Evaluation of a long day care intervention targeting the mealtime environment and curriculum to increase children's vegetable intake: a cluster randomised controlled trial using the MOST framework
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Date
2024
Authors
Morgillo, S.
Bell, L.K.
Gardner, C.
Kashef, S.
Stafford, K.
Zarnowiecki, D.
Poelman, A.A.M.
Cochet Broch, M.O.
Johnson, B.J.
Gulyani, A.
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Journal article
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Public Health Nutrition, 2024; 27(1, article no. e87):1-14
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Abstract
Objective: To determine the reach, adoption, implementation and effectiveness of an intervention to increase children’s vegetable intake in long day care (LDC).
Design: A 12-week pragmatic cluster RCT, informed by the Multiphase Optimisation Strategy (MOST), targeting the Mealtime environment and Curriculum. Children’s vegetable intake and variety was measured at follow up using a modified SFS-ECEC and analysed using a two-part mixed model for non-vegetable and vegetable consumers. Outcome measures were based on the RE-AIM framework.
Setting: Australian LDC centres.
Participants: Thirty-nine centres, 120 educators and 719 children at follow up.
Results: There was no difference between intervention and waitlist control groups in the likelihood of consuming any vegetables when compared to non-vegetable consumers for intake (OR=0.70, [95%CI 0.34-1.43], p=0.32) or variety (OR=0.73[95%CI 0.40-1.32], p=0.29). Among vegetable consumers (n=652) there was no difference between groups in vegetable variety (exp(b):1.07[95%CI:0.88-1.32, p=0.49) or vegetable intake (exp(b):1.06[95% CI:0.78,1.43]),p=0.71) with an average of 1.51 [95%CI 1.20-1.82] and 1.40 [95%CI 1.08-1.72] serves of vegetables per day in the intervention and control group respectively. Intervention educators reported higher skills for promoting vegetables at mealtimes, and knowledge and skills for teaching the curriculum, than control (all p<0.001). Intervention fidelity was moderate (n=16/20 and n=15/16 centres used the Mealtime environment and Curriculum, respectively) with good acceptability among educators. The intervention reached 307/8556 centres nationally and was adopted by 22% eligible centres.
Conclusions: The pragmatic self-delivered online intervention positively impacted educator’s knowledge and skills and was considered acceptable and feasible. Intervention adaptations, using the MOST cyclic approach, could improve intervention impact on children’ vegetable intake.
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Link to a related website: https://unpaywall.org/10.1017/S1368980024000557, Open Access via Unpaywall
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Copyright 2024 The Author(s). This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence, which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited. (http://creativecommons.org/licenses/by/4.0/)