Assessing the scalability of healthy eating interventions within the early childhood education and care setting: Secondary analysis of a Cochrane systematic review.

OBJECTIVE: Early childhood education and care (ECEC) is a recommended setting for the delivery of health eating interventions 'at scale' (i.e. to large numbers of childcare services) to improve child public health nutrition. Appraisal of the 'scalability' (suitability for delivery at scale) of interventions is recommended to guide public health decision-making. This study describes the extent to which factors required to assess scalability are reported among ECEC-based healthy eating interventions.

DESIGN: Studies from a recent Cochrane Systematic Review assessing the effectiveness of healthy eating interventions delivered in ECEC for improving child dietary intake were included. The reporting of factors of scalability was assessed against domains outlined within the Intervention Scalability Assessment Tool (ISAT). The tool recommends decision makers consider the problem, the intervention, strategic and political context, effectiveness, costs, fidelity and adaptation, reach and acceptability, delivery setting and workforce, implementation infrastructure, and sustainability. Data was extracted by one reviewer and checked by a second reviewer.

SETTING: ECEC.

PARTICIPANTS: Children six months to six years.

RESULTS: Of 38 included studies, none reported all factors within the ISAT. All studies reported the problem, the intervention, effectiveness, and the delivery workforce and setting. The lowest reported domains were intervention costs (13% of studies) and sustainability (16% of studies).

CONCLUSIONS: Findings indicate there is a lack of reporting of some key factors of scalability for ECEC-based healthy eating interventions. Future trials should measure and report such factors to provide important information to support policy and practice decision makers when selecting interventions to be scaled-up.