Promoting healthy diet and movement in UK preschoolers: Evidence-based co-development of health promotion materials

Promoting healthy diet and movement in UK preschoolers: Evidence-based co-development of health promotion materials | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Promoting healthy diet and movement in UK preschoolers: Evidence-based co-development of health promotion materials Kathryn R. Hesketh, Ruth Kipping, Raj Lakshman, Alice Porter, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7991594/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Excess weight remains a concern for preschool-aged children. To support action in practice, we synthesised systematic review evidence assessing determinants of health behaviours in 0-6-year-olds to inform the co-production of health promotion materials to promote UK preschoolers’ healthy weight. Methods Phase 1: Synthesis of review-level evidence on dietary (i.e. fruit and vegetable, obesogenic food and sugar-sweetened beverage consumption), feeding (i.e. portion size), and movement behaviours (i.e. physical activity and sedentary behaviour) (Spring 2024). Determinants (assessed in cross-sectional, longitudinal and intervention studies) and their direction of association with each behaviour were extracted and synthesised according to the socio-ecological model (i.e. individual, interpersonal, organisational and environmental domains). Phase 2: Phase 1 findings informed five co-design webinars with policy and practice partners, healthcare practitioners and childcare providers (‘interest holders’), co-producing a range of materials to promote healthy behaviours (launched Spring 2025). Results Twenty-nine determinants were associated with two or more health behaviours [individual (n = 8); interpersonal (n = 11); organisational (n = 6); and environmental (n = 4) domains]. Interpersonal determinants (e.g. relating to parents, siblings, other carers) were assessed often and tended to be positively associated with movement and dietary behaviours. Co-design webinars with 51 interest-holders, whose key priorities included supporting healthy weight and promoting physical activity/ healthy food availability, resulted in co-production of a free-to-use infographic; four animations; social media stills and dominos (for children). Conclusions Common determinants of preschoolers’ health behaviours were leveraged to co-develop health promotion materials, incorporating interest-holders’ key priorities. Child-friendly outputs, with diverse representations of families, were co-produced to support UK preschoolers’ healthy weight. Physical Activity Diet behaviour Sedentary synthesis preschool Figures Figure 1 Figure 2 Figure 3 Introduction In England, 22.1% of children are living with overweight or obesity at age five, with prevalence the highest for those living in the most deprived areas 1 . Similar levels and patterns are seen internationally 2 , with both diet and movement behaviours known to be important for maintaining a healthy weight and building positive habits during the preschool period and beyond 3 . Focusing health promotion activities on the youngest age groups therefore represents good value for money and offers potential for sustained impacts into later childhood and beyond 4 . A wide range of reviews, mostly focussed on single health behaviours, have been conducted to identify (components of) effective interventions to promote positive diet and movement behaviours during the preschool period 5 – 8 . Limited research has considered if different health behaviours share common determinants, which might offer efficient leverage for positive behaviour change. Moreover, incorporating lived experience in developing interventions is likely to have greater impact on intervention uptake and success 9 . Previously, we completed of a suite of reviews to assess correlates and determinants of dietary and movement behaviours in preschool-aged children 10 . To enhance the dissemination and impact of this work, we undertook a two-phase project. First, we sought to understand whether health behaviours in preschoolers share common determinants, by summarising the evidence on the factors influencing both positive and less desirable behaviours. Then, mapping evidence according to the socio-ecological model (SEM) 11 , we conducted co-design workshops to co-produce materials to support and promote health behaviours in UK preschool-aged children (i.e. aged 2–5 years). Phase 1 Methods To systematically summarise the evidence focused predominately on the determinants (i.e. longitudinal associations) of health behaviours in children 0-6 years, we synthesised data from dietary (i.e. fruit and vegetable 12 , obesogenic food consumption 13 and sugar-sweetened beverage consumption 14 ), feeding (i.e. portion size 15 ), and movement behaviour (i.e. physical activity 16,17 and sedentary behaviour 18 ) reviews, largely undertaken using a single protocol 10 . Determinants (assessed in cross-sectional, longitudinal, and intervention studies), and their direction of association with behaviours of interest, were extracted. Each extracted determinant was scored based on direction of evidence: for favourable behaviours, a “+” indicated the determinant increased the behaviour and for unfavourable behaviours, “+” indicated that the determinant decreased the behaviour, i.e. in both cases “+” indicated a positive public health impact on the behaviour. A “-“ indicated a negative impact; “0” indicated no association found; and “?” indicated no clear association in one direction (i.e. studies identified that suggest both + and – associations with behaviours). Only determinants studied for two or more distinct behaviours were synthesised. The SEM 11 is a useful framework around which to organise the identified determinants, as it recognises that individuals are embedded within a large interactive social system, which has a cumulative effect on their health behaviours and subsequent outcomes. Determinants identified across all studies were therefore categorised by SEM domains, namely individual, interpersonal, organisational and environmental domains.  Much of the work synthesised draws on quantitative evidence, but qualitative evidence was included where quantitative evidence was limited or not available. Finally, using the synthesis and a prior theoretical framework 16 , we derived an overarching theoretical framework to outline the determinants of children’s health behaviours, which mapped onto the socio‐ecological model. Findings Twenty-nine determinants were assessed with two or more behaviours and extracted [individual (n=8); interpersonal (n=11); organisational (n=6); and environmental (n=4) domains] (Table 1), forming the basis of phase 1 synthesis. Interpersonal determinants were commonly assessed, with a number of consistent associations identified. Parental and sibling modelling, and childcare provider training tended to be positively associated with both movement and dietary behaviours. In contrast, use of rewards and treats, child preference and temperament, and parental barriers, including time, were negatively associated with children’s health behaviours. Several factors showed variable associations across the behaviours, including the childcare setting, which tended to be positively associated with movement behaviours, but negatively associated with children’s dietary behaviours. Determinants identified for multiple dietary behaviours tended to be negatively associated with these behaviours, including previous consumption/ habits, peer modelling, and food availability close to the home (e.g. proximity to fast/food outlets and eating out). Table 1 Determinants studied for two or more dietary, feeding and/or movement behaviours in 0-6-year-olds Health behaviours reviewed Higher levels promote healthy weight Higher levels promote excess weight Determinant of behaviour Physical activity^ 16,18 Fruit and Veg 12 Sedentary behaviour 18 Obesogenic foods 13 Sugar-sweetened beverages 14 Portion size* 15 Individual (child) Child preference + / - - - Child age 0 0 - ? 0 Temperament +/- ? Screen time - - Opportunities for play +/- Previous consumption/patterns - / + - Siblings + ? - Ethnicity (white) ? + Interpersonal Peer/ Sibling modelling + - - Parent monitoring/goals + + Parental modelling + 0 - + Rewards/ treats (incentives) + - - Parent SES (low) ? / + - 0 Younger parent ? - Parent barriers - - Early food environment + - Home environment +/- - Parenting style - ? ? Time +/- - Organisational Childcare setting +/- + - - Provider training + + School nutrition policy + + Parent-provider +/- Additional providers +/- Structured time + - Environmental Food availability - -/+ Out of home consumption - Weather +/- Safety - ^ Assessed in qualitative and quantitative reviews; * Determinant increases portion size NB: For favourable behaviours, + indicates the determinant increases the behaviour and for unfavourable behaviours, + indicates that the determinant decreases the behaviour, i.e. in both case + indicates has a positive impact on the behaviour; “-“ indicates a negative impact; “0” indicates no association found; “?” indicates no clear association in one direction (i.e. studies identified that suggest both + and – associations with behaviours); + / - indicates both positive and negative associations identified across different reviews Many of the identified determinants were modifiable or amendable to intervention but we also identified two key non-modifiable determinants (i.e. minority ethnic status, those from lower income families), with evidence suggesting that tailoring intervention foci with these specific demographic groups in mind may be beneficial for children’s health behaviours. We developed an overarching theoretical framework based on the evidence synthesis (Figure 1), which highlights the many different actors, domains and locations of influence on a young child’s health behaviours. This was developed from an existing framework, 3 and adapted to encompass the dietary, feeding and movement behaviours identified in Table 1. Phase 2 Methods Following the development of the evidence synthesis and framework, and in anticipation of Phase 2 work, we shared a summary of findings and Figure 1 with key strategic project partners in the North East, East and South West of England to gauge their appropriateness. They suggested that the overarching model presented in Fig. 1 was a helpful resource around which to base early years health promotion, but we modified it slightly to incorporate income inequality (on the left-hand side), reflecting our initial project aims and key cross-cutting priorities for early years strategies in England 19 . Their comments lead to identifying the determinants in Fig. 2, which were in line with current work across all interest holders and departments consulted, with policy and practice key priorities highlighted in red. These determinants (a subset of Table 1, outlined in Fig. 2) were consistently associated with several behaviours or specifically relevant to one behaviour (i.e. opportunities for play is only relevant to movement behaviours), but were also plausible targets for behaviour change that were aligned with current early years strategies; these determinants were therefore taken forward to form the basis of the co-design and development work in Phase 2. Using the evidence synthesis and framework, we conducted five online Engagement and Involvement webinars with policy and practice partners; health visitors; and early years educators (henceforth ‘interest holders’) located in the North East, East and South West of England. Participants were recruited through the project team’s existing networks; professional bodies (i.e. Institute of Health Visiting; National Day Nurseries Association); and word of mouth. The purpose of the webinars was to understand interest holders’ key priorities; which determinants most aligned with their ongoing work; and what they felt would be the most appropriate resources for their practice. Webinars started with a brief introduction about the project; moved into two structured sessions focused on their priorities and potential resources, during which participants contributed to an online discussion whiteboard; and finished with a summary and opportunity for questions and reflection. We conducted ongoing synthesis during the webinars using the whiteboard, and combined information across webinars using thematic synthesis upon completion. Combining this with evidence from phase 1, we then worked with a design company to co-develop a tailored range of health promotion materials, iterating with a smaller number of participants, ultimately co-producing several project outputs. Findings and outputs A total of 51 participants engaged in co-development webinars, with a smaller group of 10 interest holders providing ongoing feedback as part of the project team. Interest holders mentioned that their key priorities were: supporting healthy weight; promoting physical activity, good sleep/ hygiene and healthy food availability; limiting screen time; and minimising food insecurity. Reflecting the broad range of professions and workplaces of interest holders, they felt that resources should be suitable for parents; childcare practitioners; healthcare professionals; GPs and those working in community organisations. Finally, interest holders stated that infographics; images for social media; videos and resources for practitioners were important potential outputs, where ensuring that children and families from diverse backgrounds were represented and supported was key, preferably with the option for them to also be ‘family-facing’ (or routinely shared with families). From this, and based on available budget, the smaller co-design team felt that an infographic; animations; social media stills and dominos for children would be appropriate project outputs. The project lead (KH) worked with the design company to incorporate the determinants outlined in Fig 2 into appropriate groupings for media outputs and generate associated characterisations (e.g. grouping safety and weather together for one of the social media videos). Storyboards, scripts and visual images were then developed and referred to the project team to be signed off at regular intervals. Key considerations, such as interpretability, diversity of representation and accessibility were central to developing the resources, given the important subgroups identified in phase 1. Following several iterations, final project outputs included an infographic (Figure 3), four animated videos (each one highlighting determinants at one level of the SEM; Supplementary material 1); 12 social media stills; and Dominos using project still images. The latter were disseminated across nurseries in project areas, and the former are available free of charge to download from the project website. Overall, interest holders felt that the outputs were appropriate and important resources, with one reflecting that they had “ captured the range of issues we deal with, and allow families we work with to see themselves reflected in the images ”. Reflections, strengths and limitations This is one of the first studies to synthesise evidence across systematic reviews to identify determinants common to dietary and movement behaviours in preschool-aged children. In addition to providing a valuable stand-alone evidence summary, we used this to co-develop health promotion materials with key interest holders, working with a wide range of policy and practice; healthcare and childcare practitioners, across disciplinary boundaries, to capture priorities and need across diverse regions of England. Whilst we aimed to include childcare providers, relatively few participated in the co-production phase and so greater input from this domain may have resulted in differing perceived need. Indeed, there was a strong line of evidence pointing towards the importance of childcare provider training for children’s health behaviours, but it was not possible to explore this further due to budget constraints. Also, although the range of literature covered by reviews was 0-6-year-olds, much of the evidence of determinants was taken from research conducted with children aged 2-5 years old and may not be applicable to younger children. Additional behaviours of interest in 0–2-year-olds relevant to this work (e.g. breastfeeding, formula feeding, complementary feeding, weaning) were not explicitly covered, although in some instances prior behaviours such as bottle feeding and the early introduction of solids were themselves a determinant of later dietary behaviours. It should be noted that whilst some determinants were assessed across multiple behaviours, others were not assessed at all in the literature (e.g. impact of male care providers/ grandparents, wider built environment, national obesity policies). There may therefore be factors not yet considered empirically, but that are nonetheless relevant to promoting healthy behaviours in this age group. Certainly, work carried out around national obesity policies for children in the UK found that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural factors that maintain health inequalities, including poverty and food insecurity. 10 Nevertheless, though by no means exhaustive, determinants identified here can be taken forward as an evidence-based guide for intervention development to support health behaviours in preschool-aged children. Although a formal evaluation of whether the materials effected behaviour change was not possible, we will continue to track engagement with online materials and numbers of downloads to support understanding of reach and impact. Conclusions Health behaviours in preschool-aged children share some common determinants (e.g. child preference; family - member modelling; the childcare setting) which may be leveraged during intervention development to better support children and families engage in multiple positive health behaviours. Co-development of health promotion materials allowed interest holders to incorporate their key priorities into co-produced materials, resulting in child friendly outputs, with diverse representations of families, to better support healthy weight, growth and development during the preschool period. Abbreviations Socioecological model (SEM) Declarations Ethics approval and consent to participate: All participants consented to participate in Participant Engagement and Involvement activities, associated with this work. Consent for publication: Not applicable. Availability of data and materials: Data extraction templates and files are available from the corresponding author on request. Competing Interests: The authors declare that they have no competing interests. Funding: This project is funded/supported by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR) (Grant Reference Number NIHR 204000). The work of KRH and EvS was supported by the Medical Research Council (grant numbers MC_UU_00006/5). KRH is funded by a UKRI Future Leaders Fellowship (MR/Y019164/1). AP is funded by The NIHR, Bristol Biomedical Research Centre (Grant Reference Number NIHR203315). Authors contributions KH designed the study, supported by RK, RL, CS and EvS. KH performed the evidence synthesis, collated the tables, and developed study materials and supporting documentation for phase 2. All authors reviewed the synthesis and contributed to materials for phase 2. KH led work during phase 2 and all authors contributed to co-development of health promotion materials. KH drafted the initial manuscript, all authors critically reviewed the manuscript, read and approved the final manuscript. Acknowledgements: We would like to acknowledge the interest holders who gave their time to contribute to the webinars and PIE work without whom this work would not be possible. The National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR), is a partnership between the Universities of Bristol, Cambridge, Exeter and Sheffield; Imperial College London; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster; Fuse, The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland, Cumbria and Teesside Universities; and PHRESH, the Public Health RESearch for Health consortium, a collaboration between the Universities of Birmingham, Warwick and Keele. 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Determinants of change in accelerometer-assessed sedentary behaviour in children 0-6 years of age: a systematic review. Obesity Reviews 2019; : 1–24. Department of Health and Social Care. The best start for life: a vision for the 1,001 critical days. London, 2021. Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial1.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7991594","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":539374031,"identity":"8d8ed075-f08b-4b7c-96a8-4d92c356659a","order_by":0,"name":"Kathryn R. 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15:52:55","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":70887,"visible":true,"origin":"","legend":"","description":"","filename":"5809f86ecf0842f18bab4d064964be081structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7991594/v1/e27ab60891ffed3855f446e2.xml"},{"id":95285844,"identity":"c2832f48-854d-4a9e-a223-123bf24b830a","added_by":"auto","created_at":"2025-11-06 09:58:48","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79246,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7991594/v1/0ebb36028cd8b3c9fba5785f.html"},{"id":95314275,"identity":"bd4d7afc-f8d2-4118-88ba-b9ac6393a726","added_by":"auto","created_at":"2025-11-06 15:52:39","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":147824,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eOverarching theoretical model of influences on dietary, feeding and movement behaviours related to healthy weight and growth in 0-6 years-olds\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7991594/v1/81b135d9947a9c195a5216d7.png"},{"id":95285835,"identity":"a4853932-c8e7-49ab-872f-524fc7ad0795","added_by":"auto","created_at":"2025-11-06 09:58:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":202787,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKey determinants of dietary and movement behaviours in preschool-aged children\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7991594/v1/019b82141d8f253ccee10040.png"},{"id":95314431,"identity":"2bacf9f4-5879-43a4-9584-8e3d0e2cf2da","added_by":"auto","created_at":"2025-11-06 15:52:49","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":476012,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInfographic outlining determinants of dietary and movement behaviours in preschool-aged children\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7991594/v1/b8b5790545c2f94da5cc5d2d.png"},{"id":98775341,"identity":"f4ae4b77-b4a2-4c14-a94a-287c62df61b0","added_by":"auto","created_at":"2025-12-22 12:19:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1498095,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7991594/v1/d6f8d7df-62f4-40b0-a9d8-f1ecca80343f.pdf"},{"id":95285825,"identity":"fff17ac8-f0b6-48d4-963a-723fff4c44ab","added_by":"auto","created_at":"2025-11-06 09:58:48","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":14635,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementarymaterial1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7991594/v1/34187a2575cd25d9d2d7abf6.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Promoting healthy diet and movement in UK preschoolers: Evidence-based co-development of health promotion materials","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn England, 22.1% of children are living with overweight or obesity at age five, with prevalence the highest for those living in the most deprived areas\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Similar levels and patterns are seen internationally \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e, with both diet and movement behaviours known to be important for maintaining a healthy weight and building positive habits during the preschool period and beyond\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Focusing health promotion activities on the youngest age groups therefore represents good value for money and offers potential for sustained impacts into later childhood and beyond\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eA wide range of reviews, mostly focussed on single health behaviours, have been conducted to identify (components of) effective interventions to promote positive diet and movement behaviours during the preschool period\u003csup\u003e\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Limited research has considered if different health behaviours share common determinants, which might offer efficient leverage for positive behaviour change. Moreover, incorporating lived experience in developing interventions is likely to have greater impact on intervention uptake and success\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Previously, we completed of a suite of reviews to assess correlates and determinants of dietary and movement behaviours in preschool-aged children\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. To enhance the dissemination and impact of this work, we undertook a two-phase project. First, we sought to understand whether health behaviours in preschoolers share common determinants, by summarising the evidence on the factors influencing both positive and less desirable behaviours. Then, mapping evidence according to the socio-ecological model (SEM)\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e, we conducted co-design workshops to co-produce materials to support and promote health behaviours in UK preschool-aged children (i.e. aged 2\u0026ndash;5 years).\u003c/p\u003e"},{"header":"Phase 1","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eMethods\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo systematically summarise the evidence focused predominately on the determinants (i.e. longitudinal associations) of health behaviours in children 0-6 years, we synthesised data from dietary (i.e. fruit and vegetable\u003csup\u003e12\u003c/sup\u003e, obesogenic food consumption\u003csup\u003e\u0026nbsp;13\u003c/sup\u003e and sugar-sweetened beverage consumption\u003csup\u003e14\u003c/sup\u003e), feeding (i.e. portion size\u003csup\u003e15\u003c/sup\u003e), and movement behaviour (i.e. physical activity\u003csup\u003e16,17\u003c/sup\u003e and sedentary behaviour\u003csup\u003e18\u003c/sup\u003e) reviews, largely undertaken using a single protocol\u003csup\u003e10\u003c/sup\u003e. Determinants (assessed in cross-sectional, longitudinal, and intervention studies), and their direction of association with behaviours of interest, were extracted. Each extracted determinant was scored based on direction of evidence: for favourable behaviours, a \u0026ldquo;+\u0026rdquo; indicated the determinant increased the behaviour and for unfavourable behaviours, \u0026ldquo;+\u0026rdquo; indicated that the determinant decreased the behaviour, i.e. in both cases \u0026ldquo;+\u0026rdquo; indicated a positive public health impact on the behaviour. A \u0026ldquo;-\u0026ldquo; indicated a negative impact; \u0026ldquo;0\u0026rdquo; indicated no association found; and \u0026ldquo;?\u0026rdquo; indicated no clear association in one direction (i.e. studies identified that suggest both + and \u0026ndash; associations with behaviours). Only determinants studied for two or more distinct behaviours were synthesised.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe SEM\u003csup\u003e11\u003c/sup\u003e is a useful framework around which to organise the identified determinants, as it recognises that individuals are embedded within a large interactive social system, which has a cumulative effect on their health behaviours and subsequent outcomes. Determinants identified across all studies were therefore categorised by SEM domains, namely individual, interpersonal, organisational and environmental domains.  Much of the work synthesised draws on quantitative evidence, but qualitative evidence was included where quantitative evidence was limited or not available. Finally, using the synthesis and a prior theoretical framework\u003csup\u003e16\u003c/sup\u003e, we derived an overarching theoretical framework to outline the determinants of children\u0026rsquo;s health behaviours, which mapped onto the socio‐ecological model. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFindings\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwenty-nine determinants were assessed with two or more behaviours and extracted [individual (n=8); interpersonal (n=11); organisational (n=6); and environmental (n=4) domains] (Table 1), forming the basis of phase 1 synthesis. Interpersonal determinants were commonly assessed, with a number of consistent associations identified. Parental and sibling modelling, and childcare provider training tended to be positively associated with both movement and dietary behaviours. In contrast, use of rewards and treats, child preference and temperament, and parental barriers, including time, were negatively associated with children\u0026rsquo;s health behaviours. Several factors showed variable associations across the behaviours, including the childcare setting, which tended to be positively associated with movement behaviours, but negatively associated with children\u0026rsquo;s dietary behaviours. \u0026nbsp;Determinants identified for multiple dietary behaviours tended to be negatively associated with these behaviours, including previous consumption/ habits, peer modelling, and food availability close to the home (e.g. proximity to fast/food outlets and eating out).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1 Determinants studied for two or more dietary, feeding and/or movement behaviours in 0-6-year-olds\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"704\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 535px;\"\u003e\n \u003cp\u003eHealth behaviours reviewed\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHigher levels promote healthy weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 346px;\"\u003e\n \u003cp\u003eHigher levels promote excess weight\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eDeterminant of behaviour\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003ePhysical activity^\u003csup\u003e16,18\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eFruit and Veg\u003csup\u003e12\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eSedentary behaviour\u003csup\u003e18\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eObesogenic foods\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003eSugar-sweetened beverages\u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003ePortion size*\u003csup\u003e15\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndividual (child)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eChild preference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+ / - \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eChild age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTemperament\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+/-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eScreen time\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eOpportunities for play\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+/-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePrevious consumption/patterns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e- / +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSiblings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEthnicity (white)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInterpersonal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003ePeer/ Sibling modelling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eParent monitoring/goals\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eParental modelling\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eRewards/ treats (incentives)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eParent SES (low)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e? / +\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eYounger parent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eParent barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eEarly food environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eHome environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+/-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eParenting style\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eTime\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+/-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOrganisational\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eChildcare setting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+/-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eProvider training\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSchool nutrition policy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eParent-provider\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+/-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eAdditional providers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+/-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eStructured time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEnvironmental\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eFood availability\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e-/+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eOut of home consumption\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eWeather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e+/-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 170px;\"\u003e\n \u003cp\u003eSafety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e^ Assessed in qualitative and quantitative reviews;\u0026nbsp;* Determinant increases portion size\u003c/p\u003e\n\u003cp\u003eNB: For favourable behaviours, + indicates the determinant increases the behaviour and for unfavourable behaviours, + indicates that the determinant decreases the behaviour, i.e. in both case + indicates has a positive impact on the behaviour; \u0026ldquo;-\u0026ldquo; indicates a negative impact; \u0026ldquo;0\u0026rdquo; indicates no association found; \u0026ldquo;?\u0026rdquo; indicates no clear association in one direction (i.e. studies identified that suggest both + and \u0026ndash; associations with behaviours); + / - indicates both positive and negative associations identified across different reviews\u003c/p\u003e\n\u003cp\u003eMany of the identified determinants were modifiable or amendable to intervention but we also identified two key non-modifiable determinants (i.e. minority ethnic status, those from lower income families), with evidence suggesting that tailoring intervention foci\u0026nbsp;with these specific demographic groups in mind may be beneficial for children\u0026rsquo;s health behaviours. We developed an overarching theoretical framework based on the evidence synthesis (Figure 1), which highlights the many different actors, domains and locations of influence on a young child\u0026rsquo;s health behaviours. This was developed from an existing framework,\u003csup\u003e3\u003c/sup\u003e and adapted to encompass the dietary, feeding and movement behaviours identified in Table 1.\u0026nbsp;\u003c/p\u003e"},{"header":"Phase 2","content":"\u003cp\u003e\u003cstrong\u003e\u003cu\u003eMethods\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFollowing the development of the evidence synthesis and framework, and in anticipation of Phase 2 work, we shared a summary of findings and Figure 1 with key strategic project partners in the North East, East and South West of England to gauge their appropriateness. They suggested that the overarching model presented in Fig. 1 was a helpful resource around which to base early years health promotion, but we modified it slightly to incorporate income inequality (on the left-hand side), reflecting our initial project aims and key cross-cutting priorities for early years strategies in England\u003csup\u003e19\u003c/sup\u003e. Their comments lead to identifying the determinants in Fig. 2, which were in line with current work across all interest holders and departments consulted, with policy and practice key priorities highlighted in red. These determinants (a subset of Table 1, outlined in Fig. 2) were consistently associated with several behaviours or specifically relevant to one behaviour (i.e. opportunities for play is only relevant to movement behaviours), but were also plausible targets for behaviour change that were aligned with current early years strategies; these determinants were therefore taken forward to form the basis of the co-design and development work in Phase 2.\u003c/p\u003e\n\u003cp\u003eUsing the evidence synthesis and framework, we conducted five online Engagement and Involvement webinars with policy and practice partners; health visitors; and early years educators (henceforth \u0026lsquo;interest holders\u0026rsquo;) located in the North East, East and South West of England. Participants were recruited through the project team\u0026rsquo;s existing networks; professional bodies (i.e. Institute of Health Visiting; National Day Nurseries Association); and word of mouth. The purpose of the webinars was to understand interest holders\u0026rsquo; key priorities; which determinants most aligned with their ongoing work; and what they felt would be the most appropriate resources for their practice. Webinars started with a brief introduction about the project; moved into two structured sessions focused on their priorities and potential resources, during which participants contributed to an online discussion whiteboard; and finished with a summary and opportunity for questions and reflection. We conducted ongoing synthesis during the webinars using the whiteboard, and combined information across webinars using thematic synthesis upon completion. Combining this with evidence from phase 1, we then worked with a design company to co-develop a tailored range of health promotion materials, iterating with a smaller number of participants, ultimately co-producing several project outputs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cu\u003eFindings and outputs\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 51 participants engaged in co-development webinars, with a smaller group of 10 interest holders providing ongoing feedback as part of the project team. Interest holders mentioned that their key priorities were: supporting healthy weight; promoting physical activity, good sleep/ hygiene and healthy food availability; limiting screen time; and minimising food insecurity. Reflecting the broad range of professions and workplaces of interest holders, they felt that resources should be suitable for parents; childcare practitioners; healthcare professionals; GPs and those working in community organisations. Finally, interest holders stated that infographics; images for social media; videos and resources for practitioners were important potential outputs, where ensuring that children and families from diverse backgrounds were represented and supported was key, preferably with the option for them to also be \u0026lsquo;family-facing\u0026rsquo; (or routinely shared with families).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFrom this, and based on available budget, the smaller co-design team felt that an infographic; animations; social media stills and dominos for children would be appropriate project outputs. The project lead (KH) worked with the design company to incorporate the determinants outlined in Fig 2 into appropriate groupings for media outputs and generate associated characterisations (e.g. grouping safety and weather together for one of the social media videos). Storyboards, scripts and visual images were then developed and referred to the project team to be signed off at regular intervals. Key considerations, such as interpretability, diversity of representation and accessibility were central to developing the resources, given the important subgroups identified in phase 1. Following several iterations, final project outputs included an infographic (Figure 3), four animated videos (each one highlighting determinants at one level of the SEM; Supplementary material 1); 12 social media stills; and Dominos using project still images. The latter were disseminated across nurseries in project areas, and the former are available free of charge to download from the project website. Overall, interest holders felt that the outputs were appropriate and important resources, with one reflecting that they had \u0026ldquo;\u003cem\u003ecaptured the range of issues we deal with, and allow families we work with to see themselves reflected in the images\u003c/em\u003e\u0026rdquo;.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Reflections, strengths and limitations","content":"\u003cp\u003eThis is one of the first studies to synthesise evidence across systematic reviews to identify determinants common to dietary and movement behaviours in preschool-aged children. In addition to providing a valuable stand-alone evidence summary, we used this to co-develop health promotion materials with key interest holders, working with a wide range of policy and practice; healthcare and childcare practitioners, across disciplinary boundaries, to capture priorities and need across diverse regions of England.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhilst we aimed to include childcare providers, relatively few participated in the co-production phase and so greater input from this domain may have resulted in differing perceived need. Indeed, there was a strong line of evidence pointing towards the importance of childcare provider training for children\u0026rsquo;s health behaviours, but it was not possible to explore this further due to budget constraints. Also, although the range of literature covered by reviews was 0-6-year-olds, much of the evidence of determinants was taken from research conducted with children aged 2-5 years old and may not be applicable to younger children. Additional behaviours of interest in 0\u0026ndash;2-year-olds relevant to this work (e.g. breastfeeding, formula feeding, complementary feeding, weaning) were not explicitly covered, although in some instances prior behaviours such as bottle feeding and the early introduction of solids were themselves a determinant of later dietary behaviours. It should be noted that whilst some determinants were assessed across multiple behaviours, others were not assessed at all in the literature (e.g. impact of male care providers/ grandparents, wider built environment, national obesity policies). There may therefore be factors not yet considered empirically, but that are nonetheless relevant to promoting healthy behaviours in this age group. Certainly, work carried out around national obesity policies for children in the UK found that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural factors that maintain health inequalities, including poverty and food insecurity.\u003csup\u003e10\u003c/sup\u003e Nevertheless, though by no means exhaustive, determinants identified here can be taken forward as an evidence-based guide for intervention development to support health behaviours in preschool-aged children. Although a formal evaluation of whether the materials effected behaviour change was not possible, we will continue to track engagement with online materials and numbers of downloads to support understanding of reach and impact.\u0026nbsp;\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eHealth behaviours in preschool-aged children share some common determinants (e.g. child preference; family\u003cb\u003e-\u003c/b\u003emember modelling; the childcare setting) which may be leveraged during intervention development to better support children and families engage in multiple positive health behaviours. Co-development of health promotion materials allowed interest holders to incorporate their key priorities into co-produced materials, resulting in child friendly outputs, with diverse representations of families, to better support healthy weight, growth and development during the preschool period.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eSocioecological model (SEM)\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e All participants consented to participate in Participant Engagement and Involvement activities, associated with this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e Data extraction templates and files are available from the corresponding author on request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This project is funded/supported by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR) (Grant Reference Number NIHR 204000). The work of KRH and EvS was supported by the Medical Research Council (grant numbers MC_UU_00006/5). KRH is funded by a UKRI Future Leaders Fellowship (MR/Y019164/1). AP is funded by The NIHR, Bristol Biomedical Research Centre (Grant Reference Number NIHR203315).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKH designed the study, supported by RK, RL, CS and EvS. KH performed the evidence synthesis, collated the tables, and developed study materials and supporting documentation for phase 2. All authors reviewed the synthesis and contributed to materials for phase 2. KH led work during phase 2 and all authors contributed to co-development of health promotion materials. KH drafted the initial manuscript, all authors critically reviewed the manuscript, read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We would like to acknowledge the interest holders who gave their time to contribute to the webinars and PIE work without whom this work would not be possible. The National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR), is a partnership between the Universities of Bristol, Cambridge, Exeter and Sheffield; Imperial College London; The London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster; Fuse, The Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland, Cumbria and Teesside Universities; and PHRESH, the Public Health RESearch for Health consortium, a collaboration between the Universities of Birmingham, Warwick and Keele. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eNHS England Digital. National Child Measurement Programme. National Child Measurement Programme. 2025. https://digital.nhs.uk/services/national-child-measurement-programme/ (accessed Aug 4, 2025).\u003c/li\u003e\n\u003cli\u003ePanico L, Boinet C, Akabayashi H, \u003cem\u003eet al.\u003c/em\u003e International differences in gradients in early childhood overweight and obesity: the role of maternal employment and formal childcare attendance. \u003cem\u003eEur J Public Health\u003c/em\u003e 2023; 33: 468\u0026ndash;75.\u003c/li\u003e\n\u003cli\u003ePhillips SM, Spiga F, Moore THM, \u003cem\u003eet al.\u003c/em\u003e Interventions to prevent obesity in children aged 2 to 4 years old. Cochrane Database of Systematic Reviews. 2025; 2025. DOI:10.1002/14651858.CD015326.pub2.\u003c/li\u003e\n\u003cli\u003eThe Center for High Impact Philanthropy. Invest in a Strong Start for Children. 2015.\u003c/li\u003e\n\u003cli\u003eMatwiejczyk L, Mehta K, Scott J, Tonkin E, Coveney J. Characteristics of effective interventions promoting healthy eating for pre-schoolers in childcare settings: An umbrella review. Nutrients. 2018; 10. DOI:10.3390/nu10030293.\u003c/li\u003e\n\u003cli\u003eCoelho VAC, Tolocka RE. Levels, factors and interventions of preschool children physical activity: A systematic review. Ciencia e Saude Coletiva. 2020; 25: 5029\u0026ndash;39.\u003c/li\u003e\n\u003cli\u003eAl-walah MA, Donnelly M, Cunningham C, Heron N. Which behaviour change techniques are associated with interventions that increase physical activity in pre-school children? A systematic review. \u003cem\u003eBMC Public Health\u003c/em\u003e 2023; 23. DOI:10.1186/s12889-023-16885-0.\u003c/li\u003e\n\u003cli\u003eKooij MCJ, Smit AJP, Breeman LD, \u003cem\u003eet al.\u003c/em\u003e Exploring Evaluation of eHealth Lifestyle Interventions for Preschool Children: A Scoping Review. Mayo Clinic Proceedings: Digital Health. 2025; 3. DOI:10.1016/j.mcpdig.2025.100223.\u003c/li\u003e\n\u003cli\u003eMorley C, Jose K, Hall SE, \u003cem\u003eet al.\u003c/em\u003e Evidence-informed, experience-based co-design: A novel framework integrating research evidence and lived experience in priority-setting and co-design of health services. \u003cem\u003eBMJ Open\u003c/em\u003e 2024; 14. DOI:10.1136/bmjopen-2024-084620.\u003c/li\u003e\n\u003cli\u003eLakshman R, Mazarello Paes V, Hesketh K, \u003cem\u003eet al.\u003c/em\u003e Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses. \u003cem\u003eSyst Rev\u003c/em\u003e 2013; 2: 28.\u003c/li\u003e\n\u003cli\u003eBronfenbrenner U. Ecological Models of Human Development. In: International Encyclopedia of Education, Vol3, 2nd edn. Oxford: Elsevier, 1994: 1643\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Malley, Claire L. Characterising the determinants of fruit and vegetable consumption in pre-school children. 2019. http://etheses.dur.ac.uk/13214/http://etheses.dur.ac.uk.\u003c/li\u003e\n\u003cli\u003eMazarello Paes V, Ong KK, Lakshman R. Factors influencing obesogenic dietary intake in young children (0\u0026ndash;6 years): systematic review of qualitative evidence. \u003cem\u003eBMJ Open\u003c/em\u003e 2015; 5: e007396.\u003c/li\u003e\n\u003cli\u003eMazarello Paes V, Hesketh K, O\u0026rsquo;Malley C, \u003cem\u003eet al.\u003c/em\u003e Determinants of sugar-sweetened beverage consumption in young children: A systematic review. \u003cem\u003eObesity Reviews\u003c/em\u003e 2015; 16: 903\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003ePorter A, Kipping R, Summerbell C, Dobrescu A, Johnson L. What guidance is there on portion size for feeding preschool-aged children (1 to 5 years) in the United Kingdom and Ireland? A systematic grey literature review. \u003cem\u003eObesity Reviews\u003c/em\u003e 2020; 21: 1\u0026ndash;16.\u003c/li\u003e\n\u003cli\u003eHesketh KR, Lakshman R, van Sluijs EMF. Barriers and facilitators to young children\u0026rsquo;s physical activity and sedentary behaviour: a systematic review and synthesis of qualitative literature. \u003cem\u003eObesity Reviews\u003c/em\u003e 2017. DOI:10.1111/obr.12562.\u003c/li\u003e\n\u003cli\u003eHesketh K, O\u0026rsquo;Malley C, Mazarello Paes V, \u003cem\u003eet al.\u003c/em\u003e Determinants of Change in Physical Activity in Children 0-6 years of age: A Systematic Review of Quantitative Literature. \u003cem\u003eSports Medicine\u003c/em\u003e 2017; 47: 1349\u0026ndash;74.\u003c/li\u003e\n\u003cli\u003eAzevedo L, Van Sluijs E, Moore H, Hesketh K. Determinants of change in accelerometer-assessed sedentary behaviour in children 0-6 years of age: a systematic review. \u003cem\u003eObesity Reviews\u003c/em\u003e 2019; : 1\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eDepartment of Health and Social Care. The best start for life: a vision for the 1,001 critical days. London, 2021.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":true,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Physical Activity, Diet, behaviour, Sedentary, synthesis, preschool","lastPublishedDoi":"10.21203/rs.3.rs-7991594/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7991594/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eExcess weight remains a concern for preschool-aged children. To support action in practice, we synthesised systematic review evidence assessing determinants of health behaviours in 0-6-year-olds to inform the co-production of health promotion materials to promote UK preschoolers\u0026rsquo; healthy weight.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003e Phase 1: Synthesis of review-level evidence on dietary (i.e. fruit and vegetable, obesogenic food and sugar-sweetened beverage consumption), feeding (i.e. portion size), and movement behaviours (i.e. physical activity and sedentary behaviour) (Spring 2024). Determinants (assessed in cross-sectional, longitudinal and intervention studies) and their direction of association with each behaviour were extracted and synthesised according to the socio-ecological model (i.e. individual, interpersonal, organisational and environmental domains). Phase 2: Phase 1 findings informed five co-design webinars with policy and practice partners, healthcare practitioners and childcare providers (\u0026lsquo;interest holders\u0026rsquo;), co-producing a range of materials to promote healthy behaviours (launched Spring 2025).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eTwenty-nine determinants were associated with two or more health behaviours [individual (n\u0026thinsp;=\u0026thinsp;8); interpersonal (n\u0026thinsp;=\u0026thinsp;11); organisational (n\u0026thinsp;=\u0026thinsp;6); and environmental (n\u0026thinsp;=\u0026thinsp;4) domains]. Interpersonal determinants (e.g. relating to parents, siblings, other carers) were assessed often and tended to be positively associated with movement and dietary behaviours. Co-design webinars with 51 interest-holders, whose key priorities included supporting healthy weight and promoting physical activity/ healthy food availability, resulted in co-production of a free-to-use infographic; four animations; social media stills and dominos (for children).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eCommon determinants of preschoolers\u0026rsquo; health behaviours were leveraged to co-develop health promotion materials, incorporating interest-holders\u0026rsquo; key priorities. Child-friendly outputs, with diverse representations of families, were co-produced to support UK preschoolers\u0026rsquo; healthy weight.\u003c/p\u003e","manuscriptTitle":"Promoting healthy diet and movement in UK preschoolers: Evidence-based co-development of health promotion materials","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-06 09:58:43","doi":"10.21203/rs.3.rs-7991594/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"61225fe9-bc88-43ec-9e5a-eb78c837f6ac","owner":[],"postedDate":"November 6th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-19T19:23:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-06 09:58:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7991594","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7991594","identity":"rs-7991594","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}