- Title
- Improving the implementation of menu dietary guidelines in childcare services
- Creator
- Seward, Kirsty Louise
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background and aims: Dietary risk factors are a leading contributor to the global disease burden of non-communicable diseases (NCDs). To reduce the health burden of dietary risk factors, the World Health Organisation recommends that countries develop national dietary guidelines providing guidance on food, food groups and dietary patterns known to protect against the development of NCDs, and that such guidelines are implemented in various community settings such as schools and childcare services. As dietary risk factors are prevalent from an early age in young children and have been shown to track into adulthood, implementing dietary guidelines within the childcare setting represents a promising strategy to improve the health of the population. In order to realise the potential benefits of doing so, strategies that are effective in improving implementation within this setting are needed. However, evidence regarding the barriers and/or facilitators of guideline implementation and of the effectiveness of strategies to support such implementation in the childcare setting is limited. This thesis sought to address these evidence gaps to better guide efforts to improve the implementation of menu dietary guidelines in childcare. Specifically, it aimed to: Comprehensively and systematically review and synthesise the literature that reports factors (barriers and/or facilitators) which influence the implementation of menu dietary guidelines within the childcare setting (Chapter 2); Describe the psychometric properties of a measure, based on the Theoretical Domains Framework, to assess factors that influence the implementation of menu dietary guidelines in the childcare setting (Chapter 3); Assess the effectiveness of an intervention to improve the implementation of menu dietary guidelines in the childcare setting and the impact on food provision and child food intake while in care; as measured: i) at the service level, ii) at the individual level (Chapters 5 & 6); Provide recommendations for future research and practice to improve the implementation of menu dietary guidelines in childcare services (Chapter 7). Results: Through the systematic review (Chapter 2), this thesis demonstrated that the most commonly identified factors related to the implementation of childcare sector menu dietary guidelines were the ‘environmental context and resources’ such as insufficient menu planning tools and resources and insufficient time. A tool to assess factors which influence the implementation of menu dietary guidelines was shown to have good discriminant validity and internally consistency. Using a parallel group randomised controlled trial with 45 New South Wales childcare services a multi-strategy intervention designed to address service level barriers was effective in improving implementation of sector menu dietary guidelines (Chapters 4, 5 & 6). Specifically, relative to control services, intervention services were more likely to be compliant with guidelines related to the provision of fruit; meat and meat alternatives; dairy; and discretionary foods. Furthermore, the intervention resulted in a significant increase in service-level child serve consumption for fruit and vegetable food groups, and individual level serve consumption for vegetable; wholegrain cereals; and meat/meat alternatives food groups, compared to the control group. This thesis recommends investigating the use of technology such as web-based programs and leveraging the existing infrastructure and expertise of external catering services to scale up the implementation of menu dietary guidelines in the childcare setting. Furthermore it recommends that research targeting the implementation of menu dietary guidelines in childcare services should include cost-effectiveness measures, to assist policy makers and practitioners to choose future support strategies. Conclusion: The findings of this thesis provide new evidence for enhancing the implementation of dietary guidelines by child care services. Further the evidence demonstrates that by enhancing such implementation, the quality of child diet is significantly enhanced.
- Subject
- nutrition; childcare; implementation; child diet; nutrition guidelines; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1406273
- Identifier
- uon:35610
- Rights
- Copyright 2019 Kirsty Louise Seward
- Language
- eng
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 523 KB | Adobe Acrobat PDF | View Details Download |