First Bite: A research program to help 3-5-year-old children eat more veggies.

“First Bite” is an multi-component intervention that primarily aims to improve vegetable intake of 3-5-years-old children in ECEC services and at home through targeted strategies to increase behavioural intentions and opportunities to eat vegetables. Intervention content includes: repeated exposure to vegetables, hands-on experiential learning, reinforcement of this learning at home and positive eating environment and educator practices within ECEC services. Proposed strategies will include: 1) training for educators on positive feeding practices and eating environments; 2) a daily vegetable break at ECEC services; 3) 8-week curricula including hands-on experiential learning activities at ECEC services focused on vegetables; 4) parent-targeted nutrition promotion messaging via ECEC services to reinforce experiential eating and to promote vegetable eating practices at home. The multi-component program will engage children, parents and their carers through ECEC services. 1) Professional Development for educators Practical training will be provided on best practices for supportive mealtime environments and educator feeding. A set of 6 x 15-minute modules will relate to feeding roles, role modelling, food refusal, pressure to eat and fussy eating geared towards promoting self-regulation of eating in children. The videos will be co-designed in partnership with the collaborating Local Health Districts (LHD) Early Years teams and the ECEC Advisory Group. All video online training modules will be made available via Vimeo (online video platform) to the randomly selected ECEC intervention services an average of five weeks before First Bite commencement and are to be completed at their convenience at least two weeks prior to the start of the intervention period. ECEC services will be encouraged to view the videos during their staff meeting times, with ongoing access available to educators afterwards. If viewing is not possible during staff meeting times, Educators can complete training at another time. To track fidelity, a Director's discussion/reflection journal will accompany the videos. This will be used to guide the forward planning needed for First Bite implementation at individual ECECs level. The discussion/reflection journal will also incorporate a minimalist planning checklist to identify the ways ECEC services plan to implement First Bite following each video presentation, and also to identify ways to decrease barriers in their specific services to aid full implementation of the program. A written manual will also be made available. ECEC Directors and Educators will be asked to complete the First Bite pre/post surveys which will identify both ECEC curriculum and practice changes. Directors will be interviewed at a 6- month follow-up for their reflections on the program to determine if any First Bite intervention strategies have been continued within their service and how these strategies could be enhanced to facilitate long-term sustainability. The control services will receive access to the resources after data collection following the 8- week First Bite program 2) Daily Vegetable Break ECEC children will be given the opportunity to taste test different individual vegetables five to ten times, along with familiar vegetables as identified by the ECEC Advisory Group. A song will be sung at the beginning of the vegetable break to help solidify the positive messaging around eating vegetables. Children will be given the opportunity to explore their vegetable of the week through their senses of vision, sound, touch, taste and smell. Multiple tastings of the same vegetable are required for children to learn acceptance of new tastes and textures of vegetables. The Veggie Break will occur between breakfast and lunch, separate to the morning tea and will last 30 minutes. Children will be involved with some vegetable preparation twice a week before sharing the vegetable platter. We encourage this activity to be conducted prior to morning tea. Ideally, this is to be the first group activity of the day following free play. Each ECEC will have its own curriculum time frames, so the morning time slot of the Veggie Break will be curriculum dependent. Three vegetables will be provided weekly for the Veggie Break and will be a combination of one familiar vegetable, one unfamiliar vegetable and a vegetable of the week which high in carotenoid content. These will be served on a shared platter where children can choose vegetables and serve themselves. Each intervention ECEC service will be visited by a researcher around weeks 4-5 of the program to assess the fidelity of implementation of the Veggie Break and other First Bite activities. A dedicated First Bite email and contact phone number will also be used to answer any queries regarding implementation. The ECEC Directors will also be asked to record in the discussion/reflection journal the First Bite activities that have been undertaken for that day, and any changes they have made to those activities to better fit their ECEC context. 3) Experiential learning activities for children Healthy eating strategies will be incorporated into the ECEC curriculum to be delivered by ECEC Directors and Educators. The strategies will include the development of an 8-week immersive calendar of activities including storybooks, songs, gardening, art, sensory play and taste exposure experiences, and the delivery of the developed resources, activity and lesson plans to ECEC educators. The resources and guides will be included in a home pack (for parents), and an Educator pack (for ECEC services). These packs will also be available online and will include storybooks, and information to guide parents and educators to enhance interactions and engagement during the experiential learning activities. The discussion/reflection journal will be used to record the frequency of activities completed by the participating children including vegetable consumption at the ECEC service. This program will be finalised after consultation with the ECEC Advisory Group. 4) Resources for parents The videos and text messages will be sent over an 8-week period to parents through the parent communications tool used by their ECEC (such as Kinderloop or Storypark apps, email or text messaging). The narrative style of the videos aligns closely with Narrative Persuasion, Social Cognitive Theory and the Trans-theoretical Model. Parents will be notified of the “veggie of the week” to be included, if possible, in their child’s lunch boxes and in home meals. Videos will be 2-3 minutes in length and will be sent every Monday to parents via a Vimeo access link in the newsletter. Vimeo provides a analytics reports which will identify the number of views by parents. Topics span the Food Literacy model developed by Vidgen and Galleos and will include: preparing vegetables for meals, vegetable eating tips, role modelling, fussy eating, and encouraging healthy eating. Practical tips and advice to assist in packing a healthy lunchbox will be provided, which will be supplemented with e-newsletters and the vegetable of the week suggestion. Children's lunchbox contents will be observed at baseline and post-intervention to determine any changes in vegetable content. This will be done discreetly out of children's and parents' view if possible. A checklist of vegetables will be used to identify any vegetables changes in the lunchbox. The videos and text messages will be sent over an 8-week period to parents through the parent communications tool used by their ECEC (such as Kinderloop or Storypark apps, email or text messaging). The narrative style of the videos aligns closely with Narrative Persuasion, Social Cognitive Theory and the Trans-theoretical Model. Parents will be notified of the “veggie of the week” to be included, if possible, in their child’s lunch boxes and in home meals. 5. Intentional group teaching activity. First Bite consists of a combination of group activities and individual activities. Intentional group reaching activities are structured activities that are set up by educators for children to engage with concurrently in a group. This differs to Individual activities, which involve activity stations that children can engage in or not, by themselves or with others. A core Intentional teaching activity (15-20 min) will be conducted and repeated twice a week as most children attend ECEC two days a week, This activity involves children exploring the characteristics of two specified vegetables each week. Including This includes a visual assessment of the vegetables, touching them, smelling them and discussing vegetable characteristics. Children will also discuss what sound the vegetable may make when being eaten and what it may taste like when licked. These communication skills regarding vegetable characteristics are encouraged to be carried over into the daily vegetable break and into the home. Taste investigation is by child’s choice only. Educators reiterate that taste changes over time, and discuss cultural differences in food preparation as an extension activity. Three supporting activities will be conducted daily. These supporting activities encompass games, stories, singing, arts and crafts and include free play activity stations. The Vegetable Break (20-30 minutes) will be implemented daily, with sensory assessment of vegetables completed twice a week during the Vegetable Break. Children will be given the equivalent of one serving of vegetables, consisting of three different vegetables (1 familiar, 1 unfamiliar, 1 with a high carotenoid level) to eat as they choose during this time.