Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services

Background Despite the existence of effective interventions and best‐practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. Objectives The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to: 1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes; 2. describe the cost or cost‐effectiveness of such strategies; 3. describe any adverse effects of such strategies on childcare services, service staff or children; 4. examine the effect of such strategies on child diet, physical activity or weight status. Search methods We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). Selection criteria We included any study (randomised or non‐randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre‐based childcare services to no intervention, 'usual' practice or an alternative strategy. Data collection and analysis The review authors independently screened s and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative assessment via meta‐analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). Main results We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices tar