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While the family day care setting provides a unique opportunity to improve child health, few studies have assessed obesity prevention practices of this setting. This study aimed to examine the (a) prevalence of implementation of evidence‐based healthy eating and physical activity policies and practices among schemes (ie overarching governing agency) and educators in the family day care setting in Australia; and (b) associations between educator socio‐demographic characteristics and implementation of healthy eating and physical activity practices. Family day care schemes (n = 16) responsible for educators (n = 174) located in the Hunter New England region of NSW participated in a telephone survey in 2018, reporting their implementation of evidence‐based healthy eating and physical activity policies and practices. Linear mixed regression analyses were used to determine whether educator characteristics were associated with higher percentages of implementation. Few schemes had comprehensive breastfeeding (0%) and screen time (19%) policies. However, the majority of educators (81%) communicated with families when lunchboxes were not consistent with guidelines. Educators implemented an average of 64.3% of practices assessed. Educators located in higher socioeconomic areas implemented a significantly higher percentage of practices than those in lower socioeconomic areas (P< .000). Educator years of experience was positively associated with percentage of implementation (P= .009). The implementation of obesity prevention policies and practices in the family day care setting is variable and associated with educator socio‐demographic characteristics. There is a need to support family day care schemes to improve their obesity prevention environments, particularly those related to policies.

Supporting centre‐based childcare services to create physical activity (PA) environments is a recommended strategy to improve child PA. This study aimed to describe the implementation of PA policies and practices by these services, and to examine the associations with service characteristics. Nominated supervisors of childcare services (n = 309) in the Hunter New England region, New South Wales, Australia, completed a telephone interview. Using previously validated measures, the interview assessed the implementation of evidence‐based practices shown to be associated with child PA. This includes: (a) provision of active play opportunities, (b) portable play equipment availability, (c) delivery of daily fundamental movement skills, (d) having at least 50% of staff trained in promoting child PA the past 5 years and (e) having written PA and small screen recreation policies. Although 98% (95% CI 96, 99) of childcare services provided active play opportunities for at least 25% of their daily opening hours, only 8% (95% CI 5, 11) of services fully implemented all policies and practices; with no service characteristic associated with full implementation. Long day care service had twice the odds of having a written PA policy (OR 2.0, 95% CI 0.7, 5.8), compared to preschools (adjusted for service size, socio‐economic disadvantage and geographical location). Improvements could be made to childcare services’ operations to support the promotion of child PA. To ensure the benefits to child health, childcare services require support to implement a number of PA promoting policies and practices that are known to improve child PA.

Despite recommendations, early childhood education and care services do not plan menus in accordance with sector dietary guidelines. This study aimed to examine the following among Australian long day care services: (a) menu planning practices; (b) prevalence of menu compliance with sector dietary guidelines; and (c) menu planning practices associated with higher menu compliance with sector dietary guidelines. Long day care services within Hunter New England, NSW participated in a pen and paper survey assessing menu planning practices and socio‐demographic and service characteristics. Two‐week menus were assessed for compliance with sector dietary guidelines, based on the number of servings of food groups and discretionary foods provided per child, per day. Staff from 72 services completed the survey and 69 provided their menu. Results indicated the service cook was fully responsible for planning the menu in 43% of services, and 57% had received written support to assist with menu planning. Service menus were compliant with an average of 0.68 out of six food groups and discretionary foods. In poisson regression models, a shorter menu cycle length (P= .04) and the receipt of training opportunities to support menu planning (P< .01) were significantly associated with higher menu compliance. Menu compliance with sector dietary guidelines is low among participating long day care services. The implementation of practices such as shortening of the menu cycle and the provision of training opportunities may assist in the planning of menus that are more compliant with dietary guidelines in this setting.

Modifying the scheduling of physical activity opportunities to provide children with more frequent opportunities for outdoor free play has been demonstrated to increase child physical activity while in care. The primary aim of this study was to describe the implementation of continuous free play schedules to allow children to access outdoor play areas, consistent with sector guidelines in a national sample of Australian childcare services. Secondary aims were to investigate the associations between the implementation of such schedules and service characteristics, and assess the perceived barriers and enablers to implementation. A cross‐sectional study was undertaken with a random sample of 326 centre‐based childcare services located across Australia. Childcare service characteristics, continuous free play scheduling and perceived barriers and enablers to implementation were assessed via a survey administered to service managers online or via telephone. A total of 203 service managers (62%) reported implementing a continuous free play schedule, for three periods of 126 minutes per period, each day on average. Service type (long day care services), size (services with higher numbers of child enrolments [≥80 children]) and socio‐economic area (services located in lower socio‐economic areas) were associated with the implementation of a continuous free play schedule. The most prevalent barriers to implementation included insufficient staff to ensure adequate supervision of children (69%) and service layout being unsuitable (65%), while the most prevalent enablers included advice on how to overcome staffing or supervision issues (89%) and to re‐orientate the service layout (54%). There is scope to support the implementation of continuous free play schedules consistent with childcare sector guidelines. Future intervention research that targets the reported barriers and enablers to implementation is needed.

Purpose: To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare compliance with nutrition guidelines.Design: Parallel group randomized controlled trial.Setting: Hunter New England region, New South Wales, Australia.Participants: Forty-four childcare centers that prepare and provide food on-site to children while in care.Intervention: The intervention was designed using the Theoretical Domains Framework, targeted managers, and cooks and included implementation strategies that addressed identified barriers.Measures: Outcomes included the proportion of menus providing food servings (per child) compliant with overall nutrition guideline recommendations and each individual food group assessed via menu assessments. Cook knowledge of recommendations, intervention acceptability, adverse events, and barriers were also assessed via questionnaires with cooks and managers.Analysis: Logistic regression models, adjusted for baseline values of the outcome.Results: At baseline and follow-up, zero centers in the intervention and control groups were compliant with the overall menu guidelines or for the vegetable and meat food groups. Follow-up between-group differences in compliance for discretionary (33.3 vs 5, P= .18), dairy (41.7 vs 15, P= .16), breads and cereals (8.3 vs 10 P= 1.00), and fruit (16.7 vs 10, P= .48) were all nonsignificant. Relative to the control group, intervention centers showed a significantly greater increase in percentage of cooks with correct knowledge for vegetable servings (93.3 vs 36.4, P= .008).Conclusion: Although the application of the theoretical framework produced a broader understanding of the determinants of menu compliance, due to the complexity of guidelines, limited follow-up support, lower training uptake, and low intervention dose, the intervention was not effective in supporting the practice change required.

Many early childhood education and care (ECEC) services fail to implement recommended policies and practices supportive of healthy eating and physical activity. The purpose of this study was to assess whether certain theoretically-based factors are associated with implementation of healthy eating and physical activity policies and practices in a sample of ECEC services. A cross-sectional survey was conducted with Service Managers of ECEC services. The survey assessed the operational characteristics, policy, and practice implementation, and 13 factors were suggested by Damschroder’s Consolidated Framework for Implementation Research to impede or promote implementation. Logistic regression analyses found a significant association between implementation factor score and full implementation (OR 1.38; 95% CI 1.18–1.61; p =<0.01), indicating that for every one point increase in implementation score, ECEC services were 38 % more likely to be fully implementing the policies and practices. The findings highlight the opportunities for improving implementation of obesity prevention interventions in this setting by developing interventions that address such factors.

Many early childhood education and care (ECEC) services fail to implement recommended policies and practices supportive of healthy eating and physical activity. The purpose of this study was to assess whether certain theoretically-based factors are associated with implementation of healthy eating and physical activity policies and practices in a sample of ECEC services. A cross-sectional survey was conducted with Service Managers of ECEC services. The survey assessed the operational characteristics, policy, and practice implementation, and 13 factors were suggested by Damschroder's Consolidated Framework for Implementation Research to impede or promote implementation. Logistic regression analyses found a significant association between implementation factor score and full implementation (OR 1.38; 95% CI 1.18-1.61; p = <0.01), indicating that for every one point increase in implementation score, ECEC services were 38 % more likely to be fully implementing the policies and practices. The findings highlight the opportunities for improving implementation of obesity prevention interventions in this setting by developing interventions that address such factors.

Objective:To describe children's physical activity levels during childcare and associations with modifiable characteristics. Methods:A cross‐sectional study of 328 preschool children (43% girls; age 3–5 years) and 145 staff from 20 long day care centres in the Hunter Region of NSW, Australia. Pedometers assessed child physical activity levels. Centre characteristics and staff attitudes and behaviours towards children's physical activity were assessed using surveys, interviews and observational audit. Results were analysed using descriptive statistics and linear regression. Results:Over the measurement period, average step count of children was 15.8 (SD=6.8) steps/minute. Four‐year‐olds had the highest step counts (16.4, SD=7.1, p=0.03) with no differences by sex. Step counts were significantly higher in centres that had a written physical activity policy (+3.8 steps/minute, p=0.03) and where staff led structured physical activity (+3.7 steps/minute, p<0.001) and joined in active play (+2.9 steps/minute, p=0.06). Conclusions:Written physical activity policy, structured staff‐led physical activity and staff joining in active play were associated with higher levels of physical activity. Implications:Childcare physical activity interventions should consider including strategies to encourage written physical activity policies and support structured staff led physical activities.

To describe children's physical activity levels during childcare and associations with modifiable characteristics.