Food provision in long day care requires a multilevel approach to optimise health and developmental outcomes for young children
Date of Award
Edith Cowan University
Doctor of Philosophy
School of Medical and Health Sciences
In 2022, 1.4 million children in Australia attended early childhood education and care (ECEC) services, of which at least 25% were overweight or obese. Poor nutrition in the early years affects a child’s health and development trajectory. Long day care (LDC) is a unique setting in which a nationally coordinated approach could optimise nutrition for children. The aim of this research was to accurately measure food provision and explore how director and cook behaviours influence menu compliance and whether members of a community of practice (CoP) undertake knowledge-brokering activities to advocate food provision quality in LDC.
Research was completed in three phases. Phase 1: Determined food provision compliance of LDC compared with 50% of the Australian Dietary Guidelines (ADGs) for children aged two to three years. Raw food ingredients were weighed for one meal and two snacks over two days in 30 metropolitan LDC centres in Western Australia. Ingredient weights and cost were entered into Foodworks 8.0.3. Data and then exported to R (version 3.4.2). A one-sample t-test compared the LDC mean servings of core food groups and discretionary foods against 50% of ADG recommendations. Macro/micronutrients were compared with 50% of relevant nutrient reference values. Phase 2: Used theoretical domains framework (TDF) to determine behaviour domain differences of directors and cooks in achieving compliant menus. An online survey was emailed to 4,913 LDC centres. Seven-point Likert scale scores were summed and averaged for each domain and the mean ranks compared the behaviour domain scores between cooks and directors using the Mann–Whitney U test. General linear modelling was used to adjust for age and education. Phase 3: Identified knowledge-brokering activities undertaken by National Nutrition Network members in the formation of a CoP. A convenience sample of members completed a checklist and were interviewed at two time points. Content analysis determined the frequency of 40 knowledge-brokering tasks. Interviews were transcribed, uploaded to NVivo and thematically analysed.
Results: Phase 1: 10% of the LDC services provided 50% of all food groups when compared with the ADGs. Saturated fats, sodium and discretionary foods were significantly overprovided. Phase 2: 166 participants completed surveys (director [n = 102] or cook [n = 64]). An adjusted analysis found ‘professional role and identity’, ‘beliefs about capabilities’ and ‘skills’ differed significantly between roles. Cooks were confident in menu planning, saw it as a part of their role and had skills to plan a menu, unlike directors. However, directors felt time and financial resources were provided to do this task, more so than cooks. Phase 3: At Timepoint 1, 10 checklists and 13 interviews; Timepoint 2, 13 checklists and 22 interviews, had been completed. Linkage and exchange and knowledge management domains were most frequently identified at the two timepoints.
Food provision guidelines were not met for all food groups by 90% of LDC services. Cooks reported having the skills and confidence to plan compliant menus more than directors yet identified a lack of support, time and resourcing to do this. Members of a national network that formed a CoP were knowledge brokers and the first of their kind in Australia to support a coordinated approach to improving food provision in ECEC, aiming to positively affect the health and developmental outcomes of children and contribute to broader public health efforts to reduce overweight and obesity in Australian children.
Access to this thesis is embargoed until 7th November 2025.
Sambell, R. (2023). Food provision in long day care requires a multilevel approach to optimise health and developmental outcomes for young children. Edith Cowan University. https://doi.org/10.25958/2ttg-vb97