Adaptation and evaluation of a nutrition and physical activity program for early childhood education settings in Aboriginal and Torres Strait Islander communities in remote Far North Queensland.

ISSUE ADDRESSED: Good nutrition, physical activity and adequate sleep are essential for the healthy growth and development of young children. Due to complex cultural, historical, social factors, Aboriginal and Torres Strait Islander children face additional challenges to optimal health, particularly in remote areas of Australia. 'Learning, Eating, Active Play and Sleep' (LEAPS) was a Queensland-wide professional development program designed to support early childhood education and care (ECEC) educators to implement and reinforce healthy nutrition and physical activity in their services. This article describes the adaptation, implementation and evaluation of LEAPS for remote ECEC settings in Cape York. METHODS: An Aboriginal and Torres Strait Islander Reference Group was commissioned to provide advice about the appropriateness of the existing program for Aboriginal and Torres Strait Islander ECEC settings. Based on the advice of the Reference Group, the program was adapted for use in Cape York and was evaluated using the RE-AIM framework and a combination of data sources. Quantitative data provided information about changes to participant knowledge and confidence regarding nutrition and physical activity and in-depth interviews allowed further insights into enablers and challenges for successful program implementation. CONCLUSION: A tailored LEAPS program increased participants' knowledge and confidence regarding nutrition and physical activity in ECEC settings. The importance of community consultation, building relationships and face-to-face delivery of training were highlighted as key enablers. The evaluation identified a number of challenges relating to competing priorities, limited support for ongoing implementation and adoption of improved practices. SO WHAT?: Poor nutrition and growth in children in remote Aboriginal and Torres Strait Islander communities indicates the need for the ongoing commitment to and investment in nutrition and physical activity across a range of community settings. To achieve success, this requires a dedicated preventative health workforce supporting evidence-informed, coordinated programs driven by community priorities and developed via community development approaches.

Healthy Choice Rewards: A Feasibility Trial of Incentives to Influence Consumer Food Choices in a Remote Australian Aboriginal Community.

Poor diet including inadequate fruit and vegetable consumption is a major contributor to the global burden of disease. Aboriginal and Torres Strait Islander Australians experience a disproportionate level of preventable chronic disease and successful strategies to support Aboriginal and Torres Strait Islander people living in remote areas to consume more fruit and vegetables can help address health disadvantage. Healthy Choice Rewards was a mixed methods study to investigate the feasibility of a monetary incentive: store vouchers, to promote fruit and vegetable purchasing in a remote Australian Aboriginal community. Multiple challenges were identified in implementation, including limited nutrition workforce. Challenges related to the community store included frequent store closures and amended trading times, staffing issues and poor infrastructure to support fruit and vegetable promotion. No statistically significant increases in fruit or vegetable purchases were observed in the short time frame of this study. Despite this, community members reported high acceptability of the program, especially for women with children. Optimal implementation including, sufficient time and funding resources, with consideration of the most vulnerable could go some way to addressing inequities in food affordability for remote community residents.