1. Summary of intervention, measures and absolute intervention effect size in included studies.
| Study | Implementation strategies | Comparison group | Primary implementation outcome measures | Effect sizea |
| Alkon 2014 | Educational materials, educational meetings and audit and feedback | Usual practice |
Score: nutrition and physical activity policy quality using the CHPHSPC and nutrition and physical activity practices using the EPAO assessed via observation (5 measures) % of staff or services implementing a practice: Services with a nutrition or physical activity policy (2 measures) % of foods offered to children (10 measures) |
Median (range)c: 1.4 (0 to 4.29) Median (range): 33%% (22% to 44%)c Median (range): 7.7% (133% to ‐2.7% |
| Bell 2014 | Educational materials, educational meetings, audit and feedback, opinion leaders, and small incentives or grants | Usual practice |
% of staff or services implementing a practice: percentage of services implementing nutrition policies and practices and menus consistent with nutrition recommendations (10 measures) Quantity of food served (servings/items): mean number of items or servings of healthy/unhealthy foods on service menus (4 measures) |
Median (range): 9.5% (2% to 36%) Median (range): 0.5 serves/items (‐0.4 to 0.8) |
| Benjamin 2007 | Educational materials, educational meetings, and audit and feedback | Usual practice | Score: nutrition, physical activity environments assessed via questionnaire (NAPSACC) completed by service managers (total score) | Mean difference (95% CI)c: 5.10 (‐2.80 to 13.00) |
| Finch 2012 | Educational materials, educational meetings, audit and feedback, opinion leaders and small incentives | Usual practice |
% of staff or services implementing a practice: percentage of services implementing physical activity policies and practices (11 measures) Minutes of service or staff implementation of a policy of practice: time (hours/day) spent on structured physical activities (1 measure) |
Median (range): 2.5% (‐4% to 41%) Mean: 6 minutes |
| Finch 2014 | Educational materials, educational meetings, audit and feedback, opinion leaders and small incentives | Usual practice |
Frequency of staff or service implementation of a practice: occasions of implementation of fundamental movement skill activities, staff role modelling and verbal prompts and positive comments (4 measures) Minutes of service or staff implementation of a policy of practice (per session or day): minutes of fundamental movement skill activities, structured time, television viewing or seated time (4 measures) % of staff or services implementing a practice: services with seated time > 30 minutes or with an activity policy (2 measures) Mean number of resources or equipment per service: (3 measures) |
Median (range): 2.6 (12.1 to 0.6) Median (range)c: 4.3 minutes (‐12 minutes to 39 minutes) Median (range): 5 (30 to ‐20) Median (range): ‐01 (‐0.6 to ‐0.1) |
| Gosliner 2010 | Educational materials, educational meetings, educational outreach visits or academic detailing with small incentives or grants with staff wellness programme | Educational materials, educational meetings, educational outreach visits or academic detailing | % of staff or services implementing a practice: Provision of food items by staff 'more often' assessed via staff‐completed questionnaire (8 measures) | Median (range): 17% (0% to 23%) |
| Hardy 2010 | Educational materials, educational meetings, educational outreach visits or academic detailing with small incentives or grants | Usual practice |
Minutes of service or staff implementation of a policy of practice: Minutes (per week or session) of structured and unstructured play or fundamental movement skills activities (3 measures) Frequency of staff or service implementation of a practice: Frequency (per week or day) of structured or unstructured play, and of fundamental movement skill activities (3 measures) % of staff or services implementing a practice: conduct of food‐based activities, development of new rules around food and drink bought from home, and the provision of health information to families (3 measures) |
Median (range): 7.7 minutes (6.5 minutes to 10.1 minutes) Median (range): 0.2 (‐0.9 to 1.9) Median (range)c: 11% (‐7% to 31%) |
| Johnston Molloy 2013 | Educational materials, manager and staff educational meetings and audit and feedback | Educational materials, manager educational meetings, and audit and feedback | Score: On the Health Promotion Evaluation Activity Scored Evaluation form assessed via observation (total score) | Difference in median score: ‐2b |
| Ward 2008 | Educational materials, educational meetings, and audit and feedback | Usual practice | Score: nutrition and physical activity practices using the EPAO assessed via observation (total score) | Mean difference (95% CI)c: 1.01 (0.18 to 1.84) |
| Williams 2002 | Educational materials, educational meetings, educational outreach visits or academic detailing with small incentives or grants | Usual practice | Quantity of food served (servings/grams): Primary outcome – grams of saturated fat assessed via menu audit (one measure) | Median (range): 17% (0% to 23%) |
| O’Neill 2017 | Educational meetings, release of practice guidelines | Usual practice |
% of staff or services implementing a practice: Percent of services implementing a practice consistent with standards for the setting (13 measures) Score: physical activity environment using the EPAO assessed via researcher observation (1 measure‐ total score) |
Median (range) OR = 1.01; 95% CI: 0.87 to 1.29 (OR 1.35 to 0.89) Mean difference: 0.9 (P = 0.06) |
| Jones 2015 | Audit with feedback, educational material, educational meetings, opinion leaders, local consensus approach, educational outreach or academic detailing. Other: employment of communication strategies and implementation support staff |
Usual practice |
Score: mean number of policies and practices implemented (1 measure) % of staff or services implementing a practice: proportion of services implementing all seven healthy eating and physical activity policies and practices (1 measure) |
Mean Difference: 0.4 (P = 0.05) Main analysis OR: 1.33 (0.64, 2.76) |
| Seward 2017 | Audit with feedback, educational materials, educational meetings, opinion leaders, educational outreach or academic detailing | Usual practice |
Score: Mean number of food groups compliant with guidelines % of staff or services implementing a practice: Proportion of services fully compliant with nutrition guidelines for all food groups (7 measures) |
Mean difference 1.57 (0.82, 2.33) OR Median (range): OR 6.26; 95% CI 1.26 to 43.40 (OR 1 to 16.54) |
| Yoong 2016 | Educational materials | Usual practice | Quantity of food served: number of fruit and vegetable serves on the service menu assessed via questionnaire (2 measures) | Mean difference median (range): 0.25 (0.0 to 0.50) |
| Esquivel 2016 | Educational materials, educational meetings. Other: monthly employee wellness activities | Waiting‐list control (delayed intervention) | Score: nutrition and physical activity environments using the EPAO assessed via researcher observation (total score) | Mean difference: 1.1 |
| Mazzucca 2017 | Educational materials, educational meetings, educational outreach or academic detailing, reminders, tailored interventions | Usual practice | Score: physical activity environment assessed using modified EPAO assessed via service self‐report (7 measures) | Median/Mean differences (range): 0.4 (‐0.7 to 0.9) |
| Morshed 2016 | Educational materials, educational meeting | Usual practice | Quantity of food served: number of fruit, vegetable, and whole grain servings, grams of discretionary fat, teaspoons of added sugar, and grams of fat from milk provided assessed via researcher observation (6 measures) |
Relative change estimate: OR (95% CI): 1.00 (0.81 to 1.24) (OR 1.09 to 0.82) |
| Sharma 2018 | Educational meetings, educational outreach or academic detailing, reminders | Usual practice | Score: Implementation index assessed via teacher‐completed survey (1 measure) | Mean difference: 15.17 |
| Stookey 2017 | Audit with feedback, educational materials, educational meetings, educational outreach or academic detailing, incentives, tailored interventions | Waiting‐list control (delayed intervention). | % of staff or services implementing a practice: children’s exposure to three nutrition and physical activity practices: use of physical activity curriculum, staff usually join in physically active play; pitchers of drinking water visible in the classroom (1 measure) | OR (95% CI): 6.5; (1.1 to 40.6) |
| Ward 2017 | Audit with feedback, educational materials, educational meetings | Waiting‐list control (delayed intervention) | Score: nutrition environment assessed using the EPAO assessed via service self‐report (total score) | Mean difference: 0.73 |
| Finch 2019 | Educational materials, audit with feedback, continuous quality improvement, educational outreach or academic detailing, opinion leaders, tailored interventions | Usual practice |
Score: mean number of policies and practices implemented (1 measure) % of staff or services implementing a practice: Proportion of services implementing all six policies/practices (1 measure) |
Mean difference: 0.1; 95% CI −0.4 to 0.6 OR (95%CI): 0.51 (0.16 to 1.58) |
aEffect size calculated first using the primary outcome (where a single primary outcome was reported); otherwise using a total score (when total and subscale scores were provided); otherwise using the median effect size across measures (where more than one outcome measure was reported and not specified as primary).
bMean not reported. Represents the difference in median score between manager‐ and staff‐trained versus manager only‐trained group.
cAdditional data obtained from study authors where unclear or missing
CHPHSPC: Californian Childcare Health Programme Health and Safety Checklist DOCC: Diet Observation in Child Care EPAO: Environment and Policy Assessment and Observation NAPSACC: Nutrition and Physical Activity Self‐Assessment for Child Care