Feasibility and acceptability of the Veggie Brek intervention
RECRUITMENT
Although the recruitment data met the amber stop–go criterion, the average recruitment rate for children (68%) is higher than a comparable UK-based study (37%) where 12 nurseries (with 476 eligible children) were recruited to take part in a feasibility trial exploring a physical activity, nutrition and oral health intervention in nursery settings [The Veggie Brek intervention was highly acceptable to nursery staff. The quantitative data suggested that the intervention was implemented with high fidelity, with the qualitative data revealing that staff commented very positively about the intervention, both as a concept and practically. Staff felt that the intervention and evaluation processes could easily fit into their everyday morning routines with the activities quickly becoming routine. Staff also commented that they wanted to continue implementing the intervention after the end of the study.Findings suggested that overall staff preferred the data collection sheets rather than taking food photographs. Photographs may allow for greater accuracy and precision of measuring children’s vegetable intake as the coding can be undertaken by a blinded independent assessor. However, the coding process revealed that photographs sometimes did not clearly show the leftover vegetables and, notably, the staff interview data revealed that data collection sheets were more feasible and acceptable to eight of the nine staff interviewed. This finding aligns with recent research which has indicated that logging food intake with photographs is viewed less favourably than using text [Overall, children were willing to eat vegetables at breakfast time and nursery staff commented that children were interested in consuming them, frequently asking questions to staff about them. Interestingly, staff interviews revealed the manner in which children consumed the vegetables with some children treating the vegetables like a dessert (eating them after their main breakfast food) and others adding them to their main breakfast food. Staff also commented on the importance of repeated exposure – as has been highlighted previously in the literature [The findings of this study should be interpreted in the context of its strengths and limitations. In regard to strengths, it is the first study to investigate offering vegetables to children at breakfast time. It assessed different measures of collecting data on vegetable consumption (data collection sheets and photographs) to inform future research in this area. A large number of children were recruited to take part from nurseries of different sizes and set-ups, highlighting the pervasiveness of the intervention’s feasibility and acceptability across nursery types. This was a notable strength considering that the study was conducted during the COVID-19 pandemic, demonstrating the robustness of the intervention protocol. Finally, the mixed-methods approach facilitated a richer understanding of the intervention than using quantitative data alone, allowing for more-nuanced amendments to the intervention protocol before a future definitive RCT is undertaken. Regarding limitations, while our recruitment strategy sought nurseries of varying size and funding options for children’s attendance, the strategy did not ensure a diversity of nurseries in regard to relative deprivation. This should be remedied in a future definitive RCT by including a stratification based on nurseries’ index of multiple deprivation markers. Another limitation of the recruitment strategy is that the intended 2:1 cluster ratio was not achieved, as one (control group) nursery only collected consent from one child (of a possible 12) and was excluded. Notwithstanding the 3:1 ratio that this exclusion facilitated, the average demographic information for the children in the intervention and control group nurseries was similar. However, going forward into a definitive RCT, researchers should allocate more time and resource for the recruitment phase and include an internal pilot with a recruitment-based progression criterion to mitigate this risk.The data also support the need to investigate the effectiveness of the Veggie Brek intervention in nurseries and kindergarten settings. From a public health perspective, an effectiveness trial is important to facilitate because UK children do not eat a sufficient amount of vegetables each day. The Veggie Brek intervention provides another time in the day where children are exposed to vegetables, with regular exposure a key factor in increasing the likelihood that children will like and eat vegetables [