The Healthy Incentive for Pre-schools (HIP) Project: The Development, Validation, Evaluation and Implementation of an Healthy Incentive Scheme in the Irish Full Day Care Pre-school Setting.

Abstract

While many children are now cared for outside the home, inadequate nutrition and physical activity practices in pre-schools have been reported. This study aimed to develop a validated nutrition and health related evaluation tool and an education information resource for pre-schools, and determine whether their use can promote improved food service and nutrition and physical activity practices in this setting. Following a pilot phase undertaken in Co. Wicklow (n 12), pre-schools providing a full day care service in the Midland Area of Ireland were invited to participate in the study (n, 100). Direct observation was used to collect data (food and fluid provision; physical activity; outdoor time; staff practices and availability of nutrition and health resources) in each pre-school during one full day both prior to, and 6-9 months following the training period, using the specifically developed data collection tool, the Pre-school Health Promotion Activity Scored Evaluation Form. Post-intervention, self-assessment data were also collected using the same evaluation tool. All foods offered were recorded using household measures, and a photographic food atlas developed specifically for this project. A Delphi investigation was undertaken to identify pre-schools’ most favoured incentives for project inclusion. Of 76 services that registered interest in participating, pre-intervention data were collected in 58 facilities. Pre-schools were randomised into 2 training intervention groups: a ‘manager only trained’ group (n, 27); and a ‘staff and manager trained’ group (n, 18). Pre-intervention, poor nutrition and health practices were observed. Significant improvement (P\u3c 0.05) in nutrition and health related practice was observed within both intervention delivery groups in all areas evaluated; training of staff had no significant impact on overall practice. Scores assigned by direct independent observation were lower than pre-school self-assessment scores. Grant aid for food and physical activity, and project participation recognition, were the incentives most favoured by pre-schools. This intervention was the first in Irish pre-schools to demonstrate that Pre-school Health Promotion Activity Scored Evaluation Form use supported by education improved practice with no significant additional effect of staff education