ANZCTR - Registration

The ANZCTR website will be unavailable from 1pm until 3pm (AEDT) on Wednesday the 30th of October for website maintenance. Please be sure to log out of the system in order to avoid any loss of data.

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been endorsed by the ANZCTR. Before participating in a study, talk to your health care provider and refer to this information for consumers

Trial registered on ANZCTR

Registration number

ACTRN12616000974404

Ethics application status

Approved

Date submitted

20/06/2016

Date registered

25/07/2016

Date last updated

10/09/2018

Type of registration

Prospectively registered

Titles & IDs

Public title

The effect of a web-based, menu planning intervention on childcare provision of food in line with dietary guidelines

Scientific title

A randomised controlled trial of an online menu-planning intervention to improve childcare service adherence to dietary guidelines

Secondary ID [1]

Nil known

Universal Trial Number (UTN)

Trial acronym

Linked study record

Health condition

Health condition(s) or problem(s) studied:

dietary intake

Condition category

Condition code

Public Health

Health promotion/education

Public Health

Health service research

Diet and Nutrition

Obesity

Intervention/exposure

Study type

Interventional

Description of intervention(s) / exposure

The intervention is an online menu planning tool, that is incorporated within the usual mandatory web-based reporting systems of Australian childcare centres (childcare management software (CCMS)). It will primarily target menu planners (i.e. cooks) and childcare service managers, and seek to ensure that foods provided by childcare services adhere with dietary guidelines consistent with accreditation standards for the sector.

The intervention will be delivered across approximately 12 months and specifically target menu planners and service supervisors.
The components of the intervention are as below:
a) Automated menu planning and decision support: The web-based program will enable menu planners to undertake electronic meal planning by selecting pre-entered recipes or adding new meals/snacks into the menu planning tool. The program will provide an automated assessment of menu adherence to dietary guidelines, based on the meal combinations entered food combinations included in menu plans and calculate the number of serves provided from of each of the food groups according to the Australian Dietary Guidelines. Information on child allergies already entered into the CCMS software will also be used to ensure meal plans support overall service needs.

b) Feedback, prompts and reminders: The program will provide menu planners with real time feedback on the number of food groups on their menu and whether that meets dietary guidelines. Cooks will be supported to identify relevant meal/snack ideas or substitutions to enable menu adherence. Where menus do not adhere to the guidelines or where services are not engaging, an alert will appear on the front page linked to the CCMS reporting section, prompting service managers to discuss these with menu planners and encourage amendment.

c) Communication strategies and managerial support: Each service's daily menu will be automatically displayed to parents of children attending care via the parent portal of the CCMS software. Daily reports of adherence can also be generated and displayed in the service. To facilitate broad support for healthy meal provision, service managers will be prompted to send parents and service staff evidence-based information regarding child nutrition. They will also communicate service responsibilities to serve food consistent with guidelines and promote the benefits of good nutrition on child health, behaviour and well-being. Service managers will be encouraged to demonstrate their support and endorsement of guideline adherence to menu planners and other service staff.

d) Training and support to use new systems: Technical support will be provided to services to introduce the system, and troubleshoot any problems related to use. Specifically, one face-to-face half-day training session with menu planners and services managers will be undertaken by health promotion staff with relevant health qualifications. This training will provide information related to the updated childcare specific guidelines, demonstrate use of the web based program and answer any queries services may have in relation to adherence to guidelines as well as provide support to use the program to change/update their menus. Across the 12 months, depending on needs, services will also receive three additional telephone contacts (support calls will vary in duration between 15 -45 minutes) by support staff primarily to identify and address any impediments to use, and be offered online telephone training if required. Services will be sent one newsletter promoting the online program. Services will also be able to access general technical support as well as menu planning support via the 'Help-desk' of the CCMS program already used by service for all other general queries with the program. All queries will be responded to online by health service staff with knowledge of the program and menu guidelines.

e) Other online resources: Additional resources including useful tips to engage with the system, fact sheets about menu planning, sample menus, nutrition policies and other useful resources will be made available via the online program.

f) Provision of portable tablets: All intervention services will be supplied with a tablet to maximise integration of the system and allow portable access to the program during meal preparation.

The support staff will log the delivery and brief content of each support call on a monitoring spreadsheet. The research team will also have access to an electronic log of the frequency and duration of service login into the web-based program.

Intervention code [1]

Prevention

Comparator / control treatment

The control group will continue to access their usual CCMS software and will not receive any additional support from the research team. Services will not receive access to the menu planning program until after the follow up period (approximately 12-15 months post baseline data collection).

Control group

Active

Outcomes

Primary outcome [1]

Primary trial outcome measure – Menu adherence to sector specific guidelines (number of food groups where service menus meets the recommendations of guidelines): The primary outcome of the trial will be the mean number of food groups on the menu that meet dietary guideline recommendation. According to the guidelines for the sector, childcare menus need to provide at least 50% of the recommended number of serves for the following food groups: i) fruit (1 serve), ii) vegetables and legumes/beans (2 serves), iii) wholegrain cereal foods and breads (2 serves), iv) milk, yoghurt, cheese (and/or alternatives) (1 serve), v) lean meat and poultry, fish, eggs, tofu, seeds and legumes (0.75 serves) vi) and no discretionary foods. Each service will receive a possible score out of six. Adherence will be assessed via a comprehensive one-week menu review by a dietitian or nutritionist, the recommended practice for assessing usual food provision. Information regarding food recipes, number of children each recipe caters for and product information will be collected by the research team. Each service’s one-week menu will be entered into the web-based menu planning tool, which will calculate menu adherence.

Timepoint [1]

Baseline and approximately 3 and 12 months post intervention (12 months is the primary time point)

Secondary outcome [1]

Child BMI z-score - Child weight and height (adjusted for age and gender) will be measured by trained research assistants using a digital scale (NUWEIGHT LOF842) and standing stadiometer (Charder HM 200P stadiometers) in a subsample of up to 35 services.

Timepoint [1]

Baseline and approximately 12 months post intervention

Secondary outcome [2]

Child diet while in care will be measured using a repeat cross-sectional design via direct observation for a subsample of up to 35 services. Observations will be undertaken using an adapted version of the validated Dietary Observation for Child Care system food record tool. Two trained and blinded research assistants will be present for core service meal times. For each child, the research assistant will document the types and portion sizes of food and beverages consumed, and observe the spillage and sharing that occurs during meal times. At the end of each meal, children’s plate wastage will also be assessed using a standard protocol adapted from previous studies. Child dietary intake outside of care (assessed via a parent questionnaire) will be collected to assess for potential compensatory dietary behaviours. In addition, childcare educators will complete a brief food intake record about the foods usually eaten by children during care hours.

Timepoint [2]

Baseline and approximately 12 months post intervention

Secondary outcome [3]

Proportion of services providing the appropriate number of wholegrain cereal foods and breads on the menus to meet nutrition guidelines (2 serves). Similar to the primary outcome, adherence will be assessed via a comprehensive one-week menu review by a dietitian or nutritionist, the recommended practice for assessing usual food provision. Each service’s one-week menu will be entered into the web-based menu planning tool, which will calculate food group adherence.

Timepoint [3]