Effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services: a randomised controlled trial

doi:10.1186/s13012-015-0340-z

Randomized Controlled Trial

. 2015 Oct 25:10:147.

doi: 10.1186/s13012-015-0340-z.

Effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services: a randomised controlled trial

Jannah Jones^{1

2

3

4}, Rebecca Wyse^{5

6

7

8}, Meghan Finch^{9

10

11

12}, Christophe Lecathelinais^{13

14}, John Wiggers^{15

16

17

18}, Josephine Marshall^{19

20}, Maryann Falkiner^{21

22}, Nicole Pond^{23

24}, Sze Lin Yoong^{25

26

27

28}, Jenna Hollis^{29

30

31}, Alison Fielding^{32

33}, Pennie Dodds^{34

35}, Tara Clinton-McHarg^{36

37

38

39}, Megan Freund^{40

41

42

43}, Patrick McElduff⁴⁴, Karen Gillham^{45

46}, Luke Wolfenden^{47

48

49

50}

Affiliations

¹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. jannah.jones@hnehealth.nsw.gov.au.
² School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. jannah.jones@hnehealth.nsw.gov.au.
³ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. jannah.jones@hnehealth.nsw.gov.au.
⁴ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. jannah.jones@hnehealth.nsw.gov.au.
⁵ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
⁶ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
⁷ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
⁸ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
⁹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. meghan.finch@hnehealth.nsw.gov.au.
¹⁰ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. meghan.finch@hnehealth.nsw.gov.au.
¹¹ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. meghan.finch@hnehealth.nsw.gov.au.
¹² Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. meghan.finch@hnehealth.nsw.gov.au.
¹³ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. christophe.lecathelinais@hnehealth.nsw.gov.au.
¹⁴ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. christophe.lecathelinais@hnehealth.nsw.gov.au.
¹⁵ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. john.wiggers@hnehealth.nsw.gov.au.
¹⁶ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. john.wiggers@hnehealth.nsw.gov.au.
¹⁷ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. john.wiggers@hnehealth.nsw.gov.au.
¹⁸ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. john.wiggers@hnehealth.nsw.gov.au.
¹⁹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. jmarshall9@hotmail.com.
²⁰ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. jmarshall9@hotmail.com.
²¹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. maryann.falkiner@hnehealth.nsw.gov.au.
²² Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. maryann.falkiner@hnehealth.nsw.gov.au.
²³ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. nicole.pond@hnehealth.nsw.gov.au.
²⁴ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. nicole.pond@hnehealth.nsw.gov.au.
²⁵ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. serene.yoong@hnehealth.nsw.gov.au.
²⁶ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. serene.yoong@hnehealth.nsw.gov.au.
²⁷ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. serene.yoong@hnehealth.nsw.gov.au.
²⁸ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. serene.yoong@hnehealth.nsw.gov.au.
²⁹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. jenna.hollis@abdn.ac.uk.
³⁰ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. jenna.hollis@abdn.ac.uk.
³¹ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. jenna.hollis@abdn.ac.uk.
³² Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. alison.fielding@hnehealth.nsw.gov.au.
³³ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. alison.fielding@hnehealth.nsw.gov.au.
³⁴ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. pennie.gibbins@hnehealth.nsw.gov.au.
³⁵ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. pennie.gibbins@hnehealth.nsw.gov.au.
³⁶ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. tara.clintonmcharg@hnehealth.nsw.gov.au.
³⁷ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. tara.clintonmcharg@hnehealth.nsw.gov.au.
³⁸ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. tara.clintonmcharg@hnehealth.nsw.gov.au.
³⁹ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. tara.clintonmcharg@hnehealth.nsw.gov.au.
⁴⁰ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. megan.freund@hnehealth.nsw.gov.au.
⁴¹ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. megan.freund@hnehealth.nsw.gov.au.
⁴² Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. megan.freund@hnehealth.nsw.gov.au.
⁴³ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. megan.freund@hnehealth.nsw.gov.au.
⁴⁴ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. patrick.mcelduff@newcastle.edu.au.
⁴⁵ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. karen.gillham@hnehealth.nsw.gov.au.
⁴⁶ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. karen.gillham@hnehealth.nsw.gov.au.
⁴⁷ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. luke.wolfenden@hnehealth.nsw.gov.au.
⁴⁸ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. luke.wolfenden@hnehealth.nsw.gov.au.
⁴⁹ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. luke.wolfenden@hnehealth.nsw.gov.au.
⁵⁰ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. luke.wolfenden@hnehealth.nsw.gov.au.

PMID: 26498746
PMCID: PMC4619985
DOI: 10.1186/s13012-015-0340-z

Randomized Controlled Trial

Effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services: a randomised controlled trial

Jannah Jones et al. Implement Sci. 2015.

. 2015 Oct 25:10:147.

doi: 10.1186/s13012-015-0340-z.

Authors

Affiliations

¹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. jannah.jones@hnehealth.nsw.gov.au.
² School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. jannah.jones@hnehealth.nsw.gov.au.
³ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. jannah.jones@hnehealth.nsw.gov.au.
⁴ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. jannah.jones@hnehealth.nsw.gov.au.
⁵ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
⁶ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
⁷ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
⁸ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. rebecca.wyse@hnehealth.nsw.gov.au.
⁹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. meghan.finch@hnehealth.nsw.gov.au.
¹⁰ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. meghan.finch@hnehealth.nsw.gov.au.
¹¹ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. meghan.finch@hnehealth.nsw.gov.au.
¹² Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. meghan.finch@hnehealth.nsw.gov.au.
¹³ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. christophe.lecathelinais@hnehealth.nsw.gov.au.
¹⁴ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. christophe.lecathelinais@hnehealth.nsw.gov.au.
¹⁵ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. john.wiggers@hnehealth.nsw.gov.au.
¹⁶ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. john.wiggers@hnehealth.nsw.gov.au.
¹⁷ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. john.wiggers@hnehealth.nsw.gov.au.
¹⁸ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. john.wiggers@hnehealth.nsw.gov.au.
¹⁹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. jmarshall9@hotmail.com.
²⁰ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. jmarshall9@hotmail.com.
²¹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. maryann.falkiner@hnehealth.nsw.gov.au.
²² Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. maryann.falkiner@hnehealth.nsw.gov.au.
²³ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. nicole.pond@hnehealth.nsw.gov.au.
²⁴ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. nicole.pond@hnehealth.nsw.gov.au.
²⁵ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. serene.yoong@hnehealth.nsw.gov.au.
²⁶ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. serene.yoong@hnehealth.nsw.gov.au.
²⁷ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. serene.yoong@hnehealth.nsw.gov.au.
²⁸ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. serene.yoong@hnehealth.nsw.gov.au.
²⁹ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. jenna.hollis@abdn.ac.uk.
³⁰ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. jenna.hollis@abdn.ac.uk.
³¹ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. jenna.hollis@abdn.ac.uk.
³² Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. alison.fielding@hnehealth.nsw.gov.au.
³³ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. alison.fielding@hnehealth.nsw.gov.au.
³⁴ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. pennie.gibbins@hnehealth.nsw.gov.au.
³⁵ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. pennie.gibbins@hnehealth.nsw.gov.au.
³⁶ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. tara.clintonmcharg@hnehealth.nsw.gov.au.
³⁷ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. tara.clintonmcharg@hnehealth.nsw.gov.au.
³⁸ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. tara.clintonmcharg@hnehealth.nsw.gov.au.
³⁹ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. tara.clintonmcharg@hnehealth.nsw.gov.au.
⁴⁰ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. megan.freund@hnehealth.nsw.gov.au.
⁴¹ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. megan.freund@hnehealth.nsw.gov.au.
⁴² Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. megan.freund@hnehealth.nsw.gov.au.
⁴³ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. megan.freund@hnehealth.nsw.gov.au.
⁴⁴ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. patrick.mcelduff@newcastle.edu.au.
⁴⁵ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. karen.gillham@hnehealth.nsw.gov.au.
⁴⁶ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. karen.gillham@hnehealth.nsw.gov.au.
⁴⁷ Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. luke.wolfenden@hnehealth.nsw.gov.au.
⁴⁸ School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. luke.wolfenden@hnehealth.nsw.gov.au.
⁴⁹ Hunter Medical Research Institute, Newcastle, NSW, 2300, Australia. luke.wolfenden@hnehealth.nsw.gov.au.
⁵⁰ Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. luke.wolfenden@hnehealth.nsw.gov.au.

PMID: 26498746
PMCID: PMC4619985
DOI: 10.1186/s13012-015-0340-z

Abstract

Background: The primary aim of this study was to evaluate the effectiveness of an intervention to increase the implementation of healthy eating and physical activity policies and practices by centre-based childcare services. The study also sought to determine if the intervention was effective in improving child dietary intake and increasing child physical activity levels while attending childcare.

Methods: A parallel group, randomised controlled trial was conducted in a sample of 128 childcare services. Intervention strategies included provision of implementation support staff, securing executive support, staff training, consensus processes, academic detailing visits, tools and resources, performance monitoring and feedback and a communications strategy. The primary outcome of the trial was the proportion of services implementing all seven healthy eating and physical activity policies and practices targeted by the intervention. Outcome data were collected via telephone surveys with nominated supervisors and room leaders at baseline and immediately post-intervention. Secondary trial outcomes included the differences between groups in the number of serves consumed by children for each food group within the Australian Guide to Healthy Eating and in the proportion of children engaged in sedentary, walking or very active physical activity assessed via observation in a random subsample of 36 services at follow-up.

Results: There was no significant difference between groups for the primary trial outcome (p = 0.44). Relative to the control group, a significantly larger proportion of intervention group services reported having a written nutrition and physical activity policy (p = 0.05) and providing adult-guided activities to develop fundamental movement skills (p = 0.01). There were no significant differences between groups at follow-up on measures of child dietary intake or physical activity.

Conclusions: The findings of the trial were equivocal. While there was no significant difference between groups for the primary trial outcome, the intervention did significantly increase the proportion of intervention group services implementing two of the seven healthy eating and physical activity policies and practices. High levels of implementation of a number of policies and practices at baseline, significant obesity prevention activity in the study region and higher than previously reported intra-class correlation of child behaviours may, in part, explain the trial findings.

Trial registration: Australian Clinical Trials Registry (reference ACTRN12612000927820 ).

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Figures

**Fig. 1**
Participant recruitment and retention by group

See this image and copyright information in PMC

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References

1. World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. 2007. http://www.dietandcancerreport.org/cancer_resource_center/downloads/Seco.... Accessed 30 Jan 2015.
1. Ezzati M, Lopez A, Rodgers A, Murray C. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. World Health Organization. 2004. http://www.who.int/healthinfo/global_burden_disease/cra/en/. Accessed 30 Jan 2015.
1. Birch LL, Ventura AK. Preventing childhood obesity: what works? Int J Obes [London] 2009;33:S74–S81. doi: 10.1038/ijo.2009.22. - DOI - PubMed
1. Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr. 1994;59(5):955–9. - PubMed
1. Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity. 2010;18(S1):S27–S35. doi: 10.1038/oby.2009.429. - DOI - PubMed

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[1] World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. 2007. http://www.dietandcancerreport.org/cancer_resource_center/downloads/Seco.... Accessed 30 Jan 2015.

[2] World Cancer Research Fund/American Institute for Cancer Research. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. 2007. http://www.dietandcancerreport.org/cancer_resource_center/downloads/Seco.... Accessed 30 Jan 2015.

[3] Ezzati M, Lopez A, Rodgers A, Murray C. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. World Health Organization. 2004. http://www.who.int/healthinfo/global_burden_disease/cra/en/. Accessed 30 Jan 2015.

[4] Ezzati M, Lopez A, Rodgers A, Murray C. Comparative quantification of health risks: global and regional burden of disease attributable to selected major risk factors. World Health Organization. 2004. http://www.who.int/healthinfo/global_burden_disease/cra/en/. Accessed 30 Jan 2015.

[5] Birch LL, Ventura AK. Preventing childhood obesity: what works? Int J Obes [London] 2009;33:S74–S81. doi: 10.1038/ijo.2009.22. - DOI - PubMed

[6] Birch LL, Ventura AK. Preventing childhood obesity: what works? Int J Obes [London] 2009;33:S74–S81. doi: 10.1038/ijo.2009.22. - DOI - PubMed

[7] Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr. 1994;59(5):955–9. - PubMed

[8] Dietz WH. Critical periods in childhood for the development of obesity. Am J Clin Nutr. 1994;59(5):955–9. - PubMed

[9] Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity. 2010;18(S1):S27–S35. doi: 10.1038/oby.2009.429. - DOI - PubMed

[10] Hesketh KD, Campbell KJ. Interventions to prevent obesity in 0–5 year olds: an updated systematic review of the literature. Obesity. 2010;18(S1):S27–S35. doi: 10.1038/oby.2009.429. - DOI - PubMed

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Effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services: a randomised controlled trial

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Effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services: a randomised controlled trial

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