The Healthy Incentive for Pre-Schools (HIP) Project
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Technological University Dublin ARROW@TU Dublin Doctoral Science 2013-2 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. Charlotte Johnston Molloy [email protected] Follow this and additional works at: https://arrow.tudublin.ie/sciendoc Part of the Biochemical Phenomena, Metabolism, and Nutrition Commons, and the Medical Nutrition Commons Recommended Citation Johnston Molloy, C. (2013). 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. Technological University Dublin. doi:10.21427/D7WW20 This Theses, Ph.D is brought to you for free and open access by the Science at ARROW@TU Dublin. It has been accepted for inclusion in Doctoral by an authorized administrator of ARROW@TU Dublin. For more information, please contact [email protected], [email protected]. This work is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 4.0 License 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. A thesis submitted for the degree of Doctor of Philosophy by Charlotte Johnston Molloy B.Sc. (Hum. Nut. & Diet.), M.Sc. (Agr.) Supervisors Dr. John M. Kearney Prof. Nóirín Hayes Dr. Clare Corish School of Biological Sciences Dublin Institute of Technology February 2013 i 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< 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. ii Declaration Page I certify that this thesis which I now submit for examination for the award of Doctor of Philosophy (Ph.D.), is entirely my own work and has not been taken from the work of others, save and to the extent that such work has been cited and acknowledged within the text of my work. This thesis was prepared according to the regulations for postgraduate study by research of the Dublin Institute of Technology and has not been submitted in whole or in part for another award in any other third level institution. The work reported on in this thesis conforms to the principles and requirements of the Dublin Institute of Technology’s guidelines for ethics in research. Dublin Institute of Technology has permission to keep, lend or copy this thesis in whole or in part, on condition that any such use of material of the thesis be duly acknowledged. Signature_________________________ Date ____________________________ Candidate iii Acknowledgements There are a huge number of people involved with this study to whom I owe an enormous amount of thanks. Firstly to Dr. Clare Corish, (School of Biological Sciences, Dublin Institute of Technology) my main academic supervisor, for her constant help and unwavering support throughout the project’s lifetime; Clare your help has been invaluable and hugely inspirational, thank you so very, very much for all the words and emails no matter the time of day or year. No query was left unanswered, and anything that I considered might be a problem was quickly talked through and instead reduced to an easily surmountable task. A great big thank you also to Dr. John Kearney (School of Biological Sciences, Dublin Institute of Technology) and Professor Nóirín Hayes (School of Applied Arts, Dublin Institute of Technology), my associate supervisors, for all their encouragement, support and kindness throughout all the phases of the study. Your assistance and time have been extremely valuable and are greatly appreciated. Thank you also to Professor Mary McNamara (School of Graduate Research, Dublin Institute of Technology) and Dublin Institute of Technology for supporting this research project. I would like to thank very sincerely Ms. Corina Glennon Slattery, my Community Dietitian Manager, Health Service Executive Dublin Mid-Leinster, (Midland Area), whose persistent assistance and dedication to the Healthy Incentive for Pre-schools project has ensured its completion; I cannot thank you enough Corina for all the support and for raising my spirits and hopes when they were flagging. Special thanks also to all the members of the Community Nutrition and Dietetic Service, Health Service Executive, Dublin Mid-Leinster (Midland Area) for assistance through the project, but particularly Ms. Cara Cunningham and Ms. Maria Murtagh for their iv technical support and encouragement and Ms. Cathriona Loonam for project administration assistance through phase 3 of the project. This project was supported by safefood, the Food Safety Promotion Board, under Grant No. [safefood Grant No. 01-2008]; in association with the Health Service Executive, Ireland. I would like to take this opportunity to thank most sincerely safefood for their support of this research, most particularly Dr. Marian Faughnan and Dr. Cliodhna Foley Nolan. I would also like to express my gratitude to the Health Service Executive for their project assistance, especially Ms. Sheelagh Reaper Reynolds, Mr. Joseph Ruane and Mr. Fergal Fox. A very big thank you to the project’s National Advisory Group for their constant support and direction throughout the study. The National Advisory Group consisted of Dr. Cliodhna Foley Nolan, Dr. Marian Faughnan and Dr. Aileen McGloin, safefood; Ms. Marion Brennan and Ms. Rita Melia, Early Childhood Ireland; Ms. Kara Murphy, Ms. Ann Spain, Ms. Anne Gerety, Ms. Sheelagh Reaper-Reynolds, Ms. Corina Glennon Slattery, Health Service Executive; Ms. Sinead Keenan, Healthy Food for All; Dr. Clare Corish, Dr. John Kearney and Prof. Nóirín Hayes, Dublin Institute of Technology. I would also like to express my gratitude to the Local Expert Group from the Midlands for their support throughout the project process; this group consisted of: Ms. Kara Murphy (formerly Pre-school Training Officer and with the Pre-school Inspection Team); Ms. Caroline O’Connor Hughes (formerly Childminding Advisory Officer and with the Pre-school Inspection Team); Ms. Fiona McHugh (Childminding Advisory Officer); Ms. Mary-Kate Holohan, Ms. Niamh Lawlor, Ms. Patricia Moran, Ms. Louise Meehan (Environmental Health Officers with the Pre-school Inspection Team); Ms. Deirdre Molloy and Ms. Anne Gerety (Public Health Nurses with the Pre-school Inspection Team). v Thank you too to Ms. Sarah Mumford, Senior Community Dietitian, Health Service Executive (Eastern Area) for her help and assistance in enabling the phase one pilot work for this project to take place in Co. Wicklow. This project would not have been possible without the time and participation of the pre-schools offering a full day care service who took part in the process in counties Wicklow, Westmeath, Longford, Laois and Offaly. Their hard work, enthusiasm and assistance in this project have been extremely valuable and I would like to take this opportunity to thank everyone involved most sincerely for all their openness, interest, support and dedication to the project. Finally, I would really, really like to acknowledge and thank all my family and friends who have been so patient and understanding through the ‘long road that has been travelled’ over the last number of years. Particularly to