Researchers tested a program called NAPSACC UK designed to help nurseries and early childhood centers improve children’s nutrition and physical activity habits. The program involved staff training, goal-setting, and support from health experts over 12 months across 52 nurseries in the UK. While most nurseries successfully completed the first phase and achieved their nutrition and activity goals, only about 40% completed a second phase due to staffing challenges. Staff and managers really liked the program and planned to keep the changes, but researchers noted they need to measure whether children’s actual health improved.

The Quick Take

  • What they studied: Whether a structured program helping nursery staff improve children’s eating habits and physical activity is practical to use and whether staff like it
  • Who participated: 52 nurseries and early childhood centers across the UK (25 received the program, 27 did not), plus interviews with nursery managers, staff, and health practitioners
  • Key finding: About 76% of nurseries completed the first phase of the program, and 83% of nutrition goals and 70% of physical activity goals were achieved. However, only 40% completed the second phase, mainly because nurseries struggled with staffing shortages
  • What it means for you: Nurseries can successfully implement programs to improve children’s nutrition and activity, and staff appreciate the support. However, staffing challenges in the childcare sector may make it difficult to maintain these programs long-term. If your child attends a nursery, this suggests they may have opportunities for healthier eating and more playtime, but results depend on the nursery’s ability to manage the program alongside daily operations

The Research Details

This study tested a nutrition and physical activity program in 52 UK nurseries over 12 months. Half the nurseries (25) received the NAPSACC UK program, while the other half (27) continued with their normal practices. The program involved two six-month cycles where nursery staff completed self-assessments of their current practices, attended training workshops, and set specific goals for improving children’s nutrition and activity levels. Public health experts provided ongoing support throughout the process.

Researchers gathered information in multiple ways: they observed training sessions and workshops, sent questionnaires to staff, conducted interviews with 11 practitioners who delivered the program, 11 nursery managers, 5 local commissioners, and held focus groups with the research team. They also reviewed the nurseries’ self-assessment forms and goal-setting documents. This mixed approach allowed them to understand both what happened (did nurseries complete the program?) and how people felt about it (did they like it and find it useful?).

The researchers used a method called thematic analysis to find patterns in the information they collected. They looked for common themes both by using predetermined categories and by discovering new patterns that emerged from the data. They also compared information from different sources to make sure their findings were accurate.

This type of study is important because it doesn’t just measure whether a program works—it also examines whether it’s realistic to use in real-world settings like nurseries. Many programs work well in controlled research environments but fail when nurseries try to use them in their daily operations. By studying how nurseries actually implemented the program, what challenges they faced, and whether staff liked it, researchers can understand what needs to change before rolling out the program more widely. This helps ensure that any future improvements to children’s health through nurseries are actually achievable.

This study has several strengths: it involved multiple nurseries across different locations, used multiple methods to collect information (observations, questionnaires, interviews, and document review), and compared what nurseries said with what they actually did. However, the study focused on whether the program was practical and acceptable rather than measuring whether children’s actual health improved. The researchers also noted that staffing challenges in the nursery sector during the study period may have affected results. Additionally, the study doesn’t tell us whether the changes nurseries made actually lasted after the formal program ended.

What the Results Show

Three-quarters of the nurseries that received the program (19 out of 25) successfully completed the first six-month cycle. This shows that most nurseries could implement the program despite their busy schedules. However, only 40% of nurseries completed the second six-month cycle, primarily because of widespread staffing shortages in the UK childcare sector that made it difficult to schedule training workshops.

When nurseries did complete the program, they achieved impressive results with their goals. About 83% of nutrition goals were fully or partially achieved—for example, nurseries might have added more fruits and vegetables to meals or reduced sugary snacks. About 70% of physical activity goals were achieved, such as increasing outdoor playtime or adding more movement activities. Nurseries that completed both cycles showed greater improvements in their self-assessment scores than those completing only one cycle, suggesting that the program works better with more time and repetition.

Nursery managers and staff had very positive views of the program. They appreciated the opportunity to step back and think carefully about their current practices through the self-assessment process. Staff highly rated the training workshops and valued the ongoing support from public health practitioners who helped them understand how to make changes. Most managers said they planned to continue the improvements they had made, even after the formal program ended.

Nursery managers showed varying levels of commitment to continuing the self-assessment and goal-setting processes after the program officially ended. While most planned to maintain the specific changes they made (like healthier snacks or more outdoor time), fewer said they would continue the formal process of regularly assessing their practices and setting new goals. This suggests that while individual changes may stick around, the systematic approach to continuous improvement might not continue without ongoing support. Local commissioners (officials who oversee childcare services) also expressed support for the program, recognizing its potential value for children’s health.

The NAPSACC program was originally developed and tested in the United States, where it showed promise for improving nutrition and physical activity in childcare settings. This UK study adapted the program for British nurseries and found that staff engagement and goal achievement were similar to what was seen in US studies. However, the UK study revealed that staffing challenges specific to the British childcare sector created barriers that weren’t as prominent in previous research. This highlights how programs may need adjustment when moved to different countries or contexts.

The most important limitation is that this study measured whether nurseries liked the program and whether they achieved their own goals, but it did not measure whether children’s actual health improved (such as changes in weight, fitness, or eating habits). This is a significant gap because the ultimate goal is to improve children’s health, not just to get nurseries to set goals. Additionally, the study was conducted during a period of severe staffing shortages in UK nurseries, which may have made the program harder to implement than it would be under normal circumstances. The study also didn’t follow up long-term to see whether nurseries actually maintained the changes they made after the formal program ended. Finally, because this was a real-world study in actual nurseries, there may have been differences between the nurseries that received the program and those that didn’t, which could affect the results.

The Bottom Line

Based on this research, nurseries should consider implementing structured programs like NAPSACC UK to improve children’s nutrition and physical activity (moderate confidence). The program appears practical and staff appreciate it. However, nurseries should ensure they have adequate staffing and time to implement the program properly. Parents and childcare commissioners should advocate for adequate staffing levels in nurseries, as this appears to be a major barrier to implementing health improvement programs. Future versions of the program should include ways to measure whether children’s actual health improves, not just whether nurseries achieve their goals.

Nursery managers and staff should care about this research because it shows a practical way to improve their services that staff find valuable. Parents should care because it suggests their children’s nurseries could offer better nutrition and more physical activity opportunities. Local health officials and commissioners should care because it shows how to support nurseries in making these improvements. However, this research is less relevant for families who care for children at home, as the program is specifically designed for nursery settings.

Nurseries that implement this program can expect to see changes in their practices and policies within the first six months. However, the research suggests that greater improvements occur over 12 months with two full cycles of assessment and goal-setting. Changes to children’s actual health and development would likely take longer—probably several months to a year—to become noticeable. Maintaining these changes long-term requires ongoing commitment and support.

Want to Apply This Research?

  • If your nursery uses a health tracking app, suggest tracking weekly servings of fruits and vegetables offered, daily outdoor play time in minutes, and the number of structured movement activities per week. Compare these metrics monthly to see if they’re improving.
  • Nursery staff could use an app to log daily physical activity opportunities (outdoor play, dance sessions, movement games) and nutrition changes (new healthy snacks introduced, water availability increased). This creates accountability and helps identify which changes are easiest to maintain.
  • Set up quarterly reviews where nursery staff review their tracked metrics against their original goals. Use the app to document which changes have stuck around and which ones need more support. Share progress with parents through the app to build community support for maintaining healthy practices.

This research describes a program to help nurseries improve children’s nutrition and physical activity, but it does not measure whether children’s actual health improved. Parents should not rely on this study alone to make decisions about their child’s nursery. While the program shows promise and staff found it valuable, more research is needed to confirm that it actually improves children’s health outcomes. If you have concerns about your child’s nutrition, physical activity, or health, consult with your pediatrician or healthcare provider. This summary is for informational purposes and should not replace professional medical advice.