Implementation of health promotion practices among early childhood education and care staff in the Netherlands: A mixed methods study

The Early Childhood Education and Care (ECEC) setting plays a pivotal role in fostering lifelong healthy behaviours and habits, as these are largely formed through early childhood experiences. This study examined ECEC staff's health promotion practices and the determinants of the implementation of health topics at ECEC locations. Health-related topics addressed included nutrition, physical activity and media education. A mixed method approach with a sequential explanatory design was used. Observations, using the 'Healthy Childcare observation tool', were conducted at sixteen ECEC locations and semi-structured interviews were conducted among ten staff members. The findings indicate that ECEC staff engaged in a broad range of health topics to varying extents. A positive attitude towards the health topics and perceived competence were found to facilitate the implementation of the health topics. The main barriers were linked to organisational and socio-political factors, including insufficient training on health topics, and time and financial constraints. A systems approach is recommended, involving attention for health promotion in (post-)initial training of ECEC staff, the physical and social environments, partnerships with other organisations and parents, in order to address the implementation barriers and ultimately enhance health outcomes for children in attending ECEC.