Early Childhood Education and Care (ECEC) services are critical settings for promoting healthy eating behaviours and shaping lifelong dietary patterns, while also contributing to broader food system sustainability. However, creating food environments that are simultaneously nutritious, environmentally sustainable, and practical for implementation remains challenging, even though this is recognised by the sector as an emerging priority. There is evidence of poor diet quality and high food wastage in ECEC, with implications for both human and planetary health.(1,2) A co-design process with ECEC sector workforce and interest-holders was undertaken from 2021-2025 to develop practical strategies for the promotion of sustainable and nutritious food environments, guided by the FAO-WHO Sustainable Healthy Diets Guiding Principles(3). This produced i) a toolkit resource for a whole-of-service approach (including children)(4), and ii) a self-administered food served/wasted audit tool (5).
This study reports on the feasibility, acceptability, and practice change elicited by these co-designed strategies via a three-arm pilot trial with ECEC services randomly allocated to receive the toolkit, audit tool, or both. Surveys included organisational readiness (ORIC), implementation outcome measures for acceptability, appropriateness and feasibility(6), open-ended items to describe practice changes, and repeat questions for educator feeding practices to determine unintended consequences (GoNAPSACC).
Twenty eight of the 42 recruited services completed the trial [toolkit only n=10; audit only n=11; toolkit+audit n=7]. Pre-intervention organisational readiness scores were high across all groups, although slightly lower in the toolkit+audit group (49/60) than in audit only (55/60) and toolkit only (52/60) groups. Post-intervention respondents included ECEC directors (n=25), educators (n=31) and cooks (n=22). Respondents in toolkit only (n=25) and audit only (n=37) groups reported high feasibility, acceptability and appropriateness of these strategies. Lower scores were reported in the toolkit+audit group (n=16), especially by cooks. At baseline, educators indicated regularly encouraging children to ‘finish their plates’ and this coercive feeding practice remained high across all groups, particularly the audit-only group. Qualitative data indicated that both the toolkit and audit elicited practice change regarding food waste, with the toolkit supporting a broader awareness of environmental sustainability practices and greater involvement of children.
These findings suggest that the co-designed toolkit can facilitate whole-of-service environmental sustainability practices across multiple domains, while a weighed food audit tool appears to specifically promote awareness and associated practice change of food waste. Both strategies require clear signposting to support responsive feeding practices. Higher attrition in services receiving both strategies (toolkit+audit) requires further investigation to determine whether this relates to intervention intensity or organisational readiness. Practical co-designed tools can support the ECEC sector to deliver nutritious and environmentally sustainable food environments, with potential benefits for child health, food waste reduction and sustainable food systems more broadly.