Meghan Finch1,2,3,4, Kirsty Seward2,4, Taya Wedesweiler1, Fiona Stacey1,2,3,4, Alice Grady1,2,3,4, Jannah Jones1,2,3,4, Luke Wolfenden1,2,3,4, Sze Lin Yoong1,2,3,4. 1. 1 Hunter New England Population Health, Wallsend, New South Wales, Australia. 2. 2 School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia. 3. 3 Hunter Medical Research Institute, Newcastle, New South Wales, Australia. 4. 4 Priority Research Center for Health Behaviour, University of Newcastle, Newcastle, New South Wales, Australia.
Abstract
PURPOSE: To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare compliance with nutrition guidelines. DESIGN: Parallel group randomized controlled trial. SETTING: Hunter New England region, New South Wales, Australia. PARTICIPANTS: Forty-four childcare centers that prepare and provide food on-site to children while in care. INTERVENTION: The intervention was designed using the Theoretical Domains Framework, targeted managers, and cooks and included implementation strategies that addressed identified barriers. MEASURES: Outcomes included the proportion of menus providing food servings (per child) compliant with overall nutrition guideline recommendations and each individual food group assessed via menu assessments. Cook knowledge of recommendations, intervention acceptability, adverse events, and barriers were also assessed via questionnaires with cooks and managers. ANALYSIS: Logistic regression models, adjusted for baseline values of the outcome. RESULTS: At baseline and follow-up, zero centers in the intervention and control groups were compliant with the overall menu guidelines or for the vegetable and meat food groups. Follow-up between-group differences in compliance for discretionary (33.3 vs 5, P = .18), dairy (41.7 vs 15, P = .16), breads and cereals (8.3 vs 10 P = 1.00), and fruit (16.7 vs 10, P = .48) were all nonsignificant. Relative to the control group, intervention centers showed a significantly greater increase in percentage of cooks with correct knowledge for vegetable servings (93.3 vs 36.4, P = .008). CONCLUSION: Although the application of the theoretical framework produced a broader understanding of the determinants of menu compliance, due to the complexity of guidelines, limited follow-up support, lower training uptake, and low intervention dose, the intervention was not effective in supporting the practice change required.
RCT Entities:
PURPOSE: To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare compliance with nutrition guidelines. DESIGN: Parallel group randomized controlled trial. SETTING: Hunter New England region, New South Wales, Australia. PARTICIPANTS: Forty-four childcare centers that prepare and provide food on-site to children while in care. INTERVENTION: The intervention was designed using the Theoretical Domains Framework, targeted managers, and cooks and included implementation strategies that addressed identified barriers. MEASURES: Outcomes included the proportion of menus providing food servings (per child) compliant with overall nutrition guideline recommendations and each individual food group assessed via menu assessments. Cook knowledge of recommendations, intervention acceptability, adverse events, and barriers were also assessed via questionnaires with cooks and managers. ANALYSIS: Logistic regression models, adjusted for baseline values of the outcome. RESULTS: At baseline and follow-up, zero centers in the intervention and control groups were compliant with the overall menu guidelines or for the vegetable and meat food groups. Follow-up between-group differences in compliance for discretionary (33.3 vs 5, P = .18), dairy (41.7 vs 15, P = .16), breads and cereals (8.3 vs 10 P = 1.00), and fruit (16.7 vs 10, P = .48) were all nonsignificant. Relative to the control group, intervention centers showed a significantly greater increase in percentage of cooks with correct knowledge for vegetable servings (93.3 vs 36.4, P = .008). CONCLUSION: Although the application of the theoretical framework produced a broader understanding of the determinants of menu compliance, due to the complexity of guidelines, limited follow-up support, lower training uptake, and low intervention dose, the intervention was not effective in supporting the practice change required.
Authors: Alice Grady; Kirsty Seward; Meghan Finch; Luke Wolfenden; Rebecca Wyse; John Wiggers; Christophe Lecathelinais; Sze Lin Yoong Journal: Int J Environ Res Public Health Date: 2020-06-29 Impact factor: 3.390
Authors: Alice Grady; Luke Wolfenden; John Wiggers; Chris Rissel; Meghan Finch; Victoria Flood; David Salajan; Ruby O'Rourke; Fiona Stacey; Rebecca Wyse; Christophe Lecathelinais; Courtney Barnes; Sue Green; Vanessa Herrmann; Sze Lin Yoong Journal: J Med Internet Res Date: 2020-02-04 Impact factor: 5.428
Authors: Ruth K Crowe; Yasmine C Probst; Jennifer A Norman; Susan E Furber; Rebecca M Stanley; Sarah T Ryan; Cecilia Vuong; Megan L Hammersley; Karen Wardle; Lisa Franco; Michael W Beets; R Glenn Weaver; Marc Davis; Christine Innes-Hughes; Anthony D Okely Journal: BMC Public Health Date: 2022-02-11 Impact factor: 3.295
Authors: Audrey Elford; Cherice Gwee; Maliney Veal; Rati Jani; Ros Sambell; Shabnam Kashef; Penelope Love Journal: Int J Environ Res Public Health Date: 2022-03-30 Impact factor: 3.390
Authors: Janet A Curran; Allyson J Gallant; Helen Wong; Hwayeon Danielle Shin; Robin Urquhart; Julia Kontak; Lori Wozney; Leah Boulos; Zulfiqar Bhutta; Etienne V Langlois Journal: BMJ Open Date: 2022-01-17 Impact factor: 2.692
Authors: Alice Grady; Courtney Barnes; Luke Wolfenden; Christophe Lecathelinais; Sze Lin Yoong Journal: J Med Internet Res Date: 2020-11-20 Impact factor: 5.428