Discussion
This study evaluated the impact of a menu box delivery service to support menu compliance and improve food provision and children’s dietary intakes in the ECEC setting. While intervention centre menus showed greater compliance with food group guidelines at follow-up, the impact observed was similar between the intervention and comparison centres in regard to child food provision and intake, including vegetable intake. Satisfaction and acceptability of the intervention were low for cooks but greater for directors, albeit pilot process data (Evaluations in the literature of childcare centre menu compliance with Australian menu guidelines demonstrate that the provision of vegetables and legumes, as well as meat and alternatives, is consistently least likely to meet menu planning guidelines of all food groupsImportantly, however, the impact of the menu box delivery service intervention on food provision and child intake was equivalent to, but not superior to comparison centres following usual practice. These findings are similar to those reported in previous studies. For example, Bell Previous literature, both in Australia and internationally, has found that effective interventions to promote healthy eating in children within the age group attending ECEC settings (2–5 years) are those that target both environmental- and individual-level factors through multicomponent interventionsDespite acceptability of the menu box delivery service intervention being low for cooks (similar to that for cooks in the comparison group), director acceptability was high amongst pilot questionnaire data with intervention centre cooks and directors (Food budget restrictions can play a role in centre-level food provision decisions in childcare centres, particularly related to types or quality of foods providedStrengths of this study include the novelty of the intervention being the first study to explore a menu box delivery concept outside the commercial household environment, the cluster randomised controlled study design and staff (director and cook) feedback. However, a number of limitations exist. First, the 8-week intervention implementation period may not have been an adequate duration to observe changes in children’s dietary intake given the variability in day-to-day child attendance in care. Healthy eating interventions in child care are recommended to have a minimum 12-month duration, or ideally 2 to 4 yearsFinally, the methodology used for measuring plate waste differed between baseline and follow-up, due to the implications of COVID-19 restrictions. This affected the capacity to draw a direct comparison between baseline and follow-up data. The methodology used to analyse child food provision and consumption follow-up data may have also impacted the reliability of the plate waste measures, as both child dietary provision and consumption were estimated from photographs. The findings of this novel study, which piloted the application of a menu box delivery service in the LDC setting, suggest that this is a viable model. Study findings showed that although menu compliance can be improved via a menu box delivery service, impacts on food provision and consumption in children were similar for the intervention and comparison groups. The innovative combination of sector guidelines and an emerging food service model could support longer-term, sustainable improvements in centre menu compliance, which may improve children’s food provision and intakes in the longer term. Following refinement of the menu box delivery service to improve cook acceptability, future trials are recommended to be conducted in larger samples of cooks to ensure in-depth staff feedback and with longer follow-up periods to determine the long-term effect on child dietary intake. Future opportunities should seek to continue to harness benefits of a meal kit subscription services such as its popularity and convenience