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Implementation of Centre-level Food and Nutrition Policies: A Mixed-Methods Study of Child Care Centres in Alberta
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- Author / Creator
- Lima do Vale, Marjorie
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Child care centres are important spaces for health promotion. Although child care centres have an important role in offering meals that include important nutrients that young children need for healthy growth and development and in supporting young children in developing healthy eating behaviours that can be carried into adulthood, food environments in child care are sub-optimal. Food and Nutrition Policies (FNP) have the potential to improve child care food environments, but evidence is still limited. The purpose of this sequential, mixed-methods study was to: i) perform a scoping review to identify theories, models and frameworks (TMFs) used to inform the implementation of healthy eating interventions in centre-based child care services in developed countries, ii) conduct a cross-sectional survey to describe resources and strategies in place to support FNP implementation in child care centres in Edmonton, Alberta, and iii) complete a theoretically-informed multiple case study to describe characteristics of the innovation, recipients, and context that influence the implementation of FNP among child care centres classified as low and high implementers. The scoping review identified 28 different TMFs targeting different socio-ecological levels across 38 studies. Majority of studies relied on individual-focused TMFs. Poor TMF selection, use and reporting were identified, particularly in the development of implementation strategies, which could limit TMF’s utility. The cross-sectional survey included 43 (13% response rate) child care centres across the Edmonton metropolitan region. Almost all of the participating centres had FNP in place (94%). However, on average, only about 9 of the 17 resources and processes (range 1–17) required to support FNP implementation were well-established across centres. More often, policies lacked a description of goals and providers’ responsibilities, centres did not secure resources for policy implementation and lacked evaluation of policy implementation. The multiple case study presented a comprehensive description of factors that might influence FNP implementation in child care centres. In terms of innovation, lack of clarity on FNP and a limited degree of fit were the main gaps to implementation. Also, providers had limited
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nutrition knowledge and skills, had limited power and authority to enforce policy and reported a perception of low parents’ commitment. In general, child care centres provided a supportive environment for FNP implementation, but mechanisms to embed and evaluate FNP implementation lacked focus on FNP. Overall, cases were influenced by external and system-level factors, such as regulatory frameworks, incentives and environmental stability. Access to inter-organizational networks varied across the different organizational structures (profit, non-profit, franchised). In conclusion, collaborations between researchers, policymakers, practitioners and families can help to build capacity for FNP implementation and to address the gaps identified. -
- Subjects / Keywords
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- Graduation date
- Fall 2020
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- Type of Item
- Thesis
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- Degree
- Doctor of Philosophy
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- License
- Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.