This review looked at the effects of strategies to improve the implementation (or correct undertaking) of policies, practices or programmes by childcare services that promote children's healthy eating, physical activity and/or obesity prevention. The authors also looked at whether these strategies improved childcare service staff knowledge, skills or attitudes. In addition, they wanted to determine the cost or cost-effectiveness of providing implementation support, whether support strategies were associated with any adverse effects and whether there was an impact on child nutrition, physical activity or weight status.

A number of childcare service-based interventions have been found to be effective in improving child diet, increasing child physical activity and preventing excessive weight gain. Despite the existence of such evidence and best-practice guideline recommendations for childcare services to implement these policies and practices, many childcare services fail to do so. Without proper implementation, children will not benefit from these child health-directed policies and practices.

The review identified 10 trials, eight of which examined implementation strategies versus usual practice, and two that compared different types of implementation strategies. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. The strategies tested were only a small number of those that could be applied to improve implementation in this setting.

None of the strategies identified in the review improved implementation of all the targeted policies or practices. However, most strategies reported improvement for at least one policy or practice. The findings provide weak and inconsistent evidence of the effects of these strategies on improving the implementation of policies, practices and programmes, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. The lack of consistent terminology in this area of research may have meant some relevant studies were not picked up in the search. Nonetheless, the few identified trials suggest that research to implement such policies and practices in childcare services is only in the early stages of development. The authors rated the evidence for all outcomes as very low quality and thus we cannot be overly confident in the findings.

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