"I'm not sure whether I will implement it": exploring barriers and facilitators to implementing a digital "healthy eating" resource in early education and care settings - teachers' perspectives.

BACKGROUND: Scaling up effective interventions to promote healthy eating habits in children in real-world settings is a pressing need. The success of implementation hinges crucially on engaging end-users and tailoring interventions to meet their specific needs. Building on our prior evaluation of a digital "healthy eating" resource for early childhood education and care (ECEC) staff; this qualitative study aims to pinpoint the barriers and facilitators that influence the successful implementation of such interventions. METHODS: We conducted twelve semi-structured interviews with ECEC teachers in a Norwegian municipality. Interview participants were later invited to participate in focus groups where two discussions were conducted with five of the participants to reflect on the initial interview findings. Thematic analysis, facilitated by NVivo software, was employed to analyse the data, aiming to identify and summarize teachers' subjective experiences and perspectives. RESULTS: Teachers' perceptions of barriers to the implementation of an upcoming digital "healthy eating" resource included: (1) No established tradition of using digital resources at work; (2) Uncertainty regarding the achievable outcomes of implementation; (3) Perception of the new "healthy eating" resource as cooking-focused and unnecessary; and (4) Hectic everyday life serving as a barrier to the long-term use of a digital resource. Facilitators for implementation included: (1) A user-friendly format; (2) Newsletters featuring seasonal tips inspire and serve as effective reminders; (3) Emphasis on research and legislation; and (4) Structuring the resource as a series and an idea bank. CONCLUSIONS: The findings underscore the essential need for tailored strategies and comprehensive support structures to successfully implement a culturally appropriate digital "healthy eating" resource for ECEC staff, ensuring effectiveness and feasibility. TRIAL REGISTRATION: This study was not registered in a trial registry as it is not a clinical trial or intervention study but serves as a pilot for the Nutrition Now study, trial identifier ISRCTN10694967 ( https://doi.org/10.1186/ISRCTN10694967 ), registration date: 19/06/2022.

Staff feeding practices, food neophobia, and educational level in early education and care settings: A cross-sectional study.

Feeding practices in early childhood education and care (ECEC) settings are important for the development of healthy eating habits early in life. However, there is limited research on feeding practices among ECEC staff working with infants and toddlers, and how these practices relate to staff education. This study assessed the feeding practices, level of food neophobia, and participation in shared meals among ECEC staff, and examined whether there were differences in feeding practices related to education and shared meals. Furthermore, we explored the association between food neophobia levels among ECEC staff and their respective feeding practices in ECEC. In total, 130 ECEC teachers and other staff from two Norwegian ECEC trials completed a questionnaire about feeding practices and level of food neophobia. Our results showed that ECEC staff commonly used modelling and encouraging balance and variety feeding practices, but used food as a reward and emotion regulation less often. These practices differed by staff educational level, favoring highly educated staff. We found that more than half of ECEC staff ate lunch together with the children every day, and those who did so used positive feeding practices (encouraging balance and variety and modelling) more than those who did not eat with children; however, they also used restriction for health more often. Higher scores on food neophobia were associated with less use of emotion regulation and restriction for health when adjusted for relevant variables. In conclusion, our results show there is potential to improve feeding practices in ECEC, especially focusing on ECEC staff with low education. Suggested ways forward are updating guidelines to cover feeding practices and working on implementing these guidelines.

Wow! They really like celeriac! Kindergarten teachers' experiences of an intervention to increase 1-year-olds' acceptance of vegetables.

Exposure to varied foods in early life is important for short- and long-term health and development. Strategically introducing toddlers to new vegetables is not a common practice in Norwegian kindergartens. Therefore, we developed, conducted, and evaluated a web-based cluster randomised kindergarten intervention, Pre-schoolers' Food Courage 2.0. The purpose of the current qualitative study was to explore kindergarten teachers' experience of implementing this intervention and what they thought facilitated the positive impact of the intervention reported in the quantitative evaluation. Ten individual telephonic interviews with kindergarten teachers who took part in the intervention study were conducted using a semi-structured interview guide. Data were transcribed verbatim and subjected to thematic analysis. Five main themes were identified: 1) One-year-olds love food and renewal of the menus was inspiring; 2) One-year-olds are surprisingly willing to try and accept novel foods; 3) Novel food at meals stimulate social interaction; and 4) The Sapere method is a fun and explorative activity for 1-year-olds. These four themes were the features perceived as the effective elements of the intervention by the kindergarten teachers. The fifth main theme was: 5) Sustained impact on kindergarten teachers' practices and beliefs. The kindergarten teachers found the intervention easy to implement, and they were surprised by the foods 1-year-olds like and how the intervention increased their food acceptance. This age window of opportunity seems to be underused in kindergartens. By using the strategies described in the intervention, kindergarten staff effectively took advantage of this opportunity and consequently, child and kindergarten staff behaviour in relation to food was enhanced. Interventions targeting healthy feeding practices may potentially have a long-term public health impact by increasing food variety and vegetable intake in toddlers. TRIAL REGISTRATION: ISRCTN98064772.

"A bumpy road": Kindergarten staff's experiences with an intervention to promote healthy diets in toddlers.

This study explores the experiences of kindergarten staff with a multi-component kindergarten-based intervention, the aims of which were to reduce levels of food neophobia and to promote healthy diets in toddlers (aged 2-3 years). A qualitative design was chosen for the study, and the data are based on three focus group interviews. Altogether, 15 kindergarten staff were interviewed using a semi-structured interview guide. The focus group interviews were analyzed using qualitative content analysis. Five main themes emerged from the interviews: i) Successful development of sensory knowledge, ii) Food neophobia, iii) Implementing new routines, a challenge for some, iv) Lack of cooking skills, and v) Inspired to continue. A main finding was that all kindergarten staff perceived the sensory education sessions as successful and reported that both toddlers and staff expanded their food vocabulary and increased their attention to sensory impressions of food. However, the staff reported that some toddlers were less willing to taste new lunch dishes than to taste new foods in the sensory education sessions. The staff also noted that the guidelines for feeding practices resulted in unfamiliar situations at the lunch table. The staff agreed that cooking novel foods was time consuming and left less time for other tasks. Finally, all kindergarten staff expressed that they would like to continue with portions of the food intervention. Our main interpretation is that the intervention presented several challenges, especially regarding cooking and feeding practices. If kindergartens are to be a place to promote healthy eating habits in the early years, sufficient time and resources for cooking seem to be needed and food and feeding practices included in the curriculum of kindergartens and higher education for kindergarten teachers. TRIAL REGISTRATION: ISRCTN74823448.

Food neophobia and its association with intake of fish and other selected foods in a Norwegian sample of toddlers: A cross-sectional study.

Reluctance to try novel foods (food neophobia) prevents toddlers from accepting healthy foods such as fish and vegetables, which are important for child development and health. Eating habits established between ages 2 and 3 years normally track into adulthood and are therefore highly influential; even so, there are few studies addressing food neophobia in this age group. This cross-sectional study investigated the relationship between the level of food neophobia and the frequency of toddlers' intake of fish, meat, berries, fruit, vegetables, and sweet and salty snacks. Parents of 505 toddlers completed a questionnaire assessing the degree of food neophobia in their toddlers (mean age 28 months, SD ± 3.5), and frequency of intake of various foods. Food neophobia was rated by the Children's Food Neophobia Scale (CFNS, score range 6-42). Associations between CFNS score and food frequency were examined using hierarchical multiple regression models, adjusting for significant covariates. Toddlers with higher CFNS scores had less frequent intake of vegetables (ß = -0.28, p < 0.001), berries (ß = -0.17, p = 0.002), fruits (ß = -0.16, p < 0.001), and fish (ß = -0.15, p = 0.001). No significant associations were found for CFNS score and frequency of toddlers' intakes of meat or of sweet and fatty snacks. These findings suggest that food neophobia in toddlers is associated with lower diet quality, and indicate a need for intervention studies to address the food neophobia.

Study protocol for a multi-component kindergarten-based intervention to promote healthy diets in toddlers: a cluster randomized trial.

BACKGROUND: There is concern about the lack of diversity in children's diets, particularly low intakes of fruit and vegetables and high intakes of unhealthy processed food. This may be a factor in the rising prevalence of obesity. A reason for the lack of diversity in children's diets may be food neophobia. This study aimed to promote a healthy and varied diet among toddlers in kindergarten. The primary objectives were to reduce food neophobia in toddlers, and promote healthy feeding practices among kindergarten staff and parents. Secondary objectives were to increase food variety in toddlers' diets and reduce future overweight and obesity in these children. METHODS: This is an ongoing, cluster randomized trial. The intervention finished in 2014, but follow-up data collection is not yet complete. Eighteen randomly selected kindergartens located in two counties in Norway with enrolled children born in 2012 participated in the intervention. The kindergartens were matched into pairs based on background information, and randomly assigned to the intervention or control groups. A 9-week multi-component intervention was implemented, with four main elements: 1) kindergarten staff implemented a pedagogical tool (Sapere method) in daily sessions to promote willingness to try new food; 2) kindergarten staff prepared and served the toddlers a cooked lunch from a menu corresponding to the pedagogical sessions; 3) kindergarten staff were encouraged to follow 10 meal principles on modeling, responsive feeding, repeated exposure, and enjoyable meals; and 4) parents were encouraged to read information and apply relevant feeding practices at home. The control group continued their usual practices. Preference taste tests were conducted to evaluate behavioral food neophobia, and children's height and weight were measured. Parents and staff completed questionnaires before and after the intervention. Data have not yet been analyzed. DISCUSSION: This study provides new knowledge about whether or not a Sapere-sensory education and healthy meal intervention targeting children, kindergarten staff, and parents will: reduce levels of food neophobia in toddlers; improve parental and kindergarten feeding practices; improve children's dietary variety; and reduce childhood overweight and obesity. TRIAL REGISTRATION: ISRCTN74823448 DOI 10.1186/ISRCTN74823448.