Examining the food environment and nutrition practices in preschool settings in Ireland
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Background: As early years care settings contribute significantly to children’s nutrient intake and acquisition of long-term dietary habits, a health-promoting preschool setting can be an important intermediate for encouraging and supporting healthy eating habits. With recent increase in investment in the early years care sector by the Irish Government, it is timely to review the food environment and related processes within preschools to ensure best practice in promoting healthy food and diets to preschoolers. Understanding nutrition-related processes in the preschool setting and the determinants and context in which they occur is an important prerequisite for targeted and effective changes to support healthy eating in the preschool setting. Aims: Using a settings approach this thesis aims to explore the factors influencing the food environment and nutrition practices in Irish preschool settings by: 1) examining preschool nutrition policies, mealtime practices, and the food environment; 2) identifying staff perceptions and behaviours related to food and nutrition in preschools; 3) exploring very young children’s perceptions about healthy eating and their food preferences; 4) examining parent views and perceptions related to food and nutrition for preschoolers; and 5) exploring barriers and opportunities for promoting healthy nutrition in preschools. Methods: Purposive sampling was used and 10 preschools with different services and approaches to food provision were recruited. All stakeholders involved in promoting and feeding preschool children were involved, including children (n=64), staff (n=10) and parents (n=10). A mixed method research design was used including observation, document review, questionnaires and semi-structured interviews with caregivers and parents. Creative and visual methods were used with children. Inductive thematic analysis was conducted using NVivoPro11. Findings: Study 1 revealed that preschool staff demonstrated their motivation to educate children and provide them with nutritious and balanced food and several positive nutrition practices were observed. However, the findings also revealed a lack of effective healthy eating policies leading to an unsupportive nutrition environment and a lack of staff training on nutrition. Importantly, staff could not see any scope to change nutrition practices. Finally, perception of families’ poor food habits and parental attitudes created challenges in the implementation of healthy eating practices at preschools. Study 2 demonstrated that creative research methods with very young children provide meaningful data. Children described the sensory appeal of food and expressed their emotions in response to foods. Family and social influences clearly influenced their food preferences and their knowledge of healthy food was evident. Children as young as age 3 years recognize internal cues of hunger and satiety and can self-regulate food intake, however this ability is determined by environmental factors. The findings also show that children prefer a variety of food. Study 3 illustrates the challenges faced by parents when feeding their children, related to child preferences and external food environmental factors. While parents expressed the need for nutrition-related information from preschools, inadequate communication between parents and staff hindered collaboration between these two settings to support children’s healthy eating. Therefore, the study’s findings indicate a need to improve communication between staff and parents, active invitation of parents to participate in preschools, creating opportunities for parental nutrition training, and greater parental involvement in preschool nutrition practices. Conclusion: This research provides a holistic picture of the complex processes occurring within the socio-ecological system related to preschool nutrition and provides a comprehensive account of nutrition-related determinants and a conceptual map illustrating the relationships between them. The study identified barriers and facilitators to promoting healthy eating in the Irish preschool setting at four levels (individual, organisational, community, and policy) and outlined key action areas (the need for changing the organisational culture in preschools, conducting nutrition and capacity-building training for all stakeholders and improving staff-parent communication and parental involvement) which can be used to direct the development of future interventions to improve nutrition in young children via contextually relevant changes within available resources.