Enhancing healthy eating and active play in the Australian early childhood education and care system.

Early childhood education and care (ECEC) settings are crucial for promoting healthy eating (HE) and physical activity (PA) among young children. However, the implementation of health promotion strategies in these settings is often inconsistent and suboptimal. This study applied a systems thinking approach to identify potential leverage points for improving HE and PA promotion in Australian ECEC settings. The study involved qualitative systems mapping through a desktop review and interviews with a purposive sample of stakeholders from the ECEC sector, to explore gaps, opportunities, and strategies, for strengthening HE and PA promotion. Interview data were analysed in NVivo 14 using reflexive thematic analysis within a constructivist paradigm. The desktop review showed that although ECEC quality is regulated in Australia, the standards for HE and PA promotion are vague and inconsistently assessed. Implementation support is provided at the state/territory level, but the availability and intensity of this support vary widely across jurisdictions, resulting in fragmented practices. Interviews with 16 participants, including ECEC providers (n = 4), quality assurance bodies (n = 2), and health promotion support organizations (n = 10) identified three key themes: (i) a mismatch in problem perception, (ii) the 'carrot or stick' approach, and (iii) the need to build sector capacity. From a systems thinking perspective, these findings highlight the need for a nationally coordinated approach to align quality standards, implementation support, and workforce development in the ECEC sector.