The impact of healthy eating interventions within Outside School Hours Care Services: A Systematic Review

OBJECTIVE: This systematic review aimed to evaluate the effectiveness of nutrition interventions delivered in Outside School Hours Care (OSHC) services for children aged 4-12 years. DESIGN: Five electronic databases were searched for articles published up to February 2024. Eligible studies were quantitative evaluations of nutrition interventions conducted in OSHC settings, including randomised controlled trials, quasi-experimental, and pre-post studies designs. Study selection, data extraction, and risk of bias assessments (ROB 2 and ROBINS-I tools) were conducted independently by two reviewers. SETTING: Formal OSHC services operating before and/or after school and during school holidays in high-income countries. Outcomes assessed included children's dietary intake, food provision, healthy eating behaviours, staff practices, service policies, and health indicators such as Body Mass Index. PARTICIPANTS: Children (aged 4-12) and staff at OSHC services. RESULTS: Thirty-three studies involving approximately 13,880 participants were included. Interventions varied in duration (7 weeks to 3 years) and components, including nutrition education, staff training, family engagement, menu and policy changes, and many also a physical activity component. Most studies reported improvements in food provision, children's dietary intake, and staff nutrition practices. Interventions focused on food provision, menu planning and policy were most effective. Few studies reported significant changes in anthropometric outcomes. Risk of bias was moderate across studies. CONCLUSIONS: This review highlights effective strategies to improve children's dietary habits and food environments in OSHC services. Sustained interventions that focus on food provision, menu planning and/or policy are recommended. Future research should explore multi-level initiatives, digital tools, fidelity, and cost-effectiveness.