Physical activity, sedentary behaviour and healthy eating in out of school hours care: an observational audit and pilot intervention
Creators: name: Woods, Andrew John
Publisher: name: University of Wollongong
Year: 2025
Subjects: classificationCode: 4206
subject: Public health
classificationCode: 3210
subject: Nutrition and dietetics
classificationCode: 3903
subject: Education systems

description: <b>Background</b>Promoting physical activity (PA) and healthy eating and limiting sedentary behaviour are important for the growth and development of children aged 5-12 years. Out of school hours care (OSHC) is a childcare setting which provides opportunities to promote child health behaviours, however, little is known about the health promoting environments of before school care settings. The aim of this thesis was, therefore, to better understand the PA, sedentary behaviour, and healthy eating environments of before school care; and promote healthy levels of these behaviours in OSHC services.<b>Methods</b>This thesis includes three studies which are presented as four research papers. Study one was a systematic review of the correlates of PA and sedentary behaviour in OSHC. Study two was a cross-sectional examination of the PA, sedentary behaviour and healthy eating environments of before school care programs. Study three used findings from the first two studies to co-create an OSHC intervention with stakeholders and end-users. The intervention was then pilot tested using a cluster randomised controlled trial (RCT) design.<b>Results</b>The systematic review identified 18 cross-sectional studies reporting 116 PA and 64 sedentary behaviour correlates. The most frequently reported correlates of PA were child sex (males more active), staff engaging in PA, an absence of elimination games, and scheduling PA in daily programming. For sedentary behaviour the most frequently reported correlates were child sex (females more sedentary) and age (older children more sedentary).Study two included 49 observational visits across 25 before school care programs and collected accelerometry data for 654 child observation days. Child PA (accelerometry) data were analysed, and it was found that 17% of children (n = 112) reached the ≥ 15 minutes of moderate-to-vigorous intensity PA (MVPA) recommendation for before school care, with boys more active than girls. Children were more likely to meet the recommendation in services where staff promoted and engaged in PA; PA equipment was available; children were observed in child-led free play; and a written PA policy existed. Direct food observations showed that fruit was provided on 22% (n=11) of days and vegetables on 12% (n=6). Services with nutrition policies containing specific and measurable language on food provision were more likely to provide fruit (p = 0.027); and services that reported staff training for healthy eating provided more vegetables (p = 0.037).Study three focussed on the before and after school care programs of four OSHC services (intervention = 2 services; waitlist-control = 2 services). The co-created professional development program was found to be both feasible and acceptable. Post-intervention, there were no significant between group differences in changes in children meeting MVPA guidelines, however, small to medium effect sizes (d = 0.08 - 0.62) were detected. Frequency of fruit provision increased more in before school care intervention programs, and vegetables provision increased more in both before and after school care intervention programs.<b>Conclusions</b>To the candidate’s knowledge, this thesis is the first known research to assess the PA, sedentary behaviour and healthy eating environments of Australian before school care services; and to assess a co-created staff professional development program to improve these environments in OSHC services. The findings highlight modifiable practices at service and staff levels to improve child PA and healthy eating opportunities while attending OSHC. They also present a framework for a staff professional development program which is both feasible and acceptable. Larger intervention trials are recommended to further evaluate impacts on child PA and service food provision.