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Issue Addressed: Good nutrition, physical activity and adequate sleep are essential for the healthy growth and development of young children. Due to complex cultural, historical, social factors, Aboriginal and Torres Strait Islander children face additional challenges to optimal health, particularly in remote areas of Australia. 'Learning, Eating, Active Play and Sleep' (LEAPS) was a Queensland-wide professional development program designed to support early childhood education and care (ECEC) educators to implement and reinforce healthy nutrition and physical activity in their services. This article describes the adaptation, implementation and evaluation of LEAPS for remote ECEC settings in Cape York., Methods: An Aboriginal and Torres Strait Islander Reference Group was commissioned to provide advice about the appropriateness of the existing program for Aboriginal and Torres Strait Islander ECEC settings. Based on the advice of the Reference Group, the program was adapted for use in Cape York and was evaluated using the RE-AIM framework and a combination of data sources. Quantitative data provided information about changes to participant knowledge and confidence regarding nutrition and physical activity and in-depth interviews allowed further insights into enablers and challenges for successful program implementation., Conclusion: A tailored LEAPS program increased participants' knowledge and confidence regarding nutrition and physical activity in ECEC settings. The importance of community consultation, building relationships and face-to-face delivery of training were highlighted as key enablers. The evaluation identified a number of challenges relating to competing priorities, limited support for ongoing implementation and adoption of improved practices. SO WHAT?: Poor nutrition and growth in children in remote Aboriginal and Torres Strait Islander communities indicates the need for the ongoing commitment to and investment in nutrition and physical activity across a range of community settings. To achieve success, this requires a dedicated preventative health workforce supporting evidence-informed, coordinated programs driven by community priorities and developed via community development approaches., (© 2020 Australian Health Promotion Association.)

Background: Many women with hyperglycaemia in pregnancy do not receive care during and after pregnancy according to standards recommended in international guidelines. The burden of hyperglycaemia in pregnancy falls disproportionately upon Indigenous peoples worldwide, including Aboriginal and Torres Strait Islander women in Australia. The remote and regional Australian context poses additional barriers to delivering healthcare, including high staff turnover and a socially disadvantaged population with a high prevalence of diabetes., Methods: A complex health systems intervention to improve care for women during and after a pregnancy complicated by hyperglycaemia will be implemented in remote and regional Australia (the Northern Territory and Far North Queensland). The Theoretical Domains Framework was used during formative work with stakeholders to identify intervention components: (1) increasing workforce capacity, skills and knowledge and improving health literacy of health professionals and women; (2) improving access to healthcare through culturally and clinically appropriate pathways; (3) improving information management and communication; (4) enhancing policies and guidelines; (5) embedding use of a clinical register as a quality improvement tool. The intervention will be evaluated utilising the RE-AIM framework at two timepoints: firstly, a qualitative interim evaluation involving interviews with stakeholders (health professionals, champions and project implementers); and subsequently a mixed-methods final evaluation of outcomes and processes: interviews with stakeholders; survey of health professionals; an audit of electronic health records and clinical register; and a review of operational documents. Outcome measures include changes between pre- and post-intervention in: proportion of high risk women receiving recommended glucose screening in early pregnancy; diabetes-related birth outcomes; proportion of women receiving recommended postpartum care including glucose testing; health practitioner confidence in providing care, knowledge and use of relevant guidelines and referral pathways, and perception of care coordination and communication systems; changes to health systems including referral pathways and clinical guidelines., Discussion: This study will provide insights into the impact of health systems changes in improving care for women with hyperglycaemia during and after pregnancy in a challenging setting. It will also provide detailed information on process measures in the implementation of such health system changes.