Discussion
fatigue
This is the first study to assess the impact of targeted dissemination strategies (animated video or e-newsletter) on increasing ECEC service intentions to adopt an indoor-outdoor program for the full day and offer more time outdoors, compared with a standard email control in response to COVID-19. The study found the animated video group had a significantly higher intention to adopt more time outdoors than the control group, and had twice the odds of implementing indoor-outdoor programs, compared to control. While intentions to implement an indoor-outdoor program in the intervention groups was not statistically significantly different compared with control, these results appear to support the use of targeted dissemination strategies to improve ECEC service intentions for practice adoption that are important prerequisites for improving practice implementation [These findings are consistent with a previous study assessing the impact of distribution of educational material on ECEC cook’s intentions to adopt nutritional guidelines [Surprisingly, this study found no differences between groups in knowledge or awareness of the Guidelines which were the key targeted constructs of the dissemination strategies. This may be due to multiple sources (e.g. NSW Department of Education, ECEC-based bodies) circulating the Guidelines to services simultaneously, serving as a source of trial contamination and addressed within the control group (as minimum care) [Whilst the cost of the animated video appears significantly higher than the e-newsletter, a large proportion of the cost was for the purchase of the software subscription (AUD$1012.00), which could be shared across all communication approaches. Additionally, it should be noted that once the animated video is developed, it can easily and at a negligible cost, be disseminated to a large number of recipients via email or other means. Further research is needed to identify the true value and public health benefit of such an investment within a larger sample of ECEC services.Strengths of the study include its randomised controlled design and theory-informed intervention development and evaluation. Limitations of this study include the variation in time (1–3 months) between receiving the dissemination strategy and when Nominated Supervisors undertook the-post intervention survey. This may have impacted on study findings as services had variable time to implement changes to their free play schedules, however date of survey completion was controlled for in our analyses. We were also unable to reach our pre-specified sample size (n = 500) due to challenges with obtaining consent to participate in the survey in the specific three month time frame, due to factors such as COVID-19 related staff shortages, ECEC closures during lock downs and potentially staff fatigue and competing priorities during this time. As such our findings are underpowered and may be biased by those most likely to be engaged with the content.In the context of COVID-19 it should also be noted that this was a time of regular communication regarding updates to restrictions and social distancing and hence, it is difficult to know if a different result may occur without the presence of a pandemic or if disseminating guidelines unrelated to COVID-19. Additionally, this was a time of transition and adaptation in terms of lock downs and tight restrictions related to COVID-19 within Australia, potentially resulting in ECEC staff shortages and interruptions, changes to policies and practices, all of which likely impacted on adoption and implementation of the Guidelines.