The primary outcome of this feasibility RCT was the acceptability of the intervention and the trial methods, assessed against pre-set progression criteria (see Progression criteria). Progression criteria were agreed with the NIHR Public Health Research funding board and an independent TSC and were assessed using a range of methods.
Secondary outcomes
The secondary outcomes were measured at baseline (T0) prior to the intervention and 8–10 months after the baseline measurements (T1) (follow-up was deliberately staggered to assess the feasibility of following up children aged 4 years as they moved to school). These assessments were to inform the choice of primary outcomes for a full-scale trial and particularly whether or not the outcomes require data collection from parents/carers and children, or if the outcomes could be the environmental audit and zBMI using data linkage from the National Child Measurement Programme (NCMP). The outcomes included:
l child accelerometer-measured activity
l children’s height and weight
l child food and drink intake, specifically of fruit and vegetables, snacks and sugar-sweetened drinks
l child screen time
l EPAO instrument score
l parental and nursery staff mediators
l family costs
TABLE 5 The NAP SACC UK: TIDieR checklist
Item Description
Name NAP SACC UK
Why NAP SACC UK is an intervention delivered in child-care settings with the aim of improving the nutrition, oral health and PA environment, through a process of self-assessment and targeted assistance. NAP SACC UK is a theory-based programme that employs components of social cognitive theory and socioecological framework. The objectives of the programme are to improve the nutritional quality, variety and quantity of food served, increase the amount and quality of PA, and to improve oral health education, staff–child interactions and staff behaviours around nutrition and PA and child-care provider policies on nutrition and PA
NAP SACC at Home
Phase 1 work included interviews with parents, which indicated an interest in a digital media intervention for parents, where tips and ideas could be given without being invasive or‘preachy’ What: materials The NAP SACC UK intervention is based around a self-assessment tool completed by nursery
managers. This document, called the Review and Reflect, is an 80-item multiple-choice questionnaire, completed by the nursery manager, covering areas in nutrition, oral health, PA and play, outdoor play and learning, and screen time
Following completion of the Review and Reflect, the nursery manager along with the NAP SACC UK partner agree on eight goals: three nutrition, three PA and a further two of the nursery’s choice. These are recorded on the‘NAP SACC UK Action-planning’ document
Intervention materials are not yet available for access because of the possibility of undertaking a full-scale trial
NAP SACC at Home
The NAP SACC at Home intervention is based around a website called‘NAP SACC at Home’. This contains a page where parents can register their details, an initial questionnaire, goal-setting area and information pages. Additional materials included a NAP SACC at Home Facebook page, and paper copies of resources for those without internet access
What: procedures The NAP SACC UK intervention is a five stage process:
1. Self-assessment: the nursery manager completes the Review and Reflect questionnaire. This 80-item questionnaire has response options ranging from minimal to best practice for each question 2. Workshop delivery: specialised staff deliver two workshops to the nursery on (1) nutrition and oral
health and (2) PA. All staff within the nursery are encouraged to attend each of the workshops 3. Action-planning: the NAP SACC UK partner (health visitor) works with the nursery manager to set
out an action plan, listing eight goals for improvement. These are three nutrition goals, three PA goals and two further goals of their choice. The NAP SACC UK partner will help the nursery manager agree how and when these goals will be reached
4. Targeted technical assistance: the NAP SACC UK partner continues regular contact with nursery by way of telephone, e-mail or face to face, to provide support and advice to help them meet their goals
5. Evaluate, revise, repeat: the Review and Reflect self-assessment is repeated by the nursery manager and reviewed with the NAP SACC UK partner to see where improvements have been made, where they have not, and reasons why can be discussed to help overcome barriers. Action plans are revised to set new goals
NAP SACC at Home
The NAP SACC at Home part of the intervention has the following stages: 1. Parents are given details of the NAP SACC at Home website
2. Parents log on to the website and are asked to register with either an e-mail address or a telephone number
3. Parents are asked to complete a basic introductory‘healthy habits’ questionnaire around their habits at home in relation to food, drink, activity, oral health and sleep
4. As an incentive, the first 50 parents to register their details and complete the questionnaire receive a swimming voucher for a local pool
TABLE 5 The NAP SACC UK: TIDieR checklist (continued )
Item Description
5. Parents receive a tailored text/e-mail giving them suggestions or areas to set goals
6. Parents are asked to set goals online, in the areas of eating, drinking, oral health, sleeping, indoor play, outdoor play and TV screen-viewing
7. Parents are sent tailored information via text/e-mail fortnightly, containing tips and suggestions to help them meet their goals
8. Parents are encouraged to log on to the website to review their goals and set new ones Who provided The main part of the intervention was delivered by NAP SACC UK partners, who in this study were
health visitors. Health visitors are qualified nurses or midwives who have undertaken further training and qualifications in child health, health promotion, public health and education. Additionally, to undertake the role of NAP SACC partner, health visitors were given further training consisting of a 0.5-day session led by a senior early years nutrition health improvement specialist, a PA specialist and an oral health specialist, and a further 2-hour‘top-up’ training session mid-way through the intervention
Workshops were delivered by specialists. The nutrition workshop was delivered by a senior early years health improvement specialist with a background in paediatric dietetics. The PA workshop was delivered by a PA expert
NAP SACC at Home
The NAP SACC at Home part of the intervention was delivered remotely via a website (or paper copies) and via Facebook. The content of the website and Facebook page was developed by the study team, and the website was designed and built by a specialist digital media company
How The main part of the intervention was delivered face to face; this included going through the Review and Reflect and action-planning, and the workshops. Other parts of the intervention, such as on-going support and advice from the NAP SACC UK partner, could be provided over the telephone, or by e-mail All parts of the intervention were delivered to participating nurseries individually. Some parts may have been delivered on a one-to-one basis (e.g. nursery manager and NAP SACC UK partner setting goals), whereas other parts, such as the workshop, would have been delivered to a whole group of staff from one nursery
NAP SACC at Home
The NAP SACC at Home part of the intervention was delivered remotely via a website (or paper copies) and via Facebook. Parents were able log on at a time convenient to them, on laptops, PCs or mobile devices
Where The NAP SACC UK intervention is delivered in the nursery itself. The NAP SACC UK partner offers visits to the nursery as necessary, and the workshops take place at the nursery, unless the nursery request otherwise
NAP SACC at Home
Parents were able access materials via the internet from their own home, or wherever was convenient When and how
much
The NAP SACC UK intervention took place over 5 months. The initial face-to-face meetings between health visitors and nursery managers lasted≥ 2 hours. The average number of advice/support opportunities given was 2.2 face-to-face meetings, 1.8 telephone calls and 2.8 e-mails The nutrition workshops were 3 hours and the PA workshops were 2.5 hours NAP SACC at Home
Parents were able to access the website as often as they liked during the intervention period. Individually tailored texts/e-mails were sent to parents on a fortnightly basis