Healthy eating and physical activity environments for out of school hours care settings

Background: Out of school hours care (OSHC) is the second largest childcare setting in Australia. In OSHC, the types of foods and beverages offered, physical activity levels, and policy environments are relatively unknown. This thesis aimed to a) describe the current healthy eating and physical activity environments, b) examine the environmental factors associated with meeting dietary guidelines, c) investigate environmental factors associated with children achieving at least 30 minutes of moderate- to vigorous-intensity physical activity (MVPA), and d) examine how healthy eating and physical activity (HEPA) policies were associated with staff practices and child physical activity. Methods: A cross-sectional, observation study was conducted to explore the HEPA environments within a sample of 89 OSHC services across two local health districts within New South Wales (NSW). Direct observation was used to document the food and beverages offered, kitchen facilities and weekly food menus. HEPA promotion and program practices were systematically captured using the System for Observing Staff Promotion of Physical Activity and Nutrition (SOSPAN). HEPA policy environments were explored using the Healthy Afterschool Activity and Nutrition Document (HAAND) tool. Physical activity and sedentary behaviours were assessed within 3,614 children using Actigraph accelerometers. Chi square/Fisher’s exact tests were used to test the associations between setting-level factors and providing foods aligning with the Australian Dietary Guidelines and the relationship between healthy eating policy elements and staff promotion practices. ANCOVA with Bonferroni adjustments tested the associations between physical activity policy scores and child activity levels. A mixed effects logistic regression evaluated the association between program practices and children’s achieving 30 minutes of MVPA. Results: Fruit and water were the most frequently offered food and beverages observed of the two observation days. Discretionary foods (1.5±0.68/days) were offered more frequently than vegetables (0.82±0.80/days) (p Discussion: Findings from this doctoral thesis demonstrate that there is a need for additional resources and guidelines to support OSHC services in NSW to create healthier food and physical activity environments. Most OSHC services are not meeting dietary recommendations for vegetables, dairy, wholegrains, lean meats and discretionary foods after school. Future research is needed to explore the efficacy of sector-specific menu planning resources, which are cost effective and easily administered, to aid the provision of foods aligning with the Australian Dietary Guidelines. Furthermore, there are limited physical activity promotion resources, guidelines and opportunities for staff development within the OSHC sector. Evidence from this thesis indicate that relatively small changes to practice, e.g. scheduling prolonged opportunities for child-led free play, ensuring organised activities engage the largest number of children and avoiding games that eliminate children from active play, could positively impact the levels of MVPA accumulated by children. Future interventions are needed to develop cost effective physical activity promotion training, specific to OSHC sector, to assist OSHC staff facilitate environments supportive to physical activity outcomes