Exploring the role of holiday clubs in promoting healthy eating among children from food insecure backgrounds

Many UK holiday clubs offer free food to help alleviate children’s food insecurity during the school holidays, yet little research has explored whether and how children’s healthy eating is promoted in these settings. This is crucial as the UK is experiencing a public health crisis in relation to children’s poor diet and nutrition, and especially for children from food insecure backgrounds who are at an increased risk of poorer health and nutritional outcomes. This thesis investigated the role of UK holiday clubs in promoting healthy eating among children from food insecure backgrounds. This thesis includes three studies split across two parts to address the thesis aim. Part I consisted of two studies (Study 1 an observational study; Study 2 an interview and focus group study) to explore what holiday clubs currently do to promote children’s healthy eating, and what factors influence what and how holiday clubs promote children’s healthy eating. Part II consisted of one study (Study 3 an interview study with vignettes) to explore what holiday clubs could do in the future to promote children’s healthy eating. For part 1, the observational study (Study 1, N=10 holiday clubs) showed that some holiday club staff used some positive (health promoting) feeding practices, but these could have been used more frequently during mealtimes. Holiday clubs provide mostly healthy foods that largely meet the School Food Standards, but also provide some unhealthy foods that should be avoided or swapped with healthy alternatives. Holiday clubs provide mostly cold foods and would benefit from offering hot meals where this is possible. Holiday clubs do not frequently use serving styles that enable children to self-serve (e.g. buffets or family-style dining); these are beneficial for children’s development and also facilitate the use of positive feeding practices such as modelling healthy eating, and are therefore recommended to be used where possible. The interview and focus group study (Study 2, N=27 holiday club staff) showed that holiday club staff reported using a number of positive feeding practices, but also reported using a few maladaptive feeding practices that are counterproductive to promoting children’s healthy eating behaviours. The findings also showed that there are a variety of factors influencing staff’s ability to promote children’s healthy eating (e.g. logistics and resources such as staffing; staff factors such as knowledge and experience; child factors such as food preferences; parent factors such as knowledge of healthy eating), some of which are barriers to promoting children’s healthy eating. Building from Study 1 and Study 2, for part II, the interview with vignettes study (Study 3, N=25 holiday club staff) showed that implementing evidence-based feeding practices such as modelling and involvement are feasible in holiday clubs, as evidenced through holiday club staff acceptability and demand to use the practices. But this is dependent on whether some of the perceived and actual barriers (e.g. logistical and resource challenges) can be effectively managed or overcome, of which there are clear examples reported by staff in how to adapt practices in ways that overcome these barriers (for example, engaging children in simple food preparation activities if a club lacks the kitchen facilities to engage children in full cooking activities). Together, the findings of the three studies highlight that holiday clubs are a meaningful setting to promote children’s healthy eating given their frequent engagement with children and given the frequency with which they feed children as part of their holiday club provision. The findings show that holiday clubs already implement some meaningful practices that are conducive to promoting children’s healthy eating, and also highlight areas that would benefit from strengthening and development. To empower holiday clubs to achieve this, information and training resources would enable holiday clubs to enhance their mealtime interactions in ways maximise their opportunities to promote healthy eating among children from food insecure backgrounds.