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A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres.

ABSTRACT: Background: As dietary behaviours developed during early childhood are known to track into adulthood, interventions that aim to improve child nutrition at a population level are recommended. Whilst early childhood education and care (ECEC) is a promising setting for interventions targeting children's nutrition behaviours, previous interventions have largely used high intensity, face-to-face approaches, limiting their reach, implementation and potential impact at a population level. Web-based modalities represent a promising means of supporting the delivery of childcare-based interventions whilst overcoming challenges of previous approaches; however, the feasibility of using such modalities to support implementation is largely unknown. As such, this study sought to collect feasibility and pilot data to inform the design of a web-based intervention together with health promotion officer support within childcare centres. Child dietary intake will also be assessed to provide an estimate of the impact of the implementation intervention.

Methods: A superiority cluster randomised controlled trial with repeat cross-sectional data collection employing an effectiveness-implementation type-II hybrid design will be conducted with childcare centres within the Hunter New England region of New South Wales, Australia. Type-II hybrid designs provide the opportunity to assess intervention efficacy whilst piloting the feasibility of the implementation strategies. Centres allocated to the intervention group will receive access to a web-based program together with health promotion officer support to implement targeted healthy eating practices to improve child diet in care. A number of outcomes will be assessed to inform the feasibility to conduct a larger trial, including childcare centre and parent recruitment and consent rates for each component of data collection, uptake of the implementation strategies, acceptability of the intervention and implementation strategies, appropriateness of the implementation strategies and the contextual factors influencing implementation.

Discussion: This study will provide high-quality evidence regarding the potential feasibility of a web-based intervention and the impact of healthy eating practices on child diet in care. Web-based modalities provide a promising approach for population-wide implementation support to childcare centres given their potential reach and consistency with existing infrastructure.

Trial registration: Prospectively registered with Australian New Zealand Clinical Trial Registry ( ACTRN12619001158156 ).

SUBMITTER: Barnes C

PROVIDER: S-EPMC7597048 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres.

Barnes Courtney C Grady Alice A Nathan Nicole N Wolfenden Luke L Pond Nicole N McFayden Tameka T Ward Dianne S DS Vaughn Amber E AE Yoong Sze Lin SL

Pilot and feasibility studies 20201029 1

<h4>Background</h4>As dietary behaviours developed during early childhood are known to track into adulthood, interventions that aim to improve child nutrition at a population level are recommended. Whilst early childhood education and care (ECEC) is a promising setting for interventions targeting children's nutrition behaviours, previous interventions have largely used high intensity, face-to-face approaches, limiting their reach, implementation and potential impact at a population level. Web-ba ...[more]

PMID: 33292720

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Project description:BackgroundInternationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children's healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices.ObjectiveThe broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group.MethodsA 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care.ResultsOf the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11).ConclusionsThis study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099.International registered report identifier (irrid)RR2-10.1186/s40814-020-00707-w.

Project description:BackgroundA few studies have investigated tracking of dietary patterns or nutrient intake in pre-school children, but no studies have been identified examining tracking of sugar-sweetened beverages (SSB), fruit and vegetable intakes in early childhood (1-7 year olds). The purpose of this study was to investigate changes and tracking of intakes of fruit, vegetables and SSB, and association between maternal education and dietary tracking, from 18 months to 7 years of age.MethodsLongitudinal data from the nation-wide Norwegian Mother and Child Cohort Study, conducted by the Norwegian Institute of Public Health were used, including 9025 children participating at three time points (18 months, 36 months and 7 years). Frequencies of fruit, vegetables and SSB were assessed by questionnaire. Slightly different questions were used at each time point to collect information about intake. Maternal education was categorized into ≤ 12 years, 13-16 years, ≥ 17 years. Cross-tabulation, Spearman's rho and multinomial logistic regression were used for assessing change, tracking and differences by maternal education.ResultsAnalyses by gender indicated largest changes for intake of fruit and SSB from age 18 months to 7 years. Fair to moderate tracking coefficients (Spearman's rho = 0.23-0.46) for intake of fruit, vegetables and SSB were found and children assigned to low, medium and high frequency of consumption at 18 months continued to be in the same group at age 36 months and 7 years. Children of mothers with low education consumed fruit and vegetables less often and SSB more often compared to children of mothers with high education at 18 months of age. Children with higher educated mothers had lower odds for increasing fruit intake or decreasing SSB intake, compared to children with lower educated mothers showing a stable intake.ConclusionsThe tracking coefficients for intakes were fair to moderate and differences in intakes according to maternal education were found already at age 18 months. This suggests that promotion of healthy dietary behaviours at an early age is important to prevent unfavourable dietary behaviours later in childhood. Moreover, it seems important to target mothers in nutrition interventions for improving dietary habits among children.

Project description:BackgroundFruit and vegetable (FV) consumption in children in the United States (US) is very low. Adequate FV consumption is required for proper development during childhood, and dietary habits are established during preschool-age and tend to persist into adulthood. As most U.S. preschool-aged children attend childcare or preschool, this may be an opportune time and setting to conduct interventions to improve FV intake. These interventions should be based in theory and use behavior change techniques (BCTs) to explain mechanisms for expected change. To date, no published reviews have examined the effectiveness of childcare- or preschool-based FV interventions in preschoolers and their use of theoretical frameworks and BCTs.MethodsThis systematic review was completed adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were randomized controlled trials (RCTs) published between 2012 and 2022 of interventions to improve diet or FV intake in preschoolers (aged 2-5 years) in childcare or preschool-settings. A search of four databases was conducted between in September 2022 using search terms pertaining to the study's primary aim (FV consumption), age group (preschool-aged), settings (US childcare or preschool settings), and study design (RCT). Additional criteria were objective measures of FV consumption or skin carotenoids, as a proxy for FV intake. Included studies were narratively synthesized based on intervention type, measured effect, and use of theory and BCTs.ResultsThe search resulted in six studies that reported on nine interventions. Overall, six interventions increased FV intake, of which five used nutrition education and one manipulated the feeding environment. Among the three interventions with no measured effect, two manipulated the feeding environment and one used peer modeling. Effective studies used at least three BCTs, though no pattern was observed between use of theory or BCTs and intervention effect.ConclusionsWhile several studies have shown promising results, the limited number of studies identified in this review highlights key gaps in this field: there is a need for studies to test FV interventions in US childcare settings that use objective measures of FV intake, directly compare intervention components and BCTs, are theory-based, and assess long-term behavior change.

Project description:Calcium intake in adolescent and young adult female athletes often is inadequate to optimize peak bone mass, an important determinant of osteoporosis risk. The purpose of this study was to determine if calcium supplementation in eumenorrheic female collegiate athletes increases intake to recommended levels and promotes increases in bone mineral density (BMD). Forty-eight eumenorrheic female athletes from several college teams (15 soccer, 7 cross-country, 8 indoor track, and 18 basketball) were randomized at the beginning of a competitive season to receive either an oral calcium supplement (1000 mg calcium citrate/400 I.U. Vitamin D) or placebo daily throughout the training season (16 weeks). Self-reported daily pill intake was obtained every 2 weeks to assess adherence. Calcium intake was evaluated using the Rapid Assessment Method, and total body and leg BMD was measured at pre-, mid-, and postseason using dual energy x-ray absorptiometry (DEXA; Hologic QDR-2000). Pre-season calcium intake was lower than national recommendations for this age group (12), averaging 842 mg/d (SD = 719) and was lower in the placebo group compared to the supplemented group (649 +/- 268 vs. 1071 +/- 986 mg/d, respectively; p = .064). Adherence to supplementation was good, averaging 70% across the training season. Supplementation boosted total calcium intake to a mean of 1397 +/- 411 mg/d, which is consistent with recommended levels for this group (37). Supplementation did not influence BMD change during this 16-week intervention. Across teams, a small increase of 0.8% was observed in leg BMD. Change in total body BMD was modified by team, with a significant increase of 1.5% observed in basketball players. These results indicate that providing calcium supplements of 1000 mg/d is adequate to boost total intake to recommended levels during athletic training. Longer intervention trials are required to determine whether calcium supplementation has a positive effect on BMD.

Project description:BackgroundThe Nutrition Embedded Evaluation Programme Impact Evaluation (NEEP-IE) study is a cluster randomised controlled trial designed to evaluate the impact of a childcare centre-based integrated nutritional and agricultural intervention on the diets, nutrition and development of young children in Malawi. The intervention includes activities to improve nutritious food production and training/behaviour-change communication to improve food intake, care and hygiene practices. This paper presents the rationale and study design for this randomised control trial.MethodsSixty community-based childcare centres (CBCCs) in rural communities around Zomba district, Malawi, were randomised to either (1) a control group where children were attending CBCCs supported by Save the Children's Early Childhood Health and Development (ECD) programme, or (2) an intervention group where nutritional and agricultural support activities were provided alongside the routine provision of the Save the Children's ECD programme. Primary outcomes at child level include dietary intake (measured through 24-h recall), whilst secondary outcomes include child development (Malawi Development Assessment Tool (MDAT)) and nutritional status (anthropometric measurements). At household level, primary outcomes include smallholder farmer production output and crop-mix (recall of last production season). Intermediate outcomes along theorised agricultural and nutritional pathways were measured. During this trial, we will follow a mixed-methods approach and undertake child-, household-, CBCC- and market-level surveys and assessments as well as in-depth interviews and focus group discussions with project stakeholders.DiscussionAssessing the simultaneous impact of preschool meals on diets, nutrition, child development and agriculture is a complex undertaking. This study is the first to explicitly examine, from a food systems perspective, the impact of a preschool meals programme on dietary choices, alongside outcomes in the nutritional, child development and agricultural domains. The findings of this evaluation will provide evidence to support policymakers in the scale-up of national programmes.Trial registrationISRCTN registry, ID: ISRCTN96497560 . Registered on 21 September 2016.

Dataset Information

A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres.

Publications

A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres.

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