ORCID Profile
0000-0002-0836-017X
Current Organisation
Deakin University
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Health Promotion | Public Health and Health Services | Health and Community Services
Health Education and Promotion | Children's/Youth Services and Childcare |
Publisher: Wiley
Date: 17-05-2018
Publisher: JMIR Publications Inc.
Date: 24-06-2021
DOI: 10.2196/25256
Abstract: There is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. This study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. A type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ 95% CI –195.59 to –39.83 P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ 95% CI –172.84 to –3.92 P=.04) and consumed (–117.17 kJ 95% CI –233.72 to –0.62 P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes. The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs. Australian Clinical Trials Registry ACTRN12618001731280 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191& isReview=true RR2-10.1186/s12889-019-7725-x
Publisher: Springer Science and Business Media LLC
Date: 11-07-2018
Publisher: Springer Science and Business Media LLC
Date: 11-01-2017
Publisher: Wiley
Date: 24-11-2021
DOI: 10.1002/HPJA.558
Publisher: MDPI AG
Date: 13-03-2023
Abstract: Early Childhood Education and Care (ECEC) settings are important environments to support children’s physical activity (PA). In 2021, COVID-19 regulations recommended the provision of indoor–outdoor free-play programs in ECEC settings to reduce the transmission of COVID-19, resulting in an increased uptake of this practice. As the context has since changed, research suggests that ECEC services could cease the implementation of these practices. Therefore, this pilot randomised controlled trial (RCT) aims to examine the feasibility, acceptability, and impact of a sustainment strategy to ensure the ongoing implementation (sustainment) of ECEC-delivered indoor–outdoor free-play programs. Twenty ECEC services located in New South Wales, Australia that have implemented indoor–outdoor free-play programs since the release of COVID-19 guidelines will be recruited. The services will be randomly allocated either the sustainment strategy or usual care. The “Sustaining Play, Sustaining Health” program consists of eight strategies, developed to address key barriers against and facilitators of sustainment informed by the Integrated Sustainability Framework. The outcomes will be assessed via internal project records, staff surveys, and a self-reported measure of free play. This study will provide important data to support the performance of a fully powered trial within Australian ECEC settings and to inform the development of future sustainment strategies.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.APPET.2017.11.103
Abstract: Front-of-pack graphical nutritional rating of products is becoming an important strategy in many countries to improve healthy food purchases by consumers. Evidence of the effectiveness of such on facilitating healthy food choices by school food service providers has not been reported. The primary aim of the study was to assess the impact of providing front-of-pack nutritional rating information on school canteen managers' likely food selections. Secondary outcomes were canteen manager awareness, attitudes and reported barriers to using the front-of-pack information. A randomised controlled trial involving primary school canteen managers was conducted in a single region in New South Wales, Australia. Eligible participants were randomised to an intervention or control group and asked in a telephone interview which of 12 common food products sold in school canteens they would sell. Both groups received product name and brand information. The intervention group also received information regarding the nutritional rating of products. Canteen managers in the intervention group were significantly more likely than those in the control group to indicate they would sell three of the six 'healthier' products (p = 0.036, 0.005, 0.009). There was no difference between groups in the likelihood of making available for sale any of the six 'less healthy' products. The majority of canteen managers who had heard of a product nutritional rating system agreed that it was helpful in identifying 'healthier' foods (88%, n = 31). The inclusion of product nutritional rating information has the potential to improve the availability of some 'healthier' items on canteen menus and contribute to improving child dietary intake. Further research is required to determine whether the use of product nutritional rating information actually makes a difference to canteen manager choices.
Publisher: Wiley
Date: 11-03-2019
DOI: 10.1002/HPJA.238
Abstract: School-based nutrition policies can have a positive effect on the school food environment. The primary aim of this study was to assess the primary school adherence to a mandatory state-wide healthy canteen policy 12 months after an effective multi-strategic implementation intervention concluded. Primary schools were randomised to (a) a 12-14 months multi-strategic intervention or (b) no-intervention (control). The intervention aimed to improve implementation of a state-wide canteen policy by encouraging schools to remove unhealthy food and beverages (classified as ''red'' or ''banned'') from canteen menus and replace with healthy items (classified as ''green''). No implementation support was provided to either group by the research team between the 12 and 24 months data collection period. Seventy schools participated, of which 56 schools were assessed at 24-month follow-up. Intervention schools were less likely to have a menu which contained ''red/banned'' items at 24-month follow-up (RR = 2.28 95% CI: 1.18-4.40 P = 0.01). Intervention schools, however, were not more likely than controls to have a menu which contained >50% ''green'' items at 24-month follow-up (RR = 1.29 95% CI: 0.98-1.70 P = 0.10). Intervention schools were more likely to adhere to both policy components (no red/banned items and >50% green items on the menu) than control schools (RR = 2.61 95% CI: 1.29-5.29 P = 0.006). Among intervention schools that were fully adherent to the policy following implementation support (12-month post baseline), all were also adherent at the 24-month follow-up. The intervention was effective in achieving long-term school adherence to a state-wide canteen policy at 24-month follow-up. SO WHAT?: The findings suggest that sustained improvements in implementation of school nutrition policies is possible following a period (12 months) of comprehensive implementation support.
Publisher: Oxford University Press (OUP)
Date: 15-11-2018
DOI: 10.1093/HER/CYY041
Abstract: The primary aim of this study was to assess the efficacy of a childcare-based intervention in increasing child physical activity by allowing children unrestricted access to outdoor areas for free-play when structured activity is not taking place. A randomized controlled trial was conducted in six childcare services. Intervention services provided children unrestricted access outdoors for active free-play, while control services provided their usual scheduled periods of outdoor play. Consent was obtained from 231 children. Child moderate to vigorous activity (MVPA), the primary trial outcome, was assessed via accelerometer at baseline and 3 months post baseline. Intervention effects were examined using Generalised Linear Mixed Models. Controlling for child age, gender and baseline outcome measure, at follow-up there were no significant differences between groups in minutes of MVPA in-care (mean difference: 4.85 95% CI: -3.96, 13.66 P = 0.28), proportion of wear time in-care spent in MVPA (mean difference: 1.52% 95% CI: -0.50, 3.53 P = 0.14) or total physical activity in-care (mean difference in counts per minute: 23.18 95% CI: -4.26, 50.61 P = 0.10), nor on measures of child cognition (P = 0.45-0.91). It was concluded that interventions addressing multiple aspects of the childcare and home environment might provide the greatest potential to improve child physical activity.
Publisher: Springer Science and Business Media LLC
Date: 08-03-2018
DOI: 10.1007/S00068-018-0926-7
Abstract: Whole body computed tomography has become standard practice in many centres in the management of severely injured trauma patients, however, the evidence for it's diagnostic accuracy is limited. To assess the sensitivity of whole body CT in major trauma. Retrospective review of all patients with injury severity score (ISS) > 15 presenting with blunt trauma to a UK Major Trauma Centre between May 2012 and April 2014. Injuries were classified as per ISS score-1 = head and neck 2 = face 3 = chest 4 = abdomen. The authors reviewed patient's electronic charts, radiological results interventional procedure records, discharge letters and outpatient follow up documentation and referenced this with Trauma Audit and Research Network data. 407 patients with ISS > 15 presented to the Trauma centre during May 2012 and April 2014. Of these, 337 (82.8%) had a whole body CT scan. 246 pts were male, 91 were female. 74 (21.9%) were due to a fall from > 2 m, 41 (12.2%) due to a fall from 15 and further work is required to assess the use of this investigation for all major trauma patients.
Publisher: Cambridge University Press (CUP)
Date: 02-08-2018
DOI: 10.1017/S1368980018001726
Abstract: To (i) describe the proportion of foods and beverages available on school canteen menus classified as having high (‘green’), moderate (‘amber’) or low (‘red’) nutritional value (ii) describe the proportion of these items purchased by students and (iii) examine the association between food and beverage availability on school canteen menus and food and beverage purchasing by students. A cross-sectional study was conducted as part of a larger randomised controlled trial (RCT). A nested s le of fifty randomly selected government schools from the Hunter New England region of New South Wales, Australia, who had participated in an RCT of an intervention to improve the availability of healthy foods sold from school canteens, was approached to participate. School principals, canteen managers and students. The average proportion of green, amber and red items available on menus was 47·9, 47·4 and 4·7 %, respectively. The average proportion of green, amber and red items purchased by students was 30·1, 61·8 and 8·1 %, respectively. There was a significant positive relationship between the availability and purchasing of green ( R 2 =0·66), amber ( R 2 =0·57) and red menu items ( R 2 =0·61). In each case, a 1 % increase in the availability of items in these categories was associated with a 1·21, 1·35 and 1·67 % increase in purchasing of items of high, moderate and low nutritional value, respectively. The findings provide support for school-based policies to improve the relative availability of healthy foods for sale in these settings.
Publisher: Wiley
Date: 06-12-2019
DOI: 10.1002/HPJA.310
Abstract: Healthy canteen policies regulating the sales of food and beverages are available across all the states and territories in Australia. The aim of this study was to assess the compliance with a newly updated healthy school canteen policy in New South Wales (NSW) among a s le of secondary schools. A cross-sectional study of secondary school canteen menus was undertaken in selected regions across NSW (September 2017-November 2017). Government and Catholic secondary schools with a canteen menu publicly available on school websites were eligible for inclusion. Menus were classified according to the NSW Healthy School Canteen Strategy using a Quick Menu Audit tool, previously validated in primary schools. Of 62 Catholic and 128 Government secondary schools located in the study region, 53 secondary schools (25 Catholic and 28 Government) were eligible to participate. The average percentage of "everyday" (healthy) items on secondary school menus was 54% (strategy criteria is >75%). Twenty-eight per cent of menus had no "sugary drinks" (should not be sold). None of the 53 menus assessed met all strategy criteria regarding the availability of foods and beverages. There was no statistically significant difference in meeting (a) 75% minimum "everyday" items and (b) no "sugary drinks," by socio-economic region, remoteness, school enrolments or school type. If public health benefits of healthy eating policies are to be realised, secondary schools need to be supported to implement such policies. SO WHAT?: Future research assessing the impact of intervention strategies to support policy implementation in secondary schools is recommended.
Publisher: AMPCo
Date: 11-12-2017
DOI: 10.5694/MJA17.00787
Publisher: Wiley
Date: 24-01-2018
Publisher: Wiley
Date: 25-09-2017
Publisher: Elsevier BV
Date: 2017
Publisher: JMIR Publications Inc.
Date: 26-05-2022
DOI: 10.2196/35771
Abstract: Few translational trials have provided detailed reports of process evaluation results. This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P .05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention however, more participants actively withdrew from the telephone intervention. This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.
Publisher: SAGE Publications
Date: 13-07-2018
Abstract: To assess the effectiveness of an intervention including training, provision of written menu feedback, and printed resources on increasing childcare compliance with nutrition guidelines. Parallel group randomized controlled trial. Hunter New England region, New South Wales, Australia. Forty-four childcare centers that prepare and provide food on-site to children while in care. The intervention was designed using the Theoretical Domains Framework, targeted managers, and cooks and included implementation strategies that addressed identified barriers. Outcomes included the proportion of menus providing food servings (per child) compliant with overall nutrition guideline recommendations and each in idual 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. Logistic regression models, adjusted for baseline values of the outcome. 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). 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.
Publisher: Wiley
Date: 24-08-2019
DOI: 10.1002/HPJA.285
Abstract: 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 s le 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 s le 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. SO WHAT?: Future intervention research that targets the reported barriers and enablers to implementation is needed.
Publisher: Wiley
Date: 30-08-2017
Abstract: The primary aim of this study was to describe the dietary intake and physical activity levels of children while attending childcare. A cross-sectional study was conducted with 18 centre-based childcare services in the Hunter region of New South Wales, Australia. Childcare service characteristics were assessed via telephone interview. Child dietary intake and physical activity levels were assessed during a one-day observation conducted at participating childcare services using previously validated tools. Children consumed a mean of 0.2 serves of vegetables, 0.7 serves of fruit, 1.4 serves of grain (cereal) foods, 0.1 serves of lean meat and poultry, fish, eggs, nuts and seeds and legumes/beans, 0.6 serves of milk, yoghurt, cheese and alternatives, and 0.7 serves of discretionary foods during attendance at childcare. Of all child physical activity counts, 48.6% were classified as 'sedentary', and 22.3% classified as 'very active'. Bivariate analyses indicated that children attending services located in rural areas consumed significantly more serves of vegetables (0.3 serves (SD 0.7) vs 0.1 serves (SD 0.2), P = 0.05). Multivariate analyses indicated that services with large child enrolments had a significantly greater proportion of child counts classified as 'very active' (23.6% of child counts (95% CI 1.6, 29.5) vs 14.9% of child counts (95% CI 9.1, 20.6), P = 0.007). There is considerable scope to improve the diet and activity behaviours of children during attendance at childcare. Future research is needed to identify effective strategies to best support childcare services in implementing policies and practices to improve such behaviours in children.
Publisher: Oxford University Press (OUP)
Date: 28-03-2017
DOI: 10.1093/HER/CYX038
Abstract: Implementation of vegetable and fruit programs in schools is less than optimal. This study aimed to identify, using a theoretical framework, factors associated with implementation of a school vegetable and fruit program that provides a time in class for children to consume a piece of vegetable or fruit they have brought from home. Three hundred and three randomly selected school principals across the state of New South Wales, Australia responded to a 25-min telephone survey. Principals were asked if their school had implemented a vegetable and fruit program, and which of 12 factors from Damschroder's consolidated framework for implementation research had facilitated or impeded implementation. Multiple logistic regression models examined the association between such factors and program implementation. Seventy-eight percent of schools had a vegetable and fruit program. Schools were significantly more likely to implement the program if the principal believed that: the program was effective (OR = 2.97 P < 0.02) they had sufficient resources to implement the program (OR = 4.22 P < 0.0001) the program would not be difficult to implement (OR = 10.16 P< 0.0001) and that the program was as important as other school priorities (OR = 2.45 P < 0.02). Realizing the intended benefits of vegetable and fruit programs requires widespread implementation by schools. Consideration of principal beliefs about the program effectiveness, resources, difficultly and relative importance in program implementation strategies appear key to increasing program implementation.
Publisher: SAGE Publications
Date: 02-08-2018
Abstract: Due to the rising prevalence of overweight and obesity in children and adolescents, reducing childhood overweight and obesity rates is a public-health priority. A significant source of excess sugar and energy in children’s diets comes from sugar-sweetened beverages (SSB), with adolescents having the highest intake of all age groups. However, existing interventions targeting SSB intake in adolescents have multiple limitations. Schools have proven to be an appropriate setting for improving student health. To assess the effectiveness of a school-based SSB intervention in reducing daily SSB consumption and daily percentage energy from SSBs of secondary-school students. A pilot study ( switchURsip) was designed based on the Health Promoting Schools framework components. A convenience s le of schools in New South Wales, Australia will be used to recruit six schools (three intervention three control). The study incorporates strategies that focus on factors associated with SSB intake in adolescents. These strategies include: lesson plans on SSB communication with students and parents school challenge to build peer support and school nutrition environment modifications. Support strategies to facilitate implementation are executive leadership and school committees, auditing and feedback, providing resources, staff professional learning and communication and marketing. The high intake of SSB in adolescents has been consistently linked to having overweight and obesity, hence, interventions in this area should be prioritised. This pilot study intends to address identified evidence gaps by piloting the first intervention in Australia of its kind to reduce SSB intake in adolescents.
Publisher: BMJ
Date: 04-2017
Publisher: Public Library of Science (PLoS)
Date: 08-09-2021
DOI: 10.1371/JOURNAL.PONE.0256044
Abstract: This systematic review described the association between electronic nicotine delivery systems and electronic non-nicotine delivery systems (ENDS/ENNDS) use among non-smoking children and adolescents aged years with subsequent tobacco use. We searched five electronic databases and the grey literature up to end of September 2020. Prospective longitudinal studies that described the association between ENDS/ENNDS use, and subsequent tobacco use in those aged 20 years who were non-smokers at baseline were included. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess risk of bias. Data were extracted by two reviewers and pooled using a random-effects meta-analysis. We generated unadjusted and adjusted risk ratios (ARRs) describing associations between ENDS/ENNDS and tobacco use. A total of 36 publications met the eligibility criteria, of which 25 were included in the systematic review (23 in the meta-analysis) after exclusion of overlapping studies. Sixteen studies had high to moderate risk of bias. Ever users of ENDS/ENNDS had over three times the risk of ever cigarette use (ARR 3·01 (95% CI: 2·37, 3·82 p ·001, I 2 : 82·3%), and current cigarette use had over two times the risk (ARR 2·56 (95% CI: 1·61, 4·07 p ·001, I 2 : 77·3%) at follow up. Among current ENDS/ENNDS users, there was a significant association with ever (ARR 2·63 (95% CI: 1·94, 3·57 p ·001, I 2 : 21·2%)), but not current cigarette use (ARR 1·88 (95% CI: 0·34, 10·30 p = 0·47, I 2 : 0%)) at follow up. For other tobacco use, ARR ranged between 1·55 (95% CI 1·07, 2·23) and 8·32 (95% CI: 1·20, 57·04) for waterpipe and pipes, respectively. Additionally, two studies examined the use of ENNDS (non-nicotine devices) and found a pooled adjusted RR of 2·56 (95% CI: 0·47, 13·94, p = 0.035). There is an urgent need for policies that regulate the availability, accessibility, and marketing of ENDS/ENNDS to children and adolescents. Governments should also consider adopting policies to prevent ENDS/ENNDS uptake and use in children and adolescents, up to and including a ban for this group.
Publisher: JMIR Publications Inc.
Date: 25-10-2020
Abstract: here is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. his study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ 95% CI –195.59 to –39.83 i P /i =.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ 95% CI –172.84 to –3.92 i P /i =.04) and consumed (–117.17 kJ 95% CI –233.72 to –0.62 i P /i =.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes. he SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs. ustralian Clinical Trials Registry ACTRN12618001731280 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191& isReview=true R2-10.1186/s12889-019-7725-x
Publisher: MDPI AG
Date: 10-02-2022
Abstract: Early childhood education and care (ECEC) services are a key setting to support improvements in the physical activity of young children. This umbrella review gathered and synthesised systematic review evidence of the effectiveness of interventions in the ECEC setting on the physical activity levels of children aged 0–6. We also mapped the current evidence to the existing ECEC sector-specific physical activity practice recommendations. Five electronic databases were searched to identify systematic reviews that evaluated the impact of any ECEC-based interventions on the physical activity levels (e.g., moderate-to-vigorous physical activity, total physical activity) of children aged 0–6. One reviewer extracted data on intervention effectiveness and quality of the reviews, checked by a second reviewer. Ten reviews were included. Overall, the majority of the reviews found interventions delivered in ECEC improved child physical activity. Across reviews, the impact of six intervention strategies were identified, mapped to four (of eight) broad recommendations (i.e., providing opportunity, offering educator training, educators promoting the benefits of physical activity, creating a physical activity-promoting environment). The impact of the majority of recommendations, however, did not have systematic review evidence. Further investigation of the effectiveness of ECEC-based physical activity strategies is required to demonstrate support for the existing recommended practices.
Publisher: Springer Science and Business Media LLC
Date: 20-03-2018
Publisher: BMJ
Date: 09-2018
DOI: 10.1136/BMJOPEN-2017-019151
Abstract: The primary aim for this review is to determine the effectiveness of strategies to improve the implementation of policies, practices or programmes in sporting organisations. The secondary aims are to describe the cost or cost-effectiveness and adverse effects of such strategies and to examine the effects of those implementation strategies on in idual’s diet, physical activity, obesity, alcohol use or tobacco use. We conducted searches of academic databases (eg, MEDLINE, EMBASE and CENTRAL), trial registers and hand searches of selected journals. Studies were included if they were conducted at a sporting venue described a strategy to improve implementation of policies, practices or programmes focusing on one or more health risks (diet, physical inactivity, obesity, alcohol or tobacco use), and included a parallel control group. Two authors independently screened citations and extracted data. The results of included studies were synthesised narratively. Of the 5926 citations screened three studies met the inclusion criteria. Two studies were randomised controlled trials. Two studies sought to improve the implementation of nutrition-related policy and practices and one study sought to improve implementation of alcohol-related policy and practices. Each study reported improvement in at least one measure of policy or practice implementation. Two studies reported in idual-level outcomes and found a reduction in excessive alcohol consumption and an increase in purchase of fruits and vegetables at the sports club ground. Two studies assessed club revenue as a potential adverse effect, neither reported significant between-group differences on these measures. There is a sparse evidence base regarding the effectiveness of strategies to improve the implementation of policies, practices or programmes targeting chronic disease risk factors in sporting clubs. While all studies reported some improvements in implementation, for some multistrategic implementation strategies it is difficult to determine the extent to which such effects are generalisable. CRD42016039490.
Publisher: JMIR Publications Inc.
Date: 17-01-2022
Abstract: arents are the primary decision makers of the foods prepared and offered to children. There is a strong association between parent and child fruit and vegetable intakes. Healthy eating and active living interventions targeting parents of young children could have benefits for both children and parents, however there is currently limited evidence demonstrating this effect when the intervention is offered to the community remotely (using digital technologies i.e. telephone or online) as part of existing preventive health services. o assess the effectiveness of two digital interventions (computer-assisted telephone or online) healthy eating and active living interventions delivered at scale to parents of children aged 2-6 years, for increasing parent fruit and vegetable consumption (secondary outcome) at 9-months post baseline. arents (n=458) were recruited to a partially randomized preference trial comprising of three arms: 1. Computer-assisted telephone intervention 2. Online intervention 3. Written material (Control). This design allowed parents with a strong preference to select their preferred intervention and once preference trends were established, parents were randomized to obtain robust relative effects. Data were analyzed for randomized participants, preference participants and all participants. t 9-months post-baseline, parents randomized to the computer-assisted telephone intervention (n=73) had significantly higher vegetable consumption compared with parents randomized to the control (n=81) (+0.41 serves/day (95% CI: 0.02 to 0.81), p=0.04). However, there were no differences in vegetable consumption between parents who chose the computer-assisted telephone intervention (n=22) compared to those who chose the control (n=64) (preference participants). No differences in parent fruit consumption were found for randomized or preference participants for either the computer-assisted telephone or online intervention. Similarly, analysis of all participants combined found no differences in parent consumption of fruit or vegetables between either the computer-assisted telephone (n=95) or online (n=218) intervention group compared with the control (n=145). here may be some benefit to parents participating in computer-assisted telephone interventions aimed at improving the eating behaviors of their children. Future research is recommended to explore methods for optimizing parent engagement with technology-based interventions, to enable greater health benefits for both parents and their children. TN: U1111-1228-9748, ACTRN: 12619000396123
Publisher: Cambridge University Press (CUP)
Date: 27-11-2017
DOI: 10.1017/S1368980017003366
Abstract: Evidence suggests that improvements to the childcare nutrition environment can have a positive impact on child dietary intake. The primary aim of the present study was to assess, relative to usual care, the effectiveness of a multi-strategy implementation intervention in improving childcare compliance with nutrition guidelines. As a secondary aim, the impact on child dietary intake was assessed. Parallel-group, randomised controlled trial design. The 6-month intervention was designed to overcome barriers to implementation of the nutrition guidelines that had been identified by applying the theoretical domains framework. Hunter New England region, New South Wales, Australia. Forty-five centre-based childcare services. There were no differences between groups in the proportion of services providing food servings (per child) compliant with nutrition guideline recommendations for all five (5/5) food groups at follow-up (i.e. full compliance). Relative to control services, intervention services were more likely to be compliant with guidelines (OR 95 % CI) in provision of fruit (10·84 1·19, 551·20 P =0·0024), meat and meat alternatives (8·83 1·55, – P =0·023), dairy (8·41 1·60, 63·62 P =0·006) and discretionary foods (17·83 2·15, 853·73 P =0·002). Children in intervention services consumed greater servings (adjusted difference 95 % CI) of fruit (0·41 0·09, 0·73 P =0·014) and vegetables (0·70 0·33, 1·08 P & ·001). Findings indicate that service-level changes to menus in line with dietary guidelines can result in improvements to children’s dietary intake. The study provides evidence to advance implementation research in the setting as a means of enhancing child public health nutrition.
Publisher: Elsevier BV
Date: 04-2018
Publisher: JMIR Publications Inc.
Date: 07-09-2021
DOI: 10.2196/26054
Abstract: School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1 P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4 P .001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5% P .001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9% P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0 P .001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8 P .001), corresponding to a 7.7% decrease in occasional items) however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0 P=.05). Furthermore, there was no change in schools’ revenue between groups. Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. RR2-10.1136/bmjopen-2019-030538
Publisher: MDPI AG
Date: 19-05-2022
Abstract: Healthy eating and active living interventions targeting parents of young children could have benefits for both children and parents. The aim of this study was to assess the effectiveness of two remotely delivered healthy eating and active living interventions delivered at scale to parents, in increasing parent vegetable and fruit consumption (pre-specified secondary outcomes). Parents of children aged 2–6 years residing in New South Wales, Australia (n = 458), were recruited to a partially randomized preference trial consisting of three groups (telephone intervention (n = 95) online intervention (n = 218) written material (Control) (n = 145)). This design allowed parents with a strong preference to select their preferred intervention, and once preference trends had been established, all parents that were subsequently recruited were randomized to obtain robust relative effects. Parent vegetable and fruit consumption was assessed via telephone interview at baseline and 9 months later. At follow-up, randomized parents who received the telephone intervention (n = 73) had significantly higher vegetable consumption compared to those who received the written control (n = 81) (+0.41 serves/day, p = 0.04), but there were no differences in parents allocated to intervention groups based on preference. No differences in fruit consumption were found for randomized or preference participants for either the telephone or online intervention. There may be some benefit to parents participating in the Healthy Habits Plus (telephone-based) intervention aimed at improving the eating behaviors of their children.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2018
Publisher: Wiley
Date: 27-08-2019
DOI: 10.1002/HPJA.286
Abstract: 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. SO WHAT?: 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.
Publisher: Wiley
Date: 21-06-2023
DOI: 10.1002/HPJA.760
Abstract: Obesity in children is one of the most significant public health issues globally. Given the high prevalence of overweight and obesity in children, there is a need to identify effective obesity prevention efforts that can be delivered at scale to improve child health. We aimed to (i) identify obesity prevention interventions targeted at children aged 0–2 that have been scaled‐up, and their relative efficacy compared to their pre‐scale trial, (ii) describe adaptations made, and the extent to which factors related to scalability have been reported. We conducted a rapid review of pre‐scale randomised controlled trials targeting nutrition, physical activity and obesity prevention in infants, and calculated the relative effect size for relevant outcomes in the corresponding scaled up trial. We documented adaptations made to the pre‐scale trial for scale up, and explored how different components of scalability had been reported according to the Intervention Scalability Assessment Tool. Of the 14 identified pre‐scale trials, only one formal evaluation of the scale‐up trial was identified. For body mass index, % of the effect was retained, however for nutrition and behavioural outcomes, the proportion of effect retained varied from −11.1% to 144%. Significant adaptations to modality were made in the scaled up trial primarily to reduce cost and increase reach of the intervention. Reporting of scalability components varied across the 14 trials, with only one trial reporting information for all assessed components. The majority of effective interventions targeting obesity prevention in infants have not been evaluated in a scaled up form. The magnitude of effect retained for the single trial that was scaled up was variable. In general, reporting of components of scalability was sub‐optimal. The findings suggest that there is substantial need for the development and rigorous evaluation of obesity prevention interventions in children aged 0–2 which are amenable for scale.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.YPMED.2017.11.012
Abstract: Research consistently indicates that schools fail to implement mandatory physical activity policies. This review aimed to describe factors (barriers and facilitators) that may influence the implementation of school physical activity policies which specify the time or intensity that physical activity should be implemented and to map these factors to a theoretical framework. A systematic search was undertaken in six databases for quantitative or qualitative studies published between 1995-March 2016 that examined teachers', principals' or school administrators' reported barriers and/or facilitators to implementing mandated school physical activity policies. Two independent reviewers screened texts, extracted and coded data from identified articles using the Theoretical Domains Framework (TDF). Of the 10,346 articles identified, 17 studies met the inclusion criteria (8 quantitative, 9 qualitative). Barriers and facilitators identified in qualitative studies covered 9 and 10 TDF domains respectively. Barriers and facilitators reported in quantitative studies covered 8 TDF domains each. The most common domains identified were: 'environmental context and resources' (e.g., availability of equipment, time or staff), 'goals' (e.g., the perceived priority of the policy in the school), 'social influences' (e.g., support from school boards), and 'skills' (e.g., teachers' ability to implement the policy). Implementation support strategies that target these factors may represent promising means to improve implementation of physical activity policies and increase physical activity among school-aged children. Future studies assessing factors that influence school implementation of physical activity policies would benefit from using a comprehensive framework to help identify if any domains have been overlooked in the current literature. This review was prospectively registered with PROSPERO (CRD42016051649) on the 8th December 2016.
Publisher: Cold Spring Harbor Laboratory
Date: 26-03-2018
DOI: 10.1101/286757
Abstract: We assessed the causal mechanisms of a healthy lifestyle intervention for patients with chronic low back pain and knee osteoarthritis (OA), who are overweight or obese. We conducted causal mediation analyses of aggregated data from two RCTs which included 160 patients with chronic low back pain, and 120 patients with knee OA. Participants were randomised via one central randomisation schedule, to the intervention, or usual care. The intervention consisted of brief advice and referral to a 6-month telephone-based healthy lifestyle coaching service. Participants in the back pain trial were also offered a single physiotherapy consultation. The hypothesised primary mediator was self-reported weight, and alternative mediators were diet, physical activity, and pain beliefs. Outcomes were pain intensity, disability, and quality of life (QoL). Data were analysed using causal mediation analyses with sensitivity analyses for sequential ignorability. All mediation models were specified a priori . The intervention had no effect on pain intensity, disability or physical QoL. The intervention significantly improved mental QoL, however, the intervention effect was not channelled via the selected mediators. The intervention did not reduce weight, or the alternative mediators (diet, physical activity, pain beliefs), and these mediators were not associated with the outcomes (with one exception poor diet was associated with lower mental QoL). The sensitivity analyses showed that our estimates were stable across all possible levels of residual confounding. Our findings show that the intervention did not cause a meaningful change in the hypothesised mediators, and these mediators were not associated with patient outcomes.
Publisher: Oxford University Press (OUP)
Date: 14-03-2022
Abstract: The benefits of increasing public access to data from clinical trials are widely accepted. Such benefits extend to the sharing of data from high-quality systematic reviews, given the time and cost involved with undertaking reviews. We describe the application of open sources of review data, outline potential challenges and highlight efforts made to address these challenges, with the intent of encouraging publishers, funders and authors to consider sharing review data more broadly. We describe the application of systematic review data in: (i) advancing understanding of clinical trials and systematic review methods, (ii) repurposing of data to answer public health policy and practice relevant questions, (iii) identification of research gaps and (iv) accelerating the conduct of rapid reviews to inform decision making. While access, logistical, motivational and legal challenges exist, there has been progress made by systematic review, academic and funding agencies to incentivise data sharing and create infrastructure to support greater access to systematic review data. There is opportunity to maximize the benefits of research investment in undertaking systematic reviews by ensuring open sources of systematic review data. Efforts to create such systems should draw on learnings and principles outlined for sharing clinical trial data.
Publisher: JMIR Publications Inc.
Date: 22-12-2020
Abstract: here has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of such interventions are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. s such, the aim of this systematic review is to describe the association between DHI engagement (both usage and subjective experience) and dietary intake. comprehensive search for peer-reviewed literature was undertaken in four electronic databases (EMBASE, MEDLINE, PsychINFO, Scopus) from inception to December 2019. A hand search of targeted journals, grey literature searches and a search of relevant references of similar reviews was also conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). Authors single screened studies, with a pair of review authors assessing quality of studies and extracting relevant data. Narrative syntheses using vote counting was undertaken to explore to relationship between measures of engagement and dietary intake. he search resulted in 10,653 citations, of which seven studies (from nine articles) were included in the review. The majority of studies (n=5) included usage measures of engagement rather than subjective experience (n=2). Logins were the most commonly reported usage measure (n=5 studies), and fruit and vegetable intake was the most common measure of dietary intake (n=4 studies). The heterogeneity of engagement and dietary intake measures limited the use of meta-analytic techniques, however narrative review (vote counting) found mixed evidence of an association with usage measures (5 of 12 associations indicating a positive relationship, 7 were inconclusive). No evidence regarding an association with subjective experience was found (0 of 2 associations were inconclusive). The majority of included studies (n=5) were rated poor quality according to the Newcastle Ottawa Scale. he findings provide some evidence supporting an association between measures of usage and fruit and vegetable intake, however this was inconsistent. No evidence was found regarding an association with subjective experience. Given the limited number of studies included in the review and poor quality of available evidence further research examining the association between DHI engagement and dietary intake using consistent measures, with an additional focus on subjective experience is warranted. RD42018112189
Publisher: MDPI AG
Date: 02-09-2022
DOI: 10.3390/NU14173640
Abstract: The education sector is recognised as an ideal platform to promote good nutrition and decision making around food and eating. Examining adolescents in this setting is important because of the unique features of adolescence compared to younger childhood. This systematic review and meta-analysis examine interventions in secondary schools that provide a routine meal service and the impact on adolescents’ food behaviours, health and dining experience in this setting. The review was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Checklist and Cochrane Handbook recommendations. Studies published in English searched in four databases and a hand search yielded 42 interventions in 35 studies. Risk of bias was assessed independently by two reviewers. Interventions were classified using the NOURISHING framework, and their impact analysed using meta-analysis, vote-counting synthesis or narrative summary. The meta-analysis showed an improvement in students selecting vegetables (odds ratio (OR): 1.39 1.12 to 1.23 p = 0.002), fruit serves selected (mean difference (MD): 0.09 0.09 to 0.09 p 0.001) and consumed (MD: 0.10 0.04 to 0.15 p 0.001), and vegetable serves consumed (MD: 0.06 0.01 to 0.10 p = 0.024). Vote-counting showed a positive impact for most interventions that measured selection (15 of 25 41% to 77% p = 0.002) and consumption (14 of 24 39% to 76% p = 0.013) of a meal component. Interventions that integrate improving menu quality, assess palatability, accessibility of healthier options, and student engagement can enhance success. These results should be interpreted with caution as most studies were not methodologically strong and at higher risk of bias. There is a need for higher quality pragmatic trials, strategies to build and measure sustained change, and evaluation of end-user attitudes and perceptions towards intervention components and implementation for greater insight into intervention success and future directions (PROSPERO registration: CRD42020167133).
Publisher: Springer Science and Business Media LLC
Date: 25-09-2018
Publisher: Springer Science and Business Media LLC
Date: 04-04-2018
Publisher: Elsevier BV
Date: 05-2019
DOI: 10.1093/AJCN/NQY351
Abstract: Manipulating the position of food items within the physical food environment has consistently been found to influence item selection. However, the extent to which this strategy is effective in an online food environment is unknown. This study investigated whether an intervention to position fruit and vegetable snack items as the first and last menu items in an online school canteen ordering system increased the selection of those items. It was hypothesized that at follow-up, a higher proportion of online lunch orders in intervention schools would contain the target items (fruit and vegetable snacks) in comparison to control schools. Six primary schools in New South Wales, Australia, were recruited to a clustered randomized controlled trial conducted over an 8-wk period. Intervention schools received a redesigned menu where the target items were positioned first and last on the online menu. Control schools received no change to their online menu. During the baseline period 1938 students (1203 intervention, 735 control) placed at least one online lunch order and were included in the study, with 16,109 orders placed throughout the study. There was no significant difference between groups over time in the proportion of orders that contained a "Fruit and Veggie Snack" item (OR = 1.136 [95% CI: 0.791, 1.632] P = 0.490). Evidence from this large trial with robust study design and objectively collected data suggests that positioning fruit and vegetable snack items first and last within an online canteen menu does not increase the selection of these items. Further research is warranted to confirm this finding with other target menu items (e.g., treats) and across other purchasing contexts and online food ordering platforms. This trial was registered at the Australian New Zealand Clinical Trials Registry, www.anzctr.org.au/ as ACTRN12616001520426.
Publisher: JMIR Publications Inc.
Date: 30-11-2020
Abstract: chool food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. his study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. he study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as i everyday /i , i occasional /i , and i caution /i (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. rom baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1 i P /i =.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4 i P /i & .001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5% i P /i & .001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9% i P /i =.02). Relative to control schools, intervention schools had significantly greater odds of having i everyday /i items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0 i P /i & .001), corresponding to a 9.8% increase in i everyday /i items, and lower odds of having i occasional /i items purchased (OR 0.7, 95% CI 0.6-0.8 i P /i & .001), corresponding to a 7.7% decrease in i occasional /i items) however, there was no change in the odds of having i caution /i (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0 i P /i =.05). Furthermore, there was no change in schools’ revenue between groups. iven the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. R2-10.1136/bmjopen-2019-030538
Publisher: Elsevier BV
Date: 06-2018
Abstract: To describe the prevalence and change in prevalence of electronic nicotine delivery systems (ENDS) use in youth by country and combustible smoking status. Databases and the grey literature were systematically searched to December 2015. Studies describing the prevalence of ENDS use in the general population aged ≤20 years in a defined geographical region were included. Where multiple estimates were available within countries, prevalence estimates of ENDS use were pooled for each country separately. Data from 27 publications (36 surveys) from 13 countries were included. The prevalence of ENDS ever use in 2013-2015 among youth were highest in Poland (62.1% 95%CI: 59.9-64.2%), and lowest in Italy (5.9% 95%CI: 3.3-9.2%). Among non-smoking youth, the prevalence of ENDS ever use in 2013-2015 varied, ranging from 4.2% (95%CI: 3.8-4.6%) in the US to 14.0% in New Zealand (95%CI: 12.7-15.4%). The prevalence of ENDS ever use among current tobacco smoking youth was the highest in Canada (71.9%, 95%CI: 70.9-72.8%) and lowest in Italy (29.9%, 95%CI: 18.5-42.5%). Between 2008 and 2015, ENDS ever use among youth increased in Poland, Korea, New Zealand and the US decreased in Italy and Canada and remained stable in the UK. There is considerable heterogeneity in ENDS use among youth globally across countries and also between current smokers and non-smokers. Implications for public health: Population-level survey data on ENDS use is needed to inform public health policy and messaging globally.
Publisher: Elsevier BV
Date: 05-2017
Publisher: Elsevier BV
Date: 07-2017
DOI: 10.1016/J.YPMED.2017.04.003
Abstract: Universal school-based interventions that address adolescent 'resilience' may represent a means of reducing adolescent substance use, however previous systematic reviews have not examined the effectiveness of such an intervention approach. A systematic review was undertaken to 1) assess whether universal school-based 'resilience' interventions are effective in reducing the prevalence of tobacco, alcohol or illicit substance use by adolescents, and 2) describe such effectiveness per intervention characteristic subgroups. Eligible studies were peer-reviewed reports (1994-2015) of randomised controlled trials including participants aged 5-18years that reported adolescent tobacco, alcohol or illicit substance use, and implemented a universal school-based 'resilience' intervention (i.e. those addressing both in idual (e.g. self-esteem) and environmental (e.g. school connectedness) protective factors of resilience). Trial effects for binary outcomes were synthesised via meta-analyses and effect sizes reported as odds ratios. Subgroup (by intervention type, prevention approach, setting, intervention duration, follow-up length) and sensitivity analyses (excluding studies at high risk of bias) were conducted. Nineteen eligible studies were identified from 16,619 records (tobacco: n=15, alcohol: n=17, illicit: n=11). An overall intervention effect was found for binary measures of illicit substance use (n=10 OR: 0.78, 95%CI: 0.6-0.93, p=0.007,Tau
Publisher: JMIR Publications Inc.
Date: 30-06-2017
DOI: 10.2196/RESPROT.6859
Publisher: Cambridge University Press (CUP)
Date: 06-2018
DOI: 10.1017/S1368980018001465
Abstract: To assess whether parent-reported time and cost for provision of food is associated with consumption of fruits, vegetables and non-core foods in pre-schoolers. Cross-sectional analysis of baseline data from the Healthy Habits randomised controlled trial. Two subscales of the Children’s Dietary Questionnaire (CDQ) were used to assess fruit and vegetable, and non-core food consumption. Thirty pre-schools in the Hunter Region of New South Wales, Australia. Parents ( n 396) with a child aged 3–5 years attending a participating pre-school were recruited. Parents needed to reside with that child for at least four days per week and have primary responsibility for providing meals and snacks to their child. Sixty-three per cent of children had a parent-reported subscale score indicating adherence to dietary guidelines for fruit and vegetable intake, while 64% of children had a subscale score indicating they were exceeding dietary guidelines for non-core foods. Regression models revealed significant positive associations between higher CDQ scores for non-core foods (indicating higher consumption levels) and minutes that parents spent preparing food ( P =0·032 and 0·025) and amount spent on purchasing food ( P =0·043 and 0·020). The magnitude of the effects was small (estimate=0·003 and 0·001). Time and cost spent by parents on provision of food was not significantly associated with child fruit and vegetable consumption. Further explorations into time spent on food preparation and cost of food procurement are warranted to help address the increased consumption of non-core foods by pre-school children.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-03-2018
DOI: 10.1097/J.PAIN.0000000000001198
Abstract: We assessed the effectiveness of a 6-month healthy lifestyle intervention, on pain intensity in patients with chronic low back pain who were overweight or obese. We conducted a pragmatic randomised controlled trial, embedded within a cohort multiple randomised controlled trial of patients on a waiting list for outpatient orthopaedic consultation at a tertiary hospital in NSW, Australia. Eligible patients with chronic low back pain ( months in duration) and body mass index ≥27 kg/m 2 and kg/m 2 were randomly allocated, using a central concealed random allocation process, to receive advice and education and referral to a 6-month telephone-based healthy lifestyle coaching service, or usual care. The primary outcome was pain intensity measured using an 11-point numerical rating scale, at baseline, 2 weeks, and monthly for 6 months. Data analysis was by intention-to-treat according to a prepublished analysis plan. Between May 13, 2015, and October 27, 2015, 160 patients were randomly assigned in a 1:1 ratio to the intervention or usual care. We found no difference between groups for pain intensity over 6 months (area under the curve, mean difference = 6.5, 95% confidence interval −8.0 to 21.0 P = 0.38) or any secondary outcome. In the intervention group, 41% (n = 32) of participants reported an adverse event compared with 56% (n = 45) in the control group. Our findings show that providing education and advice and telephone-based healthy lifestyle coaching did not benefit patients with low back pain who were overweight or obese, compared with usual care. The intervention did not influence the targeted healthy lifestyle behaviours proposed to improve pain in this patient group.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.JNEB.2017.09.023
Abstract: To identify perceived barriers and enablers to implementation of dietary guidelines reported by early childhood education center cooks, and barriers and enablers associated with greater implementation based on assessment of center menu compliance. Cross-sectional telephone interview. Early childhood education centers, New South Wales, Australia. A total of 202 cooks responsible for menu planning 70 centers provided a menu for review of compliance with dietary guidelines. Barriers and enablers to dietary guideline implementation were determined using a tool assessing constructs of the Theoretical Domains Framework (TDF). Higher scores (≥6) for each construct indicated enablers to guideline implementation lower scores (<6) suggested barriers. Multivariable linear regression identified TDF constructs associated with greater guideline implementation. Scores were lowest for reinforcement (mean, 5.85) and goals (mean, 5.89) domains, and highest for beliefs about consequences (mean, 6.51) and social rofessional role and identity (mean, 6.50). The skills domain was positively associated with greater implementation of guidelines based on menu review (P = .01). Cooks perceived social rofessional role and identity, and beliefs about consequences to be enablers to dietary guideline implementation however, only the skills domain was associated with greater implementation. There are opportunities to target the incongruence in perceptions vs reality of the barriers and enablers to implementation. Future research could examine the utility of the TDF to identify barriers and enablers to implementation to inform intervention development and for evaluating interventions to examine intervention mechanisms.
Publisher: Wiley
Date: 20-11-2018
DOI: 10.1002/HPJA.218
Abstract: Improving implementation of school healthy canteen policies requires a comprehensive understanding of implementation barriers. Therefore, the aim of this study was to assess a range of barriers, as reported by canteen managers, using a quantitative survey instrument developed based on a theoretical framework. A cross sectional survey of primary school canteen managers from the Hunter New England region of New South Wales was conducted of eligible schools in the study region identified as having an operational canteen. Survey items assessed canteen manager employment status, canteen characteristics and potential barriers to healthy canteen policy implementation, aligned to the 14 domains of the theoretical domains framework via a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The mean domain scores of canteen managers were calculated, less than four indicating the canteen manager considered the domain was a barrier. Canteen managers were also asked to provide the current canteen menu for audit by a dietitian. Of the 184 participants, 20% (n = 36) were assessed as having menus compliant with the state policy. The five most common domains identified as potential barriers to policy implementation were behavioural regulation (n = 117, 65%), skills (n = 105, 57%), beliefs about capabilities (n = 100, 55%), reinforcement (n = 95, 52%) and goals (n = 95, 52%). Canteen managers who reported optimism as a barrier had significantly lower odds of having a menu compliant with the state policy (OR = 0.39 95% CI 0.16-0.95, P = 0.038). This study provides further evidence of perceived and actual barriers that canteen managers face when attempting to implement a healthy canteen policy, and highlights the need to address differences in canteen characteristics when planning implementation support. SO WHAT?: For public health benefits of nutrition policies within schools to be realised, the barriers to implementation need to be identified and used to help guide implementation support strategies.
Publisher: Oxford University Press (OUP)
Date: 05-05-2021
DOI: 10.1093/TBM/IBAB036
Abstract: Empirical studies to disentangle the effects of multicomponent implementation interventions are needed to inform the development of future interventions. This study aims to examine which behavior change techniques (BCTs) primarily targeting canteen manager are associated with school’s healthy canteen policy implementation. This is a secondary data analysis from three randomized controlled trials assessing the impact of a “high,” “medium,” and “low” intensity intervention primarily targeting canteen managers on school’s implementation of a healthy canteen policy. The policy required primary schools to remove all “red” (less healthy items) or “banned” (sugar sweetened beverages) items from regular sale and ensure that “green” (healthier items) dominated the menu (& %). The delivery of BCTs were retrospectively coded. We undertook an elastic net regularized logistic regression with all BCTs in a single model. Five k-fold cross-validation elastic net models were conducted. The percentage of times each strategy remained across 1,000 replications was calculated. For no “red” or “banned” items (n = 162), the strongest BCTs were: problem solving, goal setting (behavior), and review behavior goals. These BCTs were identified in 100% of replications as a strong predictor in the cross-validation elastic net models. For the outcome relating to & % “green” items, the BCTs problem solving, instruction on how to perform behavior and demonstration of behavior were the strongest predictors. Two strategies were identified in 100% of replications as a strong (i.e., problem solving) or weak predictor (i.e., feedback on behavior). This study identified unique BCTs associated with the implementation of a healthy canteen policy.
Publisher: Wiley
Date: 20-05-2021
DOI: 10.1002/HPJA.499
Abstract: To determine if a school‐based physical activity (PA) intervention that supported primary school teachers to schedule PA during school hours impacted their own PA. A 2x2 factorial group cluster‐randomised controlled trial was undertaken in 12 Australian primary schools. The nine‐month intervention supported classroom teachers to increase scheduled weekly PA for their class via physical education, sport, Energisers and integrated lessons. Teachers’ PA (n = 76) was measured at follow‐up only using accelerometers (Actigraph GT3X or GT9X). Linear mixed models were used to estimate between‐group differences in teachers’ mean minutes of sedentary, light, moderate‐to‐vigorous‐intensity physical activity (MVPA) across the school day and during class‐time. At follow‐up, there were non‐significant between‐group differences favouring intervention teachers, compared to controls, for light PA (4.9 minutes, 95% CI: −6.3, 16.0 P = .33) and MVPA (0.4 minutes, 95% CI: −10.9, 11.6 P = .94) across the school day although not favouring the intervention for sedentary behaviour (5.1 minutes, 95% CI: −11.4, 21.7 P = .48). Similar patterns were seen during class‐time for light PA and sedentary time, but not for MVPA. Supporting teachers with the scheduling of PA for their class may impact on their own PA. Fully powered studies are needed to better understand the impact of the intervention on teachers’ PA. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616001228471 ( www.anzctr.org.au/ ).
Publisher: JMIR Publications Inc.
Date: 05-12-2021
Abstract: igh school canteens are a recommended setting for public health nutrition intervention. The rapid uptake of online lunch ordering within school canteens provides a unique opportunity to support the purchase healthier lunch items via the use of choice architecture strategies. Despite this, no trial has tested the efficacy of choice architecture strategies within an online lunch ordering system on improving the nutritional quality of high school student lunch purchases. o assess the impact of embedding choice architecture strategies into an online lunch ordering system (menu labelling, prompts, item positioning, and feedback) on the nutritional quality of the school canteen lunch purchases of high school students (aged 12-19 years). cluster randomized controlled trial was conducted with nine high schools in one Australian state. Schools were randomized to receive either the choice architecture intervention, or usual online ordering. Nutrient quality was assessed using routine data collected by the online ordering system. Primary outcomes were the proportion of ‘Everyday’, ‘Occasional’, and ‘Should Not Be Sold’ items purchased, categorized using the state healthy canteen policy. Secondary outcomes were the mean energy, saturated fat, sugar, and sodium content of purchases. Linear mixed models were analyzed to assess outcomes. here were significant between group differences over time for the intervention group for the mean percentage of online lunch items per student that were ‘Everyday’ (+5.5% [95% CI 2.2, 8.9] P .001) and ‘Should Not Be Sold’ (-4.4% [95% CI -7.0, -1.8] P .001). There were no between group differences over time in the mean percentage of online lunch items that were ‘Occasional’ or the average energy, saturated fat, sugar, or sodium content of lunch orders. hese findings suggest that a low intensity, choice architecture intervention embedded within an online ordering system can increase the purchase of healthier food items for high school students. his trial was prospectively registered on Open Science Framework on 23rd October 2020 as osf.io/h8zfr.
Publisher: Elsevier BV
Date: 11-2017
Publisher: JMIR Publications Inc.
Date: 04-02-2020
DOI: 10.2196/13401
Abstract: 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. 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) in idual food groups and (3) mean servings of in idual food groups. Childcare service use and acceptability of the Web-based program were also assessed. 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. 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 in idual 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. Although improvements in childcare service overall menu and in idual 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. Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404 www.anzctr.org.au/ACTRN12616000974404.aspx
Publisher: Wiley
Date: 11-11-2018
DOI: 10.1111/IJPO.12481
Abstract: Given evidence suggesting that sleep impacts on metabolic processes, interventions targeting sleep may improve child physical activity (PA). To describe the potential effect of an intervention to increase sleep on young children's (3-6 years) moderate to vigorous PA (MVPA) and total PA. To determine adherence to the intervention, impact on sleep duration as well as feasibility, uptake and acceptability was also assessed. Pilot randomized controlled trial with 76 parent-child dyads randomly allocated to an intervention (n = 38) or control group (n = 38). Parents in the intervention group received a 3-month theory-informed intervention consisting of an online video, a telephone call and two text messages. Child PA was assessed using accelerometers at baseline and approximately 3 months. Parents also completed a sleep log and a telephone interview. The consent rate was 41% (76/186). Estimated effect size for the intervention relative to control was 10.8 min/day for MVPA, 2.7 min/day for PA and 0.9 h for sleep. Sixteen (44%) parents accessed the video, and 18 (50%) received the telephone call. Over 40% of parents found the video and telephone call useful/very useful. This study reports promising effects that an intervention targeting sleep may improve child MVPA and sleep duration. Some modifications to data collection methods and intervention delivery are needed.
Publisher: Cold Spring Harbor Laboratory
Date: 06-04-2018
DOI: 10.1101/296285
Abstract: We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. Eligible patients with chronic low back pain (n=160) were randomised to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight, and body mass index. Costs included intervention costs, healthcare utilisation costs and work absenteeism costs. An economic analysis was performed from the societal perspective. Mean total costs were lower in the intervention group than the control group (-$614 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292 95%CI: -872 to -33), medication costs (-$30 95%CI: -65 to -4) and absenteeism costs (-$1000 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e. 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses. The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings.
Publisher: BMJ
Date: 09-2017
DOI: 10.1136/BMJOPEN-2017-017498
Abstract: The implementation of dietary guidelines in childcare settings is recommended to improve child public health nutrition. However, foods provided in childcare services are not consistent with guidelines. The primary aim of the trial is 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 regarding food provision to children in care. A parallel group randomised controlled trial will be undertaken with 54 childcare services that provide food to children within New South Wales, Australia. Services will be randomised to a 12-month intervention or usual care. The experimental group will receive access to a web-based menu planning and decision support tool and online resources. To support uptake of the web program, services will be provided with training and follow-up support. The primary outcome will be the number of food groups, out of 6 (vegetables, fruit, breads and cereals, meat, dairy and ‘discretionary’), on the menu that meet dietary guidelines (Caring for Children) across a 1-week menu at 12-month follow-up, assessed via menu review by dietitians or nutritionists blinded to group allocation. A nested evaluation of child dietary intake in care and child body mass index will be undertaken in up to 35 randomly selected childcare services and up to 420 children aged approximately 3–6 years. Ethical approval has been provided by Hunter New England and University of Newcastle Human Research Ethics Committees. This research will provide high-quality evidence regarding the impact of a web-based menu planning intervention in facilitating the translation of dietary guidelines into childcare services. Trial findings will be disseminated widely through national and international peer-reviewed publications and conference presentations. Prospectively registered with Australian New Zealand Clinical Trial Registry (ANZCTR) ACTRN12616000974404.
Publisher: Springer Science and Business Media LLC
Date: 22-11-2017
Publisher: Wiley
Date: 04-12-2018
DOI: 10.1002/EJP.1334
Abstract: Economic evaluations which estimate cost-effectiveness of potential treatments can guide decisions about real-world healthcare services. We performed an economic evaluation of a healthy lifestyle intervention targeting weight loss, physical activity and diet for patients with chronic low back pain, who are overweight or obese. Eligible patients with chronic low back pain (n = 160) were randomized to an intervention or usual care control group. The intervention included brief advice, a clinical consultation and referral to a 6-month telephone-based healthy lifestyle coaching service. The primary outcome was quality-adjusted life years (QALYs). Secondary outcomes were pain intensity, disability, weight and body mass index. Costs included intervention costs, healthcare utilization costs and work absenteeism costs. An economic analysis was performed from the societal perspective. Mean total costs were lower in the intervention group than the control group (-$614 95%CI: -3133 to 255). The intervention group had significantly lower healthcare costs (-$292 95%CI: -872 to -33), medication costs (-$30 95%CI: -65 to -4) and absenteeism costs (-$1,000 95%CI: -3573 to -210). For all outcomes, the intervention was on average less expensive and more effective than usual care, and the probability of the intervention being cost-effective compared to usual care was relatively high (i.e., 0.81) at a willingness-to-pay of $0/unit of effect. However, the probability of cost-effectiveness was not as favourable among sensitivity analyses. The healthy lifestyle intervention seems to be cost-effective from the societal perspective. However, variability in the sensitivity analyses indicates caution is needed when interpreting these findings. This is an economic evaluation of a randomized controlled trial of a healthy lifestyle intervention for chronic low back pain. The findings suggest that a healthy lifestyle intervention may be cost-effective relative to usual care.
Publisher: MDPI AG
Date: 19-01-2021
Abstract: As a strategy for early childhood obesity prevention, a variety of dietary behavior and physical activity policies and guidelines published by leading health agencies and early childhood education and care (ECEC) licensing and accreditation bodies exist. Given the potential ersity in recommendations from these policies, this narrative review sought to synthesize, appraise and describe the various policies and guidelines made by organizational and professional bodies to highlight consistent recommendations and identify opportunities to strengthen such policies. An electronic bibliographic search of seven online databases and grey literature sources was undertaken. Records were included if they were policies or guidelines with specific recommendations addressing dietary behavior and/or physical activity practice implementation within the ECEC setting included children aged months and years and were developed for high income countries. Recommended dietary behavior and physical activity policies and practices were synthesized into broad themes using the Analysis Grid for Environments Linked to Obesity framework, and the quality of included guidelines appraised. Our search identified 38 eligible publications mostly from the US and Australia. Identified guidelines were largely consistent in their recommendation and frequently addressed the physical and sociocultural environment and were well-aligned with research evidence. Broader consideration of policy and economic environments may be needed to increase the impact of such policies and guidelines within the ECEC setting.
Publisher: MDPI AG
Date: 20-09-2021
DOI: 10.3390/NU13093281
Abstract: There has been a proliferation of digital health interventions (DHIs) targeting dietary intake. Despite their potential, the effectiveness of DHIs are thought to be dependent, in part, on user engagement. However, the relationship between engagement and the effectiveness of dietary DHIs is not well understood. The aim of this review is to describe the association between DHI engagement and dietary intake. A systematic search of four electronic databases and grey literature for records published before December 2019 was conducted. Studies were eligible if they examined a quantitative association between objective measures of engagement with a DHI (subjective experience or usage) and measures of dietary intake in adults (aged ≥18 years). From 10,653 citations, seven studies were included. Five studies included usage measures of engagement and two examined subjective experiences. Narrative synthesis, using vote counting, found mixed evidence of an association with usage measures (5 of 12 associations indicated a positive relationship, 7 were inconclusive) and no evidence regarding an association with subjective experience (both studies were inconclusive). The findings provide early evidence supporting an association between measures of usage and dietary intake however, this was inconsistent. Further research examining the association between DHI engagement and dietary intake is warranted.
Publisher: Wiley
Date: 04-05-2016
DOI: 10.1071/HE15095
Publisher: MDPI AG
Date: 17-11-2021
DOI: 10.3390/NU13114113
Abstract: Schools are identified as a key setting to influence children’s and adolescents’ healthy eating. This umbrella review synthesised evidence from systematic reviews of school-based nutrition interventions designed to improve dietary intake outcomes in children aged 6 to 18 years. We undertook a systematic search of six electronic databases and grey literature to identify relevant reviews of randomized controlled trials. The review findings were categorised for synthesis by intervention type according to the World Health Organisation Health Promoting Schools (HPS) framework domains: nutrition education food environment all three HPS framework domains or other (not aligned to HPS framework domain). Thirteen systematic reviews were included. Overall, the findings suggest that school-based nutrition interventions, including nutrition education, food environment, those based on all three domains of the HPS framework, and eHealth interventions, can have a positive effect on some dietary outcomes, including fruit, fruit and vegetables combined, and fat intake. These results should be interpreted with caution, however, as the quality of the reviews was poor. Though these results support continued public health investment in school-based nutrition interventions to improve child dietary intake, the limitations of this umbrella review also highlight the need for a comprehensive and high quality systematic review of primary studies.
Publisher: JMIR Publications Inc.
Date: 20-11-2020
DOI: 10.2196/22036
Abstract: Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. This study aimed to assess in a national s le of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly s led from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived in idual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. Findings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization’s capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P .001) and identifying work and in iduals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions. A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.
Publisher: Wiley
Date: 04-07-2018
DOI: 10.1111/JPC.14106
Abstract: To describe parent-reported child: (i) sleep duration (ii) sleep quality (iii) sleep hygiene practices and (iv) the proportion of children meeting sleep duration recommendations. A convenience s le of parents of Australian pre-school-aged children (3-5 years) were surveyed from the Hunter New England region of New South Wales. The cross-sectional survey was conducted via computer-assisted telephone interview. The survey assessed parent and child demographic characteristics and parent-reported child sleep duration, quality and sleep hygiene practices. A total of 488 eligible parents or guardians took part in the study. Parents reported that children slept an average of 11.03 h per night. Approximately 96% of children met daily sleep duration recommendations from sleep guidelines for their age group. The majority of parents reported that their child had 'good' sleep quality (86.89%). Almost 40% reported that their child woke at least once a night. Sleep hygiene practices were relatively well established however, a small proportion of parents indicated that they had no rules surrounding bedtime (13.52%) or television use before bed (14.52%). The current study describes the sleep duration, quality and sleep hygiene practices of a s le of pre-school-aged children in New South Wales, Australia. Future research using objective measures of sleep duration and hygiene, as well as assessing a broader spectrum of sleep hygiene practices, is needed.
Publisher: JMIR Publications Inc.
Date: 17-03-2022
DOI: 10.2196/27760
Abstract: Interventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18 P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90 P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Australian New Zealand Clinical Trials Registry ACTRN12618000133235 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379
Publisher: Wiley
Date: 14-02-2023
DOI: 10.1002/HPJA.702
Abstract: Parent‐reported data may provide a practical and cheap way for estimating young children's weight status. This study aims to compare the validity and reliability of parent‐reported height and weight to researcher‐measured data for pre‐school aged children (aged 2‐6 years). This was a nested study within a cluster randomised controlled trial (October 2016‐April 2017), conducted within 32 Early Childhood Education and Care (ECEC) services across New South Wales, Australia. Parents of children reported on demographics and child height and weight via a survey. For the same child, height and weight data were objectively collected by trained research staff at the service. We calculated mean differences, intra‐class correlations, Bland‐Altman plots, percentage agreement and Cohen's kappa coefficient ( .8 = “excellent” 0.61‐0.8 = “good” 0.41‐0.60 = “moderate” 0.21 and 0.4 = “fair [weak]” .2 = “poor”). Overall, 89 children were included (mean age: 4.7 years 59.5% female). The mean difference between parent‐reported and researcher‐measured data were small (BMI z ‐score: mean difference −0.01 [95% CI: −0.45 to 0.44]). There was “fair/weak” agreement between parent‐categorised child BMI compared with researcher‐measured data (Cohen's Kappa 0.24 [95% CI: 0.06 to 0.42]). Agreement was poor (Cohen's kappa .2) for female children, when reported by fathers or by parents with a BMI 25 kg/m 2 . There was “fair/weak” agreement between parent‐reported and measured estimates of child weight status. Parent's report of weight and height may be a weak indicator of adiposity at the level of in iduals however it may be useful for aggregate estimates.
Publisher: MDPI AG
Date: 30-06-2021
DOI: 10.3390/NU13072255
Abstract: Digital food environments are now commonplace across many food service and retail settings, influencing how the population orders and accesses foods. As such, digital food environments represent a novel platform to deliver strategies to improve public health nutrition. The purpose of this review was to explore the impact of dietary interventions embedded within online food ordering systems, on user selection and purchase of healthier foods and beverages. A systematic search of eight electronic databases and grey literature sources was conducted up to October 2020. Eligible studies were randomized controlled trials and controlled trials, designed to encourage the selection and purchase of healthier products and/or discourage the selection and purchase of less-healthy products using strategies delivered via real-world online food ordering systems. A total of 9441 articles underwent title and abstract screening, 140 full-text articles were assessed for eligibility, and 11 articles were included in the review. Meta-analysis of seven studies indicated that interventions delivered via online food ordering systems are effective in reducing the energy content of online food purchases (standardized mean difference (SMD): −0.34, p = 0.01). Meta-analyses including three studies each suggest that these interventions may also be effective in reducing the fat (SMD: −0.83, p = 0.04), saturated fat (SMD: −0.7, p = 0.008) and sodium content (SMD: −0.43, p = 0.01) of online food purchases. Given the ongoing growth in the use of online food ordering systems, future research to determine how we can best utilize these systems to support public health nutrition is warranted.
Publisher: Elsevier BV
Date: 12-2019
DOI: 10.1016/J.PUHE.2019.07.003
Abstract: Although evidence-based interventions (EBIs) and effective strategies to implement them exist, they cannot be used by policy makers and practitioners if they do not align with end users' needs. As such, adaptations to EBIs and implementation approaches are likely to occur to increase 'fit' with end users' capacity. This article describes an approach undertaken by a population health service delivery unit in one Australian state to develop an adapted implementation strategy to support the implementation of the mandatory healthy canteen policy (EBI) to all schools located in the service delivery region. This is a case study of adapting an intervention to improve implementation of the healthy canteen policy. This is a six-step pragmatic, empirically driven approach. The steps include (i) adapt, where appropriate, the EBI to facilitate implementation (ii) identify end users' capacity for implementation (iii) identify opportunities to adapt the implementation interventions while preserving meaningful intervention impact (iv) undertake program adaptation (v) develop training and resources to support delivery of implementation strategies and (vi) evaluate the adapted intervention. This article describes the application of these steps by the authors to develop an adapted support strategy consistent with end users' needs. This study provides some guidance on how to adapt implementation support approaches particularly when EBIs cannot be adapted. Future empirical research providing guidance on making practical adaptation decisions are needed.
Publisher: Wiley
Date: 12-10-2023
DOI: 10.1002/HPJA.820
Publisher: Wiley
Date: 05-03-2021
DOI: 10.1002/HPJA.469
Abstract: Secondary schools provide an opportune setting for interventions addressing excessive sugar‐sweetened beverage (SSB) intake in adolescence. This trial aimed to assess the impact of school environmental strategies, delivered as part of a broader intervention, among Year 7‐9 students’ SSB consumption. Between March and July 2018, we conducted a cluster randomised controlled trial with 862 students attending six secondary schools (3 intervention and 3 control) in New South Wales. The intervention targeted SSB availability, placement, promotion and pricing, and increased availability and promotion of water. Control schools followed their usual programmes. Primary outcomes included mean daily SSB consumption (millilitres) and mean daily percentage energy from SSB (kilojoules). Sub‐group analysis explored primary outcomes for gender, school year level and frequency of canteen use. Of the 2265 eligible students, 1092 (50.2%) provided active parental consent and 940 (86.0%) participated in baseline data collection. No significant differences were observed between groups at follow‐up for mean daily SSBs consumed (−10.17 mL, CI: −24.78 45.12, P = 0.57) or mean daily percentage energy from SSBs (−0.20%, CI: −0.87 0.47, P = .56). Significant effects were observed among girls in intervention compared to girls in control schools for mean daily SSB consumption (−52.02 mL, CI 99.8 94.14, P = .03) and mean daily percentage of energy from SSBs (−0.90%, CI: −1.82 0.02, P = .05). At 3‐month mid‐intervention evaluation, the intervention failed to impact on mean daily consumption and mean percentage energy from SSBs, overall. However, an intervention effect was observed in girls. The limited overall effect is likely due to inadequate intervention dose related to the short duration, limiting opportunities for schools to fully implement the environmental strategies. A longer intervention duration with additional implementation support to allow adequate time to embed the strategies within the school is recommended. Implementation support strategies would ensure staff are supported throughout the process.
Publisher: Wiley
Date: 04-2020
DOI: 10.1002/HPJA.268
Abstract: 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. SO WHAT?: 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.
Publisher: Cambridge University Press (CUP)
Date: 11-08-2023
DOI: 10.1017/S1368980023001714
Abstract: Food-based dietary guidelines (FBDG) are an important resource to improve population health however, little is known about the types of strategies to disseminate them. This study sought to describe dissemination strategies and content of dissemination plans that were available for FBDG. A cross-sectional audit of FBDG with a published English-language version sourced from the United Nations FAO repository. We searched for publicly available dissemination strategies and any corresponding plans available in English language. Two authors extracted data on strategies, which were grouped according to the Model for Dissemination Research Framework (including source, audience, channel and message). For guidelines with a dissemination plan, we described goals, audience, strategies and expertise and resources according to the Canadian Institute for Health Research guidance. FBDG from fifty-three countries mostly from high-income ( n 28, 52·8 %), and upper-middle income ( n 18, 34 %) areas were included. n/a. The source of guidelines was most frequently health departments (79·2 %). The message included quantities and types of foods, physical activity recommendations and 88·7 % included summarised versions of main messages. The most common channels were infographics and information booklets, and the main end-users were the public. For twelve countries (22·6 %), we were able to source an English-language dissemination plan, where none met all recommendations outlined by the Canadian Institute for Health Research. The public was the most frequently identified end-user and thus most dissemination strategies and plans focused on this group. Few FBDG had formal dissemination plans and of those there was limited detailed provided.
Publisher: Wiley
Date: 07-10-2020
DOI: 10.1002/HPJA.420
Abstract: 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.
Publisher: Wiley
Date: 12-2018
DOI: 10.1002/HPJA.220
Abstract: Online systems offer opportunities to provide effective, ongoing support to childcare services to implement dietary guidelines. The study aimed to assess the effectiveness of a dissemination strategy on childcare service: (i) adoption and (ii) use of an online menu planning program designed to increase compliance with dietary guidelines. A nonrandomised controlled trial was conducted with long day care services across Australia. All services received an email invitation to access an online evidence-based menu planning program. Services in the intervention also received training, telephone contact and provision of a portable computer tablet to encourage program adoption and use. Outcomes were assessed at the 6-month follow-up using analytics data recorded by the online program. Outcomes included the proportion of services having accessed the program (adoption) and the proportion of services with a current menu entered in the program (use as intended). Twenty-seven interventions and 19 control services took part. At the 6-month follow-up, 100% vs 58% of services had adopted the online menu planning program (OR: 14.67, 95% CI: 2.43-infinity P < 0.01) and 41% vs 5% of services had a current menu entered in the program (OR: 9.99, 95% CI: 1.01-534.57 P < 0.01) in the intervention and control arms respectively. This study highlights the need for strategies to support adoption and use of an online menu planning program in childcare services if the potential benefits of such a program are to be achieved. Future research should explore the effectiveness of differing strategies to increase adoption and use of online programs at scale. SO WHAT?: Strategies to support childcare service uptake and use of online programs are required in order for the potential public health benefits of such technologies to be realised.
Publisher: JMIR Publications Inc.
Date: 16-12-2021
Abstract: ew translational trials have provided detailed reports of process evaluation results. his study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. ixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at i P /i & .05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. ata were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention however, more participants actively withdrew from the telephone intervention. his is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.
Publisher: BMJ
Date: 06-2017
Publisher: Springer Science and Business Media LLC
Date: 07-2020
DOI: 10.1186/S13012-020-01011-0
Abstract: Nudge interventions are those that seek to modify the social and physical environment to enhance capacity for subconscious behaviours that align with the intrinsic values of an in idual, without actively restricting options. This study sought to describe the application and effects of nudge strategies on clinician implementation of health-related guidelines, policies and practices within studies included in relevant Cochrane systematic reviews. As there is varied terminology used to describe nudge, this study examined studies within relevant systematic reviews. A two-stage screening process was undertaken where, firstly, all systematic reviews published in the Cochrane Library between 2016 and 2018 were screened to identify reviews that included quantitative studies to improve implementation of guidelines among healthcare providers. Secondly, in idual studies within relevant systematic reviews were included if they were (i) randomised controlled trials (RCTs), (ii) included a nudge strategy in at least one intervention arm, and (iii) explicitly aimed to improve clinician implementation behaviour. We categorised nudge strategies into priming, salience and affect, default, incentives, commitment and ego, and norms and messenger based on the Mindspace framework. The number and percentage of trials using each nudge strategy was calculated. Due to substantial heterogeneity, we did not undertake a meta-analysis. Instead, we calculated within-study point estimates and 95% confidence intervals, and used a vote-counting approach to explore effects. Seven reviews including 42 trials reporting on 57 outcomes were included. The most common nudge strategy was priming (69%), then norms and messenger (40%). Of the 57 outcomes, 86% had an effect on clinician behaviour in the hypothesised direction, and 53% of those were statistically significant. For continuous outcomes, the median effect size was 0.39 (0.22, 0.45), while for dichotomous outcomes the median Odds Ratio was 1.62 (1.13, 2.76). This review of 42 RCTs included in Cochrane systematic reviews found that the impact of nudge strategies on clinician behaviour was at least comparable to other interventions targeting implementation of evidence-based guidelines. While uncertainty remains, the review provides justification for ongoing investigation of the evaluation and application of nudge interventions to support provider behaviour change. This review was not prospectively registered.
Publisher: Wiley
Date: 29-11-2017
Publisher: JMIR Publications Inc.
Date: 06-07-2020
Abstract: ew Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. his study aimed to assess in a national s le of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly s led from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived in idual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. indings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The i changes needed in team interactions /i subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with i organization’s capacity to innovate /i scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of i ease of the adoption decision /i ( i P /i & .001) and i identifying work and in iduals involved in implementation /i ( i P /i =.001) were significantly associated with high intentions to adopt digital health interventions. substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood.
Publisher: JMIR Publications Inc.
Date: 03-12-2020
Abstract: nternationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children’s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. he broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates) examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies understand the potential cost of delivering and receiving implementation support strategies and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. f the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). his study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. ustralian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 R2-10.1186/s40814-020-00707-w
Publisher: JMIR Publications Inc.
Date: 06-02-2021
Abstract: nterventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. his study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. ata on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18 i P /i =.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90 i P /i =.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). he intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. ustralian New Zealand Clinical Trials Registry ACTRN12618000133235 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379
Publisher: JMIR Publications Inc.
Date: 15-12-2021
DOI: 10.2196/25902
Abstract: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children’s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates) examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies understand the potential cost of delivering and receiving implementation support strategies and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Of the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156 www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 RR2-10.1186/s40814-020-00707-w
Publisher: Wiley
Date: 20-01-2017
DOI: 10.1111/JPC.13464
Publisher: MDPI AG
Date: 30-03-2021
DOI: 10.3390/NU13041139
Abstract: The association between healthy eating practices and child dietary intake in childcare centres where parents pack foods from home has received little attention. This study aimed to: (1) Describe the nutritional content of foods and beverages consumed by children in care and (2) Assess the association between centre healthy eating practices and child intake of fruit and vegetable servings, added sugar(grams), saturated fat(grams) and sodium(milligrams) in care. A cross-sectional study amongst 448 children attending 22 childcare centres in New South Wales, Australia, was conducted. Child dietary intake was measured via weighed lunchbox measurements, photographs and researcher observation, and centre healthy eating practices were assessed via researcher observation of centre nutrition environments. Children attending lunchbox centres consumed, on average 0.80 servings (standard deviation 0.69) of fruit and 0.27 servings (standard deviation 0.51) of vegetables in care. The availability of foods within children’s lunchboxes was associated with intake of such foods (p 0.01). Centre provision of intentional healthy eating learning experiences (estimate −0.56 p = 0.01) and the use of feeding practices that support children’s healthy eating (estimate −2.02 p = 0.04) were significantly associated with reduced child intake of saturated fat. Interventions to improve child nutrition in centres should focus on a range of healthy eating practices, including the availability of foods packed within lunchboxes.
Publisher: PeerJ
Date: 30-10-2018
DOI: 10.7717/PEERJ.5846
Abstract: Osteoarthritis and spinal pain are common and burdensome conditions however, the majority of patients with these conditions do not receive care that is consistent with clinical practice guidelines. Telehealth models of care have the potential to improve care for osteoarthritis and spinal pain patients. The aim of this review was to assess the effectiveness of verbal real-time telehealth interventions, including telephone-based and videoconferencing interventions to reduce pain intensity and disability in patients with osteoarthritis of the knee or hip and spinal pain (back or neck pain). We searched seven electronic databases from inception to May 2018. Randomised controlled trials (RCTs), cluster-RCTs, and non-randomised controlled trials were included. Two review authors independently extracted data for each included study. Primary outcomes were pain intensity and disability. We conducted primary meta-analyses combining all conditions with similar interventions and comparators. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated using random effects models. We used the Cochrane Risk of Bias tool to assess risk of bias, and GRADE to evaluate the quality of evidence. We included 23 studies with 56 trial arms and 4,994 participants. All studies utilised telephone-based interventions. Only two studies used a telephone only approach and the remainder included educational materials and/or face-to-face components. We found no studies utilising videoconferencing. Meta-analysis showed telephone-based interventions (with educational materials) for osteoarthritis and spinal pain improved pain intensity ( n = 5 trials, n = 1,357 participants, SMD −0.27, 95% CI [−0.53, −0.01], Tau 2 = 0.06, I 2 = 74% moderate-quality evidence) and disability ( n = 7 trials, n = 1,537 participants, SMD −0.21, 95% CI [−0.40, −0.02], Tau 2 = 0.03, I 2 = 56% moderate-quality evidence) compared to usual care. Meta-analyses found telephone with face-to-face interventions does not improve pain and disability compared to usual care or face-to-face care alone. We are moderately confident that telephone-based interventions reduce pain intensity and disability in patients with osteoarthritis and spinal pain compared to usual care, but telephone plus face-to-face interventions are no more effective than usual care or face-to-face interventions alone.
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.JOCA.2018.01.003
Abstract: To determine the effectiveness of telephone-based weight loss support in reducing the intensity of knee pain in patients with knee osteoarthritis, who are overweight or obese, compared to usual care. We conducted a parallel randomised controlled trial (RCT), embedded within a cohort multiple RCT of patients on a waiting list for outpatient orthopaedic consultation at a tertiary referral hospital in NSW, Australia. Patients with knee osteoarthritis, classified as overweight or obese [body mass index (BMI) between ≥27 kg/m Between May 19 and June 30 2015, 120 patients were randomly assigned to the intervention (59 analysed, one post-randomisation exclusion) or usual care (60 analysed). We found no statistically significant between group differences in pain intensity [area under the curve (AUC), mean difference 5.4, 95%CI: -13.7 to 24.5, P = 0.58] or weight change at 6 months (self-reported mean difference -0.4, 95%CI: -2.6 to 1.8, P = 0.74). Among patients with knee osteoarthritis who are overweight, telephone-based weight loss support, provided using an existing 6-month weight management and healthy lifestyle service did not reduce knee pain intensity or weight, compared with usual care. ACTRN12615000490572.
Publisher: Springer Science and Business Media LLC
Date: 04-04-2017
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.YPMED.2017.09.024
Abstract: Children attending centre based childcare services consume as much as two thirds of their daily dietary requirements while in care. However, such services often fail to provide foods that are consistent with guideline recommendations. Developing strategies to improve childcare service adherence to menu dietary guidelines requires a comprehensive understanding of factors that may impede or promote implementation. The primary aim of this systematic review is to describe factors (barriers and facilitators) that may influence the implementation of menu dietary guidelines regarding food provision in centre-based childcare services and to map these factors to a theoretical framework. Over 7000 citations were identified from all sources. Duplicate abstracts were removed and selection criteria applied. Twelve studies (1994-2015) were included in the review. Dual data extraction was conducted and the reported factors were synthesised using the theoretical domains framework (TDF). Barriers and facilitators identified in qualitative studies were classified into 8 and 10 of the 14 TDF domains. Barriers and facilitators reported in quantitative studies covered 6 and 3 TDF domains respectively. The most common domain of which both barriers and facilitators to the implementation of menu dietary guidelines were identified was 'environmental context and resources'. This is the first study that comprehensively assesses literature to identify factors that influence the implementation of menu dietary guidelines in childcare services utilising a theoretical framework. Findings provide guidance to support researchers and policy makers design strategies to improve menu dietary guideline implementation and, as such have the potential to improve food provision in care.
Start Date: 04-2018
End Date: 09-2022
Amount: $330,000.00
Funder: Australian Research Council
View Funded Activity