Early childhood (commonly defined as 0-5 years) is a critical period for supporting the development of healthy eating habits that may track into later life [1]. An unhealthy diet during childhood is associated with both undernutrition and overweight and obesity [2]. As such, an unhealthy diet is a risk factor for nutrient deficiencies, impaired growth and development, and adverse chronic disease outcomes that can influence lifelong health [2-4]. Internationally, health [5] and government [6,7] authorities have established dietary guidelines outlining the types and amounts of foods children and adults are recommended to eat to support good health. However, population surveys demonstrate that globally, compliance with dietary guidelines is low across age groups and that children’s diets are suboptimal (eg, diets low in vegetables and high in energy-dense, nutrient-poor foods are prevalent) [8-11].

Setting-based health promotion, where health is created and lived by people within the settings of their everyday life [12], is widely advocated as evidence-based best practice [13]. Early childhood education and care settings have been identified in systematic reviews as opportune places to promote early childhood nutrition [14,15]. Long day care or center-based care (herein referred to as childcare) is the most common form of early childhood education and care setting in Australia, with almost 800,000 children attending for an average of 30.5 hours (approximately 3 days) per week [16]. Similarly high patterns of childcare attendance are observed across other high-income countries, for example, in European countries [17], the United States [18], and the United Kingdom [19], reflecting changes in family workforce patterns, including increased female participation and shared caring responsibilities [20].

In Australia, half of childcare services operate as private, for-profit organizations, while 35% are private and not-for-profit. The remainder are managed by state or local governments (11%) or nongovernment schools (4%) [21]. Families accessing childcare services are supported by a means-tested national government subsidy, whereby families with lower income are eligible for a greater subsidy amount [22]. However, this does not guarantee affordability for everyone, and access to childcare is unequally distributed across Australia, with regional, remote, and disadvantaged areas more likely to experience low provision or absence of childcare [23].

Childcare services commonly provide meals and snacks for attending children, contributing up to two-thirds of their daily food intake [24]. As such, they have an important opportunity to support early childhood nutrition, and fundamental to this is planning a healthy childcare menu [25]. Recognizing this, leading health [26-28] and childcare [29,30] authorities around the world have established recommendations for healthy menu planning and food provision in the childcare setting. For example, the World Health Organization Commission on Ending Childhood Obesity advocates mandatory childcare nutrition standards [26], and the Australian National Quality Standard [29] requires childcare services to ensure “healthy eating... [is] promoted and appropriate for each child” (Element 2.1.3). However, a broad, international evidence base indicates that childcare menus do not meet dietary guidelines and are suboptimal for both food [25,31-33] and nutrient [34,35] provision.

Several barriers to healthy food provision in childcare have been identified in the literature, including insufficient menu planning tools and support resources, lack of time, and limited nutrition and dietary guideline knowledge [36]. Although limited in number, small randomized controlled trials (RCTs) have shown that some intervention strategies, including menu auditing and feedback [37,38], provision of menu planning resources [37-39], and expert implementation support [37,39], can improve childcare food provision. However, implementation models have traditionally relied on in-person support [40] and ongoing resourcing [41], limiting the scalability and sustainability of intervention strategies to date.

Web-based menu planning tools are emerging as a novel strategy for improving childcare food provision [42,43]. Given that almost all childcare services have access to computers and the internet [44], web-based tools may provide a mechanism for delivering scalable and sustainable menu planning support across the childcare sector, including in geographically dispersed locations. Such tools can be embedded into existing web-based childcare management systems [43] and completed at a time, location, and pace convenient for end users, with modest financial and staff resourcing requirements compared with other mechanisms [15]. Using digitalized systems, web-based menu planning tools can integrate user-engagement features, such as automated calculations of food groups on menus, comparisons with dietary guidelines, provision of instant feedback reports, and direct links to easily accessible and relevant web-based support resources [42,43].

To our knowledge, only two published RCTs have considered the impact of childcare programs that incorporate web-based tools to support healthy menu planning and food provision: (1) a pilot RCT (n=31) of the Go-NAPSACC (Nutrition and Physical Activity Self-Assessment for Child Care) program in the United States [42] and (2) an Australian RCT (n=54) of the feedAustralia menu planning tool in the state of New South Wales [43]. Although both tools were shown to improve healthy food choices on childcare menus, neither resulted in significant increases in menu compliance with sector food provision guidelines [42,43]. Authors from both studies called for future research to identify factors that influence the implementation of web-based menu planning tools in the childcare setting and exploration of strategies to inform their widespread use across the sector [42,43].

The implementation and effectiveness of web-based health promotion tools in achieving public health impact is largely determined by end-user engagement [45]. In the childcare setting, users of web-based menu planning tools are most likely to be staff members who plan, prepare, and provide food for children—namely childcare cooks and directors [25,46]. However, little is known about how these users engage with web-based menu planning tools to support healthy food provision. From the limited evidence base, user acceptance of such programs is reportedly high, although studies to date have considered feedback from directors only [42,43] or captured only quantitative data [43]. This indicates that existing evidence may not reflect the nuanced perspectives of all stakeholders, including cooks and directors, who are likely to use web-based menu planning programs in practice.

In the Australian state of Victoria, the Victorian government has invested in the development and implementation of a web-based menu planning tool called FoodChecker [47]. Delivered by Nutrition Australia Victorian Division (NAV), FoodChecker is freely available to all Victorian childcare services to support menu alignment with sector dietary recommendations [48]. FoodChecker has been used by a third of Victorian childcare services since its inception in 2017 (NAV Program Manager, personal communication, December 14, 2021). The flow of the FoodChecker website, including the home page, menu data input template, and a sample automated report of menu alignment with dietary guidelines, is shown in Figures 1-3 [47]. The rollout of FoodChecker provides an opportunity to explore the use of web-based menu planning tools for providing equitable, scalable, and sustainable menu planning support in the childcare sector.

Despite the potential of web-based menu planning tools to improve childcare food provision, to date, there are no published qualitative studies on the ways menu planning staff have engaged with these tools. The primary aim of this study was to explore the use of the web-based menu planning tool FoodChecker in Victorian childcare services. In particular, we aimed to gain insights and perspectives from menu planning staff members, in their own words, about their use of the web-based tool to plan healthy menus and guide healthy food provision for children in childcare.

This study was part of a broader research project on healthy eating and physical activity in childcare, with ethics approval from the Deakin University Human Ethics Advisory Group (HEAG-H91_2021). All participants provided voluntary and informed consent to participate and received an Aus $20 (US $13.94) gift card in appreciation of their time.

A qualitative descriptive study was conducted to explore participants’ perspectives about their use of a web-based menu planning tool in the childcare setting. Although all research team members held nutrition qualifications, they sought to learn from the experience and expertise of the childcare staff. The researchers held an ontological position that embraced subjectivity, focusing on participants’ personal experiences, insights, and opinions as opposed to seeking an absolute truth. The methods and results of this study were reported in accordance with the Standards for Reporting Qualitative Research checklist [49].

A cross-sectional survey of childcare staff members involved in planning childcare menus was conducted between July and September 2021 in Victoria, Australia. The survey explored the use of the web-based menu planning tool FoodChecker. Participant perceptions of FoodChecker were captured using a web-based qualitative survey, a data collection method recognized as beneficial for harnessing nuanced accounts of participant experiences within the qualitative descriptive paradigm [50].

Childcare services were identified from the Australian Children’s Education and Care Quality Authority National Register [51] in July 2021. Eligible services were required to (1) be located in Victoria, Australia; (2) be open for at least 8 hours each weekday; (3) operate for at least 48 weeks annually; and (4) prepare and provide lunch, morning tea, and afternoon tea for attending children on each weekday. Services that did not provide food for children (eg, where meals were provided by parents) were ineligible because of differing meal planning requirements and because these represent a minority of childcare services in Victoria [52]. As childcare cooks and directors frequently share menu planning responsibilities [25,46], data were collected from both staff groups. A target sample size was not predetermined because of the inductive nature of the investigation and the desire to capture as broad a range of responses as possible from those with experiential expertise in childcare menu planning. Given that there are no published data on the proportion of childcare services in Victoria that provide food to children, the size of the target population was unknown. As such, data collection continued until no further responses were received.

An email invitation was sent to directors of all Victorian childcare services on the Australian Children’s Education and Care Quality Authority National Register in July 2021 (N=1726) with a link to a voluntary self-administered director survey on the secure REDCap (Research Electronic Data Capture; Vanderbilt University) platform [53]. Directors providing consent responded to a screening question (within the director survey) regarding FoodChecker use (yes, no, or unsure). Directors who nominated that FoodChecker was or may have been used at their service were sent a link to a FoodChecker survey, which included individual consent. This could be forwarded to the cook responsible for planning the service’s menu or completed by the director if they were involved in menu planning. One reminder email was sent to directors who did not respond to the initial recruitment email after 2 weeks. To maximize cooks’ participation in the FoodChecker survey, the study was advertised to cooks in September 2021 via a post on a social media webpage commonly accessed by the target population.

Survey response files were downloaded from REDCap, deidentified, and uploaded to NVivo (version 20; QSR International), a secure web-based data analysis platform [58].

Constructs of the Technology Acceptance Model (TAM) were used to report themes identified from the inductive analysis related to the degree to which participants perceived FoodChecker would be useful and easy to use, and external variables specific to the individual or organization influencing perceptions and use (Figure 4 [64]). The TAM is a validated, widely used, and highly predictive model of information technology use [65], which posits that acceptance of a technology is directed by the degree to which users perceive the system to be useful (or enhance their job performance) and easy to use (or free from effort) [66]. It has been significantly associated with the intention to use a digital menu planning tool in the childcare sector [44].

A total of 64 participants (comprising 34 directors and 30 cooks) from 53 childcare services participated in this study (Figure 5); 52% (33/64; n=30 cooks and 3 directors) responded to the FoodChecker survey. The remaining participants (31/64, 48% directors) responded to the director survey only.

Childcare service and participant characteristics are presented in Table 2. Most services were located in metropolitan areas of Victoria (47/53, 89%) and privately owned (40/53, 75%). Half of the services (n=27) were located in regions classified as high SEP. Furthermore, 60% (32/53) of services reported using FoodChecker for menu planning. Most commonly, FoodChecker was used monthly or when menus were updated. Most participants had a minimum of certificate- or diploma-level qualification (55/64, 86%). Fewer than half (26/64, 41%) of the participants reported receiving nutrition training.

Participant responses to quantitative questions about FoodChecker are presented in Table 3. A total of 79% (26/33) of participants responded to quantitative questions about FoodChecker. Of these, the majority agreed FoodChecker was useful for their role (22/24, 92%) or childcare services (23/25, 92%). Furthermore, most participants agreed that due to using FoodChecker, their confidence about planning healthy menus had improved (20/26, 77%), they had learned something (17/24, 71%) and that their service’s menu had changed (17/25, 68%).

Almost all participants, including directors and cooks, described FoodChecker as useful in their role or for the childcare sector, particularly for supporting child nutrition and health, improving organizational processes, and aiding the menu planner role.

Participants identified several variables that influenced their perceptions of FoodChecker and their use of the tool.

In this novel study, we aimed to explore the use of a web-based menu planning tool for childcare services. Among the first of its kind, the study sought insights and perspectives from childcare cooks and directors, in their own words, about their use of a web-based tool to plan menus and guide food provision for children in childcare. The study found that cooks and directors alike considered the web-based tool to be useful in their roles, although use was influenced by a variety of factors including awareness, perceived need, time, resources, organizational support, and budgetary considerations. Participants made recommendations to improve the web-based tool, including the need to update navigation and functionality, integrate strategies to reduce data input time, and provide more links to relevant web-based resources to support healthy menu planning.

To the best of our knowledge, this is the first study to consider insights from both cooks and directors about their use of a web-based childcare menu planning tool, with limited previous analyses focusing on acceptance by childcare directors only [42,43]. As such, this study offers an end-user perspective most likely to represent insights from both staff groups involved in menu planning. Participants described a variety of motivations important for menu planning, particularly the need to support children’s health and nutrition, improve food provision and menu planning processes, and aid the menu planner role. Similar motivations have been reported in previous analyses of childcare menu planners [68,69]. However, this is the first study to document the usefulness of a web-based menu planning tool for integrating these motivations into practice.

In this study, directors and cooks emphasized the value of a web-based menu planning tool for both the childcare sector and within their specific role. Comparatively, in limited prior evidence, reports on the perceived value of web-based menu planning tools in childcare settings have been mixed. For instance, while directors have previously reported high intentions to use a web-based menu planning tool and high levels of computer access [44], cooks have reported not using or requiring web-based menu planning tools and having limited computer literacy and access [68]. This discordance could indicate differing needs, levels of computer access, or perceived levels of computer literacy between cooks and directors in childcare settings. Indeed, in this study, one cook reported low levels of digital literacy, and another indicated that a lack of technology in the kitchen was a barrier to using a web-based menu planning tool. These challenges were not reported by the directors.

In this study, the web-based menu planning tool was considered valuable for supporting engagement with families, particularly for sharing menus and recipes. This is important, given that family engagement is widely recommended to increase the impact of childcare-based healthy eating interventions [70]. Most childcare services use web-based platforms to communicate with families [44], indicating the potential to extend the use and reach of web-based menu planning tools to the family and home environment. Indeed, this is demonstrated in the feedAustralia intervention where parents can use a mobile app to view daily food offerings and access sample menus and recipes that they can recreate at home [71].

Despite the consensus about the usefulness of the web-based menu planning tool in this study, there were mixed reports from both directors and cooks about how easy it was to use the tool in practice. It stands to reason that user training may improve ease of use, as reported in the Go-NAPSACC trial [42]. However, the participants in this study did not discuss the need for FoodChecker training but rather the need to update navigation and functionality within the web-based tool to make it easier to use. Given that up to 80% of health technologies have limited success owing to a lack of end-user adoption or sustained use [45], understanding and integrating user preferences within web-based systems is necessary to increase their use and impact [72]. Future developments of web-based childcare menu planning tools should therefore consider strategies to improve user engagement (such as simpler site navigation or functionality to facilitate faster data input), to amplify their adoption, for sustained use over time, and for public health impact. This indicates the importance of directing funding toward the ongoing development of web-based menu planning tools for the childcare sector to meet user expectations, particularly in the current era of rapid technological advancement.

The limited evidence available has demonstrated that, even when the acceptability of a web-based menu planning program in the childcare sector is high, use may still be variable [42,43]. This indicates that factors external to the system itself (eg, individual or organizational factors) may influence use. Exploration of such factors was novel to this study, with participants reporting that awareness, perceived need, time, management support, and the food budget were important variables relevant to their uptake of the web-based menu planning tool.

Several participants were unaware of the tool and, as such, had not used it. Others who were aware of the tool but did not use it perceived that childcare staff had adequate nutrition knowledge and skills to plan a healthy menu. Given the scope of this study did not include a menu assessment component, it was not possible to triangulate staff perceptions about their knowledge and skills in healthy menu planning and the degree to which childcare menus complied with food provision guidelines. This is an important direction for future research. Despite this, there were multiple instances in which both cooks and directors demonstrated good knowledge of the scientific evidence related to their roles. For example, participants discussed the need to provide optimum nutrition to children who received most of their meals and snacks in childcare or links between healthier eating and children’s health outcomes, as evidenced in the literature [1,24]. Although these examples of accurate nutrition knowledge are reassuring, it cannot be inferred that this knowledge is consistent or accurately translated into menu planning practices, indicating the need for healthy menu planning support in the sector.

Although support in the form of nutrition training has been shown to improve menu quality, such training is not routine [25]. Indeed, less than half of the participants in this study reported having received nutrition training. This is similar to previous studies where childcare staff reported low levels of nutrition training despite their responsibility to plan a healthy menu that meets food provision guidelines [25]. This indicates that there is scope for the design and implementation of interventions, such as web-based menu planning tools that offer accessible, evidence-based guidance that can be integrated into menu planning practices, even in the absence of formal staff nutrition training.

Some participants who stated that they did not use the web-based menu planning tool reported using an external consultant to support healthy menu planning in their service. Such consultancy may increase the financial burden of healthy menu planning, and may not be viable for all childcare services. However, it may also present a sensible approach to ensure accuracy in menu compliance with dietary guideline recommendations, if such support is available at a feasible cost.

Time was an important factor in this study, with mixed perceptions among the participants. Staff members who received dedicated and paid time within their role to use the web-based menu planning tool reported that this facilitated its use. Moreover, some participants who used the tool reported that it was time saving and reduced their workload. However, as in previous studies [73], most participants did not report receiving paid time for menu planning within their roles. Furthermore, the use of the tool was commonly perceived to be time consuming, even by participants who had never used it before. As such, perceptions about time were a deterrent to initial adoption. This indicates that there is scope to (1) integrate user-engagement features within childcare menu planning systems to improve time efficiency and (2) establish strategies to shift user perceptions about such systems from being time consuming to being time saving. These are important areas for future development, particularly given that childcare staff members are known to be a time-poor population group [36].

In addition to dedicated time, service management support and leadership were reported to facilitate the uptake of the web-based menu planning tool. Interestingly, one cook who did not want to use the program had used it on instruction from their manager to ensure menu compliance with dietary guidelines. This indicates that despite the presence of management support, menu planner resistance may exist and could be a potential barrier to ongoing use of the web-based menu planning tool.

The food budget and cost control were important considerations for participants who described budgeting resources linked to the web-based menu planning tool as useful. However, several cooks reported that specific food recommendations generated by the web-based system exceeded their allocated food budget. This is a novel finding, indicating the need for dietary guidelines and recommendations embedded within such systems to consider food budgets and financial constraints. It may also suggest the need to investigate the capacity of childcare food budgets to adequately provide optimal nutrition for children. There is scope for web-based childcare menu planning systems to integrate strategies to support services in establishing and managing food budgets, which is an area for future research and development.

Although the services in this study were located in areas of varying levels of advantage and disadvantage, half were located in regions classified by postcode as high SEP. This is consistent with data indicating that, in Victoria, there is a higher provision of childcare services in areas experiencing greater levels of advantage [23]. However, as the study achieved a modest sample size, it was not possible to determine whether area-level SEP was associated with the acceptance of the web-based menu planning tool or the degree to which the tool supported healthy food provision in childcare services. Given that area-level disadvantage is associated with poorer diet quality [74], and given that services in low SEP areas were least represented in this study, there is a need for future research to better understand the use of web-based childcare menu planning tools in lower SEP areas.

The strengths of this study warrant discussion. As this study captured perspectives from cooks and directors, the findings are likely to represent the perspectives of both staff groups involved in menu planning. The study’s qualitative descriptive underpinning provided scope to capture participant-generated data on menu planner experiences in their own words. Insights generated from spontaneous reporting were likely to reflect motivations and perspectives that are most important to users when compared with quantitative analyses using predefined, researcher-generated items and response scales [62]. The use of the validated TAM contributed to the study’s underlying theoretical foundation. In line with emerging methodology-focused evidence, a web-based qualitative survey facilitated data collection from a time-poor and varied, dispersed, and geographically heterogeneous population with the potential to reduce social desirability bias [50]. A further strength of this study was that it analyzed the use of a real-world web-based tool in current practice, to which real-time refinements are possible. As such, the exploration brought together research, reflection, and practical solutions as part of an action research approach.

Given that the FoodChecker tool is only freely available in Victoria, the scope of this study was purposely delimited to Victorian childcare services. A modest study sample was achieved, as observed in previous studies on food provision in childcare settings [68]. Furthermore, given that childcare staff are known to be a time-poor population group, the perspectives of those who have particularly limited time to engage with a web-based menu planning tool, and as such, to participate in this research, may not have been captured. This may impact the ability to generalize the findings to the broader childcare sector. However, as the analysis explored participant perceptions and insights that are subjective by nature, the findings may be indicative of childcare menu planner experiences more broadly. This should be further investigated in larger studies exploring the use of web-based menu planning tools to support healthy food provision in childcare. It was beyond the scope of this study to include a quantitative analysis of the impact of the web-based menu planning tool on menu compliance with dietary guidelines, food provision, or children’s dietary intake. These are important areas for future research.

This novel qualitative descriptive study demonstrates the usefulness of a web-based tool to support healthy menu planning in childcare services. Use of the tool was impacted by its internal functionality as well as external organizational factors. Recommendations were made to improve the web-based menu planning system.

Further research is needed to better understand how web-based menu planning tools can improve food provision and children’s consumption in the childcare setting. In particular, studies should investigate and evaluate strategies to improve user engagement with web-based menu planning tools in childcare to increase their adoption, use, and public health impact.