Comparison between the Healthy Start-Départ Santé online and in-person training of childcare educators to improve healthy eating and physical activity practices and knowledge of physical activity and fundamental movement skills: A controlled trial

Efficacy of a Physical Activity e-Learning Course Delivered to Early Childhood Educators on Preschoolers' Physical Activity and Sedentary Behaviors: A Cluster Randomized Controlled Trial

PURPOSE

This study examined the effectiveness of an early childhood educator (ECE)-focused physical activity e-Learning course on children's physical activity and sedentary time in childcare.

METHODS

A cluster randomized controlled trial was conducted in 12 childcare centers in London, Ontario, Canada. A total of 145 preschoolers and 42 ECEs participated in this study. ECEs in the intervention condition completed a 5-hour e-Learning course related to physical activity. Outcomes were preschoolers' minutes of moderate- to vigorous-intensity physical activity, light-intensity physical activity, and sedentary time assessed using accelerometers.

RESULTS

The intervention did not have a significant effect on moderate- to vigorous-intensity physical activity (d < 0.01, P = .984), light-intensity physical activity (d = -0.17, P = .386), or sedentary time (d = 0.07, P = .717) from baseline to postintervention. There was also no significant intervention effect on moderate- to vigorous-intensity physical activity (d = 0.27, P = .260), light-intensity physical activity (d = -0.08, P = .740), or sedentary time (d = -0.15, P = .520) from baseline to follow-up.

CONCLUSIONS

Providing ECEs with online training in physical activity through an e-Learning course may not be sufficient to increase physical activity levels among young children in their care. It may be essential to deliver multicomponent interventions to increase preschoolers' engagement in physical activity in childcare.

The efficacy of the TEACH e-Learning course at improving early childhood educators' physical activity and sedentary behaviour self-efficacy, knowledge, intentions, and perceived behavioural control: a randomized controlled trial

BACKGROUND

Early childhood educators play a critical role in promoting physical activity and reducing sedentary time in childcare centres. However, early childhood educators receive limited specialised pre- and in-service learning opportunities relating to these behaviours and may lack the capacity to effectively engage children in healthy movement behaviours. This study aimed to examine the efficacy of an e-Learning course on increasing early childhood educators' physical activity and sedentary behaviour-related capacities.

METHODS

A two-group parallel randomized controlled trial was conducted with early childhood educators in Canada (Mage = 41.78, 97% female). Participants randomized to the intervention group were asked to complete a physical activity and sedentary behaviour e-Learning course within a 4-week period. Participants randomized to the waitlist control condition were assigned to a waitlist to receive the intervention after the testing period. Participants reported on their self-efficacy, knowledge, intentions, and perceived behavioural control relating to physical activity and sedentary behaviours at baseline, post-intervention, and 3 months follow-up. Linear mixed effects models were estimated to determine difference in changes in outcomes from baseline to post-intervention, and follow-up.

RESULTS

A total of 209 early childhood educators participated in the study (intervention n = 98; control n = 111). The TEACH e-Learning course was found to be efficacious at improving all of the examined outcomes, with standardized effect sizes ranging from d = 0.58 to d = 0.65 for self-efficacy outcomes, d = 0.66 to d = 1.20 for knowledge outcomes, d = 0.50 to d = 0.65 for intention outcomes, and d = 0.33 to d = 0.69 for perceived behavioural control outcomes post-intervention. The intervention effects were sustained at follow-up for all outcomes apart from perceived behavioural control to limit screen time. Additionally, the magnitude of the effect for knowledge outcomes decreased at follow-up, with standardized effect sizes ranging from d = 0.49 to d = 0.67.

CONCLUSIONS

The e-Learning course was highly successful at improving early childhood educators' capacity pertaining to physical activity and sedentary behaviours. Providing training content through e-Learning may be an efficacious approach to providing continual professional learning opportunities relating to physical activity and sedentary time to early childhood educators on a large scale.

Effect of capacity building interventions on classroom teacher and early childhood educator perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills: a systematic review and meta-analysis

BACKGROUND

Capacity building may play an important role in improving classroom teachers' and early childhood educators' (ECE) capacity to implement physical activity and FMS interventions. Capacity building is the development of knowledge, skills, and structures to improve the capability of individuals and organisations to achieve effective health promotion. This review aimed to determine the efficacy of capacity building interventions on teachers' and ECEs' perceived capabilities, knowledge, and attitudes relating to physical activity and fundamental movement skills.

METHODS

An exhaustive literature search of six electronic databases was conducted. Controlled, single-group pre-post studies were included if they measured the effect of a capacity building intervention on in-service or pre-service classroom teachers' (primary or secondary) or ECEs' physical activity or fundamental skills related perceived capabilities, knowledge, or attitudes. The effects of interventions were synthesised using random effects meta-analysis. Subgroup analysis and meta-regression was conducted to determine if the effects differed based on study design, type of teacher (ECE vs. primary school), or teacher level (pre-service vs. in-service).

RESULTS

A total of 22 studies reporting on 25 unique samples were included in the meta-analyses. Only studies reporting on ECEs and primary school teachers were identified. Interventions most commonly included training/professional development, resources and toolkits, communities of practice, mentorships, and ongoing support. Results showed that capacity building interventions significantly improved teachers' and ECEs' perceived capabilities (g = 0.614, 95% CI = 0.442, 0.786), knowledge (g = 0.792 95% CI = 0.459, 1.125), and attitudes (g = 0.376 95% CI = 0.181, 0.571). The effects did not differ significantly as a function of any of the moderators examined.

CONCLUSION

Findings from this review provide strong support that capacity building interventions are efficacious at improving teachers' and ECEs' perceived capabilities, knowledge, and attitudes related to promoting physical activity and teaching fundamental movement skills. Pre-service teachers and ECEs should be provided training in physical activity and fundamental movement skills as part of their degrees, and continual professional development and capacity building should be offered to in-service teachers and ECEs to promote physical activity and fundamental movement skills in children.

Assessing the scalability of healthy eating interventions within the early childhood education and care setting: secondary analysis of a Cochrane systematic review

OBJECTIVE

Early childhood education and care (ECEC) is a recommended setting for the delivery of health eating interventions 'at scale' (i.e. to large numbers of childcare services) to improve child public health nutrition. Appraisal of the 'scalability' (suitability for delivery at scale) of interventions is recommended to guide public health decision-making. This study describes the extent to which factors required to assess scalability are reported among ECEC-based healthy eating interventions.

DESIGN

Studies from a recent Cochrane systematic review assessing the effectiveness of healthy eating interventions delivered in ECEC for improving child dietary intake were included. The reporting of factors of scalability was assessed against domains outlined within the Intervention Scalability Assessment Tool (ISAT). The tool recommends decision makers consider the problem, the intervention, strategic and political context, effectiveness, costs, fidelity and adaptation, reach and acceptability, delivery setting and workforce, implementation infrastructure and sustainability. Data were extracted by one reviewer and checked by a second reviewer.

SETTING

ECEC.

PARTICIPANTS

Children 6 months to 6 years.

RESULTS

Of thirty-eight included studies, none reported all factors within the ISAT. All studies reported the problem, the intervention, effectiveness and the delivery workforce and setting. The lowest reported domains were intervention costs (13 % of studies) and sustainability (16 % of studies).

CONCLUSIONS

Findings indicate there is a lack of reporting of some key factors of scalability for ECEC-based healthy eating interventions. Future studies should measure and report such factors to support policy and practice decision makers when selecting interventions to be scaled-up.

Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years

BACKGROUND

Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health.

OBJECTIVES

To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions.

SEARCH METHODS

We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes.

MAIN RESULTS

We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3).

AUTHORS' CONCLUSIONS

ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.

Healthy eating interventions delivered in early childhood education and care settings for improving the diet of children aged six months to six years

BACKGROUND

Dietary intake during early childhood can have implications on child health and developmental trajectories. Early childhood education and care (ECEC) services are recommended settings to deliver healthy eating interventions as they provide access to many children during this important period. Healthy eating interventions delivered in ECEC settings can include strategies targeting the curriculum (e.g. nutrition education), ethos and environment (e.g. menu modification) and partnerships (e.g. workshops for families). Despite guidelines supporting the delivery of healthy eating interventions in this setting, little is known about their impact on child health.

OBJECTIVES

To assess the effectiveness of healthy eating interventions delivered in ECEC settings for improving dietary intake in children aged six months to six years, relative to usual care, no intervention or an alternative, non-dietary intervention. Secondary objectives were to assess the impact of ECEC-based healthy eating interventions on physical outcomes (e.g. child body mass index (BMI), weight, waist circumference), language and cognitive outcomes, social/emotional and quality-of-life outcomes. We also report on cost and adverse consequences of ECEC-based healthy eating interventions.

SEARCH METHODS

We searched eight electronic databases including CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Scopus and SportDiscus on 24 February 2022. We searched reference lists of included studies, reference lists of relevant systematic reviews, the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov and Google Scholar, and contacted authors of relevant papers.

SELECTION CRITERIA

We included randomised controlled trials (RCTs), including cluster-RCTs, stepped-wedge RCTs, factorial RCTs, multiple baseline RCTs and randomised cross-over trials, of healthy eating interventions targeting children aged six months to six years that were conducted within the ECEC setting. ECEC settings included preschools, nurseries, kindergartens, long day care and family day care. To be included, studies had to include at least one intervention component targeting child diet within the ECEC setting and measure child dietary or physical outcomes, or both.

DATA COLLECTION AND ANALYSIS

Pairs of review authors independently screened titles and abstracts and extracted study data. We assessed risk of bias for all studies against 12 criteria within RoB 1, which allows for consideration of how selection, performance, attrition, publication and reporting biases impact outcomes. We resolved discrepancies via consensus or by consulting a third review author. Where we identified studies with suitable data and homogeneity, we performed meta-analyses using a random-effects model; otherwise, we described findings using vote-counting approaches and via harvest plots. For measures with similar metrics, we calculated mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. We calculated standardised mean differences (SMDs) for primary and secondary outcomes where studies used different measures. We applied GRADE to assess certainty of evidence for dietary, cost and adverse outcomes.  MAIN RESULTS: We included 52 studies that investigated 58 interventions (described across 96 articles). All studies were cluster-RCTs. Twenty-nine studies were large (≥ 400 participants) and 23 were small (< 400 participants). Of the 58 interventions, 43 targeted curriculum, 56 targeted ethos and environment, and 50 targeted partnerships. Thirty-eight interventions incorporated all three components. For the primary outcomes (dietary outcomes), we assessed 19 studies as overall high risk of bias, with performance and detection bias being most commonly judged as high risk of bias. ECEC-based healthy eating interventions versus usual practice or no intervention may have a positive effect on child diet quality (SMD 0.34, 95% confidence interval (CI) 0.04 to 0.65; P = 0.03, I2 = 91%; 6 studies, 1973 children) but the evidence is very uncertain. There is moderate-certainty evidence that ECEC-based healthy eating interventions likely increase children's consumption of fruit (SMD 0.11, 95% CI 0.04 to 0.18; P < 0.01, I2 = 0%; 11 studies, 2901 children). The evidence is very uncertain about the effect of ECEC-based healthy eating interventions on children's consumption of vegetables (SMD 0.12, 95% CI -0.01 to 0.25; P =0.08, I2 = 70%; 13 studies, 3335 children). There is moderate-certainty evidence that ECEC-based healthy eating interventions likely result in little to no difference in children's consumption of non-core (i.e. less healthy/discretionary) foods (SMD -0.05, 95% CI -0.17 to 0.08; P = 0.48, I2 = 16%; 7 studies, 1369 children) or consumption of sugar-sweetened beverages (SMD -0.10, 95% CI -0.34 to 0.14; P = 0.41, I2 = 45%; 3 studies, 522 children). Thirty-six studies measured BMI, BMI z-score, weight, overweight and obesity, or waist circumference, or a combination of some or all of these. ECEC-based healthy eating interventions may result in little to no difference in child BMI (MD -0.08, 95% CI -0.23 to 0.07; P = 0.30, I2 = 65%; 15 studies, 3932 children) or in child BMI z-score (MD -0.03, 95% CI -0.09 to 0.03; P = 0.36, I2 = 0%; 17 studies; 4766 children). ECEC-based healthy eating interventions may decrease child weight (MD -0.23, 95% CI -0.49 to 0.03; P = 0.09, I2 = 0%; 9 studies, 2071 children) and risk of overweight and obesity (RR 0.81, 95% CI 0.65 to 1.01; P = 0.07, I2 = 0%; 5 studies, 1070 children). ECEC-based healthy eating interventions may be cost-effective but the evidence is very uncertain (6 studies). ECEC-based healthy eating interventions may have little to no effect on adverse consequences but the evidence is very uncertain (3 studies). Few studies measured language and cognitive skills (n = 2), social/emotional outcomes (n = 2) and quality of life (n = 3).

AUTHORS' CONCLUSIONS

ECEC-based healthy eating interventions may improve child diet quality slightly, but the evidence is very uncertain, and likely increase child fruit consumption slightly. There is uncertainty about the effect of ECEC-based healthy eating interventions on vegetable consumption. ECEC-based healthy eating interventions may result in little to no difference in child consumption of non-core foods and sugar-sweetened beverages. Healthy eating interventions could have favourable effects on child weight and risk of overweight and obesity, although there was little to no difference in BMI and BMI z-scores. Future studies exploring the impact of specific intervention components, and describing cost-effectiveness and adverse outcomes are needed to better understand how to maximise the impact of ECEC-based healthy eating interventions.

Piloting the Virtual PLAYshop Program: A Parent-Focused Physical Literacy Intervention for Early Childhood

The PLAYshop program is a parent-focused physical literacy intervention for early childhood. This single-group mixed-methods pilot study aimed to explore the feasibility of virtually delivering and assessing the PLAYshop program. The virtual PLAYshop program included a virtual workshop, resources/basic equipment, and two booster emails (3-week and 6-week follow-up). Data on 34 preschool-aged children (3-5 years) and their parents from Edmonton and Victoria, Canada, were collected via an online questionnaire, virtual assessment session, and interview at single or multiple time points (baseline, post-workshop, 2-month follow-up). Intraclass correlation coefficients (ICCs), paired t-tests, repeated measures ANOVAs, and thematic analyses were conducted. Regarding feasibility, most parents (≥94%) were satisfied/extremely satisfied with the virtual workshop and planned to continue physical literacy activities post-workshop. The virtual assessment protocol for children's fundamental movement skills (FMS; overhand throw, underhand throw, horizontal jump, hop, one-leg balance) was feasible, with high completion rates (>90%) and reliable scoring (ICC = 0.79-0.99). For positive changes in potential outcomes, a medium effect size was observed for children's hopping skills (d = 0.54), and large effect sizes were observed for several parental outcomes (partial η² = 0.20-0.54). The findings support the feasibility and potential positive outcomes of the virtual PLAYshop program. A larger randomized controlled efficacy trial is recommended.

Training Pre-Service Early Childhood Educators in Physical Activity (TEACH): Protocol for a Quasi-Experimental Study

Background: Early childhood educators (ECEs) influence young children’s early uptake of positive health behaviours in childcare settings and serve as important daytime role models. As such, it is imperative that post-secondary early childhood education programs provide students with the foundational knowledge and professional training required to confidently facilitate quality active play opportunities for young children. The primary objective of the Training pre-service EArly CHildhood educators in physical activity (TEACH) study is to develop and implement an e-Learning course in physical activity and sedentary behaviour to facilitate improvements in: pre-service ECEs’ self-efficacy and knowledge to lead physical activity and outdoor play opportunities and minimize sedentary behaviours in childcare. This study will also explore pre-service ECEs’ behavioural intention and perceived control to promote physical activity and outdoor play, and minimize sedentary behaviour in childcare, and the implementation of the e-Learning course. Methods/Design: A mixed-methods quasi-experimental design with three data collection time points (baseline, post-course completion, 3-month follow-up) will be employed to test the e-Learning course in early childhood education programs (n = 18; 9 experimental, 9 comparison) across Canada. Pre-service ECEs enrolled in colleges/universities assigned to the experimental group will be required to complete a 4-module e-Learning course, while programs in the comparison group will maintain their typical curriculum. Pre-service ECEs’ self-efficacy, knowledge, as well as behavioural intention and perceived behavioural control will be assessed via online surveys and module completion rates will be documented using website metrics. Group differences across timepoints will be assessed using linear mixed effects modelling and common themes will be identified through thematic analysis. Discussion: The TEACH study represents a novel, evidence-informed approach to address the existing gap in physical activity and sedentary behaviour-related education in Canadian post-secondary early childhood education programs. Moreover, e-Learning platforms, can be employed as an innovative, standardized, and scalable way to provide ECEs with consistent training across jurisdictions.

Implementation of an e-Learning course in physical activity and sedentary behavior for pre- and in-service early childhood educators: Evaluation of the TEACH pilot study

Background

Childcare-based physical activity (PA) and sedentary behavior (SB) interventions have traditionally used in-person training to supplement early childhood educators’ (ECEs) knowledge and confidence to facilitate physically active programming for the children in their care. However, this method of delivery is resource-intensive and unable to reach a high number of ECEs. The purpose of the Training pre-service EArly CHildhood educators in PA (TEACH) pilot study was to test the implementation (e.g., fidelity, feasibility, acceptability) of an e-Learning course targeting PA and SB among a sample of pre-service (i.e., post-secondary students) and in-service (i.e., practicing) ECEs in Canada.

Methods

A pre-/post-study design was adopted for this pilot study, and implementation outcomes were assessed cross-sectionally at post-intervention. Pre-service ECEs were purposefully recruited from three Canadian colleges and in-service ECEs were recruited via social media. Upon completing the e-Learning course, process evaluation surveys (n = 32 pre-service and 121 in-service ECEs) and interviews (n = 3 pre-service and 8 in-service ECEs) were completed to gather ECEs’ perspectives on the e-Learning course. Fidelity was measured via e-Learning course metrics retrieved from the web platform. Descriptive statistics were calculated for quantitative data, and thematic analysis was conducted to analyze qualitative data.

Results

Moderate-to-high fidelity to the TEACH study e-Learning course was exhibited by pre-service (68%) and in-service (63%) ECEs. Participants reported that the course was highly acceptable, compatible, effective, feasible, and appropriate in complexity; however, some ECEs experienced technical difficulties with the e-Learning platform and noted a longer than anticipated course duration. The most enjoyed content for pre- and in-service ECEs focused on outdoor play (87.5% and 91.7%, respectively) and risky play (84.4% and 88.4%, respectively).

Conclusions

These findings demonstrate the value of e-Learning for professional development interventions for ECEs. Participant feedback will be used to make improvements to the TEACH e-Learning course to improve scalability of this training.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40814-022-01015-1.

Evaluation of the impact of the Healthy Start/Départ Santé intervention on improving menu planning practices and improving the congruence between planned menus and actual food served in Saskatchewan childcare centres

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The majority of centres did not comply with the recommended nutrition guidelines.

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More than 50% of centres listed processed foods in amounts exceeding recommendations.

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The interventions may effectively improve the accuracy and reliability of menus.

The objective of this study was to evaluate the impact of the Healthy Start/Départ Santé (HS/DS) intervention program on improving menu planning practices and improving the congruence between planned menus and actual food served in licensed childcare centres in Saskatchewan.

Overall, 39 licensed childcare centres in the province of Saskatchewan, Canada, were selected through a cluster randomized control trial to evaluate the impact of the HS/DS intervention. The pre and post intervention food menus of these centres were analyzed and compared to the Saskatchewan Childcare Nutrition Guidelines (SCNG). The food and beverages served at lunch were observed and digitally recorded using digital plate-waste measures. The congruence between the planned menus and the actual food served was assessed. Descriptive analyses and non-parametric tests were performed to determine the impact of the intervention.

The results of this study indicated that there was no significant difference between the groups regarding the distribution and proportion of centres that adhered to the SCNG. The centres that received the intervention demonstrated significant improvements in adherence to their written menus, with the proportions of match between the items that served and listed (p-value = 0.029), and additional items served (p-value = 0.014). Within each group, intervention and usual practice, there were significant differences in centres that met the foods to limit guideline among the usual practice centres (p-value = 0.035). Findings from this study indicated that the HS/DS intervention had a positive impact on improving the adherence of the participating centres to the centres’ planned menus.

HS/DS trial registration number: NCT02375490.