A cross-sectional study assessing barriers and facilitators to the sustainability of physical activity and nutrition interventions in early childhood education and care settings

Background: Effective evidence-based physical activity and nutrition interventions to prevent overweight and obesity and support healthy child development need to be sustained within Early Childhood Education and Care (ECEC) services. Despite this, little is known about factors that influence sustainability of these programs in ECEC settings. Therefore, the aim of this study was to describe the factors related to sustainability of physical activity and nutrition interventions in ECEC settings and examine their association with ECEC service characteristics.

Methods: A cross-sectional study was undertaken with a nationally representative sample of 473 Australian ECEC services. Factors related to the sustainability of ECEC-based physical activity and nutrition interventions were assessed using the validated Integrated Measure of PRogram Element SuStainability in Childcare Settings (IMPRESS-C), measuring Outer Contextual Factors, Inner Contextual Factors, Processes and Characteristics of the Intervention domains for interventions that supervisors reported as currently implementing. Participants responded using a 5-point Likert scale, with responses ranging from 1 (completely disagree) to 5 (completely agree). Domain scores were calculated for each service by averaging item responses. Linear regression models between ECEC service characteristics and the IMPRESS-C domains were undertaken.

Results: Data from 473 Australian childcare services nationally found that the domains: Processes ( $\overline{x}$ =3.78, SD = 0.64), consisting of partnership/engagement and training/support/supervision; and Outer Contextual Factors ( $\overline{x}$ =3.93, SD = 0.63), including policy and legislation, and socio-political context had the lowest mean scores indicating they may likely be barriers to sustainability. Linear regression analyses revealed no statistically significant associations between examined factors and ECEC service characteristics. There was a statistically significant association between the number of years services delivered their interventions and the Characteristics of the Intervention domain (p = 0.035) suggesting that this domain may influence sustainability of programs.

Conclusions: This study suggests that factors related to the Processes and Outer Contextual Factors domains had the lowest scores and as such, strategies to support the sustainability of physical activity and nutrition interventions implemented in ECEC settings may need to consider how to best address these factors.