The present study aimed to explore whether there is an association between serving high-quality food (in line with nutrition guidelines) and the food budget in a kindergarten. To investigate differences in diet quality, we tested five different budget levels. Surprisingly, the main findings showed that the odds of serving high-quality food did not increase in line with the increases in the food budget. Furthermore, in addition to the very low food budget, we tested low budget levels compared to the medium, high, and very high budget levels. Again, there were no significant differences between the groups. Therefore, it is uncertain if it is necessary with a high or very high food budget to serve food in line with nutrition guidelines in kindergartens.
Northern kindergartens are not administered in the same way as in Norway. For example, there is an additional fee for food and beverages. In Finland and Sweden, for instance, the food in kindergartens is fully subsided (5). To our knowledge, there is difficult to find previous research on food cost and budget in kindergartens in European and Northern countries.
In Norwegian kindergartens, the food budget in kindergartens seems to vary and not be consistent (17). For example, the kindergartens can ask for an additional parental fee for food and meals, not regulated by the government, which varies from 0 to 1200 NOK (17). In the present study, the food budget is from 120-1000 NOK, and it might seem that the kindergartens have a food budget without any explanation or reason for why the budget is like it is, even if the kindergarten is a “whole meal kindergarten” and serves all the daily meals. There is variation within the food budget also if it is in the same municipality or kindergarten chain.
However, to our knowledge, there are non-comparable numbers on how the organizing of food and food budget is across the Nordic countries in schools and kindergartens, and there is a lack of research (5). The diet quality in northern kindergartens, as well as in other countries, seems to vary (5, 18). The research aims to identify perceived implementation difficulties and barriers to achieving best practice standards among providers, showing that 81 % of providers mean that the food budget is a barrier to serving healthy food (19). However, a study from England done in a daycare setting indicated that the food budget was related to the Chef’s quality of ingredients (20). Some schools use ultraproccesed food in Sweden to decrease food costs (5). In the literature, there is an assumption about food cost as one of the primary barriers to healthy food; thus, this is not tested.
A recent evaluation of the Norwegian initiative to improve the fish amount(“fiskesprell”) suggests that cost/budget is a barrier to serving fish meals in kindergartens (21).On the other hand, 72 % answered that they had economic circumstances to serve fish in the same report, and only 5 % meant a better economy would affect children’s fish intake (21). In addition, the kindergartens had overall good meal practices, for instance, good educational plans and high diet quality in line with nutrition guidelines. In our interpretation, these results indicate that the food budget not necessarily is the most important when the kindergartens work with food and meals. Another cluster- randomized from Norway, intending to increase vegetable intake, indicated that kindergartens with a higher food budget served more vegetables (22). Despite these results, these findings are not comparable to the current study. We analyzed a total diet score on quality and not a single item like vegetables. In the present study, we also tested different budget levels from very low to very high and low budget compared to medium, high and very high budget levels. The Norwegian study reported that those with a higher budget than low (> 251 NOK) served more vegetables compared to very low budget (22). Nevertheless, the same study pointed out that the vegetable variations were higher in those with very low budgets. Therefore, other determinants will probably also affect the intake (22). Moreover, previous research shows that structured programs and policies where the authorities or local decision-makers initiate different areas of action may increase the diet quality in kindergartens (23, 24). For instance, a small qualitative Norwegian study found that the physical environment was related to diet with high quality in kindergartens (25).
Another aspect is knowledge and nutrition literacy that might be necessary to work adequately with food and meals in kindergartens, in line with the framework plan (4). The Norwegian government has a strategy to increase “health literacy” in public, both at the individual and structural levels (26). Therefore, kindergartens have the potential to promote good health and might be seen as a “Health literate health organization” (26). However, if kindergartens do not have baseline knowledge, it might be challenging to know how they could, in a better way, increase diet quality and good food and meal practice.
Since there are variations in diet quality in Norwegian kindergartens (7, 27) and other countries (5, 28), there is a need to explore how we in the future can streamline work with food and meals with increased attention to other determinants and environmental factors.
It is a problem if it is an established truth that the food budget is the essential factor in light of diet quality in kindergartens. Therefore, the policymakers need to think differently about how they can increase diet quality in kindergartens. In Norway, and probably in other countries, one can see an ever-increasing food budget. In those countries where meals are included in kindergarten price, there might be a risk for more ultraprocced food , and less healthy food because one believes that these types of food decrease the budget. Another chance is in those countries where kindergartens themselves ask for an additional fee for food, for instance, in Norway and Denmark (5) which might directly increase social inequality and potentially make “high” and “low” class kindergartens.
According to WHO, social inequalities regarding health must be solved, both in rural and rich countries (29), and higher food budgets without a professional reason will increase social inequality. Overall, food prices may play a role in some contexts (30), and the current study has indicated that there should be a minimum budget to maintain a diet of high quality.
However, the present study results show that a high food budget is not a good indicator of high diet quality in kindergartens. Therefore, one solution can be a standard budget model with a low/medium budget that includes examples of food that can be served according to nutrition guidelines. And of course, as mentioned earlier, it also makes a system for how all kindergarten should work with food and meals and include the kindergarten’s framework plan even more.
Strength and limitations of the study
The present study has some strengths but also some limitations. First of all, according to statistics in Norway, there is a total of 47 % public and 53 % private kindergartens in Norway ( SSB).
In the present study, 68, 5% of kindergartens were private, and 31.5% were public, while generally, in Norway, the number of public kindergartens is higher. In addition, there are over 5500 kindergartens in Norway, and we have data from 324, which only is 5.8 % of the total population. Since the kindergarten could sign up themselves, there might be a bias in the sample, and the external validity is low.
The response rate in this study is high (over 95% according to those who participate in the Healthier kids platform), which also indicates motivated participants. Therefore, the baseline score in diet quality could be higher than other kindergartens; thus, this it’s a well-known challenge in surveys and other studies about nutrition.
There are further limitations to the study. The web-based questionnaire has not been validated. Thus, it is tested for reliability, and we did a factor analysis.
The Cronbach’s alpha was .68, under acceptable value (16). The one question about milk loaded very low, and if this item were deleted, the Cronbach’s would increase to .78, which is an acceptable value (16). Therefore, we also did a sensitivity where the diet score excluded milk. Again, the results were equal to the primary analysis.
The results showed very broad confidence intervals when we analyzed a very low food budget compared to the other levels. Therefore, the results in this first analysis must be interpreted with caution. On the other hand, we also tested low food budgets compared to the other budget levels, strengthening the results.
Pedagogical leaders or leaders make the response to questions on behalf of the kindergarten. But unfortunately, this can give a skewed answer that is not necessarily reflecting the truth in kindergartens.