Evaluation of a menu box delivery service to improve menu compliance and child vegetable intake in Australian long day cares

Author: Shabnam Kashef

Kashef, Shabnam, 2022 Evaluation of a menu box delivery service to improve menu compliance and child vegetable intake in Australian long day cares, Flinders University, College of Nursing and Health Sciences

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Dietary patterns established in childhood continue into adulthood and, if healthy, contribute to the prevention of disease later in life. National Australian surveys demonstrate that on average, neither children nor adults are meeting the Australian Dietary Guidelines. In particular, vegetable consumption remains poor. Children spend a considerable amount of time in early childhood education and care settings. Long day care (LDC) centres that serve meals on site present an opportune setting to target children’s eating behaviours at a stage of life where these behaviours are malleable. Analysis of Australian childcare centre menus shows that many are failing to meet menu planning guidelines for many food groups. Cooks report a number of key barriers to implementing menu planning guidelines, including lack of time, budget, knowledge and confidence. This warrants the exploration of an innovative food service model to support menu compliance and child dietary intake in these settings.

Thesis Aim

The aim of this study was to develop, implement and evaluate the impact of a menu box delivery service tailored to the LDC setting on the food provision and intake, including vegetable intake, of children aged 2–5 years.


An eight-week cluster randomised controlled trial was conducted across eight South Australian LDC centres. A menu box delivery service (intervention centres, n = 4) was compared with an Online Cook Training and Menu Assessment Tool (standard practice for comparison centres, n = 4). The trial outcomes included menu compliance and cook feedback, child dietary provision and consumption (measured via plate waste). A within-trial economic evaluation was also conducted. Centre menus were assessed against the menu planning guidelines and cook feedback was collected via interviewer-administered questionnaires. Feedback was coded into themes. Child dietary outcomes were measured via plate waste separated into food groups based on the menu planning guidelines. The economic evaluation analyses included a cost-effectiveness analysis, cost-consequence analysis and a budget impact analysis from the centre and service provider perspective.


Comprehensive dietary data were collected from 224 children at follow up across four intervention (n = 98) and four comparison (n = 126) centres. At follow up, intervention centre menus exceeded menu planning guidelines for vegetables (2.0 ± 0.7 serves). No significant differences were found in the median number of serves/day between intervention and comparison centres, for provision (intervention, 0.9 inter-quartile range [IQR] 0.7–1.2; comparison, 0.8 IQR 0.5–1.3) or consumption (intervention, 0.5 IQR 0.2–0.8; comparison, 0.5 IQR 0.3–0.9) of vegetables. Cooks and directors in the comparison group found the training and Menu Assessment Tool unrealistic to complete within time constraints. Intervention centre directors and cooks enjoyed the order and delivery process for the menu box delivery service. However, food preparation following the recipes was perceived to be time consuming and inappropriate for the setting. The total cost of the intervention menu ($4.62/child/day, 95% confidence interval [CI] $4.58, $4.67) over the eight-week study period was higher than the menu cost in comparison centres ($2.28/child/day, 95% CI $2.27, $2.30).


To the best of the PhD candidate’s knowledge, there is no evidence in the literature regarding the use of a menu box delivery style food service model in a LDC centre. The innovative combination of sector guidelines and an emerging food model could support longer-term, sustainable improvements in centre menu compliance. Overall, the outcomes of this study show that although menu compliance can be improved via a menu delivery service, impacts of mealtime provision and consumption in children were similar for intervention and comparison groups. While cooks and directors were positive about the order and delivery process for the menu box delivery service, more work is required to ensure that recipes and costs are appropriate for LDC settings. This study provides a comprehensive evaluation of the novel food service model and highlights elements for improvement.

Keywords: childcare, nutrition, child nutrition, long day care, dietary intake, economic evaluation, public health, public health nutrition, diet quality, health economics, community health, randomised controlled trial, cluster randomised controlled trial

Subject: Nutrition thesis

Thesis type: Doctor of Philosophy
Completed: 2022
School: College of Nursing and Health Sciences
Supervisor: Rebecca Golley