Effectiveness of a Web-Based Menu-Planning Intervention to Improve Childcare Service Compliance With Dietary Guidelines: Randomized Controlled Trial

Abstract

Background Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines. Objective This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups; (2) individual food groups; and (3) mean servings of individual food groups. Childcare service use and acceptability of the Web-based program were also assessed. Methods A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up. Results No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for individual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P<.001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable. Conclusions Although improvements in childcare service overall menu and individual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted. Trial Registration Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404; http://www.anzctr.org.au/ACTRN12616000974404.aspx

Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines.

“…The impact of the intervention on the speci ed trial outcomes are presented in detail elsewhere (50). Compared to usual practice services, intervention services achieved a non-signi cant increase in the primary outcome; the mean number of food groups on the menu that were compliant with dietary guidelines (relative effect size 0.26; 95%CI -0.61 to 1.14; p=0.55).…”

Economic evaluation of a web-based menu planning intervention to improve childcare service adherence with dietary guidelines.

“…The impact of the intervention on the speci ed trial outcomes are presented in detail elsewhere (48). Compared to usual practice centres, intervention centres achieved a non-signi cant increase in the primary outcome; the mean number of food groups on the menu that were compliant with dietary guidelines (relative effect size 0.26; 95%CI -0.61 to 1.14; p = 0.55).…”

A pilot randomised controlled trial of a web-based implementation intervention to increase child intake of fruit and vegetables within childcare centres

“…These analytics include, but not limited to, total time logged into the program, completion of the self-assessment and action plan, most frequently used program features and the number of requests for assistance. The research team has previously used these metrics to evaluate childcare centre adoption of web-based programs [ 21 , 56 ]. Internal records detailing the provision of implementation strategies, including the completion, duration and centre staff in attendance at the educational outreach visit; type (i.e.…”

“…However, we estimated the number of centres required as approximately 25% of the number needed for a fully-powered implementation trial. Based on consent rates from previous web-based intervention studies conducted within the ECEC setting and allowing for a childcare centre attrition rate at follow-up of 10%, it is estimated recruitment of 22 childcare centres would be sufficient to provide data to inform feasibility of undertaking the trial [ 21 ]. To assess the impact of the intervention on child diet, an approximate difference of 0.3 servings of both fruit and vegetables is considered clinically significant based on the potential reduction in risk of chronic disease [ 66 , 67 ].…”

“…Within Australia, one RCT with 54 centres evaluated the impact of a web-based menu planning program on centre provision of foods in accordance with sector dietary guidelines. Whilst the intervention did not result in a statistically significant increase in dietary guideline compliance, significant improvements in the provision and consumption of healthy foods and a significant decrease in unhealthy healthy foods were found [ 21 , 22 ]. Whilst these studies show promise, little is known about the feasibility of implementing such an intervention within Australian childcare centres, particularly amongst those that are not responsible for providing food to children.…”