l Phase 1: intervention adaptation and development, in which the NAP SACC materials were adapted for use in the UK and the NAP SACC UK home component to involve parents/carers was created.
l Phase 2: feasibility cluster RCT with embedded process evaluation and health economic methods (Figures 1 and 2). The logic model for the NAP SACC UK intervention is shown in Figure 3.
Transcription and anonymised analysis
Identify eligible child-care providers in North Somerset
and Cardiff with North Somerset Council and Cardiff Council early years
staff
Randomly select eight eligible child-care providers
in North Somerset and eight in Cardiff
Letter of invitation to take part in phase 1 sent from North Somerset Council to manager (with information sheet, consent form and
prepaid envelope)
Consent to take part in phase 1
One focus group and 10 interviews with staff from child-care providers
(12 staff)
Recruited child-care providers gave out letters of invitation to parents (with information
sheet, consent form and prepaid envelope) to take part in telephone interviews
Data collection/analysis
Interviews and focus group with parents
Transcription and anonymised analysis
Data
Piloting
Consent
Recruitment
Consent to take part in phase 1
31 telephone interviews with parents of children
aged 2–4 years
Transcription and anonymised analysis
NAP SACC intervention adapted by the research team with a health visitor, a child-care manager and a dietitian
University of Bristol sent letters of invitation to staff (with information sheet, consent
form and prepaid envelope) to take part in focus groups
Consent to take part in phase 1
Four focus groups with staff groups (16 staff)
Transcription and anonymised analysis
Final changes to NAP SACC UK Pilot NAP SACC UK at Home with parents
Child-care providers Early years; public health;
health visitors; and Wales Healthy and Sustainable Pre-School
Scheme staff Parents
Cluster randomisation of child-care providers
Consent
Randomly selected 12 eligible child-care providers stratified by size and deprivation separately for North Somerset and
Gloucestershire
Letter of invitation to take part in phase 2 sent from Council manager (with information sheet, expression of interest form
and prepaid envelope)
Consent to take part in phase 2 returned to University of Bristol
September 2015–January 2016: baseline data collection from nurseries, parents and children
Data collection
Recruitment
Randomisation
Parent consent for child to take part in
phase 2 sent to University of Bristol
July–November 2016: follow-up data collection from nurseries, parents and children Six intervention nurseries Six control nurseries
February–June 2016: delivery of NAP SACC UK intervention
Data
Intervention
Research team telephoned and arranged visits to child-care providers who expressed interest and gave consent form to those
willing to take part
Randomly selected further child-care providers to invite if 12 did not give consent
Eligible child-care providers identified in North Somerset and Gloucestershire with North Somerset Council and Gloucestershire County Council
Recruited child-care providers gave out letters to parents of 2- to 4-year-olds to request consent for their child to take part (with information sheet,
consent form and prepaid envelope)
Household and nursery environment characteristics
Sociodemographic factors for the child and family: area-level deprivation (IMD score using home postcode), gender, ethnicity
Nursery environment factors self-reported by nursery: nursery policy to promote healthy eating and physical activity and reduce sedentary behaviours, external initiatives to promote healthy eating and physical activity and/or reduce sedentary behaviour
Nursery factors reported on national website: Ofsted school performance factors
Guidance and policy context
Eat Better Start Better28 Change4Life;64 Food and Health Guidelines for early years and child-care settings;7,28 Start Active, Stay Active65
Intervention
Mediators (method of measurement in brackets)
Increased moderate to vigorous physical activity (accelerometry)
Decreased sedentary time (accelerometry)
Outcomes (method of measurement in brackets)
Increased fruit and vegetables consumed per day (CADET)
Decreased unhealthy snacks, high fat foods and high energy drinks consumed per day (CADET)
Physical activity and diet
behaviours
Decreased screen viewing (questions added to CADET)
Obesity-related
Reduced body mass index (if overweight or obese) (zBMI)
Decreased prevalence of overweight and obesity (zBMI and IOTF/UK1990 thresholds)
Home: ‘NAP SACC at Home’ component for parents to review nutrition, physical activity, sedentary, oral health and sleep behaviours at home with ideas for changes at home supported by post, text and e-mail reminders
Nursery environment factors assessed by EPAO
Nursery staff/parents increased knowledge of best practice about nutrition and physical activity (process evaluation)
Nursery staff/parents increased
knowledge of health benefits of nutrition, physical activity, decreasing sedentary time and health risks for children from excess weight (process evaluation)
Nursery staff/parents strengthened self-efficacy and internal motivation for improving children and staff health, improving children’s nutrition and physical activity (self-efficacy and motivation measures)
Knowledge
Self-efficacy and
motivation
Nursery: ‘Review and Reflect’ against best practice with regular targeted assistance from a NAP SACC UK partner to undertake goal-setting and action-planning to change the environment, policies and practices:
• Fruit and vegetables • High-fat foods • Beverages • Meals and snacks • Menu and variety • Food items outside regular meals and snacks • Supporting healthy eating • Oral health promotion
• Nutrition education for children, parents and staff
• Nutrition policy
• Active play and inactive time • Screen use and viewing • Play environment • Supporting physical activity
• Physical activity education for children, parents and staff
• Physical activity policy
Nutrition
Physical activity
FIGURE 3 Logic model of NAP SACC UK. IOTF, International Obesity Task Force.
THE NAP SACC UK FEASIBILITY STUDY OVERVIEW NIHR Journals Library www.journalslibrary.nihr.ac.uk