasibility. TRIAL REGISTRATION This study was not registered in a trial registry as it is not a clinical trial or intervention study but serves as a pilot for the Nutrition Now study, trial identifier ISRCTN10694967 ( https://doi.org/10.1186/ISRCTN10694967 ), registration date: 19/06/2022.
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Affiliation(s)
- Sissel H Helland
- Department of Nutrition, and Public Health, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, Kristiansand, 4604, Norway.
| | - Kristine Vejrup
- Norwegian Armed Forces Joint Medical Services, Institute of Military Epidemiology, Oslo, Norway
| | - Nina C Overby
- Department of Nutrition, and Public Health, Faculty of Health and Sport Sciences, University of Agder, PO Box 422, Kristiansand, 4604, Norway
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Medin AC, Vik FN, Helle C, Helland SH, Wills AK, Osorio NG, Lian H, Ersfjord TI, Van Daele W, Bjørkkjær T, Valen EN, Gebremariam MK, Grasaas E, Kiland C, von Thiele Schwarz U, Abel MH, Love P, Campbell K, Rutter H, Barker ME, Hillesund ER, Øverby NC. Scaling up evidence-based digital early life nutrition interventions in a county setting: an implementation trial - protocol for Phase 2 of the Nutrition Now project. Front Public Health 2024; 11:1326787. [PMID: 38264256 PMCID: PMC10803599 DOI: 10.3389/fpubh.2023.1326787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] Open
Abstract
Background Few effective health interventions transition from smaller efficacy or effectiveness studies to real-world implementation at scale, representing a gap between evidence and practice. Recognising this, we have developed Nutrition Now - a tailored digital resource building on four efficacious dietary interventions, aiming to improve nutrition in the important first 1,000 days of life. Nutrition Now targets and guides expectant parents and parents of 0-2 year olds, serves as a reliable source of evidence-based information for midwives and public health nurses at maternal and child healthcare (MCH) centres, and offers pedagogical tools for early childhood education and care (ECEC) staff. The aim of this study is to implement Nutrition Now at scale and evaluate the impact of different sets of multifaceted implementation strategies on implementation outcomes. Methods A quasi-experimental design with three study arms will be used, providing either low, medium or high implementation support, when rolled out in 50 municipalities in 2 counties in Norway. Nutrition Now will be implemented in MCH and ECEC settings and made available to expectant parents and parents of 0-2 year olds through social media and MCH. The implementation support builds on strategies described in the Expert Recommendations for Implementing Change (ERIC) implementation framework and is informed by dialogues with stakeholders. Impact of the different degree of implementation support will be assessed by examining reach, adoption, fidelity, and sustainability using usage data generated from the Nutrition Now resource, publicly available municipal data and qualitative interviews with MCH and ECEC staff. Discussion Nutrition Now Phase 2 will break new ground by scaling up successively delivered and complementary dietary interventions in the first 1,000 days of life in a real-life context. The project also seeks to identify what level of implementation support is most effective when implementing digital, scalable, evidence-based early-life nutrition interventions in community settings. The project will inform implementation research and provide knowledge about effective implementation strategies to be used in a national scale-up of Nutrition Now. Trial registration The study is registered prospectively (submitted 14/06/2022, registration date: 19/06/2022) in the International Standard Randomised Controlled Trial Number registry (ISRCTN): reg. Number: ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967.
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Affiliation(s)
- Anine Christine Medin
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Frøydis Nordgård Vik
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Christine Helle
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Sissel Heidi Helland
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Andrew Keith Wills
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Natalie Garzon Osorio
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Henrik Lian
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Torunn Iveland Ersfjord
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Wim Van Daele
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Tormod Bjørkkjær
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Erlend Nuland Valen
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Mekdes Kebede Gebremariam
- Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Erik Grasaas
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Charlotte Kiland
- Department of Political Science and Management, Faculty of Social Sciences, University of Agder, Kristiansand, Norway
| | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Procome, Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Hope Abel
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Penny Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Harry Rutter
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Mary Elizabeth Barker
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Elisabet Rudjord Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
| | - Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Priority Research Centre Lifecourse Nutrition, Kristiansand, Norway
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Helland SH, Bjørkkjær T, Grasaas E, Øverby NC. Staff feeding practices, food neophobia, and educational level in early education and care settings: A cross-sectional study. Appetite 2023; 180:106379. [PMID: 36410564 DOI: 10.1016/j.appet.2022.106379] [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: 07/07/2022] [Revised: 10/30/2022] [Accepted: 11/13/2022] [Indexed: 11/23/2022]
Abstract
Feeding practices in early childhood education and care (ECEC) settings are important for the development of healthy eating habits early in life. However, there is limited research on feeding practices among ECEC staff working with infants and toddlers, and how these practices relate to staff education. This study assessed the feeding practices, level of food neophobia, and participation in shared meals among ECEC staff, and examined whether there were differences in feeding practices related to education and shared meals. Furthermore, we explored the association between food neophobia levels among ECEC staff and their respective feeding practices in ECEC. In total, 130 ECEC teachers and other staff from two Norwegian ECEC trials completed a questionnaire about feeding practices and level of food neophobia. Our results showed that ECEC staff commonly used modelling and encouraging balance and variety feeding practices, but used food as a reward and emotion regulation less often. These practices differed by staff educational level, favoring highly educated staff. We found that more than half of ECEC staff ate lunch together with the children every day, and those who did so used positive feeding practices (encouraging balance and variety and modelling) more than those who did not eat with children; however, they also used restriction for health more often. Higher scores on food neophobia were associated with less use of emotion regulation and restriction for health when adjusted for relevant variables. In conclusion, our results show there is potential to improve feeding practices in ECEC, especially focusing on ECEC staff with low education. Suggested ways forward are updating guidelines to cover feeding practices and working on implementing these guidelines.
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Affiliation(s)
- Sissel H Helland
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
| | - Tormod Bjørkkjær
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
| | - Erik Grasaas
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
| | - Nina C Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, University of Agder, Norway.
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Øverby NC, Hillesund ER, Helland SH, Helle C, Wills AK, Lamu AN, Osorio NG, Lian H, Ersfjord TI, Van Daele W, Bjørkkjær T, Valen EN, Gebremariam MK, Grasaas E, Kiland C, Schwarz UVT, Abel MH, Love P, Campbell K, Rutter H, Barker ME, Vik FN, Medin AC. Evaluating the effectiveness and implementation of evidence-based early-life nutrition interventions in a community setting a hybrid type 1 non-randomized trial - the Nutrition Now project protocol. Front Endocrinol (Lausanne) 2022; 13:1071489. [PMID: 36704042 PMCID: PMC9871808 DOI: 10.3389/fendo.2022.1071489] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/15/2022] [Indexed: 01/11/2023] Open
Abstract
UNLABELLED Disappointingly few efficacious health interventions are successfully scaled up and implemented in real world settings. This represents an evidence-to-practice gap, with loss of opportunity to improve practice. Aiming to improve nutrition in the first 1000 days of life, we have combined four efficacious dietary interventions into a single adapted digital resource (Nutrition Now) for implementation in a Norwegian community setting. Nutrition Now targets pregnant women and parents of 0-2-year-olds with messages focusing on healthy dietary behaviours. Early childhood education and care (ECEC) staff are provided with pedagogical tools addressing healthy food exposure and child food acceptance. Objectives: a) evaluate the effectiveness of provision of the Nutrition Now resource on child diet and diet-related outcomes, with special attention to the influence of socio-economic position, b) gather information on the effectiveness of the implementation process to inform forthcoming scale-up and c) perform trial- and model-based economic evaluations. This is a hybrid type 1 implementation study, focusing on evaluation of effectiveness. A quasi-experimental design with pre- and post-tests, where one municipality gets access to the resource (n~800), while a matched non-equivalent control municipality (n~800) does not, will be used. Effectiveness will be assessed by examining e.g., diet outcomes, developmental outcomes, and feeding practices. The resource will be implemented in ECEC settings and made available to pregnant women and parents through the Norwegian system of maternal and child health (MCH) care. The implementation process includes iterative adjustments and implementation strategies from the implementation framework Expert Recommendations for Implementing Change (ERIC) informed by dialogues with stakeholders. Implementation outcomes (e.g., acceptability and adoption) will be assessed through questionnaires and interviews with parents, ECEC and MCH staff, with particular attention to ethnic diverse groups. Both within-trial and modelling-based economic evaluation will be performed. Nutrition Now will bridge the existing evidence-to-practice gap through rigorous scientific effectiveness evaluation of municipal scale up and inform subsequent county scale up. The study is the first to implement efficacious nutrition interventions in early life with potential for health improvement using technology to maximise the reach and impact of both parental and MCH dietary guidance and ECEC practice. CLINICAL TRIAL REGISTRATION https://www.isrctn.com/, identified ISRCTN10694967.
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Affiliation(s)
- Nina Cecilie Øverby
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
- *Correspondence: Nina Cecilie Øverby,
| | - Elisabet Rudjord Hillesund
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Sissel Heidi Helland
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Christine Helle
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Andrew Keith Wills
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Admassu Nadew Lamu
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Natalie Garzon Osorio
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Henrik Lian
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Torunn Iveland Ersfjord
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Wim Van Daele
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Tormod Bjørkkjær
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Erlend Nuland Valen
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Mekdes Kebede Gebremariam
- Department of Community Medicine and Global Health , Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Erik Grasaas
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Charlotte Kiland
- Department of Political Science and Management, Faculty of Social Sciences, University of Agder, Kristiansand, Norway
| | - Ulrica von Thiele Schwarz
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- Procome, Medical Management Centre, LIME, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Hope Abel
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway
| | - Penny Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Karen Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Harry Rutter
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
- Department of Social and Policy Sciences, University of Bath, Bath, United Kingdom
| | - Mary Elizabeth Barker
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Frøydis Nordgård Vik
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
| | - Anine Christine Medin
- Department of Nutrition and Public Health, Faculty of Health and Sport Sciences, Priority Research Centre Lifecourse Nutrition, University of Agder, Kristiansand, Norway
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