Table 1 Application of the consolidated framework for implementation research

 Intervention source: Was the intervention developed internally by childcare services or by external agencies?

The implementation strategies were designed externally by an expert advisory group of health promotion practitioners, psychologists, dietitians, behavioural scientists, and physical activity experts, in consultation with nominated supervisors from local childcare services. Facilitated feedback was provided from a reputable source via experienced government health service support officers known to the services.

 Evidence strength and quality: What are the nominated supervisor perceptions of the strength and quality of evidence that the intervention will have the intended outcomes?

Targeted policies and practices were consistent with national mandatory licensing and accreditation requirements and state government evidence-based healthy eating and physical activity best practice guidelines for the setting. These links were communicated to nominated supervisors during telephone contacts and via newsletters.

 Adaptability: Is the intervention able to be adapted or tailored to meet the needs of the childcare service?

Telephone discussions included a focus on facilitating adaptation around ways in which practices could be applied in each service (e.g. different methods of communicating with families or integration of structured learning experiences within service routines).

 Complexity: What are the nominated supervisor perceptions of implementation difficulty?

Telephone discussions focused on integrating policy and practice change within existing service routines to reduce the burden on each childcare service. This was communicated during telephone contact and highlighted via case studies included in newsletters.

 Design quality and packaging: What are the nominated supervisor perceptions of how the intervention is presented?

Tools and resources were reviewed by nominated supervisors to ensure that they were visually appealing, professionally presented, and user-friendly during formative work preceding the trial.

 Cost: What are the costs of the intervention and associated implementation?

As the implementation strategies formed part of Hunter New England Population Health’s routine service delivery, they were provided at no cost to the service. In addition, suggestions given to services to support policy and practice implementation prioritised low or no cost approaches. These were communicated during telephone contacts and via case studies included in newsletters.

 External policy and incentives: What are the external strategies to spread the intervention (including policy and regulations, external mandates, recommendations, and guidelines)?

Targeted policies and practices were consistent with national mandatory licensing and accreditation requirements and state government evidence-based healthy eating and physical activity best practice guidelines for the setting.

The application of continuous quality improvement processes (facilitated reflection, problem-solving, goal setting, and action planning) during telephone contacts also aligns with external accreditation requirements for the child care setting.

 Tension for change: Does the nominated supervisor perceive the current situation as needing to change?

The need for change was demonstrated via individualised feedback reports of policy and practice implementation and advocated by implementation support staff during telephone contacts.

 Relative priority: Do childcare service staff have a shared perception of the importance of implementation within the childcare service?

Nominated supervisors nominated supervisors were expected to endorse implementation of the targeted practices and to communicate goals and action plans, as well as progress to service staff.

 Organisational incentives and rewards: Does the intervention include incentives such as goal-sharing awards, performance reviews, and increased stature?

Services that demonstrate achievement of all policies and practices received a certificate of recognition and were promoted to other intervention services in newsletters.

 Goals and feedback: Are goals clearly communicated, acted upon, and fed back to nominated supervisor?

Facilitated performance feedback was provided to services regarding implementation of targeted policies and practices.

Continuous quality improvement processes including review of progress, positive reinforcement, and discussion of deficits identified from feedback reports, problem-solving, goal setting, and action planning were incorporated into the telephone contacts.

 Leadership engagement: Are nominated supervisors committed, involved, and accountable for the implementation?

Nominated supervisors were encouraged to circulate feedback reports to management committees and childcare service staff.

 Access to information and knowledge: How easy is it for nominated supervisors to access information and knowledge about the intervention and how to incorporate it into work tasks?

Nominated supervisors received resources and ongoing support from implementation support staff via scheduled telephone contacts and email. Services were also provided with contact details for implementation support staff and encouraged to follow-up at any time for advice or assistance and all resources were made available via the program website.

 Engaging: Are appropriate individuals involved in the implementation through education, role modelling, and training?

Nominated supervisors were directly engaged in implementation through telephone discussions regarding service priorities, service goals, and strategies to meet goals and overcome barriers. Nominated supervisors were also encouraged to communicate and endorse practice changes to service educators.

 External change agents: Are individuals available who are affiliated with an outside entity who facilitate intervention decisions in a desirable direction?

Facilitated feedback and implementation support was provided from a reputable source via experienced government health service support officers known to the services.