Beyond Local Champions: Contextual Factors Shaping the Implementation of Healthy Eating Interventions in Centre‐Based Care – A Qualitative Study With Educators and Cooks

ABSTRACT

Issue Addressed

The early childhood education and care (ECEC) setting provides a critical opportunity to reach young children and families to support optimal nutrition and development. Despite the abundance of healthy eating interventions delivered in this setting, the most effective ways to improve children's diets remain unclear. These efforts are hindered by our limited understanding of the complex set of factors that influence the successful implementation of healthy eating interventions. This study aims to explore early childhood educator and cooks' experiences of the contextual factors influencing the implementation of healthy eating policies and practices.

Methods

A qualitative study using semi‐structured interviews was conducted with 10 educators and cooks from New South Wales, Australia. The Consolidated Framework of Implementation Research was used to guide data collection. Data were analysed using reflexive thematic analysis.

Results

Educators and cooks expressed commitment to implementing healthy eating policies and described support from directors and local health services. However, ECEC sector conditions inhibited implementation success. Barriers to implementation included inadequate collaboration between management, educators, cooks and parents; limited opportunities for partnerships and networking within the ECEC sector and beyond; and insufficient nutrition education and training.

Conclusions

Addressing broader systems‐level factors by strengthening work infrastructure, partnerships, and nutrition education and training opportunities is necessary to improve the implementation success of healthy eating policies and practices in the ECEC sector.

So What?

Findings can inform policymakers to consider barriers faced by ECEC staff in implementing healthy eating interventions.

1. Introduction

Early childhood education and care (ECEC) is a powerful setting for promoting healthy development and eating habits in early years. ECEC attendance is associated with better language skills, academic achievement and reduced risk of poverty in adulthood [1, 2]. Following major policy reforms implemented in 2008 to increase access to preschool programmes, the number of Australian children attending preschool, including programmes provided by centre‐based long day care, has grown [3]. In 2024, almost 60% of Australian children attended centre‐based day care and spent on average 27 h in care per week [4]. Given the number of children in attendance and long hours in care, centre‐based ECEC services provide opportunities to improve children's eating behaviours and diets.

The majority of studies investigating the effectiveness of interventions to optimise children's diets have been conducted in the ECEC setting [5]. However, the effectiveness of ECEC‐based healthy eating interventions remains unclear [6]. Interventions show favourable results for fruit intake, but there appears to be little to no effect on the consumption of vegetables, energy‐dense nutrient‐poor foods and sugar‐sweetened beverages [6]. Support strategies such as providing educational materials, audit and feedback, incentives, reminders and tailored advice may improve intervention implementation, but these strategies did not translate to better child dietary outcomes [7]. Implementation issues can attenuate the potential benefits of evidence‐based healthy eating interventions on children's dietary outcomes in the real world [8].

In Australia, the implementation of healthy eating practices in the ECEC setting is varied and some practices remain poorly implemented [9]. Research suggests that long day care centres providing food on site are not meeting menu planning guidelines [10, 11]. The National Quality Standards (NQS) set quality benchmarks which state that healthy eating be “promoted and appropriate” for children [12]. In New South Wales (NSW), the state‐funded Munch & Move initiative is delivered by local government health services to support implementation of state‐specific best practice guidelines on healthy eating and nutrition for the ECEC setting [13]. However, food provision guidelines vary across each state and territory and only three out of eight jurisdictions provide state‐funded programmes [14]. As such, there have been calls for a national coordinated approach to provide support to ECEC services to implement healthy eating policies and practices [14]. Given the differences in guidelines, support and resources, it is important to gain a systems‐level understanding of how the various factors interact to influence implementation across jurisdictions within Australia.

The ECEC setting is shaped by a complex set of influences, many of which pose challenges to implementing and sustaining healthy eating policies and practices. A substantial body of research has examined the barriers and enablers to implementing healthy eating policies and practices in the ECEC setting [15]. Qualitative studies to investigate the barriers and enablers to a health‐promoting food environment [16], menu planning guideline implementation [17] and factors influencing food service provision [18] have been previously conducted in Queensland, Victoria and South Australia, respectively. In NSW, factors influencing the implementation of healthy eating policies and practices have been previously explored; however, these studies use a deductive quantitative approach which may limit insight into specific barriers related to implementation and overlook important factors [19, 20, 21]. Notably, most of these studies have applied the Theoretical Domains Framework which focuses on describing ‘inner setting’ factors such as knowledge, skills and beliefs at the individual level, social influences at the interpersonal level, and environmental context and resources at the organisational level.

Our understanding of the ‘outer setting’ such as the sociocultural values and economic, environmental and political conditions within the broader systems in which ECEC services operate remains limited. Addressing these broader influences is essential for the development of effective, system‐level policy interventions. For example, in the United States, the Child and Adult Care Food Program reduces financial barriers by providing free or subsidised meals to children in low‐income communities, with participating centres reporting fewer implementation challenges compared to non‐participating centres [22]. Given that health and nutrition support in Australia is state‐based, and the level of support varies across states, it is important to understand contextual factors within each state. In NSW, where the state‐funded healthy eating programme exists, further qualitative research into system‐level influences on policy implementation could also inform support strategies in the ECEC setting across other jurisdictions.

Within the ECEC setting, ECEC staff play a critical role in providing a safe environment to meet children's health and nutritional needs and nurture healthy eating habits. Particularly important are early childhood educators and cooks. Educators can shape the dietary behaviours of young children through modelling healthy eating, providing nutrition education and reinforcing positive behaviours during mealtimes [23] whilst ECEC cooks or chefs play an integral part in the planning and preparation of meals, as well as exposing children to food through health‐promoting menus [18]. Australian research has predominantly focused on directors and cooks, with limited attention to educators' perspectives. Exploring and comparing the experiences of both educators and cooks is integral to understanding the contextual factors influencing the delivery of healthy eating policies and practices given their different roles. This study aims to add to the body of evidence and examine the inner and outer setting factors influencing the implementation of healthy eating policies and practices from the perspectives of early childhood educators and cooks in NSW, Australia.

2. Methods

The researchers followed the Standards for Reporting Qualitative Research (SRQR) reporting guideline [24]. This study was approved by the Sydney Local Health District Human Research Ethics Committee (Project Number X23‐0379).

2.1. Qualitative Approach and Paradigm

This study is underpinned by an interpretivist or social constructivist paradigm assuming that reality is multiple and subjective, and meaning is shaped by past experiences and social context [25, 26]. A qualitative descriptive approach allowed authors to explore and present findings in a way that closely reflects the multiple and subjective experiences of participants [27]. This approach is relevant to constructing meaningful and nuanced accounts of how context influences experiences of educators and cooks and better understand the complexities of implementing healthy eating policies and practices unique to the ECEC setting.

Four authors are experienced in research into nutrition and early childcare settings. As practitioners with extensive experience in the early childcare sector, authors J.C. and A.H.‐P. bring nuanced insights and understanding of the childcare environments. Authors P.P. and M.A.‐F. have considerable experience conducting mixed‐methods research involving qualitative study design and analysis. Author D.R. is an experienced researcher in the ecology of nutrition. Our complementary perspectives and experiences enhanced the study's methodology and ensured transparency, as we were cognisant and reflective of our respective experiences in data collection, analysis and interpretation.

2.2. Recruitment

Early childhood educators and cooks currently employed at a centre‐based ECEC service providing food to children were eligible to participate. As we were interested in exploring the different experiences with external factors such as local community conditions, we used purposeful sampling to recruit participants from ECEC services located across central and south eastern Sydney where there are ethnically diverse communities. Educators and cooks were invited to participate by representatives from Local Health District Health Promotion Services who have an existing relationship with ECEC services through the Munch & Move initiative. Recruitment materials including a study flyer and information about the risks and benefits associated with the study were distributed by email, newsletters, workshops and a Facebook page. Those interested were able to voluntarily participate by following a link from the flyer to an online survey to collect informed written consent and demographic data (Appendix A).

2.3. Data Collection

Data were collected using semi‐structured interviews, which allowed for guided exploration of participant experiences within the allocated timeframe recognising that educators and cooks are time poor. As it has been previously reported that there are workforce challenges, staff shortages and poor work conditions [28], individual interviews allowed for confidential discussion of workplace relationships and barriers. The interview guide (Appendix B) contained seven open‐ended questions and additional prompts based on the Consolidated Framework of Implementation Research (CFIR). The CFIR describes factors influencing implementation across five domains: Innovation, Outer Setting, Inner Setting, Individuals and Implementation Process [29]. The interview focused on exploring participant experiences of implementing the Innovation or healthy eating policies and programmes, and how implementation is influenced by Inner Setting and Outer Setting domains to allow for in‐depth exploration of contextual factors most relevant to addressing the study aims. The interview guide was piloted with an educator and cook not included in this sample to ensure clarity and relevance of the questions. The number of educators and cooks interviewed was guided by the information power principle whereby the depth and richness of data was achieved amongst a targeted sample [30, 31]. Participants were recruited with support from health promotion services, resulting in a homogenous sample of cooks and educators who were more involved in nutrition and healthy eating, thus offering insights relevant to the study aims. The study had a specific aim and was informed by the established CFIR framework. Based on these factors, the sample size of 12 participants was deemed to provide sufficient information power to address the study aims. Participants were interviewed at the ECEC service where they were employed by the first author (J.C.). Verbal consent was obtained prior to collecting audio recording of the interviews using Zoom software. Audio recordings were transcribed verbatim using Microsoft Word. Participants received an AUD $30 gift voucher following the interviews to reimburse them for their time. Ten interviews with four educators and six cooks were conducted between December 2023 and April 2024. Interviews ranged from 18 to 70 min, with a mean of 36 min.

2.4. Data Analysis

Reflexive thematic analysis was selected because it is suited to our theoretical orientation, valuing meaning produced from participants subjective experiences and researchers perspectives and assumptions [32]. The theoretical flexibility of reflexive thematic analysis also allowed for authors to bring in constructs from the CFIR to provide a lens to code and understand patterns of meaning [33]. Data were analysed by the first author (J.C.) using Braun and Clarke's six‐phase approach [34]. Transcripts were first inductively open coded to allow themes to emerge from the data. This was followed by a second round of coding using a deductive approach guided by the CFIR to articulate specific constructs and generate initial themes. J.C. continued to review and refine the themes until clear central organising concepts were identified, ensuring a fit with the data set. To ensure research quality, each stage of the analytic process was documented and J.C. reflected on the values and perspectives as a dietitian and researcher throughout the process. Data were managed using Nvivo 14.

3. Results

Participant and centre characteristics are presented in Table 1.

TABLE 1.

Demographic characteristics of participating educators (n = 4) and cooks (n = 6) and centre characteristics (n = 10).

	n (%)
Participant characteristics
Gender
Female	9 (90.0)
Male	1 (10.0)
Age
30–39 years	4 (40.0)
40–49 years	4 (40.0)
50–59 years	1 (10.0)
60–69 years	1 (10.0)
Education level
Secondary education	1 (10.0)
Certificate I–IV	3 (30.0)
Graduate or advanced diploma	3 (30.0)
Degree (bachelor, masters, doctorate)	3 (30.0)
Median years of experience in ECEC (range)	9 (4–25)
Country of birth
Australia	2 (20.0)
Other a	8 (80.0)
Centre characteristics
Mean number of children (range)	63 (30–102)
Service provider type
For‐profit	2 (20.0)
Non‐profit	8 (80.0)
Food preparation
All meals cooked on site	10 (100.0)
Socio‐economic status (SEIFA 2021) b
Most disadvantaged (quintiles 1–3)	0 (0.0)
Most advantaged (quintiles 4 and 5)	10 (100.0)

^a Argentina, Brazil, India, Indonesia, Netherlands, Northern Ireland, Taiwan, and United States of America.

^b Socio‐Economic Indexes for Areas (SEIFA) IRSAD quintiles: Index of Relative Socio‐economic Advantage and Disadvantage (IRSAD) provides a measure of advantage and disadvantage based on economic and social conditions, such as income and occupation of people and households within a geographical area. A high score indicates a relative lack of disadvantage and greater advantage. Most disadvantaged = quintiles 1–3. Most advantaged = quintiles 4 and 5.

3.1. Theme 1: Inner Setting Factors Fostering Local Champions

Inner setting factors fostering local champions capture participants reflections of the factors driving implementation of healthy eating practices. Participants articulated reliance on personal motivations, interests and experiences to fulfil their roles around food and nutrition. Outside of their individual attributes, participants described supportive relationships in the inner setting, which contributed to their ability to act with agency and feel empowered in their roles.

3.1.1. You Only Limit Yourself

Whilst acknowledging challenges, both educators and cooks described being confident in their competence, knowledge and skills required to fulfil their role and implement healthy eating practices. This was evident in the way participants described opportunities to innovate. For example, one educator commented ‘we are not hesitant to try something different’ (participant 27). Participants situated their experience as different from others suggesting this is not the case across the sector.

I'm special. I'm different, you know. I can do it. I can do a very good meal in one hour, but that's me, [other cooks] they can't. (Participant 32, cook)

I think if you probably talk to other chefs there would be a lot more barriers. Just because this comes like second nature to me. (Participant 18, cook)

Some participants attributed their capability to their years of experience in the industry and previous roles in commercial kitchens which equipped them with practical knowledge and skills to adapt in the ECEC setting. Participants also described their own motivation to challenge themselves, articulating a commitment to continuous improvement and learning. One cook commented ‘I think you only limit yourself’ (Participant 20).

I love to do lots of research and I like to learn new things. And yeah, I do a lot of it on my own. (Participant 11, cook)

Additionally, participants described a sense of personal fulfilment in their roles, especially in fostering children's healthy eating habits and supporting families to manage fussy eating. One cook commented that the sense of fulfilment from educating and exposing children to new foods was very important, otherwise ‘it becomes just a job, and you just become a robot […] it's very satisfying to see [the food] not coming back’ (Participant 40). Participants highlighted the importance of connecting with children and families and helping families who might not have the knowledge around nutrition and healthy eating. When asked about incentives, participants frequently described seeing changes in children's eating habits as a key motivating factor to continue to implement healthy eating practices.

I'm here because I would like to make a difference in children's lives […] And it's also building the relationships with the kids and the parents. [My reward] doesn't come from the company. (Participant 50, cook/chef)

3.1.2. You Are a Role Model for the Job

Educators frequently described their own personal interest in healthy eating and nutrition as a facilitator to advocate for and implement healthy eating policies and practices. For instance, centres relied on educators whose passion or ‘area of expertise’ was food and nutrition to plan and run cooking experiences with the children. One participant highlighted the importance of training opportunities in reinforcing staff interest to implement healthy eating practices and share this knowledge with other staff.

I attended a lot of [Munch & Move] training […] it confirms my own personal value and philosophy that ‘Oh yes, this is very important, this is what we need to do with the children’. (Participant 44, educator)

Educators also discussed being ‘a role model for the job’ and reflected on their own personal eating habits influencing delivery of healthy eating practices. For example, one educator commented that being a ‘healthy eater’ allowed them to better role model healthy eating habits during mealtimes. Participants reflected that their personal experiences provided credibility when supporting families. One participant likened the situation to being a personal trainer, commenting if the personal trainer was not physically active themselves, they would not have any customers. Another participant reflected that her own personal experience as a mother of five was a ‘selling point to families’ (Participant 52, educator). Participants noted unhealthy habits in educators around them and attributed this to educators being ‘mentally really exhausted when [they are] working with the children the whole day’ (Participant 17, educator).

3.1.3. Supportive Leadership

In addition to their own capability, motivation and interest, participants described supportive relationships and high‐quality communication within their organisation to facilitate implementation of healthy eating policies and practices. Participants emphasised the importance of trust from directors and autonomy to be creative as facilitators to fulfilling their roles.

I have a great director, that literally lets me be creative and do what I need. I have access to my own […] iPad in the kitchen. So yeah, I can always look up new inventive things, I've got the teacher support. We've got a lot of parents' support. (Participant 18, cook/chef)

Participants also identified flexibility around budget from centre directors as an important facilitator.

[The director] always told me that there's no budget for food we can buy. So, I like the freedom in everything I get here and that has boost up my confidence as well. (Participant 27, educator)

Furthermore, centre routines around mealtimes and programming time, was described as pivotal for creating a supportive environment for participants to deliver healthy eating practices.

3.2. Theme 2: Outer Setting Sector Challenges

Whilst participants articulated feeling capable and motivated to deliver healthy eating practices, implementation was contingent on factors outside of their control. Outer setting sector challenges captures the tensions articulated by participants between commitment to implement healthy eating policies and practices under ideal conditions and complexities in their daily reality. Participants reflected on goals to improve implementation of healthy eating practices but described uncertainty around when goals could be achieved. Implementation was dependent on the right conditions and when opportunities aligned. Participants described staff shortages, being too busy and not having enough time to plan fun ways of engaging children, lack of ideas and prepared resources, and waiting to ‘get back into routine’ (Participants 17 and 20). This idea is articulated by participant 11 who described implementing cooking activities with children ‘in the beginning of the year when things were a little bit better’.

3.2.1. Out of Our Control

Implementation of healthy eating practices relied on certain individuals with interest or expertise to improve or implement, rather than a collaborative effort. There was a tension in beliefs around what educators, cooks and families should be doing and whose responsibility it was to engage children. Some educators felt that the cooks should improve the menu, such as including more variety of foods to encourage children to eat. On the other hand, cooks described their role as limited to providing food and educators to motivate children to eat. Some cooks articulated that it should be the responsibility of an external expert to ensure that the menu meets nutritional requirements.

I don't know how the educators they feed the kids, but for me it's their job to motivate the kid to eat it. (Participant 32, cook)

Participants commented on the importance of collaboration to support implementation of healthy eating practices. For instance, collaboration between educators to plan cooking experiences and cooks to organise materials to support with delivery. However, participants articulated that the lack of communication and support from other staff was a limitation to supporting children's healthy eating behaviours.

I think another barrier is the people you work with, if we all have the same mindset about healthy eating, we could come up with a project together to do with the children. (Participant 17, educator)

Educators expressed that they can only guide families and that ultimately, it's up to children and families' choices. Some articulated that implementing healthy eating practices were lower on their priorities because it was up to children to decide what and how much to eat. Educators were happy to support families with healthy eating when asked by families but did not feel comfortable initiating the conversation. Educators expressed they didn't want to appear to question their parenting and offend families.

So I think parents have the prime most responsibility. We can guide them, we can tell them. But at the end of the day, it's their children, their choice. (Participant 27, educator)

3.2.2. Outer Setting Partnerships

Participants described partnership and trust from parents as a crucial factor. One educator noted that ‘the collaboration with the family is the biggest thing and maybe the only one externally. (Participant 44, educator).

Participants described reaching out to government health service support, Munch & Move, for free training to support them to deliver healthy eating policies and practices. This included working with Munch & Move to manage and support families with fussy eating, menu planning and training. However, beyond partnerships with families and Munch & Move, educators and cooks reflected that there were limited opportunities for partnerships outside of the ECEC setting, particularly with external organisations in the community.

I'm just thinking maybe childcare should get linked up to NSW Health services. Do some programmes where they come into childcare centres…I think it's very good if we all can be included, educators get a chance, parents get a chance. (Participant 27, educator)

Cooks reflected that they felt alone in their role, due to a lack of opportunities to network and communicate with other cooks in the sector. Participants reflected there were no active support networks and relied on their own peer networks.

The only people that I work with is Munch and Move. Cooks in centres, they should be supported a little bit more but sadly […] it's just once you're once you're in, it's up to you to make that leg work. (Participant 11, cook)

Cooks also frequently emphasised the importance of having a reliable food supply. Cooks commented that access to multiple local suppliers and pre‐cut meats and bigger cans to maximise time efficiency was an important factor to support their role.

3.2.3. Inadequate Industry Support

Cooks articulated that they did not feel as though their challenges were understood by service providers or by the ECEC sector. Cooks described instances where service providers failed to consider the practicalities of food preparation in the ECEC setting, leading to conflicting priorities and increased pressure. Some attributed this to poor communication and a lack of opportunities to voice their perspectives.

Look, I feel like management does a lot of talking. I feel like it should be a bit more about how we do things, how the kitchens run, like what our menus are, what our struggles are, you know, like try to keep on budget, where can we get the better option? (Participant 18, cook)

Participants also perceived guidelines were not practical for the demands of their role. Participants felt that guidelines did not consider available resources including time and space, food allergies, children's taste preferences, and fussy eaters, and felt guidelines were too restrictive or boring.

Participants described being thrown in at the deep end when starting their role and expected to support healthy eating without adequate support and guidance, given the lack of nutrition education received during their training. Participant 11 likened their experience to being ‘thrown into the middle of the ocean. You must swim. You might drown. Good luck to you’. Some cooks expressed concern about the quality of new educators, noting the lack of experience, confidence and knowledge.

But also to the fact that when I entered the company I had no support to start with, they had nothing to offer in terms of the network in terms of previous menus. All they said is here's your password, you need to order from Coles. Here is your budget $800, go for it. (Participant 50, cook)

Participants commented that there was inadequate support and guidance from providers. Beyond that there were also limited opportunities for training to upskill themselves within the workplace setting. Participants often relied on upskilling themselves by paying for their own courses and doing their own research through the internet or Facebook groups for cooks. Participant 32 compared ECEC with the aged care sector to highlight the lack of training and professional development opportunities in the ECEC sector.

Well, I think when I was in aged care, just comparing environments. We had lots of training like we had courses like we had to do refresh courses every six months and all this. Was it a little bit overwhelming, yes. But like now in childcare, there's none. (Participant 32, cook)

Whilst some participants felt fulfilled supporting healthy eating and motivated to do their own research as explored in Theme 1, for other participants, competing demands and the lack of support meant that professional development around healthy eating was not prioritised in planning and practice. Furthermore, participants described not knowing where to go to access information and professional development opportunities, again relying on their own research, highlighting the lack of sector support.

[…] if I could get it, I would. I've never thought about it and how to even go about it. I should probably go and google it. (Participant 52, educator)

Participants articulated unrealistic expectations from centres/providers to complete administrative, planning, and quality improvement tasks on top of their primary responsibilities.

I think like the factor to that is a more like a like the whole bigger picture with the early childhood. Sometimes you always find time constraint everywhere like we have so many things to do but there's such little time. (Participant 44, educator)

Participants described doing their own research in their own time, which was not recognised by the centre. Participant 50 described feeling undervalued and commented on the need for more compensation for their responsibilities.

They should either one, if they don't want to pay cooks to do menus they create menu, get somebody to create menus for them and then just distribute it them quarterly […] Or pay the cooks quarterly. If educators are getting paid to plan activities for children […] it just seems logical that of course the cook needs time to plan a menu. (Participant 50, cook)

3.2.4. Inconsistent Practices

Participants expressed frustrations at the inconsistencies in practices between the home and ECEC setting and between ECEC services. Some participants described unhealthy home environments and practices that undermined the efforts at ECEC. Participants attributed this to a lack of support for families, such as inadequate nutrition education and financial resources for some.

And then it also needs to be backed up with the support at home. What I find is a lot of families are they pick the kids up and they have chocolates in the car for them, which is [against] everything we're teaching them to eat healthy […] you have to have the support all the way through or it just doesn't work, or everything you've done up until they get to the age of three starts to fall apart. (Participant 50, cook)

Cooks noted differences in guidelines between jurisdictions within Australia, noting NSW guidelines felt more restrictive. Participants also described differences in healthy eating policies and practices between private for‐profit and non‐profit service types. These descriptions were inconsistent with some describing for profit/private centres were more restrictive with food budgets and focused on profit maximisation whilst other constructions were more positive, describing more resources and support for healthy eating. Inconsistencies were described in how food was served, how they prioritised healthy eating and how staff were treated. Participants expressed frustrations at the inconsistencies and commented on the need for further support.

I've been in many centres and every centre is different […] So in my opinion, if we have something standard by the government would be good. (Participant 35, cook)

4. Discussion

This study highlighted the importance of addressing contextual factors to support the implementation of healthy eating policies and practices in ECEC services located in NSW, one of only three Australian jurisdictions with government‐funded state‐wide healthy eating intervention. We used the CFIR to guide data collection and identification of Inner setting organisational factors and Outer setting factors encompassing the broader sociocultural, economic, environmental and political conditions. These findings build on previous qualitative research conducted in NSW by offering a more comprehensive understanding of the implementation context and Outer setting factors that may have previously been overlooked. Our study revealed that there was commitment from ECEC staff, support from directors, and healthy eating support provided by local health services. However, current ECEC sector conditions were not conducive to the successful implementation of healthy eating policies and practices. Implementation success was limited by inadequate work infrastructure to support collaboration between management, cooks, educators and families, lacking partnerships with external organisations, insufficient opportunities for nutrition training and education, and tension between regulatory requirements and educators and cooks.

Cooks were confident in their own capability to implement nutrition guidelines and educators were motivated to role model and implement healthy eating practices. This is consistent with previous literature highlighting that personal beliefs and experience influenced educator attitudes and confidence and guided their approach to feeding within their professional role [35]. Similarly, a study conducted in South Australia exploring factors influencing food service provision found that cooks were confident in their ability to manage challenges such as budget [36]. Findings from this study suggest cooks and educators are constrained by other educators, cooks and parents who do not share the same values and beliefs. Research shows that educators were more fulfilled when there were shared values and vision which allowed for great job control and low levels of emotional exhaustion [37]. Perceived inconsistencies in parent engagement or systems‐level support can undermine educators' perception of their ability to implement healthy eating practices [38]. Whilst previous literature has primarily focused on educators, our findings suggest that similar challenges are also experienced by cooks. Furthermore, parent support and partnership were identified as important enablers but participants expressed frustration at inconsistencies between home and ECEC settings. These findings suggest that implementation support is needed to engage educators, cooks, providers, and families and strengthen collaborative efforts to implement healthy eating policy and practice. Staff communication, collaboration and well‐established internal social networks have been identified as a facilitator to healthy food provision [15]. Further research to explore how to improve work infrastructure and organisational practices with centre management is recommended.

This study identified insufficient workforce nutrition education and training, and participants mostly relied on their own research. In comparison to previous studies which have identified insufficient menu planning tools and difficulty finding easy to use resources [15, 16], cooks in this study were aware of the available menu planning tools and resources. This may be attributed to government‐funded state‐wide support available in NSW which provides tools and support to implement jurisdictional nutrition guidelines. However, the educators were less knowledgeable of nutrition education resources, suggesting further support to engage educators is needed. Our findings emphasised the need to improve on‐the‐job training and ongoing access to free training to overcome challenges to implement the guidelines such as accommodating food allergies and family preferences. Consistent with findings from South Australia which previously had a training programme which ended in 2013, there is currently a lack of ongoing training for cooks and chefs within the industry, limiting capacity to respond to complexities within their roles [18]. Providing ongoing training such as through an e‐learning course can provide continual opportunities for professional development on a large scale in the ECEC setting [39]. Further research to investigate training and support strategies for ECEC staff to identify the most effective approaches for promoting healthy eating in early childhood settings is recommended.

We identified a tension between expectations of service providers, educators, cooks and regulatory requirements. Furthermore, inconsistencies in the implementation of healthy eating policies and practices between centres related to feeding practices were identified as a barrier to intervention success. Varying interpretations of the NQS may influence the implementation of healthy eating policies and practice [40]. Whilst the NQS emphasises the importance of promoting healthy eating, it lacks guidance on effective implementation. Additionally, the current assessment and rating process does not require observation of food provision, mealtime practices or related learning experiences. As a result, there may be discrepancies between policy and practice. For example, a previous study observing meals provided to children in ECEC services in highly disadvantaged communities found that these meals were not meeting the recommended serves of meat, vegetables, fruit, dairy and grains outlined by the Australian Dietary Guidelines [41]. Strengthening the NQS and guidelines to operationalise the standards may improve awareness and understanding of educators' and cooks' roles around healthy eating and support the implementation of nutrition guidelines [17, 20]. Additionally, strengthening the assessment and rating process is recommended to ensure that food provision and mealtime environments are in line with centre menus and policies. A more collaborative approach with regulatory authorities is needed to mentor ECEC staff through the compliance model, helping to align expectations and reduce tension [38].

However, growing job demands without adequate support and pay have been associated with high levels of burnout and stress, decreased wellbeing and increased staff turnover in the ECEC setting [28]. Participants expressed feeling undervalued, highlighting complex role‐related challenges and a lack of time, partnerships and support networks to address these challenges, particularly amongst cooks. In addition to factors relating to the organisational and regulatory environment reported in previous studies, this study identified partnerships and connections as important enablers to implementing healthy eating policy and practice. Multisectoral partnerships are a crucial outer factor to ensure support for implementation and improve healthy eating in the ECEC setting [42]. Participants in this study highlighted the difference in systems‐level support between the aged care sector and the ECEC sector. The aged care sector currently benefits from a government‐funded workforce education and training programme which includes access to a trainer‐mentor programme and professional community [43]. In the ECEC setting, a professional network for centre cooks to share experience, knowledge and support could enhance the implementation of healthy eating policies and practices.

Only participants from centres in advantaged areas consented to participate and most participants are currently employed at not‐for‐profit centres. As such, the sample may limit transferability of findings to all long day care services. Services located in advantaged areas are less likely to experience challenges compared to disadvantaged communities such as financial constraints and food insecurity [41, 44]. Additionally, the sample was determined by those who were interested and voluntarily elected to participate in the study, which may have resulted in a sample that over‐represents educators and cooks who were personally motivated and confident to deliver healthy eating practices. Most participants were qualified, having completed TAFE or university, and experienced with a median of 9 years of experience in the ECEC sector (Table 1). Given widely reported challenges with staff shortages, burnout and stress, the included sample may not be representative of those who did not have time or capacity to participate. Whilst the sample may limit generalisability, it offers informed and meaningful insights from experienced participants who were more engaged in healthy eating, thus offering insights that may not be apparent to those less involved. Furthermore, they represent important experiences from the many children and families they collectively and cumulatively engage. Further research is warranted to explore the contextual factors of educators and cooks located in disadvantaged areas and other service types including family day care and lunch box services, to inform healthy eating policy and practice that reflects the diverse contexts and experiences within the ECEC setting.

5. Conclusion

The ECEC setting can provide a critical opportunity to reach children and families to promote healthy eating behaviours at an early age. Whilst NSW is one of only three jurisdictions in Australia with government‐funded state‐wide support, findings from this study indicate that educators and cooks still experience significant gaps in systems‐level support. Sector‐wide challenges such as increasing job demands and insufficient paid time to complete tasks were identified as key challenges that require urgent attention. Supporting educators and cooks through provision of opportunities for professional development, partnerships and connections across the industry is recommended. There needs to be further guidance on how to achieve standards outlined in the NQS to promote healthy eating to ensure consistent implementation of healthy eating policies and practices across the ECEC sector. These recommendations support a more systematic approach and can strengthen collaboration amongst educators, cooks, parents and providers across the ECEC sector to enhance implementation of healthy eating policies and practices.

Author Contributions

J.C., A.H.‐P., P.P., D.R. and M.A.‐F. conceptualised and designed the research study. J.C. conducted the interviews. J.C. and M.A.‐F. analysed the data. J.C. prepared the initial draft. A.H.‐P., P.P., D.R. and M.A.‐F. reviewed and edited the paper.

Ethics Statement

This study was approved by the Sydney Local Health District Human Research Ethics Committee (Project Number X23‐0379).

Conflicts of Interest

The authors declare no conflicts of interest.

Appendix A. Demographic Characteristics Survey Questions

Survey questions	Response categories
Service characteristics
Which of the following best describes your service provider?	For‐profit
	Non‐profit
	Community based
What meals does your service provide? Select all that apply:	Breakfast
	Morning tea
	Lunch
	Afternoon tea
	Late snack
	Dinner
How is food prepared at your service?	All meals are cooked on site
	All meals are outsourced
	There is a mix of meals cooked on site outsourced
How many children are enrolled at your service?
Participant characteristics
How do you describe your gender?	Male
	Female
	Prefer not to say
	Other
Which age group includes your age?	18–29 years
	30–39 years
	40–49 years
	50–59 years
	60–69 years
	70 years and over
In which country were you born? The countries listed were the most reported countries of birth in the 2021 Census. For all other countries of birth, please select the ‘Other (please specify)’	Australia
	England
	New Zealand
	India
	Philippines
	option. Vietnam
	Italy
	Other, please specify
What is your ancestry?	English
	Irish
	Scottish
	Chinese
	Italian
	Australian
	Other ancestry, please specify
Do you use a language other than English at home? If more than one language other than English, select the one that is used most often.	No, English only
	Yes, Mandarin
	Yes, Arabic
	Yes, Cantonese
	Yes, Vietnamese
	Yes, Italian
	Yes, Greek
	Yes, other, please specify
What is your highest level of education?	Degree (bachelor, masters, doctorate)
	Graduate or advanced diploma
	Certificate I–IV
	Secondary education – years 10 and above
	Secondary education – years 9 and below
	Other, please specify

Appendix B. Semi‐Structured Interview Guide

Note: Prompts have been provided to help guide the interview and probe for more information if needed; however, not all prompts will be asked.

Introduction

• Thank you for participating in this interview. Introduce the interviewer and their role.

• In this interview, I want to ask about your expert experience and knowledge as a director/educator/cook and understand what has helped or hindered your service to deliver and continue to provide healthy eating activities.

• The interview will take about 30–40 min and will be audio recorded. Your answers will then be written as notes and sent back to you for comment and/or correction. The recordings and written notes will be stored securely and used only for the purpose of this study.

• All information you provide will be confidential and you will not be identified by name in any report.

• Participation in this interview is voluntary. You are not required to answer any questions that make you feel uncomfortable. You are free to withdraw from participation at any stage.

• By participating, you are telling us you understand what you have read in the participant information sheet and consent to take part in an interview and for this information to be used in this study.

• Please ask questions about anything you do not understand or want to know more about. Do you have any questions before we begin?

To begin with, could you please briefly tell me about your role in the service?

• What is your role around food (e.g., preparation, food service, menu planning)?

• How many years of experience do you have working in early childhood education and care?

Thank you. I will now move on to some questions that will help us understand what helps or hinders your service to provide healthy eating.

CFIR domain	Objectives	Interview questions: educators	Interview questions: cooks
Context	To identify interventions currently being implemented	Can you tell me about any rules/guidelines, activities or projects at your service that support children and families with healthy eating? What do you like about it? What do you dislike?	Can you tell me about any rules/guidelines, activities or projects at your service that support you to provide healthy food? What do you like about it? What do you dislike?
Innovation	To identify the components of the innovation that enable and/or inhibit implementation and sustainment of nutrition interventions.	2What features would you need to continue, improve or discontinue the rules, activities or projects? Prompts: –What would you change and why? What would you keep and why?	2What features would you need to continue, improve or discontinue the rules, activities or projects? Prompts: –What would you change and why? What would you keep and why?
Inner setting	To identify the inner setting organisational barriers and enablers to implementation and sustainment of nutrition interventions.	3How does supporting children and families with healthy eating fit within your priorities as an educator? Prompts: –What are the values/beliefs around healthy eating? 4Tell me about the resources available in your service to support children and families with healthy eating. Prompts: – How does the space/layout and equipment at your service influence how you support healthy eating? – How does management or leadership support influence how you support healthy eating? – What are the incentives or rewards for supporting healthy eating at your service? – Tell me about any guidance or training you get for supporting healthy eating. 5What resources do you need to continue supporting healthy eating?	3How does providing healthy food fit within your priorities as a cook? Prompts: –What are the values/beliefs around healthy foods? 4Tell me about the resources available in your service to provide healthy food. Prompts: – How does space and equipment for cooking change how you provide healthy food? – How does cost/budget change how you provide healthy food? – How does management or leadership support change how you provide healthy foods? – What are the incentives or rewards for providing healthy food at your service? – Tell me about any guidance or training you get for providing healthy food. 5What resources do you need to continue providing healthy eating?
Outer setting	To identify the outer setting barriers and enablers to implementation and sustainment of nutrition interventions.	6Tell me about the things outside the control of your service that effect how you support children and families with healthy eating? Prompts: –How has the way you support healthy eating been affected by big events (e.g., COVID‐19)? –How has the way you support healthy eating been changed by community values/beliefs? –How has the way you support healthy eating been changed by community/external resources (e.g., healthy eating apps/programs)? –How has the way you support healthy eating been changed by external entities (e.g., professional networks, community partners)? 7What external support do you have/would you need to continue to support children and families?	6Tell me about the things outside the control of your service that effect how you provide healthy food? Prompts: – How has the way you provide healthy food been changed by big events (e.g., COVID‐19)? – How has the way you provide healthy food been changed by healthy eating policies and guidelines? – How has the way you provide healthy food been changed by community values/beliefs? – How has the way you provide healthy food been changed by community/external resources (e.g., menu planning apps/programs) – How do you order and shop for healthy foods? 7What external support do you have/would you need to continue providing healthy food?

Close of the interview:

Is there anything else you would like to add?

If you experience any discomfort or distress from the interview, please refer to the Participant Information Sheet for support services that you can contact. Thank you for participating in this interview today, we really value your insight and appreciate your time. I will email you a summary of the results of this study once they are ready if you have requested this in your consent form.

Chan J., Hyde‐Page A., Phongsavan P., Raubenheimer D., and Allman‐Farinelli M., “Beyond Local Champions: Contextual Factors Shaping the Implementation of Healthy Eating Interventions in Centre‐Based Care – A Qualitative Study With Educators and Cooks,” Health Promotion Journal of Australia 36, no. 4 (2025): e70098, 10.1002/hpja.70098.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.