- Title
- Improving healthy eating and physical activity in children attending early childhood education and care services
- Creator
- Lum, Melanie
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Healthy eating and sufficient physical activity in childhood reduces the risk of obesity, and non-communicable diseases later in life. Early childhood education and care (ECEC) services (including centre-based and family day care) provide an opportune setting to influence child healthy eating and physical activity behaviours given their reach and the existence of ECEC policies supportive of child health. ECEC is a priority setting of chronic disease prevention efforts and as such, a better understanding of the types of interventions that warrant population-level implementation is likely to increase the opportunity provided by these settings to improve child health. Despite this, there are a number of gaps in the evidence. First, the specific types of healthy eating and physical activity practices and their impact on child diet and physical activity is not well understood. Second, the extent of implementation of these evidence-based practices in Australia is largely unknown. Lastly, there is little understanding of the specific strategies to increase adoption and implementation of evidence-based programs in the family day care setting. Aims: This thesis aimed to gather and synthesise the evidence around recommended practices in centre-based ECEC and family day care settings to improve child healthy eating and physical activity, assess the implementation of these evidence-based practices in ECEC services, and examine the impact of a low intensity dissemination strategy on adoption and implementation of physical activity practices in the family day care setting. These studies were designed to identify key research gaps, and provide practice- and policy-relevant data to support decision-making and investment for the setting to maximise the potential of the ECEC setting to improve child health. Specifically, the objectives were to: 1. Identify and describe evidence-based interventions for healthy eating and physical activity for centre-based ECEC and family day care settings (Chapter 2, 3 and 5) via systematic reviews of the effectiveness of ECEC (centre-based and family day care) interventions on child dietary intake and physical activity; 2. Describe the evidence-practice gaps for the identified healthy eating and physical activity interventions in centre-based ECEC and family day care settings (Chapter 4 and 6); 3. Examine the effectiveness of a dissemination strategy on the adoption and implementation of physical activity guidelines in family day care (Chapter 7); and, 4. Summarise thesis findings and provide recommendations for future directions (Chapter 8). Results: Chapter 2 identified 52 included randomised controlled trials (RCTs) of healthy eating interventions in ECEC settings, which indicated such interventions can improve child diet quality (SMD 0.34, 95% CI 0.04 to 0.65; p=0.03), fruit consumption (SMD 0.11, 95% CI 0.04 to 0.18; p<0.01) and vegetable consumption (SMD 0.12, 95% CI −0.01 to 0.25; p=0.08). Chapter 3 identified 10 systematic reviews which demonstrated physical activity interventions delivered in centre-based ECEC services which involved adult-led, structured physical activity, a physical activity promoting environment or parent involvement, significantly improved child physical activity. Chapter 5 identified just two controlled trials examining the effectiveness of healthy eating and physical activity interventions on healthy eating and physical activity environments within family day care, and none which assessed the effects on child dietary, physical activity or weight outcomes. Such findings support the effectiveness of several evidence-based healthy eating and physical activity practices in centre-based ECEC services, and identify a need for further evidence of effectiveness in the family day care setting. Chapter 4 details findings of a cross-sectional survey of 1,028 centre-based ECEC services across Australia, which found that the prevalence of implementation of evidence-based healthy eating and physical activity practices in centre-based ECEC services varied across practices (range: 15-95%), and long day care services implemented significantly more healthy eating practices compared to preschools (42.3% vs 33.3%, p<0.001). In Chapter 6, a cross-sectional study of 16 family day care schemes and 174 educators, found that prevalence of implementation of practices ranged from 0-99%. Family day care educators in high socioeconomic areas, compared to low (β=5.48, 95% CI 2.20 to 8.76; p<0.001), and those with more years of experience, compared to less (β=0.26, 95% CI 0.09 to 0.43; p=0.009), implemented a higher number of practices. These findings highlight several evidence-practice gaps, indicating need for additional implementation support. Chapter 7 describes a RCT involving 49 family day care educators and found that dissemination of physical activity guidelines via video resource, compared to active control (written resource), did not impact on educators intentions to adopt the guidelines (ß=0.01, 95% CI −0.50 to 0.52; p=0.97). This suggests a further need to examine the impact of strategies to improve adoption and implementation in family day care services. Conclusion: This thesis provides an overview of the current evidence around improving the healthy eating and physical activity practices in the ECEC setting. The findings can guide future investment efforts for policy-makers and practitioners, and inform researchers in the development and evaluation of future interventions. Specifically, this thesis recommends: i) the prioritisation of healthy eating and physical activity practices for implementation investment in centre-based ECEC, using a stakeholder-driven process; ii) an update of ECEC-based healthy eating and physical activity guidelines and policies to reflect prioritised practices; and iii) the development of Type I or II interventions to examine the effectiveness and implementation outcomes of healthy eating and physical activity interventions in family day care.
- Subject
- early childhood education and care; healthy eating; physical activity; public health; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1506721
- Identifier
- uon:55925
- Rights
- Copyright 2023 Melanie Lum
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 9 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 365 KB | Adobe Acrobat PDF | View Details Download |