Understanding the translation of evidence-based nutrition practice into daily routines in centre-based childcare

Author: Louisa Matwiejczyk

Matwiejczyk, Louisa, 2020 Understanding the translation of evidence-based nutrition practice into daily routines in centre-based childcare, Flinders University, College of Nursing and Health Sciences

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Purpose: Society is judged by how well it supports its most vulnerable, particularly the very young. According to the United Nations Convention of the Rights of the Child (UNCRC), to which Australia is a signatory, a fundamental right of every child is entitlement to healthy nutrition, the conditions that support this and the prevention of non-communicable diseases. However, in Australia, not all children obtain this with a substantial proportion of children consuming poor diets and one in five children up to the age of four being overweight or obese. Despite considerable public health efforts to promote healthy eating and prevent obesity, children’s diets and obesity prevalence are getting worse. As such children do not enjoy their rights to the fullest attainment of health.

What children eat, their food preferences and nutrition-related behaviours are shaped by multifarious factors, including the environment they live in and the influence of those around them. Traditionally, this influence has primarily been the family setting but over the last 30 years changes to mothers’ workforce participation has seen most Australian children cared for in non-parental childcare. In this setting, children can receive up to two-thirds of their daily nutrition. Consequently, centre-based childcare has become an important setting for influencing children’s lifelong healthy eating patterns at an influential developmental age.

Many positive dietary outcomes have been attributed to interventions in centre-based childcare. However, the translation of nutrition best practices into day-to-day routines is better achieved when expert or researcher led and less well achieved when left to the early education and care sector to enact. Little is known about the barriers or implementation drivers that contribute to this evidence-to-practice gap or the perspectives of childcare personnel who implement these practices.

To better enable centre-based childcare services, researchers, policymakers and public health planners address this evidence-to-practice gap in the early education and care sector (EEC), this study aimed to (1) investigate the barriers and facilitators to translating evidence-based nutrition best practice into daily routines and (2) examine to what extent centre-based childcare services support children’s rights to optimal nutrition and healthy food environments.

Method: Using the Ecological Model of Health Behaviour as a theoretical framework, qualitative research informed by grounded theory was undertaken. Interviews included cooks (n=14), directors (n=13) and influential decision-makers (n=7) from 33 centre-based childcare services in South Australia, using maximum variation sampling. Guided by the Child Rights Situation Analysis framework, the findings from the thematic analysis of the three empirical studies, and an umbrella review of 12 systematic reviews, were further examined using a child rights-based approach.

Results: Findings from this research identified some novel determinants at the individual, centre, institutional and societal levels of influence which impacted the centre-based childcare environment and decision-making of cooks, directors and influential decision-makers. Acting as both barriers and implementation drivers, these determinants influenced the food, social and information environment and underpinning systems. Unique to this research was the national accreditation system, which drove continuous improvement and shaped childcare providers’ beliefs, nutrition-related decisions and practices as well as influencing enabling environments. Structural factors crucial to this were the role of the directors, as well as having a designated cook. Directors determined the centre’s strategies which the cooks and educators operationalised, whereas designated cooks ensured healthy food provision.

Nevertheless, these enablers were under threat and unsustainable. Threatening these positive practices were: constraints as a result of the NQS’ limitations on the enactment of nutrition best practice; an absence of pre-requisite, system-wide professional development; a lack of nationally consistent supporting resources and menu planning guidelines; increasing societal-driven demands threatening the sustainability of having cooks; and dissonance where the salutogenic approach of the NQS and early education and care sector policy objectives intersected with nutrition policy objectives. As such, nutrition best practice is enacted from goodwill and the positive practices seen are unsustainable.

Moreover, it would appear from the Child Rights Situation Analysis that children in childcare do not have the conditions and services needed for them to fully realise their nutrition-related rights. Governments have the authority and the resources to support centres but do not take responsibility for fulfilling their UNCRC obligations. Whereas, centre-based childcare services and supporting organisations, have the authority but not the resources and motivation is equivocal. As such, both governments and the early education and care sector are not providing the conditions and services needed for our children to achieve their fullest attainment of health.

Implications: The significance of this research is that the relevant UNCRC provisions can be invoked to mobilise governments, the EEC sector, policymakers and public health planners to strengthen the conditions and services needed to support children’s nutrition. Findings from the research undertaken as part of this doctorate informs policymakers, program planners and the early childhood sector on strategies to maximize the translation of nutrition best practice into daily routines. A greater understanding ensures better targeted investment in policy and healthy eating interventions in the early childhood sector. Improving conditions and services requires a comprehensive approach involving a range of strategies, underpinned by the NQS and the UNCRC so that decisions are weighted in favour of realising children’s rights including their entitlements to good health. To create and sustain these conditions, a culture must exist where child nutrition and children’s rights, to the fullest attainment of health, are prioritised. As such, there is an urgency to prioritise nutrition within the EEC policy environment and establish relevant system-level support, training and strategies.

Conclusion: Overall, as a society we are failing our children. In partnership with parents, centre-based childcare services are the ideal ‘protective places’ for creating the conditions and services for children to develop lifelong healthy eating habits and prevent obesity. For positive practices to be sustained and further gains made, it is imperative that governments support and resource the early education childhood sector to fulfil children’s rights to health. The process of increasing the capacity of duty-bearers to achieve children’s rights is as important as the outcome. As a signatory to the UNCRC, governments have the responsibility to implement all measures to fulfil children’s nutrition-related rights and to prioritise it. Given the phenomena of childcare in other similar countries, findings from this research may be relevant to governments and the early childhood sector internationally or in similar settings. Ensuring healthy food provision and learning environments for lifelong, healthy eating is a worthy investment in our children’s national health and education.

Keywords: healthy diet, child care, pre-schooler, obesity prevention, nutrition policy, ecological model theory, translation

Subject: Nutrition thesis

Thesis type: Doctor of Philosophy
Completed: 2020
School: College of Nursing and Health Sciences
Supervisor: Professor John Coveney