Development of an initiative package to promote children’s vegetable intake in child care

The overall project will undertake the three phases of the Multiphase Optimisation Strategy (MOST) study design to develop and evaluate a multicomponent initiative package to increase children’s vegetable intake in long day care. The Preparation Phase will develop the three initiatives for increasing children’s vegetable intake in long day care which target changes to food provision via increasing vegetables on the menu, delivery of experiential and sensory curriculum activities and use of supportive feeding practices at mealtimes. The Optimisation Phase will assess the the independent and synergistic effects of the initiatives to identify the optimal initiative package. The Evaluation Phase (described in separate trial registration) will test the effectiveness of the final initiative package. FOOD PROVISION The food provision initiative will support cooks to increase the provision of vegetables on the menu across all eating occasions. Cooks will complete an online training module, use an online menu planning tool, developed by dietitians, to review their menu and implement the revised menu. The training will take approximately 45-55 minutes to complete and covers menu planning, importance of healthy eating, implementing menu guidelines and overcoming common barriers. Cooks will use an automated online menu assessment tool to assess compliance of their menu with guidelines. There are currently no South Australian guidelines, therefore Victorian Menu Planning Guidelines will be used. Cooks will enter their current menu, recipes, and number of children for whom their menu caters and will receive an overview of compliance of the menu with guidelines for each food group. Recommendations by food group will be provided, identifying meal occasions (morning snack, lunch, and afternoon snack) and days where the menu needs to be revised the menu to meet guidelines. Cooks will have 4 weeks to complete training, the menu assessment and revise their menu according to the recommendations provided before implementing the revised menu at their next menu change. The revised menu will be evaluated after 8 weeks. Completion of the online training and menu assessment will be monitored using website analytics and questionnaires conducted with cooks at 12-week follow up. MEALTIME ENVIRONMENT The mealtime environment initiative will support educators to use practices at mealtimes that promote children’s vegetable acceptance and intake. The initiative will aim to increase educator’s knowledge and skills to use feeding practices at mealtimes that will promote vegetable familiarisation via repeated exposure and opportunities to try vegetables. Educators will complete an interactive online training module (~45-55 minutes) developed by dietitians, which includes topics about the role of the educator in fostering children’s vegetable knowledge and acceptance, how to create a supportive meal time environment, use of feeding practices, overcoming barriers related to food rejection and how to plan, implement and monitor a strategy to within their centre. The training module will promote strategies to increasing vegetable acceptance and intake within the context of creating a mealtime environment which is supportive for increasing overall healthy eating. Educators will have 4 weeks to complete the training and will then apply the knowledge and strategies learnt during mealtimes over 8 weeks. Completion of the online training and use feeding practices at mealtimes will be monitored via questionnaires at 12-week follow-up. CURRICULUM The curriculum initiative will consist of a lesson package for educators that aims to provide opportunities for children to learn about, try and enjoy vegetables by increasing their exposure to a variety of familiar and unfamiliar vegetables. The initiative is based on experiential learning, sensory education, and insights on vegetable preference development in children. The curriculum will be adapted from the evidence-based Taste & Learn vegetable education curriculum for primary school children (aged 5-12 years) to be suitable for younger children and align with The Early Years Learning Framework. The curriculum was developed by dietitians, early years learning experts and sensory scientists. The curriculum will consist of a series of 16 short (~10-20min) lessons and hands-on activities delivered during intentional teaching time, a series of 16 snack time occasions where vegetables will be tasted, supporting resources and activities (e.g. reading corner, songs) and a group reward chart to track progress of vegetables tasted. Educators will be provided with written background information and lesson plans. Educators will have 4 weeks to prepare to teach and will then teach the curriculum over 8-weeks. Delivery of the curriculum will be evaluated via a detailed checklist at 12-week follow-up.