- Title
- Creating childcare environments supportive of child obesity prevention
- Creator
- Jones, Jannah Zoe
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2017
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The high prevalence, substantial disease burden and financial costs associated with childhood overweight and obesity makes it a significant public health challenge. Despite the considerable importance of the development of healthy nutrition and physical activity behaviours in early childhood, few children aged zero to five years adhere to public health guideline recommendations for dietary intake and physical activity. Centre-based childcare services, such as preschools and long day care services, represent a valuable setting to support obesity prevention as such services can implement a range of evidence-based healthy eating, physical activity and obesity prevention policies, practices and programmes. However, the current implementation of such policies and practices by childcare services is sub-optimal. This thesis aimed to: ; Describe the dietary intake and physical activity levels of children attending Australian childcare services ; Systematically review and synthesise current evidence for the effectiveness of strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices and programmes within childcare services ; Develop and evaluate the effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services ; Discuss the need for a systematic application of implementation science to improve the impact of obesity prevention interventions in the childcare setting ; Discuss implications for future policy, practice and research To address the first thesis aim, a cross-sectional study was conducted with 18 centre-based childcare services in the Hunter region of New South Wales, Australia. A random sample of children aged 3 to 5 years was selected and their dietary intake and physical activity levels were assessed during a one-day observation using validated tools. The study found that while attending childcare, children consumed a mean of 0.2 serves of vegetables, 0.7 serves of fruit, 1.4 serves of grain (cereal) foods, 0.1 serves of lean meat and poultry, fish, eggs, nuts and seeds, and legumes/beans, 0.6 serves of milk, yoghurt, cheese and alternatives, and 0.7 serves of discretionary foods. In regards to physical activity levels, 48.6% of all child counts were classified as ‘sedentary’, and 22.3% classified as ‘very active’. The findings indicated that there is considerable scope to improve the diet and activity behaviours of children during their attendance at childcare. To address the second thesis aim, a systematic review was undertaken to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. Ten eligible trials were included in the review. None of the interventions reviewed improved the implementation of all targeted policies and practices relative to a comparison group. Current research provides weak and inconsistent evidence of the effectiveness of strategies to improve the implementation of such policies and practices. To address the third thesis aim, a randomised controlled trial was conducted to evaluate the effectiveness of an intervention to increase the implementation of healthy eating and physical activity policies and practices in a sample of 128 centre-based childcare services in the Hunter region of New South Wales, Australia. Intervention strategies included the 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 service nominated supervisors and room leaders. 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 children’s fundamental movement skills (p=0.01). There are several factors that may have limited intervention effectiveness with respect to the primary trial outcome. High implementation rates for a number of targeted policies and practices at baseline, significant obesity prevention activity in the study region in the 12 months prior to, and during the 12-month intervention, and increases in implementation in control group services, may, in part, explain the non-significant trial findings. Nonetheless, the study represents an important contribution to the limited literature regarding the implementation rates of obesity prevention interventions in the childcare setting. To address the fourth thesis aim, a viewpoint paper was written to discuss the need for a systematic application of implementation science to improve the impact of obesity prevention interventions in the childcare setting. The discussion included several recommendations for focus areas for future research efforts in the field. These include: the need for future research to better understand the barriers to the implementation of obesity prevention policies, practices and programmes and greater consideration of such barriers in the development of programme implementation strategies; improving the reporting of implementation strategies and processes in research trials; and the development and routine use of validated measures of theoretical constructs hypothesised to influence implementation. The thesis concludes with a discussion of the implications of this research for future policy, practice and research. The implications for future policy and practice include the recommendation to establish systems to enable the routine monitoring and evaluation of childcare service implementation of healthy eating, physical activity and obesity prevention policies, practices and programmes. The implications for future research include the need to investigate ways to improve the methodological rigor of trials to increase childcare service implementation of healthy eating, physical activity and obesity prevention policies and practices. The potential of childcare staff worksite wellness interventions, parent and carer involvement, and alternate simple interventions to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices and programmes in childcare services is also discussed.
- Subject
- obesity prevention; childcare services; implementation; healthy eating; physical activity
- Identifier
- http://hdl.handle.net/1959.13/1353542
- Identifier
- uon:31114
- Rights
- Copyright 2017 Jannah Zoe Jones
- Language
- eng
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