Study: Staff training and accreditation may improve childcare activity

Nearly one in four primary school children in Australia attends an outside school hours care service every week, providing a widespread setting for physical activity interventions. Between August 2022 and December 2024, researchers conducted a cluster-randomized effectiveness-implementation trial involving 197 childcare services across Western Australia, South Australia, and New South Wales to test whether staff training and voluntary accreditation can alter recreational screen time and active play management.

Key Clinical Takeaways:

• A trial of 197 before- and after-school care services tested whether web-based staff training and voluntary policy accreditation could reduce screen time and increase physical activity.
• Intention-to-treat analyses showed no statistically significant differences in guideline adherence, but per-protocol analyses indicated that accredited intervention services improved guideline adherence compared to controls.
• Staff at intervention services demonstrated significantly greater increases in physical activity-promoting behaviors during before-school care at 12 months.

Trial Design and Service Randomization Across Three States

The study enrolled services that provided before- and after-school care and enrolled at least 10 children daily. Investigators randomized 101 services to the intervention group and 96 services to the control group, collectively providing care for approximately 10,000 children. Of those enrolled, 182 services completed the study. Control group services maintained their usual programs throughout the study period. Intervention services gained access to the web-based Activated Outside School Hours Care program, allowing them to align internal policies with national guidelines for screen time and physical activity.

Implementation Requirements and Staff Training Metrics

To achieve accreditation within the 12-month study window, intervention services had to submit a screen time and physical activity policy evaluated against national guidelines, and at least 50% of their staff had to complete four online training modules. Out of the 101 intervention services, 80% registered on the program website. Among those registered, 423 staff members completed all four training modules. Ultimately, 48 intervention services met both policy and training requirements to form the per-protocol intervention sample.

Divergent Findings Between Intention-to-Treat and Per-Protocol Analyses

Primary outcomes measured service adherence to guidelines, defined as scheduling 30 minutes or less of recreational screen time and 45 minutes or more of physical activity opportunities before school, alongside 60 minutes or less of screen time and 90 minutes or less of physical activity opportunities after school. Intention-to-treat analyses revealed no statistically significant differences in the proportion of services meeting all guidelines at 3 or 12 months. In contrast, per-protocol analyses showed that accredited services in the intervention group improved adherence to all guidelines more than control services, driven primarily by improvements in after-school screen time adherence.

Changes in Staff Behavior and Childrenal Physical Activity

Regarding staff behaviors, intention-to-treat analyses showed that intervention group staff achieved significantly greater increases in physical activity-promoting behaviors during before-school care at 12 months compared to control staff. These behaviors included encouraging active play and leading active games. Per-protocol analyses confirmed that accredited services showed greater increases in these behaviors at both 3 and 12 months. Children in accredited services displayed higher moderate-to-vigorous physical activity during before-school care at 12 months. Neither analysis showed significant intervention effects on children’s observed recreational screen time or after-school moderate-to-vigorous physical activity.

Selection Bias and Limited Uptake Affect Study Results

Study authors linked limited overall program uptake to the lack of broader effects across the full intention-to-treat sample. The per-protocol findings are vulnerable to selection bias and confounding because accredited services tended to be more metropolitan, school-run, and larger than unaccredited intervention services. These structural differences prevent direct causal attribution of improvements solely to the accreditation process. The trial also did not track individual children over time, observation sessions were limited in number, and the added measure for screen availability lacked independent validation.