Healthy food in childcare: An online solution

The implementation of nutrition guidelines in childcare services to improve child nutrition is a local (Hunter New England (HNE) Local Health District), state (NSW) and national priority. However, despite significant efforts to improve the implementation of nutrition guidelines, less than 5% of childcare services in NSW meet such guidelines.1 Without initiatives to enhance the implementation of the guidelines by childcare services, the opportunity afforded by this setting to significantly improve child health cannot be achieved. The delivery of initiatives to support childcare services to meet the nutrition guidelines is a performance requirement of population health services in NSW.

The 'healthy food in childcare' initiative is a population-based health improvement initiative that aims to improve the diets of young children by supporting childcare services to provide meals consistent with nutrition guidelines. It is the first globally to use a scientifically rigorous and staged quality improvement approach to identify an effective and scalable solution to this significant problem. The initiative was co-developed by end-users and experts in the delivery of population health services and implementation science, and was based on systematic assessment of the barriers to guideline implementation among childcare service staff.2,3

Phase one of program development resulted in a high-intensity support strategy delivered by population health service dietitians to build the capacity of childcare services to interpret and apply nutrition guidelines. This strategy was evaluated with 45 childcare services in the HNE region and was found to be effective in improving the provision of healthier foods and improving child dietary intake and quality.4,5,6 However, the high cost of delivering this support limited its ability to be delivered at-scale by population health services.

In phase two of program development, the population health team partnered with information technology providers to develop an online menu-planning program (feedAustralia) to support childcare services to provide healthier foods consistent with nutrition guidelines.7 The online program was designed to support childcare cooks and menu planners with interpreting the guidelines, and reduce the computational complexity associated with assessing menu compliance. Drawing on a national database of food items, the program provides real-time automated feedback on whether a proposed menu is compliant with the guideline. The program also provides dietetics advice including suggestions for meal modifications and alternate recipes to align with guidelines.

The online program was evaluated in a randomised controlled trial across 52 childcare services in NSW. The trial found significant reductions in the provision of unhealthy foods by childcare services, improved child dietary intake, and a 10% greater proportion of children in the healthy weight range in the intervention group compared to the control group, at 12-months follow up. The program was also found to be highly acceptable and useful among childcare service staff.

The online menu planning program is available free of charge to all childcare services nationally, and accessible by parents of young children. With funding support by the Commonwealth Department of Health, the program has now been disseminated nationally, with over 1,800 childcare services accessing the program since March 2018, improving the diets of hundreds of thousands of children across Australia.

References

  1. ​Yoong SL, Skelton E, Jones J, Wolfenden L. Do childcare services provide foods in line with the 2013 Australian Dietary guidelines? A cross-sectional study. Aust N Z J Public Health 2014;38(6):595-6.
  2. Seward K, Finch M, Yoong S, Wyse R, Jones J, Grady A, Wiggers J, Nathan N, Conte K, Wolfenden L. Factors that influence the implementation of dietary guidelines regarding food provision in centre based childcare service: A systematic review. Prev Med 2017; 105: 197-205.
  3. Grady A, Seward K, Finch M, Fielding A, Stacey F, Jones J, Wolfenden L, Yoong SL. Barriers and enablers to implementation of dietary guidelines in early childhood education centers in Australia: application of the Theoretical Domains Framework. J Nutr Educ Behav 2018; 50(3): 229-37.
  4. Seward K, Wolfenden L, Finch M, Wiggers J, Wyse R, Jones J, Gillham K, Yoong S. Multistrategy childcare-based intervention to improve compliance with nutrition guidelines versus usual care in long day care services: a study protocol for a randomised controlled trial. BMJ Open 2016; 6: e010786. 
  5. Seward K, Wolfenden L, Finch M, Wiggers J, Wyse R, Jones J, Yoong S. Improving the implementation of nutrition guidelines in childcare centres improves child dietary intake: findings of a randomised trial of an implementation intervention. Public Health Nutr 2018; 21(3): 607-17.
  6. Yoong SL, Grady A, Seward K, Finch M, Wiggers J, Lecathelinais C, Wedesweiler T, Wolfenden L. The impact of a childcare food service intervention on child dietary intake in care: a cluster randomised controlled trial. Public Health Nutr (under review).
  7. Yoong S, Grady A, Wiggers J, Flood V, Rissel C, Finch M, Searles A, Salajan D, O’Rourke R, Daly J, Gilham K, Stacey F, Fielding A, Pond N, Wyse R, Seward K, Wolfenden L. A randomised controlled trial of a web-based menu planning intervention to improve childcare service adherence to dietary guidelines: a study protocol. BMJ Open 2017; 7: e017498.
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Current as at: Monday 31 May 2021
Contact page owner: Centre for Epidemiology and Evidence