Finch 2012

Methods	Study design: quasi‐experimental study Intervention duration: 3 months (staggered) Length of follow‐up from baseline: 18 months (follow‐up was conducted approximately 12 months after the initiation of the intervention with wave 1 services, and approximately 6 months after the initiation of the intervention for wave 2 services) Differences in baseline characteristics: reported Unit of allocation: childcare service Unit of analysis: childcare service
Participants	Service type: long daycare services and preschools Region: Intervention: Hunter New England region, New South Wales, Australia; Control: New South Wales, Australia Demographic/socioeconomic characteristics: Intervention: the intervention region included a large non‐metropolitan area (more than 130,000 km2) encompassing urban and rural communities with a population of 60,970 children aged 0 to 5 years. Control: the comparison region of New South Wales had an area of 801,305 km2 and included major cities, inner regional services, outer regional services, remote and very remote areas. New South Wales has a population of 506,095 children aged 0 to 5 years Inclusion/exclusion criteria: inclusion criteria: long daycare services and preschools in the Hunter New England area (intervention group) or the remainder of New South Wales (comparison group) as recorded by the licensing agency for such services. Exclusion criteria: services catering solely for children with special needs such as intellectual or physical disabilities Number of services randomised: 484 services participated in baseline measures. Intervention: 275 (not randomised, those services approached who agreed to participate and completed baseline data collection). Control: 209 (of those randomly approached and who took part in baseline evaluation). Numbers by trial group: n (control baseline) = 209 n (control follow‐up) = 164 n (intervention baseline) = 275 n (intervention follow‐up) = 228 Recruitment: Intervention: all services (n = 338) located within the intervention region were invited to participate. Control: a simple random sample of eligible centre‐based childcare services in all other regions of the state of New South Wales were invited to participate in the study as the comparison group (n = 298). Recruitment rate: Intervention: 81%; Control: 83%
Interventions	Number of experimental conditions: 2 (intervention, control) Policies, practices or programmes targeted by the intervention: ‐ Physical activity policy ‐ Conducting daily fundamental movement sessions with recommended components ‐ Time spent on structured physical activities ‐ All staff usually participate in free active play ‐ All staff usually provide verbal prompts for physical activity ‐ Children are allowed to watch small screen recreation less than once per week ‐ Children participate in seated activities for no longer than 30 minutes at a time ‐ Staff trained in physical activity Implementation strategies: ‐ Offer of staff training (1 x 6‐hour workshop) ‐ Offer of information programme resources and instructional materials: ‐ Offer of follow‐up support (2 x 15‐minute support calls, 2 support emails/faxes, 6 project newsletters) ‐ Provision of performance monitoring and feedback regarding policy and practice adoption ‐ Offer of incentives Who delivered the intervention: the staff training was delivered by external experts and follow‐up support and performance monitoring and feedback (telephone) was delivered by health service staff Theoretical underpinning: not reported Description of control: ‐ Childcare service staff were invited to attend a full day workshop provided by a non‐government organisation ‐ Provision of a printed resource folder ‐ Provision of a small financial grant to support staff attendance at training or the purchase of equipment ‐ Opportunity for additional support strategies to be provided by local health services at their discretion
Outcomes	Outcome relating to the implementation of childcare service policies, practices or programmes: ‐ Services with a physical activity policy that referred to: ‐ Child fundamental movement skills development ‐ Limits on small screen recreation and TV ‐ Physical activity training for staff ‐ Services conducting daily fundamental movement sessions with recommended components ‐ Time spent on structured physical activities ‐ Services where all staff usually participate in free active play (role modelling) ‐ Services where all staff usually provide verbal prompts for physical activity ‐ Services where children are allowed to watch small screen recreation less than once per week ‐ Services where children participate in seated activities for no longer than 30 minutes at a time ‐ Services with staff trained in physical activity Data collection method: service manager self‐report via computer‐assisted telephone interview Validity of measures used: unclear (developed following review of existing validated tools and pre‐tested prior to use) Outcome relating to staff knowledge, skills or attitudes: Service manager knowledge of: ‐ The recommended time children should be sedentary ‐ Child physical activity recommendations ‐ The recommended maximum time children should watch television Data collection method: service manager self‐report via computer‐assisted telephone interview Validity of measures used: unclear 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	The study had multiple outcomes but did not appear to adjust the P value for multiple comparisons
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	High risk	Quasi‐experimental design. High risk of selection bias as the intervention services were recruited from a selected area. Control services were randomly selected from a comparison region. No detail is provided regarding the sequence generation procedure used to randomise control services for selection. Table 2 shows that services within the intervention and comparison sites differed significantly in terms of socio‐economic areas, geographic locality and services with children of an Aboriginal background.
Allocation concealment (selection bias)	High risk	Quasi‐experimental design. Intervention services were recruited from a selected area, therefore high risk of bias as there was no concealment of allocation.
Blinding of participants and personnel (performance bias) All outcomes	Unclear risk	We assumed that due to the nature of the intervention childcare service staff and study personnel delivering the intervention were not blind to the study allocation, however, as the control group may have also received some form of intervention, systematic bias between groups in terms of performance bias is unknown.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Self‐reported physical activity policies and practices. No blinding of research personnel or participants (service managers) and due to the self‐report of this outcome, the risk of bias is considered to be high.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	83% of intervention group services included in final post‐test data analysis; 78% of comparison group services included in final post‐test data analysis. While these proportions are similar, it is unclear whether the services lost to follow‐up differed between groups. No sensitivity analysis reported to test assumptions regarding missing data.
Selective reporting (reporting bias)	Unclear risk	No prospective trial protocol or trial registration so it is unclear whether there was selective outcome reporting.
Potential confounding	Unclear risk	Authors state that "Characteristics of services were not adjusted for in the logistic regression model as we were looking at change within services and the baseline score of the services effectively controlled for potential differences in baseline characteristics between the two regions." It is unknown whether this was adequate to reduce bias due to known confounders.
Other bias	Unclear risk	—