Background: Although best practice recommendations exist to guide childcare service implementation of healthy eating and physical activity policies and practices, research indicates that implementation is poor. Due to the increasing amount of implementation research being conducted in the childcare setting, an update of this 2016 review was required to reflect the current state of the evidence.

Aim: The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating and physical activity. Secondary aims were to examine the effect of implementation strategies on cost or cost-effectiveness, adverse effects on childcare service staff, and child diet, physical activity or weight status.

Methods: A search of electronic databases and a hand search of international implementation journals and trial registries was conducted in February 2019. Authors independently screened abstracts for eligibility, extracted trial data and assessed risk of bias. Studies with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by childcare services to no intervention, ’usual’ practice or an alternative strategy were included.

Results: In addition to the 10 trials included in the 2016 review, a further 11 trials were identified as eligible. Collectively, the 21 trials sought to improve the implementation of policies and practices targeting healthy eating (six trials), physical activity (three trials) or both healthy eating and physical activity (12 trials). A range of implementation strategies were tested in the 21 trials. Nine studies using score-based measures of implementation were included in pooled analysis, indicating a significant improvement in implementation outcomes (SMD 0.49; 95%CI 0.19-0.79; I2 = 54%; p<0.001; moderate-certainty evidence). Ten studies used dichotomous measures of implementation, with seven of these included in pooled analysis indicating a non-significant improvement in implementation (OR 1.83; 95%CI 0.81-4.11; I2 = 51%; p=0.14; low-certainty evidence).

Conclusion: Current research suggests that implementation strategies may improve the implementation of policies, practices or programmes by childcare services and their staff however not child diet, physical activity or weight status.

Background: A healthy diet is important for children’s growth and development. Children need encouragement and support to adopt healthy eating behaviours. Dutch nutrition education programs such as EU-Schoolfruit (EUS) and Taste Lessons (TL) contribute to this by providing children with fruit, vegetables (FV) (EUS) and nutrition education (TL). However, little is known about which components are most effective.

Aim: To examine effective components of existing Dutch nutrition education programs for primary school children (n=1436, n=38 schools) aged 8-12 years.

Hypothesis: It is hypothesized that nutrition education programs are more effective as more components are added.

Measures: Child nutrition knowledge, food literacy and FV intakes are measured by a 30-minute questionnaire for the children.

Design: A quasi-experimental study with three arms: (1) schools that implement EUS, (2) schools that implement EUS + TL and (3) schools that implement no nutrition education. Outcomes are being assessed pre-intervention (baseline), immediately following the intervention (post-intervention), and 6 months post-intervention.

Analysis: Descriptive analysis using the statistical program R. First, the two intervention groups and the control group are being compared on their socio-demographic characteristics using one-way ANOVA. Subsequently, multilevel regression analysis will be conducted to evaluate the effect of EU-Schoolfruit and Taste Lessons on nutrition knowledge, food literacy and fruit and vegetable intake, including three levels: (1) pupil, (2) class and (3) school. Simple linear regression will be used, and potential confounders and effect modifiers will be identified. Effect sizes will be expressed as Cohen’s d.

Results: Preliminary results from T0 and T1 indicated a significant increase in nutrition knowledge only for children in schools that participated in both programs (EUS and TL), compared to the control group (p<0.01), but no significant increase in FV intake (fruits p=0.19 and vegetables p=0.20). The change in food literacy scores did not significantly differ between the three groups (p=0.99). Full results of the three measurements (T0, T1 and T2) will be presented.

Conclusion: The two existing nutrition education programs (EUS and TL) have some impact on children’s nutrition knowledge and FV intake, but specific effects of individual components needs to be evaluated in the future.

 Background: Despite recommendations, early childhood education and care (ECEC) services do not plan menus in accordance with sector dietary guidelines. An understanding of current practices undertaken in ECEC by service cooks to plan a menu, and whether these practices impact on guideline implementation, is needed to inform the development of future interventions to improve guideline implementation. This study aimed to examine the following among ECEC services: i) menu planning practices; ii) prevalence of menu compliance with sector dietary guidelines; and iii) menu planning practices associated with higher menu compliance with sector dietary guidelines.

Methods: A cross sectional study was undertaken with long day care services within Hunter New England region of NSW Australia. Cooks within participating services completed a pen and paper survey assessing a range of menu planning practices (e.g. frequency of menu review, time allocated to plan a menu). Service’s two-week menus were assessed for their compliance with sector dietary guidelines, based on the number of servings of core food groups and discretionary foods provided per child, per day. Simple and multiple variable poisson regression models were used to determine associations between menu planning practices and “higher” compliance with dietary guidelines.

Results: Cooks from 72 services completed the survey, and 69 provided a copy of their menu for review. Results indicated that the service cook was fully responsible for planning the menu in 43% of services. Service menus were compliant with an average of 0.68 food groups, out of a possible 6. In the multiple poisson regression models, a shorter menu cycle length (p<0.05) and the receipt of training opportunities to support menu planning (p<0.01) were significantly associated with higher menu compliance.

Conclusions: Menu compliance with sector dietary guidelines was low among participating services. This study resulted in novel findings not previously reported, namely that services with a shorter menu cycle, and those who have received training opportunities to support planning a menu, are significantly more likely to have higher menu compliance. The implementation of such practices may assist in the planning of menus that are more compliant with dietary guidelines to improve child nutrition in this setting.

Purpose: There is a growing prevalence of childhood obesity, especially within low-income populations. Children under age 5 spend a significant amount of time in early care education centers (ECEs), presenting an opportunity to impact their nutrition and physical activity (PA) behaviors. Aims of this study were to: understand the similarity of child health behaviors between ECE and home environments; and investigate the importance of teacher and guardian role modeling in ECE and home environments on impacting child health behaviors.
Methods: Surveys were conducted at 32 ECEs participating in the HealthMPowers program. Teachers and guardians reported their health behaviors and child’s behaviors at ECE and at home, respectively. Measures were based on benchmarks created from federal health guidelines and included frequency of fruit and vegetable consumption and PA. Data was collected at baseline and post intervention. Analysis was done on both baseline data and changes from baseline to post intervention. Similarity of child behavior between environments was assessed by kappa agreement statistics. Spearman correlation analyses were conducted to understand the associations of adult and child health behaviors.
Results/Findings: Analysis indicates agreement between childcare and home environments of 5-10% for frequency of daily fruit and vegetable consumption, and 20% for PA behavior. Spearman correlation analysis indicates that there is a positive association between guardian and child health behaviors at baseline and for changes in behavior, with correlation in behavior ranging from 0.49-0.70. (p < 0.001). Contrary to guardian association, a positive association between teacher and child behavioral changes is only significant between frequency of consumption of fruits (r= 0.09) and water daily (r = .103). The correlation between guardian and child behaviors changes from baseline to post intervention does not vary by gender of the children.

Conclusions: This research contributes to an understanding of concurrence of child behavior across environments, and how these behaviors can be influenced by health education and interventions for teachers and guardians. Understanding the influence of role modeling and consistency of behaviors between home and ECE environments allows for better recommendations regarding nutrition and PA interventions. Targeted interventions involving the guardian are essential for comprehensive child health programs.

Purpose: Educators working in early childcare centres (ECCs) are important role models to promote healthy eating (HE) and physical activity (PA) in young children. In-person training interventions with educators have shown positive impacts on children’s dietary intake and physical activity. However, the sustainability these interventions is limited by financial and human resource constraints. An online training intervention may be a more cost-effective, sustainable and effective way to reach educators, while also improving their practices. This study aimed to compare the effectiveness of an online version of the Healthy Start-Départ Santé (HSDS) intervention to the traditional in-person intervention and to usual practice on ECC educators’ HE and PA practices and knowledge of fundamental movement skills (FMS).

Methods: Seventy-eight ECCs were randomly chosen across the provinces of New Brunswick and Saskatchewan, Canada and were allocated to either the online training, the in-person training or the usual practice group. Educators in each group completed the Nutrition and Physical Activity a self-administered questionnaire before and ten months after the intervention. The questionnaire included questions regarding educators’ HE and PA practices in the ECC, as well as their knowledge of children’s FMS. Group differences were assessed with mixed-effect models. 

Results: Two hundred and four educators completed the pre and post questionnaire. Educators in the online training group reported a greater improvement in the score for HE practices then the change observed among educators in the in-person training and usual practice groups (2.4 vs. vs. 0.6 vs. 1.1, p=0.03). Educators in the online training group reported a greater improvement in the score for PA practices than the change observed among educators in the in-person training group (1.3 vs. 0.1, p=0.03). The rate of improvement in FMS knowledge did not differ across all three groups (p=0.9).  

Conclusions: The HSDS online training is a cost-effective method of enhancing educators’ knowledge of HE and PA practices in ECCs. Its ability to reach a greater number of educators makes the HSDS online training a promising method to create healthier environments in ECCs.

Purpose

The global decline in the quality of physical education (PE) has prompted multiple actions to improve student experiences. As the primary delivery agents of PE, school teachers are a key target audience for intervention. The deterioration in PE delivery prompted Sport NZ to develop Play.Sport in 2016, which is a 4-year community-based initiative that provides hands-on practical support and training for teachers, schools, and community organisations to improve the quality of physical activity, play and sport experiences for young people. Our aim was to understand the impact of Play.Sport on teacher confidence and practice in delivering PE and how this affected the subsequent experience and participation of their students. 

Methods 

A mixed-methods evaluation was completed through a total of 45 primary/intermediate schools in two regions of New Zealand between 2016-2019. We assessed change in teacher confidence and practice using a pre-post survey of 197 teachers and subsequent face-to-face interviews of 32 teachers. We assessed changes in student experiences and participation using a pre-post survey of 3185 students and subsequent focus groups with 38 students. 

Results

Teacher confidence to deliver all components of the PE curriculum improved significantly from 45% to 57%. Similarly, their confidence to effectively deliver at least one component of the curriculum significantly improved from 70% to 82%. Over 85% of teachers reported changes in how they delivered PE as a result of the initiative. This finding was substantiated by qualitative findings that highlighted the importance of the support provided by Play.Sport to develop new practice. Student data indicated significant improvement in PE classes as learning environments for: skill development (62% to 70%); working together (77% to 82%); leadership (60% to 67%); decision making (45% to 58%); community engagement (60% to 67%). The student qualitative results also indicated changes in participation across all strands of the PE curriculum. 

Conclusions 

We found that the Play.Sport initiative improved teacher confidence and practice, which subsequently positively influenced student experience and participation across the PE curriculum. Ongoing evaluation of Play.Sport will elucidate whether this translates into sustained physical activity behaviour change outside of the school setting over the longer term.

 

Purpose: Family childcare homes (FCCHs) are the second-most utilized non-relative childcare in the United States and may be more obesogenic than childcare centers. Yet, little research has been done in this setting. 

Methods: Healthy Start/Comienzos Sanos is a cluster-randomized trial to help family childcare providers (FCCPs) change FCCH environments and improve the diet and physical activity (PA) of children aged 2-5 years in their care. FCCPs completed two surveys and underwent two days of FCCH observation/measurement at baseline and 8 months. The intervention arm received a novel obesity prevention intervention and the control arm a literacy intervention. Child dietary intake was collected using the Dietary Observation in Child Care. Diet quality was calculated using the Healthy Eating Index-2015 (HEI) total and 13 component scores per child (n=366). Child’s PA was measured using hip-worn triaxial accelerometers. Children’s height and weight were measured to calculate BMI. HEI scores, PA and BMI were averaged by FCCH and ANOVA models examined change in from baseline to follow-up by experimental condition.

Results: 119 FCCP enrolled (100% female, 72% Hispanic, 16% Black, mean age 48.4 years, 11% no high school education) with 87 completing 8 month follow-up. Baseline: Children’s HEI scores averaged 61.87 (SD 10.4) (80=healthful diet). Most of children’s time in FCCH was spent sedentary (61.5%±11.0%), with only 9.9%±4.7% in moderate-to-vigorous PA (MVPA); 33% of children were overweight/obese.; Pre-Post Change: Children in the intervention group FCCH had greater changes than control group in total HEI scores (+3.82 vs. -3.34, p = 0.0004), and total vegetable (+0.49 vs. -0.37, p =0.03); added sugar (+0.97 vs. +0.01, p =  0.03) and refined grain (+1.26 vs. -0.17, p = 0.06) HEI component scores. Furthermore, intervention children decreased percent sedentary time (-1.67% vs.  +3.60%, p = 0.042) and increased percent time in MVPA (+1.46% vs. -0.40%, p < 0.08) more than control group children. As expected, there were no between treatment differences in BMI Z-score or BMI-percentile.

Conclusions: The Healthy Start intervention improved the dietary quality and decreased the sedentary time of 2-5 year old children cared for in FCCHs, which has important implications for professional development and policy.