Abstract
The study aimed to compare the effectiveness of a suite of implementation strategies of varying intensities on centre-based childcare service implementation of nutrition guideline recommendations at 12-month follow-up. A six-month three-arm parallel group randomised controlled trial was undertaken with 69 services, randomised to one of three arms: high-intensity strategies (executive support; group face-to-face training; provision of resources; multiple rounds of audit and feedback; ongoing face-to-face and phone support); low-intensity strategies (group face-to-face training; provision of resources; single round of audit and feedback); or usual care control. Across all study arms, only three high-intensity services were compliant with overall nutrition guidelines. A significant group interaction was found between the three arms for compliance with individual food groups. Relative to control, a significantly greater proportion of low-intensity services were compliant with dairy, and a significantly greater proportion of high-intensity services were compliant with fruit, vegetables, dairy, breads and cereals, and discretionary foods. No significant differences between the high- and low-intensity for individual food group compliance were found. High-intensity implementation strategies may be effective in supporting childcare service implementation of individual food group recommendations. Further research is warranted to identify strategies effective in increasing overall nutrition compliance.
Highlights
In 2017, the Global Burden of Disease study reported that more than 11 million deaths and 255 million disability-adjusted life years worldwide were due to dietary risk factors alone, including low fruit and wholegrain food intake, and high sodium intake [1]
This study is the first three-arm randomised controlled trials (RCTs) to compare the effectiveness of high- and low-intensity implementation strategies in improving childcare service compliance with nutrition guidelines for the sector
The study found significant differences in compliance with nutrition guidelines between groups for five out of six individual food groups. These findings provide guidance to policy and practice decision makers responsible for the implementation and sustainability of obesity prevention initiatives in the childcare setting
Summary
In 2017, the Global Burden of Disease study reported that more than 11 million deaths and 255 million disability-adjusted life years worldwide were due to dietary risk factors alone, including low fruit and wholegrain food intake, and high sodium intake [1]. Evidence shows that dietary patterns and food preferences established in childhood track into adulthood, increasing the risk of future chronic disease [2]. The World Health Organization encourages countries to develop national nutrition. Res. Public Health 2020, 17, 4664; doi:10.3390/ijerph17134664 www.mdpi.com/journal/ijerph
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