Process and impact evaluation of the Romp & Chomp obesity prevention intervention in early childhood settings: lessons learned from implementation in preschools and long day care settings.
BACKGROUND
The Romp & Chomp controlled trial, which aimed to prevent obesity in preschool Australian children, was recently found to reduce the prevalence of childhood overweight and obesity and improve children's dietary patterns. The intervention focused on capacity building and policy implementation within various early childhood settings. This paper reports on the process and impact evaluation of this trial and the lessons learned from this complex community intervention.


METHODS
Process data was collected throughout and audits capturing nutrition and physical activity-related environments and practices were completed postintervention by directors of Long Day Care (LDC) centers (n = 10) and preschools (n = 41) in intervention and comparison (n = 161 LDC and n = 347 preschool) groups.


RESULTS
The environmental audits demonstrated positive impacts in both settings on policy, nutrition, physical activity opportunities, and staff capacity and practices, although results varied across settings and were more substantial in the preschool settings. Important lessons were learned in relation to implementation of such community-based interventions, including the significant barriers to implementing health-promotion interventions in early childhood settings, lack of engagement of for-profit LDC centers in the evaluation, and an inability to attribute direct intervention impacts when the intervention components were delivered as part of a health-promotion package integrated with other programs.


CONCLUSIONS
These results provide confidence that obesity prevention interventions in children's settings can be effective; however, significant efforts must be directed toward developing context-specific strategies that invest in policies, capacity building, staff support, and parent engagement. Recognition by funders and reviewers of the difficulties involved in implementing and evaluating such complex interventions is also critical to strengthening the evidence base on the effectiveness of such public health approaches to obesity prevention.
Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population Health, The University of Melbourne, Carlton, Australia. andreams@unimelb.edu.au
Andrea M
AM
de Silva-Sanigorski
Andrew C
AC
Bell
Peter
P
Kremer
Janet
J
Park
Lisa
L
Demajo
Michael
M
Smith
Sharon
S
Sharp
Melanie
M
Nichols
Lauren
L
Carpenter
Rachel
R
Boak
Boyd
B
Swinburn
D001315:Australia; D057191:Capacity Building / Q000379:methods*; D002656:Child Day Care Centers; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004032:Diet / Q000379:methods*; D061345:Early Medical Intervention / Q000379:methods*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009765:Obesity / Q000517:prevention & control*; D010988:Play and Playthings; D012578:Schools, Nursery