Doctor of Philosophy
School of Health and Society
Background: In Australia, family day care (FDC) services operate under a unique two-tier structure whereby the service provider gives overarching organisational and policy support, and educators provide education and care to children in their homes. FDC services can influence children's healthy eating, physical activity and sedentary behaviours. However, research on Australian FDC services is limited. Munch & Move is a state-wide obesity prevention program offered to FDC service providers in NSW; however, the program has only been evaluated in centre-based Early Childhood Education and Care services. The overall aim of this thesis was to investigate how FDC services promote healthy eating and physical activity for children aged 0-5 years at the service provider and educator levels of the FDC sector. In addition, this thesis aimed to examine the associations with the food provided to children, educators’ feeding practices, and children's physical activity and sedentary behaviours.
Methods: First, a systematic literature review investigated the factors associated with children's dietary intake, physical activity and sedentary behaviour in FDC. Following this, FDC service providers from two large geographic areas in New South Wales, Australia, were invited to participate in a survey and policy review to examine the effect of Munch & Move training on existing policies, resources and professional development used by service providers. Finally, an observation study was conducted with FDC educators using the Environment Policy Assessment and Observation tool. The food provided was also assessed using weighed food records, and children's time spent in sedentary, light and moderate- to vigorous-intensity physical activity was measured using Actigraph GT3X+ accelerometers.
Results: The systematic review included 16 studies; six assessed associations with children's dietary intake, and 10 assessed physical activity and sedentary behaviours. Most studies were conducted in the US (n=3), and few studies assessed the same correlates. Findings from the survey and policy audit revealed service providers trained in Munch & Move were more likely to offer professional development to educators on healthy eating (90% vs. 25%, p = 0.00) and physical activity (90% vs 13%, p = 0.00), and to have more comprehensive nutrition policies (average policy score out of 17: 11.8 vs. 9.0, p = 0.03). Full-day observations were conducted with 33 educators and 105 children aged 11 months to 5 years. Less than one-quarter of children were provided with 50% of their recommended food group servings for vegetables (17%), lean meat and meat alternatives (19%), and dairy (25%); 71% of children were provided with excess discretionary foods. Educators were observed using positive and negative feeding practices during mealtimes but did not consistently use positive feeding practices. Just over half of the children (56%) in FDC met the Institute of Medicine recommendations of 15 minutes of total physical activity per hour in FDC. Healthy food provision scores were significantly associated with the children's age (younger) (p= 0·01), lower socio-economic status (p= 0·03) and the type of main meal provided (mixed dish vs. sandwich) (p= 0·01). No associations were found with educators’ feeding practices or children's physical activity levels. However, time provided for physical activity was positively associated with children's physical activity with a medium effect size.
Discussion: This thesis is the first known Australian study to objectively assess the nutrition and physical activity environments in FDC services and contributes to the literature on healthy eating, physical activity and sedentary behaviour in FDC services. The findings highlighted modifiable practices to target at the service provider and educator level to improve children’s healthy eating and physical activity behaviours. This research can inform the enhancement of the Munch & Move program by developing additional policies, resources and professional development tailored to FDC services.
Kerr, Erin Myee, Healthy eating, physical activity and sedentary behaviour in family day care, Doctor of Philosophy thesis, School of Health and Society, University of Wollongong, 2021. https://ro.uow.edu.au/theses1/1449
FoR codes (2020)
4206 Public health
Unless otherwise indicated, the views expressed in this thesis are those of the author and do not necessarily represent the views of the University of Wollongong.