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      A theory-based evaluation of a dissemination intervention to improve childcare cooks’ intentions to implement nutritional guidelines on their menus

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          Abstract

          Background

          Childcare services represent a key setting to implement nutritional interventions to support the development of healthy eating behaviours in young children. Childcare-specific nutritional guidelines outlining recommendations for provision of food in care have been developed. Despite this, research suggests that few childcare services currently implement these guidelines. This study aimed to examine the impact of providing printed educational materials on childcare service cooks’ intentions to use nutritional guidelines and provide fruit and vegetables on their menu.

          Findings

          A randomised controlled trial was conducted with 77 childcare services (38 control and 39 intervention). Intervention service cooks were mailed a two-page educational material together with a menu planning checklist. Intervention development and evaluation was guided by the theory of planned behaviour. Outcome data assessing intentions to use nutritional guidelines and serves of fruit and vegetables provided on menus (primary outcomes) as well as secondary outcomes (attitudes, behavioural regulation and social norms) were collected via a telephone interview with cooks. Relative to the comparison group, cooks in the intervention arm had significantly higher intentions to use the guidelines ( p value 0.0005), accompanied by significant changes in perceived behavioural control ( p value 0.0008) and attitudes ( p value 0.0071). No significant difference in serves of fruit ( p value 0.7278) and vegetables ( p value 0.0573) was observed.

          Conclusions

          The use of educational materials can improve childcare service cooks’ intentions to use nutritional guidelines; however, as a standalone strategy, it may not improve provision of food on menus.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s13012-016-0474-7) contains supplementary material, which is available to authorized users.

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          Most cited references12

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          The theory of planned behavior

          Icek Ajzen (1991)
          Organizational Behavior and Human Decision Processes, 50(2), 179-211
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            Translating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines.

            To recommend effective strategies for implementing clinical practice guidelines (CPGs). The Research and Development Resource Base in Continuing Medical Education, maintained by the University of Toronto, was searched, as was MEDLINE from January 1990 to June 1996, inclusive, with the use of the MeSH heading "practice guidelines" and relevant text words. Studies of CPG implementation strategies and reviews of such studies were selected. Randomized controlled trials and trials that objectively measured physicians' performance or health care outcomes were emphasized. Articles were reviewed to determine the effect of various factors on the adoption of guidelines. The articles showed that CPG dissemination or implementation processes have mixed results. Variables that affect the adoption of guidelines include qualities of the guidelines, characteristics of the health care professional, characteristics of the practice setting, incentives, regulation and patient factors. Specific strategies fell into 2 categories: primary strategies involving mailing or publication of the actual guidelines and secondary interventional strategies to reinforce the guidelines. The interventions were shown to be weak (didactic, traditional continuing medical education and mailings), moderately effective (audit and feedback, especially concurrent, targeted to specific providers and delivered by peers or opinion leaders) and relatively strong (reminder systems, academic detailing and multiple interventions). The evidence shows serious deficiencies in the adoption of CPGs in practice. Future implementation strategies must overcome this failure through an understanding of the forces and variables influencing practice and through the use of methods that are practice- and community-based rather than didactic.
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              Australian dietary guidelines

              (2013)
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                Author and article information

                Contributors
                Serene.Yoong@hnehealth.nsw.gov.au
                Jannah.Jones@hnehealth.nsw.gov.au
                jmarshall9@hotmail.com
                John.Wiggers@hnehealth.nsw.gov.au
                Kirsty.Seward@hnehealth.nsw.gov.au
                Meghan.Finch@hnehealth.nsw.gov.au
                Alison.Fielding@hnehealth.nsw.gov.au
                Luke.Wolfenden@hnehealth.nsw.gov.au
                Journal
                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                1748-5908
                25 July 2016
                25 July 2016
                2015
                : 11
                : 105
                Affiliations
                [1 ]Hunter New England Population Health, Wallsend, New South Wales 2287 Australia
                [2 ]School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales 2308 Australia
                [3 ]Hunter Medical Research Institute, Newcastle, New South Wales 2300 Australia
                [4 ]Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales 2308 Australia
                Article
                474
                10.1186/s13012-016-0474-7
                4960853
                27457651
                cf72aca2-10cc-4d7c-bfe7-8102fb4f14b0
                © Yoong et al. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 December 2015
                : 16 July 2016
                Categories
                Short Report
                Custom metadata
                © The Author(s) 2016

                Medicine
                dissemination,guideline,childcare services,nutrition
                Medicine
                dissemination, guideline, childcare services, nutrition

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