Development and Testing of a Healthy Eating and Active Living Intervention for the Family Day Care Sector

<p dir="ltr"><b>Background</b> In Australia, family day care involves educators providing care and education to children in their own homes under a service provider coordination unit. Research has demonstrated suboptimal nutrition and physical activity practices in family day care. Sector representatives have identified the need for resources to support the promotion of healthy practices and to adopt the New South Wales (NSW) Government’s ‘<i>Munch & Move</i>’ program. <i>Munch & </i><i>Move</i> is available to all NSW child care services to encourage and support services to implement healthy eating and physical activity strategies. This thesis aimed to co-develop and test a website-based quality improvement tool for family day care to promote healthier nutrition and physical activity practices.</p><p dir="ltr"><b>Methods</b> Firstly, a systematic literature review examined how website-based tools support health and education professionals with quality improvement. Then, a cross-sectional survey examined educators’ nutrition, physical activity and screen time practices and the relationships between <i>Munch & Move</i> training and professional development on these practices. Subsequently, a website-based tool was co-developed with stakeholders and formative evaluation was conducted. Finally, a randomised controlled trial assessed the extent to which nutrition and physical activity practices were incorporated into quality improvement planning using the tool.</p><p dir="ltr"><b>Results</b> The systematic review included 20 studies. Digitalising existing quality improvement processes, identifying gaps in practice and contributing to professional development were common quality improvement aims. Reported facilitators to tool usage included relevance to practice, accessibility and facilitating multidisciplinary action. Reported barriers included being time-consuming, irrelevant to practice, difficult to use and lack of organisational engagement. Almost all tools were co-developed with stakeholders.</p><p dir="ltr">NSW family day care educators (n=186) completed the cross-sectional survey. A significantly higher proportion of educators trained in <i>Munch & Move</i> offered information to families regarding food serving sizes, their nutrition policies, and children’s physical activity and screen time. Compared with those who had completed professional development once or more per year, a significantly higher proportion of educators who completed professional development less than once per year or never did not provide families with nutrition guidelines or resources.</p><p dir="ltr">In formative testing of the tool, service providers (n = 3) and educators (n = 9) used the website-based tool for four weeks. All participants chose a rating of ‘good’ or ‘excellent’ across questions on perceived convenience, ease of use and helpfulness.</p><p dir="ltr">Eight service providers and 22 educators participated in the trial. There was a significant difference in the quality of the Quality Improvement Plan (in relation to the incorporation of nutrition and physical activity practices) between the intervention and control groups at follow-up, with a mean score difference of 7.75 out of 17 (95% CI 4.54 to 10.96; p = 0.004), with a higher score indicating a better quality plan.</p><p dir="ltr"><b>Discussion</b> This is the first known website-based tool developed for family day care to promote healthier nutrition and physical activity practices. The tool was feasible and effective in improving the incorporation of healthy practices into quality improvement planning. There are opportunities for the tool to be embedded in practice, including delivery of the tool as part of training for educators. Policy implications include helping service providers in meeting quality standards and facilitating the adoption of healthy practices into policies.</p>