Evaluation of the effectiveness and implementation of the integrated Healthy Childcare approach

IMPROVING CHILD HEALTH THROUGH AN INTEGRATED APPROACH
The aim of Healthy Childcare is to improve the health of children in child daycare and after school care settings through an integrated approach. In order to achieve this aim, Healthy Childcare coaches receive an intensive train-the-trainer and are tasked with implementing the Healthy Childcare approach in their organization by systematically adapting policies, planning actions, educating daycare providers and evaluating the Healthy Childcare approach within their organization.

Healthy Childcare focusses on children in daycare (0-4 years old, including preschools and “VVE” schools) and after school care (4-12 years old) and aims to improve a healthy lifestyle through eleven health themes: nutrition, physical activity, experiencing nature, daily routines and sleeping, sexual development, physical safety, social-emotional development, healthy media use, substance use (4-12 years only), hygiene and sun protection.

The change towards healthier childcare on each theme is achieved through planning, implementing and evaluating actions on four pillars:
1. Policy making and keeping the policy up to date
2. Education and development of new skills for daycare providers
3. Adapting the social and physical environment
4. Identifying risk factors at an early stage.
Healthy Childcare is being implemented since 2016 and is well received by daycare providers. Currently 627 Healthy Childcare coaches have been trained and 459 child daycare organizations and after school care organizations are implementing the Healthy Childcare approach. The train-the-trainer course for the second half of 2019 was again fully booked.
During intervision workshops Healthy Childcare coaches report implementation and behavior change success stories. However, no research has been performed to evaluate the effectiveness of Healthy Childcare.

AIM
The aim of this project is to study the effectiveness and implementation of the Healthy Childcare integrated approach. Our research questions are:

IMPLEMENTION RESEARCH
1. How is Healthy Childcare implemented in practice and is this as intended (implementation fidelity).
2. What are the barriers and facilitating factors for implementation, and how can (implementation of) Healthy Childcare be improved?

EVALUATION OF EFFECT
3. Does participation in Healthy Childcare improve knowledge, skills, attitude and behavior of child daycare providers?
4. Does Healthy Childcare have a positive effect on (un)healthy practices in child daycare, on 11 health themes?

METHODS
In this project we will perform the following activities:

1. Making core elements and activities explicit (WP1)
2. Providing standardized training of Healthy Childcare coaches (WP2)
3. Assessing treatment delivery by Healthy Childcare coaches (WP3)
4. Assessing treatment receipt by daycare providers (WP4 and 5)
5. Assessing treatment enactment by daycare providers (WP5).

For this, a cluster RCT with a pre- and posttest in an intervention and control group will be performed at child daycare and after school care settings. Questionnaires for child daycare providers, Healthy Child Care coaches and managers will be developed and observations in child daycare centers will be performed.

EXPECTED RESULTS
This project is the first effect evaluation of Healthy Childcare. With the results of this project we aim to enter the database of effective interventions at the level of “first indications for effectiveness”.

Deliverables:
1. List of core elements and activities and their corresponding parts in the train-the-trainer
2. Evaluation of treatment delivery (protocol and report)
3. MIDI questionnaire and dataset
4. Daycare providers questionnaire and dataset
5. Observation protocol and dataset
6. Data management plan
7. Report on the implementation and effectiveness of Healthy Childcare, including recommendations
8. Submission of Healthy Childcare to the RIVM database of effective interventions.
9. Implementation plan
10. Short study description in attractive format
11. Concept scientific article

Participation in Healthy Childcare improve knowledge, skills, attitude and behavior of child daycare providers, compared to daycare providers working in a non-Healthy Childcare organisation
Healthy Childcare has a positive effect on (un)healthy practices in child daycare, on 11 health themes.

May-September 2021: recruitment phase
September- December 2021: Pretest:
a. Questionnaire, incl. primary and secondary outcomes: based on the adapted version of the CFAPQ for daycare providers (Gubbels et al., 2016 and Toussaint, 2019) and on (inter)national questionnaires, e.g. of the Early Learning Healthy Teacher Program and the Toybox teacher questionnaire (Sharma et al., 2019; Manios et al., 2014; Mouratidou et al., 2014;
b. Observations (secondary outcome): An observation protocol is being developed based on the studies of Gubbels et al., (2015;2010).
October 2021 - January 2022: Start intervention
September-December 2022: Posttest
a. Questionnaire, incl. primary and secondary outcomes: based on the adapted version of the CFAPQ for daycare providers (Gubbels et al., 2016 and Toussaint, 2019) and on (inter)national questionnaires, e.g. of the Early Learning Healthy Teacher Program and the Toybox teacher questionnaire (Sharma et al., 2019; Manios et al., 2014; Mouratidou et al., 2014;
b. Observations (secondary outcome): An observation protocol is being developed based on the studies of Gubbels et al., (2015;2010).
c. Questionnaires for managers and Healthy Childcare coaches on the implementation of Healthy Childcare, based on the MIDI questionnaire (Fleuren et al. 2014) and the monitor (www.monitorgezondekinderopvang.nl).

The aim of the intervention Healthy Childcare is to improve the health of children in child daycare and after school care settings through an integrated approach. In order to achieve this aim, Healthy Childcare coaches receive an intensive train-the-trainer and are tasked with implementing the Healthy Childcare approach in their organization by systematically adapting policies, planning actions, educating daycare providers and evaluating the Healthy Childcare approach within their organization.

Healthy Childcare focusses on children in daycare (0-4 years old, including preschools and preschools with play-based education “VVE” schools) and after school care (4-12 years old) and aims to improve a healthy lifestyle of children through eleven health themes: nutrition, physical activity, experiencing nature, daily routines and sleeping, sexual development, physical safety, social-emotional development, healthy media use, substance use (4-12 years only), hygiene and sun protection.

The change towards healthier childcare on each theme is achieved through planning, implementing and evaluating actions on four pillars:
1. Policy making and keeping the policy up to date
2. Education and development of new skills for daycare providers
3. Adapting the social and physical environment
4. Identifying risk factors at an early stage.

Healthy Childcare is being implemented since 2016 and is well received by daycare providers. Currently 627 Healthy Childcare coaches have been trained and 459 child daycare organizations and after school care organizations are implementing the Healthy Childcare approach. The train-the-trainer course for the second half of 2019 was again fully booked.
During intervision workshops Healthy Childcare coaches report implementation and behavior change success stories. However, no research has been performed to evaluate the effectiveness of Healthy Childcare.