Gosliner 2010

Methods	Study design: randomised trial Intervention duration: not reported Length of follow‐up from baseline: 10 months Differences in baseline characteristics: not reported by group Unit of allocation: childcare service Unit of analysis: childcare service staff
Participants	Service type: childcare centres Region: California, USA Demographic/socioeconomic characteristics: childcare services were located in low‐income neighbourhoods in Northern California Inclusion/exclusion criteria: inclusion criteria: services that were already participating in a health education and policy development project (Child Health and Nutrition Service Enhancement) with the Contra Costa Child Care Council Number of services randomised: 18 (9 intervention, 9 control) Numbers by trial group: n (controls baseline) = 7 n (controls follow‐up) = 7 n (interventions baseline) = 6 n (interventions follow‐up) = 6 Recruitment: 9 pairs of eligible services were matched on city of location and programme size and were randomised to either the intervention or control group Recruitment rate: 84% entered the study
Interventions	Number of experimental conditions: 2 (intervention, control) Policies, practices or programmes targeted by the intervention: Nutrition and physical activity policies, children's food and physical activity environment Implementation strategies: ‐ Training and technical assistance regarding children's health and nutrition ‐ Received a set of nutrition and physical activity policies ‐ Staff wellness programme consisting of: ‐ Kick‐off wellness training with individual health consultations including education, individual health assessments ‐ Monthly newsletters and information with pay‐checks promoting healthy eating and physical activity ‐ Group walking programme with awards for reaching milestones ‐ Staff follow‐up support visits Theoretical underpinning: not reported Description of control: control services received training and technical assistance regarding children's health and nutrition and received a set of nutrition and physical activity policies
Outcomes	Outcome relating to the implementation of childcare service policies, practices or programmes: ‐ Staff providing fresh fruits in children’s meals and snacks more often during the past year ‐ Staff providing fresh vegetables in children’s meals and snacks more often during the past year ‐ Staff providing sweetened beverages in children’s meals and snacks more often during the past year ‐ Staff providing sweetened foods in children’s meals and snacks more often during the past year ‐ Staff providing fresh fruits in children’s celebrations more often during the past year ‐ Staff providing fresh vegetables in children’s celebrations more often during the past year ‐ Staff providing sweetened beverages in children’s celebrations more often during the past year ‐ Staff providing sweetened foods in children’s celebrations more often during the past year Data collection method: childcare service staff self‐report via questionnaire Validity of measures used: unclear 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	The study did not report baseline values for the implementation outcomes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Services were matched on city of location and programme size and were randomised to intervention or control group. The sequence generation procedure was not reported.
Allocation concealment (selection bias)	Unclear risk	Whether pending allocation was concealed is unclear as no information was provided on concealment.
Blinding of participants and personnel (performance bias) All outcomes	High 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 and therefore there is a potential high risk of performance bias.
Blinding of outcome assessment (detection bias) All outcomes	High risk	Self‐reported by service managers, therefore high risk of bias due to managers being aware of allocation.
Incomplete outcome data (attrition bias) All outcomes	High risk	Data were available for 50 (56%) participants in the intervention group and 39 (44%) in the control group. Of those not returning at endpoint, most had changed employment (80%) or were on leave or vacation (14%). 7 intervention staff who reported participating in less than half of the intervention activities were considered inadequately exposed and were excluded from the analysis, leaving 43 staff in the intervention group. Therefore the intention‐to‐treat principle was not applied.
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	—