Abstract
Background:
Parents play a crucial role in shaping the development of healthy lifestyle behaviours in young children. Early Childhood Education and Care (ECEC) services are an ideal setting in which to promote these behaviours through parent communication initiatives.
Aim:
To evaluate the feasibility, acceptability and impact of the Healthy Adventures Book pack in increasing parent and carer capacity to support positive dietary intake, physical activity and screen use behaviours in their 3- to 5-year-old children.
Methods:
ECEC services in western Sydney, Australia (n = 136) and families with 3- to 5-year-old children (n = 258) participated in the study. Families received a pack containing health information, a vegetable-shaped toy and a storybook. They were encouraged to read the materials and help their child complete the activities. The study adopted a pragmatic pre-post mixed-methods design, with parents completing pre- and post-intervention questionnaires on demographic characteristics and readiness and confidence to support behaviour change. Process data were collected from parents and ECEC directors, and semi-structured interviews were conducted post-intervention. Data were analysed using Mann Whitney U tests. Thematic analysis was conducted on parent interview data.
Results:
There was a significant improvement in parent confidence to support physical activity, though no significant changes were found for other behaviours. The process evaluation indicated high acceptability; 93% of parents reported their children were excited to use the pack, 91% found it easy to complete, and 86% found it useful for learning about healthy behaviours.
Conclusion:
ECEC directors found the pack was well-received, easy to implement and effective in facilitating conversations with families about health behaviours.
Introduction
Health-related lifestyle patterns such as dietary preferences, physical activity and screen use are established early in life and become difficult to change once habitualised (Hodgkinson et al., 2019; Jones et al., 2013; Lioret et al., 2020). The first 5 years of life are key in establishing positive health behaviours that can reduce the risk of chronic illness in adulthood (Descarpentrie et al., 2021; Mistry et al., 2012). Parents play a fundamental role in the development of child health behaviours and lifestyle choices (Golan and Crow, 2004; Lioret et al., 2020; Maia et al., 2025; Mistry et al., 2012; Peters et al., 2014).
At least 90% of children aged 3–5 years in Organisation for Economic Cooperation and Development (OECD, 2021) countries attend Early Childhood Education and Care (ECEC) services. This high attendance rate makes ECEC services ideal for reaching a large number of parents with actions and initiatives to increase awareness of appropriate dietary intake, physical activity and screen use behaviours (Messiah et al., 2017; Yoong et al., 2023). Studies in this setting have found that multi-component interventions, which include parental engagement, lead to better outcomes (Jeong et al., 2021; Sisson et al., 2016; Ward et al., 2017). For example, Malek et al. (2021) found that take-home activities in a school-based health programme helped to actively engage parents and build their skills and knowledge to support their children in making healthy lifestyle choices.
In addition to parent engagement, parent health literacy (the ability to access, understand and apply health information) is recognised as a key determinant of children’s health behaviours. Higher levels of parental health literacy are associated with more favourable dietary activity, physical activity and screen use habits in young children (Csima et al., 2024). Programmes and interventions that provide accessible health information and encourage shared parent–child learning experiences may therefore help to engage families in enhancing health literacy.
In New South Wales (NSW) Australia, the Ministry of Health’s Munch & Move programme supports ECEC services in promoting the healthy development of children aged 0–5 years (Lockeridge et al., 2015). This multi-component programme provides health information resources for ECECs to share with families. A 2015 evaluation found that the annual provision of health information by ECEC services to families increased from 33% to 71% (Lockeridge et al., 2015). However, there is scope for improvement as it is likely that shared information was limited to fact sheets.
To further encourage parent engagement, Western Sydney Local Health District Health Promotion Service has developed the ‘Healthy Adventures Book’ (HAB) pack. This pack includes highly visual and low text fact healthy lifestyle sheets designed for readability and cultural acceptability in Culturally and Linguistically Diverse (CALD) communities. It also includes a plush vegetable or fruit toy and a story book. Families are encouraged to read through the materials and support their children in documenting their experiences in the scrapbook.
Previous studies have highlighted the importance of parental engagement in early childhood healthy lifestyle programmes and interventions (Lum et al., 2022; Ventura and Birch, 2008; Ward et al., 2017), but there is limited research on the effectiveness of take-home resources in increasing primary carer capacity to influence their children’s health behaviours. Most research has focused on intensive parent interventions or take-home resources as part of broader programmes (Luecking et al., 2021; Skouteris et al., 2011; Ward et al., 2017). Despite the effectiveness of family-based interventions, parent engagement remains challenging due to various environmental barriers. These include access to healthy food and physical activity opportunities, time and financial constraints and the need to align practices between home and educational settings (Luecking et al., 2020).
This study aimed to address this gap by evaluating the feasibility, acceptability and impact of the HAB pack, targeted take-home resource, in improving primary caregiver capacity to positively influence the physical activity, dietary intake and screen use health behaviours of their children aged 3–5 years. If effective, this initiative could be integrated into the existing Munch & Move programme, offering a more interactive experience for parents/carers.
Methods
The study was conducted in Western Sydney Local Health District, NSW in 2021. In November 2020, all 439 ECEC services trained in the Munch & Move Programme (a service-level initiative funded by NSW Health) were invited via email to participate in the study. The intervention commenced in February 2021. A total of 136 ECEC services registered and were then asked to recruit families with children aged 3–5 years. Inclusion criteria specified that services must be currently participating in the Munch & Move programme. Within these services, eligible participants were families with children aged 3–5 years. Children and families were excluded if they required an interpreter to complete the task, as funding was not available.
Intervention
The HAB pack includes a take-home scrapbook, a commonly used ECEC educational approach. Each ECEC service received one HAB pack, which directors of participating ECEC services distributed to families, keeping a record of who received the pack. Families had the pack for 1 week and were encouraged to read through the information in it including the facts sheets (on a healthy lunchbox, choosing water, eating more fruit and vegetables, fuss-free mealtimes, turning off screens, getting active and fundamental movement skills) and the story book (Jack’s Funtastic Day). They were asked to support their child to complete the activity in the book (taking the vegetable or fruit toy on a ‘healthy adventure’ and recording the adventures in the scrapbook (by drawing pictures, writing or gluing in photos). They were also encouraged to read through the entries from other children.
The design of the intervention was informed by Vygotsky’s sociocultural theory, particularly the central concept of the ‘zone of proximal development’, which emphasises that learning occurs most effectively through social interaction. The ‘zone of proximal development’ refers to the gap between what a child is able to do independently and what they can achieve with guidance and support from a more knowledgeable person. Learning within this zone challenges the child beyond their current abilities, while still being achievable with assistance (Vygotsky, 1978). In the context of the HAB pack intervention, the parent or caregiver was the knowledgeable person, and the scrapbook served as a tool for guided participation in the shared activity. This created a zone of proximal development for learning about healthy behaviours. Through this collaborative process, parents and caregivers were able to scaffold their child’s understanding of healthy lifestyle concepts.
Study design and data collection
The evaluation described here adopted a pragmatic pre-post mixed-methods design in a real-world context. Parents completed a pre-intervention online questionnaire including demographic questions (postcode, child age, language spoken at home, preferred written language, Aboriginal and Torres Strait Islander background, parents’ education level). For each behaviour, parents answered three questions on readiness and confidence to support their child to improve their fruit, vegetable, healthy snack food and water intake, and physical activity and screen time behaviours.
For example, for vegetable intake, parents were asked ‘Would you like to make changes to the amount of vegetables your child eats?’, with response options yes, no or unsure. They were then asked ‘How ready are you to support your child to eat vegetables’. Response options on a 4-point scale were: not ready at all, somewhat ready, completely ready or unsure. They were then asked, ‘Are you confident you can support your child to eat vegetables?’. The response options on a 5-point Likert-type scale were: not confident at all, somewhat confident, confident, very confident or unsure. Previously validated tools developed by Wright et al. (2015) and Bohman et al. (2013) were used to construct the questionnaire, with adaptations being made to ensure the tools were relevant to the intervention context. The Bohman et al. (2013) tool has also demonstrated acceptable reliability.
The post-intervention questionnaire included the same parent readiness and confidence questions (Bohman et al., 2013; Wright et al., 2015) and also seven process evaluation questions to be answered on a 5-point Likert-type scale (strongly disagree to strongly agree). These questions covered the child’s excitement to complete the activities, ease of use, usefulness of HAB pack information for learning about healthy eating and activity, reading about healthy adventures of other families in the book, the instructions provided and assistance provided by educators. Families were also asked for recommendations for changes and whether they consented to a follow-up call to discuss their experience. The questions asked were specific to the context of the study and were not based on validated instruments, they were designed to capture information relevant to improving future iterations of the intervention in this pragmatic setting.
At the end of the intervention, ECEC service directors completed a questionnaire evaluating the pack’s acceptance by educators, ease of implementation and appeal to children and families. The questionnaire also assessed whether the pack facilitated discussion with families about healthy eating and physical activity and about perceived changes in children’s attitudes and behaviours. In addition, semi-structured interviews with parents post-intervention were used to gain deeper insights into their experiences. The TREND Statement was used to guide the reporting of this study (Des Jarlais et al., 2004).
Data analysis
Statistical analysis
Changes in parent readiness and confidence from pre- to post-intervention in each behavioural area (fruit, vegetable, healthy snacks, water, physical activity and screen time) were analysed using Mann Whitney U tests due to the non-parametric distribution of the data. Frequencies and percentages were used to describe demographic and process evaluation data. Statistical analyses were conducted in SPSS version 28 (SPSS In, Chicago IL, USA).
Qualitative analysis
Interviews were transcribed verbatim by an independent transcription service. All identifying information was removed prior to thematic analysis. Thematic content analysis, using an inductive approach, as described by Braun and Clarke (2022), was conducted by two researchers JM and AW, who independently read the transcripts to familiarise themselves with the data. Initial codes were generated which were then grouped into potential themes. These were then reviewed and refined through discussion. Illustrative quotes representing the themes were selected.
Ethics
The project was approved by the Western Sydney Local Health District Research Ethics Committee (Reference: 2020/ETH02212). Informed consent was obtained by local ECEC services and participating parents.
Results
A total of 136 ECEC services in Western Sydney Local Health District enrolled in the study. Pre-intervention questionnaires were completed by a parent or primary carer from 258 families, post-intervention questionnaires were completed by a parent or primary carer from 74 families and 184 families were lost to follow-up. Twelve parents and carers were interviewed post-intervention. Nineteen services withdrew before follow-up and 20 service directors completed the post-intervention questionnaire.
Participant characteristics
Table 1 displays the characteristics of participating families. All children were 3–5 years; 54% were aged 4 years, 38% were aged 3 years and 8% were aged 5 years. Most parents were mothers (82%), 44% of families spoke a language other than English at home, and there was a high level of parent education. While a range of socioeconomic profiles was represented, most services (63%) and participants (79%) were in the least disadvantaged (deciles 6–10) Socio-Economic Indexes for Areas (SEIFA) according to the Australian Bureau of Statistics Index of Relative Socio-economic Disadvantage (IRSAD) postcode data (Australian Bureau of Statistics, 2018).
Baseline characteristics of participants (n = 258).
TAFE: Technical and Further Education (within the Australian government–funded vocational education system).
Change in parent readiness and confidence to support child health behaviour change
Analyses comparing pre- and post-intervention parent readiness and confidence (Table 2) revealed a significant improvement in confidence to support change physical activity change. Confidence levels (on a 4-point Likert-type scale: 1 = not confident at all to 4 = very confident) increased from a median of 3.00 (interquartile range [IQR]: 1.00) at baseline to 4.00 (IQR: 1.00) at follow-up (U = 7119.500; p < 0.001). No changes were observed in other areas of parent readiness and confidence.
Median and IQR for readiness and confidence to change variables at baseline and follow-up.
Significant difference between baseline and follow-up (p < 0.001).
Process evaluation
Process evaluation questions were completed by 74 parents and carers. As shown in Table 3, acceptability was high, with many families agreeing or strongly agreeing that their children were excited to use the HAB pack (93%); found it easy to complete (91%); found it useful for learning about healthy eating and physical activity (86%); and found it useful reading about other families’ adventures (84%). Most families agreed or strongly agreed that the written instructions (96%), video instructions (65%) and help of educators (82%) was useful in using the pack. Eighty-four percent (84%) of parents stated that they were more ready to support their child.
Process evaluation (n = 74).
As shown in Table 4, the HAB pack was regarded highly by ECEC services, with 100% of Directors agreeing it was well received by educators, easy to implement, appealing to children and families and made it easier to have conversations with families about healthy eating and physical activity. Most services agreed that children were more willing to try new foods (83%) and had a more positive attitude towards mealtime (89%) and physical activity (89%). Forty-four percent of services noted improvements in food being brought from home. The remainder was likely not lunch box services as they responded N/A to this question.
ECEC service director process evaluation (n = 18).
Qualitative analysis
Parent/carer interviews and open-ended questions from the evaluation survey provided in-depth feedback on the programme’s feasibility, acceptability and impact. Participants in the qualitative interviews were predominately positive in their evaluation of the programme. Key enablers described in the interviews have been grouped together into four themes: encouragement of whole family involvement and connection; easy access to health information for parents and children; enabling parents to support healthy behaviours; and continuation of learning.
Encouragement of whole family involvement and connection
Most parents and carers noted that the HAB pack had impacts beyond the encouragement of healthy eating and physical activity and promoted social connection through the shared reading of the resource. One interviewee stated: ‘All of us at some stage we all had. I think my husband read the book with him. And then I did, and my daughter and my youngest son also jumped in and were looking’.
The pack also served as a conversation starter for discussing health topics, improved knowledge and created familiarity when shopping: ‘We’ve got two daughters and they’re only two years apart so three and five years old. So, they were both interested in that. And when we went shopping, we were talking about it. Like, we tried to talk about healthy food and things anyway’.
Another parent commented that the pack: ‘. . . shows the child in pictures. It’s common-sense for adults however the child needs to be able to understand at their own level which I believe this book is good for’, acknowledging that the resource was age appropriate. Some parents suggested work sheets and colouring sheets would further help to engage children. Parents and carers also recognised the importance of peer learning for health behaviour change with one parent stating their children were ‘able to look at the other kids’ stories and what they’d done. And that inspired my kids to do various active things similar to their peers, which was nice’.
Easy access to health information for parents and children
Parents and carers deemed the pack ‘very helpful’ in communicating the guidelines on healthy eating, screen use and physical activity presented to them. This made it easy for them to determine where changes needed to be made and was informative for parents as well as children. One parent stated: ‘I found the, um, information about the age groups and the servings of different things very helpful. So I didn’t realise, for her age she should only be having, not that she eats a lot of fruit, but she should only be having one piece a day. Whereas I knew my 12-year-old should have been having more. So we’ve upped his to two, now, instead of one’.
Another noted the usefulness of the resource for time-poor parents: ‘I found that informative about, you know, what they’re to do, what they’re to eat, and how, how much activity they’re meant to have a day. . . . Like it’s, I could go and look at those things, but you don’t get time, right?’
Enabling parents to support healthy behaviours
Many families were already aware of the value of healthy eating and physical activity, but the pack acted as a prompt and motivator. Parents described it as a reminder that reinforced existing knowledge and offered practical tips for implementation. One parent shared, ‘. . . it [the information] was there, subconscious, but it just, kind of, it was just like a little reminder’. Another found the ideas useful for putting their intentions into practice, saying, ‘. . . it was just a good information, like, you know, just saying more ideas and more, more good tips’. The pack also reassured families they were on the right track: ‘It was good information, so, uh, how much, like, you can . . . How many fruits and vegetables, which is like he actually eats, but it’s actually good portion they tell you what to eat. So, yeah, I think we are okay’. Vegetable intake was a common focus. One parent reflected: ‘I think I noticed that he needs to, er, eat more vegetables, but not that serious. So I’m just thinking, you know, most of the kids are like that and I didn’t pay that much attention. But after reading the book, I am just thinking maybe I can create some kind of routine’.
The pack provided also encouraged parents to adopt more mindful habits, such as offering vegetables more often and involving children in food preparation. One parent noted: ‘I’ve been more mindful of offering vegetables with every meal and also including my child more in food prep to encourage him to eat more vegetables and to try new foods’”. The vegetable soft toy also helped to start conversations. One parent reflected: ‘It was nice to be able to talk about the different fruits and vegetables. And my younger daughter, who is actually in day care, was quite excited by some of the things. Like she had Eddie the Eggplant and she was really excited to buy eggplant and try it out’.
Screen time was another area where the pack supported change in parent behaviour. Some parents reported using screens primarily for their personal convenience, for example, to keep their child occupied while they managed household tasks or took a break– ‘We gave her iPad because we wanted our time’–and the pack provided them with strategies towards more active engagement. One parent shared: ‘we’ve been trying to encourage them to do more either active play or at least imaginative play rather than screen time . . . . and we are also trying to engage more with them in doing a little bit of dancing or doing something fun’.
Continuation of learning
Parents and carers expressed the need for additional support to reinforce the learning. One parent suggested: ‘. . . a continuation of the learning at the childcare. So that would really enhance the meaning, just having, you know, a week or two just focusing on different aspects. Something that they can take home during the week from childcare or included in the pack, like some work sheets or, or something. You need to make it that continuation to really hit home’.
Other families felt that without a physical reminder their child would forget what they had learned: ‘But one thing I’m thinking is that, uh, because we returned everything back, we didn’t really leave anything . . . Uh, have anything, uh, left behind. So, that’s basically . . . It’s, it’s probably, after a while, um, my son obviously would forget’.
Families suggested a toy to keep, or a fridge magnet, as useful reminders to continue making changes at home. They also recommended adding recipes and topics such as making healthy food interesting or incorporating screens into routines.
Discussion
The HAB pack, developed by Western Sydney Local Health District, aimed to complement the existing Munch & Move programme by providing ECEC services with an educational tool for parents on child health behaviours. This study evaluated the feasibility and acceptability of the HAB pack among ECEC services and families, and its impact parents’ and carers’ capacity to influence their child’s health behaviours.
The study demonstrated high acceptability of this HAB pack among both ECEC services and families. There was a significant improvement in parents’ confidence to support their children’s physical activity, but no significant changes were found for other health behaviours, such as healthy eating and limiting screen time.
Similar to this study’s physical activity results, a review by Hnatiuk et al. (2019) found that ECEC interventions were successful in improving physical activity, including those involving parents. Aligning with the healthy eating component of this study, a systematic review of fruit and vegetable interventions in children 5 years of age found limited evidence of efficacy (Hodder et al., 2020). However, multi-component programmes (such as those including ECEC and parent components) showed small improvements (Hodder et al., 2020). A systematic review by Ward et al. (2017) highlighted that interventions with higher ‘strength’ were more likely to demonstrate positive outcomes. ‘Strength’ here referred to ‘high impact’ strategies such as environmental and policy changes, and parent engagement strategies such as parent training, rather than passive approaches. Therefore, using a higher impact strategy, such as a parent information session or environmental changes to accompany the HAB may have improved the impact. However, these ‘stronger’ interventions and programmes are often more challenging to implement and may impact feasibility and fidelity (Ward et al., 2017).
Unlike this study, early years interventions aimed at reducing screen time have shown improvements in screen use behaviours, especially those conducted directly with parents (Downing et al., 2018). This suggests that direct parental involvement is crucial for the success of screen time interventions, but it may be that previous interventions have been more successful due to screen time being a primary focus.
While the HAB pack may be valuable, it could require additional elements to achieve similar levels of improvement. As parents suggested, fridge magnets might be a useful addition to the HAB pack. This recommendation is supported by a previous study showing their effectiveness in improving diet quality (Glanz et al., 2012). Including personalised feedback (van Beelen et al., 2014), interactive face-to-face components (Yang et al., 2023) and/or regular follow-up (Müller-Riemenschneider et al., 2008) are successful approaches used in previous health promotion interventions that might also be used to promote and reinforce behaviours to enhance the HAB pack’s effectiveness. In this study, 84% of parents felt more prepared to support their child after using the HAB pack. However, behaviour change can take a considerable time, and a longer timeframe may be needed to see significant changes (Zheng et al., 2022).
Parents reported that the HAB pack was effective in engaging their children and facilitating family discussions about healthy choices. It encouraged children to try new foods, especially vegetables, and to be more active. Parents appreciated the practical tips contained in the pack, which helped them implement health behaviours and integrate them into daily routines. ECEC educators found the HAB pack easy to use with minimal preparation and was helpful in facilitating conversations with families, bridging the gap between educators’ knowledge and parents’ engagement. These findings are consistent with previous research which highlights the importance of fostering connection between the education setting and families in health promotion initiatives. For example, Malek et al. (2021) showed that parent engagement through take-home activities can reinforce the health messages provided at school and promote consistency between the two settings. This kind of integrated approach is particularly important for young children who are strongly influenced by their environments and caregivers. Although grandparents were not specifically targeted in this study, they could participate if they were the child’s primary caregiver. This highlights the need to consider diverse family structures and caregiving roles, which may influence how interventions are implemented and received.
These findings can be further understood using Vygotsky’s sociocultural theory, specifically the concept of the zone of proximal development and the role of the more knowledgeable other. In this context, parents were the more knowledgeable other in their children’s learning environment. The pack provided parents with developmentally appropriate tools (such as the soft vegetable toy and the practical strategies provided in the resource) that enabled them to scaffold learning and guide their children’s health behaviour.
While the results of this study were modest, educators noticed changes in children’s attitudes and behaviours with respect to nutrition and physical activity. Parents and carers also observed an increased willingness to try new foods and engage in more activity. Many parents and carers expressed an interest in having this learning continue for their children throughout the time they attended ECEC. They felt that ongoing exposure to healthy messages while in ECEC could help to initiate conversations at home and encourage families to engage in healthy activities together, reinforcing the messages they receive while attending ECEC.
The Munch & Move programme is ideally suited to extend this education into the home environment. Although information is currently shared with families as part of Munch & Move, this alone may not be enough to support lasting behaviour change. More engaging and targeted strategies may be needed to help reinforce behaviour change messaging at home (Zheng et al., 2022). Limited communication between parents/carers and ECEC educators regarding healthy behaviours may be partly due to educators’ low confidence in discussing health topics with families (Rapson et al., 2020). Early years educators often lack the nutrition and physical activity literacy and skills to effectively collaborate with parents and carers. Strengthening collaboration between educators and parents/carers is vital to support children in establishing positive lifestyle behaviours (Norman et al., 2016; Zheng et al., 2022). The HAB pack helped to bridge this gap, encouraging educators to have these conversations with families. Evidence from other studies shows that a coordinated approach between educators and parents/carers contributes to healthy lifestyle behaviour changes in children (Norman et al., 2016; Zheng et al., 2022).
The HAB pack included a take-home scrapbook, an educational approach that is well-recognised and widely used in ECEC, to provide health education to families. Bergström et al. (2015) has highlighted how interventions aligned with current practice are easier to implement. This study showed that ECEC services and parents/carers found the HAB pack easy to complete, with clear instructions that fitted in with a busy lifestyle. Norman et al. (2016) found that parent targeted activities in the school setting were more effective when they were not overly difficult and required minimal preparation by teachers. Malek et al. (2021) also emphasised the importance of intervention acceptability for children, teachers and parents, aligning with this study. Parents reported the pack encouraged the whole family to interact with the resource, making it easier to have discussions with their children about healthy choices and also encouraged their children to try vegetables.
Research has demonstrated the need to tailor health interventions in disadvantaged areas to participants’ abilities (Peters et al., 2014). While participants in this study found the pack easy to use, the SEIFA measures of relative socio-economic disadvantage scores of the ECEC services and families in this study were not reflective of the western Sydney population. Most services (63%) and participants (79%) in this study were in the least disadvantaged postcodes (deciles 6–10). Western Sydney has a large CALD population living in low SEIFA areas (Australian Bureau of Statistics, 2021; Western Sydney Local Health District, 2021) and further research is needed to determine whether take-home educational activities are appropriate and effective for these families.
Strengths and limitations
A key strength of this study was the leveraging of existing relationships with ECECs to recruit participants. The familiarity of the scrapbook educational approach to the educators and parents/carers meant that the method was easily understood. However, there were several limitations. This small pre-post study had no control group, and although the questionnaire was based on validated tools, only the Bohman et al. (2013) instrument has been tested for reliability. The Wright et al. (2015) tool lacks published reliability data, and the adapted version used in this study may have influenced measurement consistency. In addition, as the various measures relied on self-report, they are subject to bias and may not reflect actual behaviour change. The COVID-19 pandemic disrupted pack distribution and resulted in reduced participation as the ECEC sector was under considerable strain during this time (Rogers et al., 2023). Many services needed to pause or cease involvement, leading to fewer families receiving the pack than expected. Post-intervention follow-up was also challenging, as parents and carers may not have had the same time or energy to invest in the study that they may have had pre-COVID-19. Determining intervention fidelity also proved difficult due to challenges in contacting services. Reduced follow-up and engagement (likely due to COVID-19) may have biased the results, and other studies have reported that COVID-19 restrictions may have affected children’s eating and physical activity habits (López-Bueno et al., 2021; McNicholas et al., 2022). This may have led to an underestimation of the intervention’s broader impact. Participants, families and ECEC services may not have been representative of the western Sydney population. Those who completed the follow-up questionnaire may have already been interested and engaged in supporting changes to their children’s health behaviours. Finally, member checking of the qualitative data was not feasible due to resource constraints, which may affect the credibility of the qualitative findings.
Conclusion
This study demonstrated high acceptability of the HAB pack among ECEC services and families, and a significant improvement in parents’ confidence in supporting their child’s physical activity. These findings suggest that a take-home resource can effectively engage parents and support health behaviour changes in young children by creating a line of communication between the ECEC setting and home environment, ensuring clear and consistent health messaging for children. However, due to the study limitations, further research is needed. Future studies should explore the medium- to longer-term effects of take-home resources, their relevance and acceptability to diverse populations, and the potential benefits of additional support elements such as parent workshops.
Footnotes
Acknowledgements
The authors thank Christine Newman, Michelle Nolan and Bonny Keevers who first conceived of the take-home scrapbook with health information/vegetable toy concept and led the development of the Healthy Adventures Book pack. They also thank Don Nutbeam who provided advice on the research methodology. They thank the Early Childhood Education and Care services, and the families involved, for their contribution to this study.
Data availability statement
The data underlying this article cannot be shared since participants did not consent to data sharing beyond the original research.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship and/or publication of this article: this work was supported by the Centre for Population Health, Western Sydney Local Health District.
