Zarnowiecki 2021.

Study name	Application of the multiphase optimisation strategy to develop, optimise and evaluate the effectiveness of a multicomponent initiative package to increase 2‐to‐5‐year‐old children's vegetable intake in long day care centres: a study protocol
Methods	Study design: Phase 1: full factorial design Phase 2: cluster‐RCT
Participants	Service type: centre‐based Country (region): Australia (Adelaide) Number of services participating: Phase 1: 32 Phase 2: 20
Interventions	Number of conditions: Phase 1: 7 interventions, 1 control Phase 2: 1 intervention, 1 control Intervention strategies: Phase 1 Intervention 1 Health curriculum Children Curriculum: a series of 16 short (~10–20‐min) lessons and hands‐on activities delivered during intentional teaching time. Children Exposure: a series of 16 snack time occasions where vegetables will be tasted and critical strategies to reinforce children’s enjoyment of vegetables can be consolidated. Materials: supporting resources and activities to further familiarise children with vegetables and their senses and a group reward chart to track progress of vegetables tasted. Ethos and environment ECEC staff Education: a lesson package for educators that aims to provide opportunities for children to learn about, try and enjoy vegetables by increasing their exposure to a variety of familiar and unfamiliar vegetables. Educators will complete an interactive online training module (~45–55 min) which includes topics about the role of the educator in promoting healthy eating, creating supportive meal time environments, use of feeding practices, overcoming barriers related to food rejection and planning and implementing a strategy within their centre. Educators and teachers will then apply the knowledge and strategies learnt in training during mealtimes in the 8 weeks of the implementation period. Training: cooks will complete an online training module, use an online menu planning tool to review their menu and implement the revised menu. Feedback: cooks will use an automated online menu assessment tool to assess compliance of their menu with guidelines and will revise their menu based on this feedback. Intervention 2 Ethos and environment ECEC staff Education: a lesson package for educators that aims to provide opportunities for children to learn about, try and enjoy vegetables by increasing their exposure to a variety of familiar and unfamiliar vegetables. Educators will complete an interactive online training module (~45–55 min) which includes topics about the role of the educator in promoting healthy eating, creating supportive meal time environments, use of feeding practices, overcoming barriers related to food rejection and planning and implementing a strategy within their centre. Educators and teachers will then apply the knowledge and strategies learnt in training during mealtimes in the 8 weeks of the implementation period. Training: cooks will complete an online training module, use an online menu planning tool to review their menu and implement the revised menu. Feedback: cooks will use an automated online menu assessment tool to assess compliance of their menu with guidelines and will revise their menu based on this feedback. Intervention 3 Ethos and environment ECEC staff Training: cooks will complete an online training module, use an online menu planning tool to review their menu and implement the revised menu. Feedback: cooks will use an automated online menu assessment tool to assess compliance of their menu with guidelines and will revise their menu based on this feedback. Intervention 4 Health curriculum Children Curriculum: a series of 16 short (~10–20 min) lessons and hands‐on activities delivered during intentional teaching time. Materials: supporting resources and activities to further familiarise children with vegetables and their senses and a group reward chart to track progress of vegetables tasted. Ethos and environment Children Exposure: a series of 16 snack time occasions where vegetables will be tasted and critical strategies to reinforce children’s enjoyment of vegetables can be consolidated. ECEC staff Education: a lesson package for educators that aims to provide opportunities for children to learn about, try and enjoy vegetables by increasing their exposure to a variety of familiar and unfamiliar vegetables. Training: cooks will complete an online training module, use an online menu planning tool to review their menu and implement the revised menu. Feedback: cooks will use an automated online menu assessment tool to assess compliance of their menu with guidelines and will revise their menu based on this feedback. Intervention 5 Health curriculum Children Curriculum: a series of 16 short (~10–20 min) lessons and hands‐on activities delivered during intentional teaching time. Materials: supporting resources and activities to further familiarise children with vegetables and their senses and a group reward chart to track progress of vegetables tasted. Ethos and environment Children Exposure: a series of 16 snack time occasions where vegetables will be tasted and critical strategies to reinforce children’s enjoyment of vegetables can be consolidated. ECEC staff Education: a lesson package for educators that aims to provide opportunities for children to learn about, try and enjoy vegetables by increasing their exposure to a variety of familiar and unfamiliar vegetables. Educators will complete an interactive online training module (~45–55 min) which includes topics about the role of the educator in promoting healthy eating, creating supportive meal time environments, use of feeding practices, overcoming barriers related to food rejection and planning and implementing a strategy within their centre. Educators and teachers will then apply the knowledge and strategies learnt in training during mealtimes in the 8 weeks of the implementation period. Intervention 6 Health curriculum Children Curriculum: a series of 16 short (~10–20 min) lessons and hands‐on activities delivered during intentional teaching time. Materials: supporting resources and activities to further familiarise children with vegetables and their senses and a group reward chart to track progress of vegetables tasted. Ethos and environment Children Exposure: a series of 16 snack time occasions where vegetables will be tasted and critical strategies to reinforce children’s enjoyment of vegetables can be consolidated. ECEC staff Education: a lesson package for educators that aims to provide opportunities for children to learn about, try and enjoy vegetables by increasing their exposure to a variety of familiar and unfamiliar vegetables. Intervention 7 Ethos and environment ECEC staff Training: educators will complete an interactive online training module (~45–55 min) which includes topics about the role of the educator in promoting healthy eating, creating supportive meal time environments, use of feeding practices, overcoming barriers related to food rejection and planning and implementing a strategy within their centre. Educators and teachers will then apply the knowledge and strategies learnt in training during mealtimes in the 8 weeks of the implementation period. Phase 2 Authors hypothesise that the optimised initiative package will include all 3 initiatives.
Outcomes	Outcomes relating to child dietary intake: Phase 1: vegetable intake Phase 2: vegetable intake Outcomes relating to child anthropometric measures: not reported
Starting date	Phase 1: January 2021 Phase 2: January 2022
Contact information	Professor Rebecca K Golley, rebecca.golley@flinders.edu.au
Notes	Phase 1: ACTRN12620001301954 Phase 2: ACTRN12620001323910p

ECEC: early childhood education and care; RCT: randomised controlled trial