Nutrition and physical activity for pre-schoolers : early childhood education teachers' knowledge and perspectives : a thesis presented in partial fulfilment of the requirements for the degree of Masters of Science in Nutrition and Dietetics, Massey University, Albany, New Zealand

Abstract

Background Caregivers’ knowledge of the links between nutrition, diet and physical activity is increasingly being recognised as important for children’s health and body size. Evidence is limited for early childhood education (ECE) teachers’ knowledge about nutrition and physical activity for pre-schoolers, especially in New Zealand. Identifying knowledge gaps amongst teachers may direct professional development, health promotion and obesity prevention strategies in childcare settings. Aims The primary aim was to measure early childhood education (ECE) teachers’ nutrition knowledge for pre-schoolers (2-5-year-olds); and their perspectives towards nutrition and physical activity. In order to achieve this, a secondary aim was to design an ECE teacher nutrition knowledge questionnaire that satisfies psychometric criteria of validity and reliability. Methods Questionnaire items were generated based on New Zealand Ministry of Health nutrition guidelines for pre-schoolers, a literature search and expert advice. Nutrition (n=40) and non-nutrition (n=51) university students completed the questionnaire once; 35 of the nutrition students completed the questionnaire twice. Psychometric tests for construct and test-retest reliability were conducted. The cross-sectional online validated questionnaire of New Zealand ECE teachers’ nutrition knowledge for pre-schoolers was then used to measure ECE teachers’ nutrition knowledge for pre-schoolers. Knowledge was scored and measured against the Ministry of Health Food and Nutrition Guidelines for Healthy Children and Young People (Aged 2-18 years): A background paper (2015c). Teachers’ perspectives towards nutrition and physical activity for pre-schoolers were assessed using Likert scales within the questionnaire. Analysis included descriptive statistics, correlation and linear regression. Results The questionnaire achieved an acceptable level of content and construct validity and test-retest reliability. ECE teachers (n=386) from New Zealand childcare centres completed the validated questionnaire. Teachers’ knowledge of nutrition was lacking; overall score was 22.56 ± 2.83 (mean ± SD), or 61% correct. Age, qualification level, employment role and years of experience did not predict overall nutrition knowledge scores. Teachers’ increased years of experience significantly predicted an increase in knowing that New Zealand nutrition and physical activity guidelines existed (B=0.02 [95% CI, 0.00-0.03], r2=0.13, P=0.033). Teachers’ increased agreement in feeling they were confident talking about nutrition to parents significantly predicted an increase in overall nutrition knowledge scores, (B=0.34 [95% CI, 0.06-0.63], r2=0.15, P=0.019). The belief that ECE teachers play a vital role in promoting pre-schoolers’ healthy eating and physical activity was widespread. Teachers generally held positive perspectives towards feeding practices and perceived themselves to understand key physical activity concepts. Common barriers for ECE teachers’ nutrition and physical activity knowledge included a lack of staff training, confidence and resources. Conclusion The questionnaire achieved an acceptable level of construct validity and test-retest reliability and is suitable to measure ECE teachers’ nutrition knowledge for preschoolers (2-5-year-olds) in New Zealand. ECE teachers may lack nutrition knowledge for pre-schoolers in New Zealand, particularly with regards to basic nutrition recommendations (servings, food/beverage choices and portion sizes). Keywords: childhood obesity, childcare, kindergarten, day care, pre-school, nutrition environment, psychometric validation, nutrition literacy