title: A pragmatic randomised controlled trial of an implementation intervention to increase healthy eating and physical activity-promoting policies, and practices in centre-based childcare services: study protocol.
abstract: BACKGROUND
  Promotion of healthy eating and physical activity in early childhood is recommended as a global chronic disease prevention strategy. Centre-based childcare services represent a promising setting to provide children with opportunities to improve healthy eating and physical activity. Evidence to inform implementation of childcare obesity prevention guidelines into routine practice in childcare, however, is lacking. This study aims to assess the effectiveness of an intervention, delivered to childcare staff, aiming to increasing service implementation of healthy eating and physical activity-promoting policies and practices.
  
  
  METHODS
  A pragmatic parallel group randomised controlled trial will be undertaken with 165 childcare services in the Hunter New England region of New South Wales, Australia. Services will be randomised to receive either a 10-month evidence-based performance review intervention with other resources to support practice change, or to a waitlist control group. The primary trial outcome is the proportion of services implementing all of the following recommended healthy eating and physical activity promoting practices: written nutrition, physical activity and small screen recreation policies; providing information to families regarding healthy eating (including breastfeeding), physical activity and small screen time; providing twice weekly healthy eating learning experiences to children; providing water and only plain milk to children; providing fundamental movement skills activities for children every day; and limiting and using electronic screen time more for educational purposes and learning experiences. Effectiveness will be assessed using a telephone interview of practice implementation with childcare staff at baseline and 12 months following baseline.
  
  
  BACKGROUND
  The study was approved by the Hunter New England Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee. Study findings will be disseminated widely through peer-reviewed publications and conference presentations.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12614000972628.
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Meghan
authors.initials: M
authors.lastname: Finch
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Sze Lin
authors.initials: SL
authors.lastname: Yoong
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Thomson
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Kirsty
authors.initials: K
authors.lastname: Seward
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia.
authors.forename: Mairead
authors.initials: M
authors.lastname: Cooney
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Jannah
authors.initials: J
authors.lastname: Jones
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Fielding
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Wiggers
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Gillham
authors.affiliation: Hunter New England Population Health, Newcastle, New South Wales, Australia School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors.forename: Luke
authors.identifier: http://orcid.org/0000-0002-6178-3868
authors.initials: L
authors.lastname: Wolfenden
mesh_terms: D001315:Australia / Q000453:epidemiology; D002648:Child; D002656:Child Day Care Centers / Q000458:organization & administration; D002662:Child Health Services / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D018673:Nutrition Policy; D009752:Nutritional Status; D016134:Organizational Policy; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D011634:Public Health
keywords: NUTRITION & DIETETICS; PUBLIC HEALTH