In Australia, over 660,000 children attend childcare services(4) where they eat up to two-thirds of their daily energy intake(5). As such, childcare services play a crucial role in supporting children to eat healthier foods. Recognising the importance of this setting, childcare service guidelines(6,7) recommend that services implement numerous policies and practices to improve child diet (e.g. staff role modelling; having a nutrition policy; providing healthy foods)(6-9). Our research shows that implementing these practices can improve child diet(10) and prevent excessive weight gain in children(11); reducing the burden from childhood obesity.
Despite their potential to improve child diet, research undertaken by the team found <30% of childcare services are implementing healthy eating policies and practices(12). Childcare service staff report they do not have the skills, knowledge, resources, or support from supervisors to implement such practices(13). Despite these challenges, our Cochrane systematic review identified limited evidence on how to provide ongoing and cost-effective support to services to implement such recommended practices(14). This is a significant problem as the opportunity afforded by this setting to improve child health during important formative years cannot be maximised.
Online approaches represent a promising modality for delivering interventions as they: i) provide broad reach regardless of geographic location; ii) can actively target childcare reported barriers to implementation; iii) are highly acceptable and are currently being used by childcare services to facilitate reporting and programming(15); and iv) are potentially more cost-effective than traditional modalities (e.g. face-to-face). These characteristics are essential in order for population-wide health promotion interventions to achieve the greatest impact.
To date, we are aware of only one randomised controlled trial examining the impact of an online intervention to improve childcare service implementation of healthy eating policies and practices to improve child diet(16). The US trial among 33 services, found use of the online intervention resulted in a significant improvement in the implementation of healthy eating practices. However, the trial relied upon childcare staff self-report to assess implementation (at risk of reporting bias), rather than gold standard observations(17). Furthermore, the effect of the online intervention on child dietary intake has not yet been evaluated; a critical missing piece of information to determine the real world impact such a program could have in improving child health.
To address this problem, we will determine the potential impact of the online intervention on childcare service practice and what children eat in care. Such pilot testing of an online intervention is important to ensure the program is acceptable, useful and beneficial to services and children; and further refinement can be made to enhance the impact of the intervention before testing with a larger number of childcare services.
Alice Grady