Johnston Molloy 2013

Methods	Study design: randomised parallel‐group trial Intervention duration: not specified Length of follow‐up from baseline: not specified Differences in baseline characteristics: not reported Unit of allocation: childcare service Unit of analysis: childcare service
Participants	Service type: preschools Region: Republic of Ireland Demographic/socioeconomic characteristics: preschools were situated in towns, villages and the countryside across 4 midland counties in a geographical area defined as disadvantaged Inclusion/exclusion criteria: inclusion criteria: preschools providing a "full day care service" (i.e. for more than 5 hours per day). Exclusion criteria: preschools that provided only sessional (less than 3.5 hours per session) or part‐time care for children; preschools designated as ineligible by the Preschool Inspection Team due to insufficient standard in other pre‐defined areas of inspection; preschools that had not been inspected by the Preschool Inspection Team in the previous 12‐month period. Number of services randomised: 61 (30 intervention group 'manager trained', 31 intervention group 'manager and staff trained') Numbers by trial group: n (intervention group 'manager trained' baseline) = 30 n (intervention group 'manager trained' follow‐up) = 24 n (intervention group 'manager and staff trained' baseline) = 31 n (intervention group 'manager and staff trained' follow‐up) = 18 Recruitment: convenience sampling was undertaken. An up‐to‐date list of preschools (n = 100) providing a 'full daycare service' was obtained and these preschools were invited to participate Recruitment rate: 61%
Interventions	Number of experimental conditions: 2 (intervention group 'manager trained', intervention group 'manager and staff trained') Policies, practices or programmes targeted by the intervention: ‐ Adequate meal and snack composition ‐ Healthy foods and fluids ‐ Appropriate serving size provision ‐ Family‐style food service ‐ Healthy preschool policy development Implementation strategies: Intervention 'manager trained': ‐ 1‐hour manager training session with a research dietitian ‐ Provision of resources (Preschool Nutrition and Health Education Resource) and best practice criterion (Preschool Health Promotion Activity Scored Evaluation Form) ‐ Provision of individualised 'written feedback record' from a pre‐intervention observation visit, suggested strategies for improvement discussed with the manager Who delivered the intervention: dietitians Theoretical underpinning: not reported Implementation strategies: Intervention 'manager and staff trained': ‐ 1‐hour manager training session with a research dietitian ‐ 1.5‐hour structured staff education session with a research dietitian including presentation, group work exercises and discussion ‐ Provision of resources (Preschool Nutrition and Health Education Resource) and best practice criterion (Preschool Health Promotion Activity Scored Evaluation Form) ‐ Provision of individualised 'written feedback record' from a pre‐intervention observation visit and suggested strategies for improvement discussed with the manager and staff Who delivered the intervention: dietitians Theoretical underpinning: adult learning methodologies
Outcomes	Outcome relating to the implementation of childcare service policies, practices or programmes: ‐ Environment ‐ Food service ‐ Meals ‐ Snacks ‐ Overall score Data collection methods: 1 day observation, preschool manager self‐report Validity of measures used: used the validated Preschool Health Promotion Activity Scored Evaluation Form Outcome relating to staff knowledge, skills or attitudes: not applicable Outcome relating to cost: not applicable Outcome relating to adverse consequences: not applicable Outcome relating to child diet, physical activity or weight status: not applicable
Notes	—
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	A random‐number table was used to allocate services to treatment groups.
Allocation concealment (selection bias)	Low risk	We assumed that allocation was conducted in a single, automated process via the random‐number table and therefore allocation could not be pre‐empted.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	Due to nature of the intervention (training), childcare service staff and study personnel delivering the intervention were not blind to study allocation, however as both groups received some form of intervention it is unknown if there is a systematic difference in the potential for performance enhancement and therefore bias.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	No information provided on whether the individuals conducting the outcome assessment (audits) were blind to group allocation.
Incomplete outcome data (attrition bias) All outcomes	High risk	Of 31 services allocated to the 'manager and staff training' intervention, only 18 received the intervention and had follow‐up data collected. Of the 30 services allocated to the 'manager training' group, 27 received the intervention and 24 had follow‐up data collected. Although data are provided to demonstrate no significant difference between those who participated and did not, this analysis is conducted for all services, not by group. Rated as high risk of bias due to the magnitude of differences in participants lost to follow‐up between groups.
Selective reporting (reporting bias)	Unclear risk	No prospective trial protocol or trial registration so it is unclear whether there was selective outcome reporting.
Other bias	Unclear risk	—