Entrepreneurship may be taught, and entrepreneurship education is flourishing at colleges and universities. However, previous documents show that entrepreneurship education is inconsistent with the research conclusions of entrepreneurial intention, which is a lack of discussion on the mediating effect of government subsidies from external resources. Based on the cognitive behavior theory, a mediating effect of entrepreneurship education on entrepreneurial strategy and entrepreneurial intention is built. By collecting the data of 334 questionnaires of college students in Pearl River Delta in China, a structural equation is used for empirical analysis. The result indicates that entrepreneurship education does not have a significant influence on entrepreneurial intention; exploration innovation and exploitation innovation have a positive influence on entrepreneurial intention, and exploration innovation and exploitation innovation have a mediating effect on entrepreneurship education and entrepreneurial intention; government subsidies have a positive regulating effect on exploration innovation, exploitation innovation, and entrepreneurial intention. In this article, the application of the cognitive behavior theory in the field of entrepreneurship research is expanded to provide the theoretical basis for building the entrepreneurship education ecosystem, which is conductive to innovation and entrepreneurship to promote regional economic development. Since Harvard Business School opened the first entrepreneurship course in 1947, entrepreneurship education has risen in the world and attracted widespread attention from entrepreneurs and education scholars . EntreprEntrepreneurship education has become an important link of talent cultivation at colleges and universities. At present, research on entrepreneurship education focuses on the construction of entrepreneurship education ecosystem , course Entrepreneurship education is aimed at cultivating innovative talents, which are the important driving force for future development . InnovatBased on the resource-based theory, entrepreneurship needs to integrate the internal and external resources, and local government subsidies are one of the important external resources to support the start-ups . GovernmIn this article, based on the social cognitive theory and resource-based theory, the research model of the influence of entrepreneurship education on entrepreneurial strategy and entrepreneurial intention is built to thoroughly explore and analyze the influence mechanism of entrepreneurship education on entrepreneurial intention and verify the regulating effect of government subsidy policy. In this article, the research and application of cognitive behavior theory in entrepreneurship education are expanded  to proviEntrepreneurship education first guides the students to confirm their own entrepreneurial intention. Based on the social cognitive theory, individuals tend to pursue their own targets only when they believe their abilities and actions can achieve the expected results . EntreprWhether entrepreneurship could be taught was a hot topic in the academic circle once. There was a viewpoint: Entrepreneurs can only be identified instead of being “produced” . HoweverHypothesis 1: Entrepreneurship education and entrepreneurial intention are positively correlated.Exploration innovation, which is one of the entrepreneurial strategies, makes destructive innovation based on new knowledge, technologies, design, and products to create customer value . March . The socEntrepreneurs must be engaged in three important tasks, mainly identifying and exploiting opportunities, taking risks, and innovating . IdentifSince entrepreneurship is a dynamic process with uncertainty and high risk, and the start-ups need to be guaranteed with innovation resources in the innovation process, undergraduate entrepreneurship will have high financial costs when it relies on their own resources in the entrepreneurship to implement innovation activities to promote competitive ability so as to achieve the operation goals. Undergraduate entrepreneurship will also face such huge risks as insufficient organization and management ability, large investment in product research and development expenditures, and high cost of improving the processes; therefore, undergraduate entrepreneurship often focuses on the entrepreneurship environment, such as research and development expenditures of the government, tax preference, financial subsidies, and other innovation policies. Therefore, the significant influence of entrepreneurship education on exploration innovation and entrepreneurial intention is researched in this article, and the research Hypothesis 2 and Hypothesis 3 are inferred on this basis:Hypothesis 2: Entrepreneurship education and exploration innovation are positively correlated.Hypothesis 3: Exploration innovation and entrepreneurial intention are positively correlated.Entrepreneurship education is aimed at developing all the basic entrepreneurial skills to achieve successful entrepreneurship . TraditiExploitation innovation is another type of entrepreneurial strategy, which is the progressive innovation based on existing technologies, products, and services to meet customer and market demands . ExploitThe development of new products and their entry into the new market are the result of entrepreneurial spirit . The comTherefore, the significant influence of entrepreneurship education on exploitation innovation and entrepreneurial intention is researched in this article, and the research Hypothesis 4 and Hypothesis 5 are inferred on this basis:Hypothesis 4: Entrepreneurship education and exploitation innovation are positively correlated.Hypothesis 5: Exploitation innovation and entrepreneurial intention are positively correlated.Government subsidy, which is used by the national or local governments to encourage and support undergraduate entrepreneurship, is an innovation policy to drive economic development and plays the role of stimulation and regulation in regional economic growth and innovation activities. In other words, after the start-ups obtain the government subsidies, they may promote the technical innovation ability by researching and developing new products, introducing new technologies, talents, and equipment as well as organizing and serving innovation, and may also promote the scale benefit through such economic means as expanding the production scale and investment so as to improve the enterprise performance. Exploitation innovation of enterprises will not affect the financial performance but will erode the enterprise resources . Since iAccording to the resource-based theory, government subsidy is a public policy to play the role of stimulation or encouragement , which iHypothesis 6: Government subsidies have a positive regulating effect on exploration innovation and entrepreneurial intention.Hypothesis 7: Government subsidies have a positive regulating effect on the exploitation innovation and entrepreneurial intention.In conclusion, this article is based on the cognitive behavioral theory and the innovation and entrepreneurship theory to analyze the influence of undergraduate entrepreneurship education on entrepreneurial strategies and entrepreneurial intention, and to verify the regulating effect of the government subsidy policy, and its research framework is shown in Undergraduate Entrepreneurship opened by colleges and universities with the support of Human Resources and Social Security Department of Guangdong Province. 1,000 questionnaires were distributed, and 516 questionnaires were collected, with a questionnaire recovery rate of 51.6%. After eliminating 109 questionnaires with incomplete information, there were 334 effective questionnaires, with an effective rate of 64.73%. Among the samples, public comprehensive universities accounted for 31.44%; public application-based universities accounted for 44.31%; independent colleges accounted for 12.57%; and private colleges accounted for 11.68%. Among the majors, science and engineering majors accounted for 33.53%; economy and management majors accounted for 46.11%; humanities/arts majors accounted for 9.88%; medical majors accounted for 1.8%; and agricultural majors accounted for 8.68%; with respect to the degree of education, undergraduate students accounted for 79.64%, and junior college students accounted for 20.36%. Among the questionnaire fillers, men accounted for 60.48% and women accounted for 39.52%. The average age was 24. The results are shown in Innovation resources at home and abroad are gathered in China’s Pearl River Delta to promote mass entrepreneurship and innovation and accelerate the formation of the innovation-oriented economic system and development mode, with the reputation of the capital of innovation. An international first-class innovation and entrepreneurship center is being built. The university encourages undergraduates to participate in innovation and entrepreneurship competitions and provides places to cultivate makers. In this research, with the students at colleges and universities in Pearl River Delta in China as the sampling objects, random samples of the written questionnaire were taken among the students in the education and training classes of The development of questions in the questionnaire is mainly referred to the previous theoretical basis and relevant literature. To make the questionnaire rigorous, after the questionnaire was designed, the scholars and professors in relevant fields and the experts of the practice field were invited to provide guidance opinions. After several modifications of questions and grammars, 30 undergraduates from the start-ups were selected for the pre-test, and the formal questionnaires in this study were completed to ensure the accuracy, adaptability, and convenience of answers after the statistical analysis on the pre-test data and after the inappropriate semantics was repeatedly corrected. The questionnaire adopted a 7-point Likert scale. The larger the number, the more you agree with the description . The questionnaire construct variables mainly include entrepreneurship education, entrepreneurial strategies of exploration innovation and exploitation innovation, and entrepreneurial intention and government subsidies. The operational definitions of variables and the basis of the research scales in the research framework are described as follows:Entrepreneurship education measured in this study focuses on the perspective of social cognition, which is analyzed from three aspects, namely, environment, organization, and personal learning and behaviors. Through the interviews with the full-time teachers, we may understand the main concerns of the entrepreneurship education at colleges and universities, such as entrepreneurship atmosphere, entrepreneurship course, and entrepreneurial activities. In addition, based on the references of Exploration innovation, which is a destructive innovation, is based on new knowledge and technologies to create customer value. Based on the scale of Exploitation innovation, which is a progressive innovation, is based on the existing technologies and products to meet customer and market demands. Based on the scale of Entrepreneurial intention is mainly based on the scale proposed by Government subsidies are mainly based on the scale proposed by In this study, gender, age, and degree of education are taken as control variables  to elimiIn this study, SPSS23.0 statistical analysis software is used in descriptive statistical analysis on the sample data, and the mean value, SD, and correlation coefficient of each variable are shown in 2 = 1,121.84, df = 382, cmin/df = 2.93 < 3, p < 0.001; SRMR = 0.05 < 0.08; CFI = 0.92 > 0.90; TLI = 0.91 > 0.90; RMSEA = 0.06 < 0.08, indicating that the questionnaire has relatively good reliability and validity and that the scale has good measurement quality  show the good matching degree of the structural models and the observation data.In this study, the path relationship among various research constructs is discussed through path analysis to verify the research hypotheses proposed in this article. Refer to t = 0.58). If Hypothesis 1 is not supported, entrepreneurship education will not directly affect the undergraduate entrepreneurial intention; exploration innovation has the positive significant influence on entrepreneurial intention . If Hypothesis 3 is supported, exploitation innovation has the positive significant influence on entrepreneurial intention . If Hypothesis 5 is supported, undergraduate entrepreneurial strategies of exploration innovation and exploitation innovation have a positive influence, and exploitation innovation can better adapt to the market demand, so the entrepreneurship success rate will be higher.First, gender and age are taken as control variables to verify the influence of entrepreneurship education, exploration innovation, and exploitation innovation on entrepreneurial intention, and the results see  show tha**, t = 3.55), and Hypothesis 2 is supported; entrepreneurship education has a positive significant influence on exploitation innovation , and Hypothesis 4 is supported, indicating that entrepreneurship education has a positive influence on both exploration innovation and exploitation innovation. Hypothesis 1 is not supported, indicating that entrepreneurship education will not directly affect entrepreneurial intention, but it promotes entrepreneurial intention through the entrepreneurial strategies of exploration innovation and exploitation innovation, so exploration innovation and exploitation innovation have the mediating effect.Second, the influence of entrepreneurship education on exploration innovation and exploitation innovation is verified. Entrepreneurship education has a positive significant influence on exploration innovation (β = 0.21t = 1.46), and Hypothesis 6 is supported, indicating that government subsidies play a regulating role in exploration innovation at the time of undergraduate entrepreneurship and entrepreneurial intention. As shown in Finally, the regulating effect of government subsidies is verified. The interaction between government subsidies and exploration innovation has a positive significant influence on entrepreneurial intention , and Hypothesis 7 is supported, indicating that government subsidies play a regulating role in exploitation innovation at the time of undergraduate entrepreneurship and entrepreneurial intention. As shown in The interaction between government subsidies and exploitation innovation has a positive significant influence on entrepreneurial intention (β = 0.48Based on the social cognitive theory, the mechanism for the influence of entrepreneurship education on entrepreneurial intention is explored and discussed in this article, and the regulating effect of the government subsidy policy is verified. By collecting the data of 334 questionnaires from students at colleges and universities in Guangdong Province, empirical analysis of structural equation is conducted to draw the empirical research conclusions: First, entrepreneurship education has no influence on entrepreneurial intention, which is inconsistent with the conclusion of previous literature research ; that isThe research results show the influence of entrepreneurship education on entrepreneurial intention as well as the mediating effect of entrepreneurial strategies. Entrepreneurship education not only provides the human capital such as knowledge and skills but also changes the students’ attitudes and behaviors . EntreprThe research results verify the regulating effect of the government subsidy policy. Entrepreneurship needs a lot of resources and a lot of funds and has certain risks for success, so the local governments shall take the funding measures such as government subsidies and talent incentives to build an entrepreneurial environment in favor of innovation . EntreprImprove the entrepreneurship education ecosystem to promote the college students’ entrepreneurial intention. First, establish a perfect entrepreneurship education mechanism. Entrepreneurship education is especially important at the early stage of entrepreneurship career, which enables the students to carefully consider whether to be engaged in entrepreneurship and is conducive to the formation of entrepreneurial intention ; second,As the subjects of entrepreneurship education learning, the students shall consider their own obvious campus characteristics. Innovation is the power for entrepreneurship program development; in the students’ entrepreneurship, many entrepreneurship programs are based on innovative technology transformation and creativity . EntreprAt present, an innovation-driven development strategy puts forward new requirements for entrepreneurship education. As a new incubator of innovative talents, entrepreneurship education shall also focus on promoting entrepreneurial professional ability. Entrepreneurship education at colleges and universities is aimed at “education” and “learning” and inspiring the students’ entrepreneurial dream and interest instead of improving the success probability of entrepreneurship in reality. It is necessary to improve the entrepreneurship education reform in colleges and universities, fully consider the demands and characteristics of undergraduate entrepreneurs, organize various teaching practice activities, and actively participate in the innovation and entrepreneurship competitions.Entrepreneurial intention is affected in multiple aspects and in multiple dimensions. In the future, a new model may be built in the aspects of the identification of entrepreneurial opportunities, the spirit of entrepreneurs, and teaching style. At the same time, the students at colleges and universities as the research object are evaluated for entrepreneurship education. In the future, dynamic tracking may be conducted, and cross-level research of organization and management levels may be conducted.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.This study was carried out in accordance with the recommendations of the Ethics Committee of Macau University of Science and Technology with written informed consent from all subjects in accordance with the Declaration of Helsinki. The protocol was approved by the Ethics Committee of the Macau University of Science and Technology.JL is responsible for the proposal of the research topic, research structure, and manuscript writing. S-ZH is responsible for data analysis, manuscript writing, and revision. KC and LY are responsible for data collection, collation, and analysis, as well as manuscript revision. All authors approved the final version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


One patient and one volunteer have been matched for a duration of 12 weeks, and participants have been encouraged to communicate through a variety of communication methods . The Phone Pal study aimed to investigate the feasibility of recruitment, participant retention, data collection procedures, intervention usage of the methods of communication and changes in outcome data. At baseline and follow-up outcome measures collected from patients and volunteers included their quality of life, physical activity, self-esteem and social comparison. Additional outcomes assessed patients' attachment, social contacts and symptoms; for volunteers, their social distance was evaluated. At follow-up both patients and volunteers rank their perception of their relationship with each other. This mixed method feasibility study has been conducted in two phases, the first stage evaluating a smaller sample of patients and volunteers recruited in London, and then a second phase with a larger sample of volunteers recruited from across the United Kingdom.The literature suggests that volunteering can be used to address social isolation and support patients with psychosis in the community. However, many expect in person meetings, requiring a greater effort of availability and commitment. There is therefore a need for more flexible, easily accessible support. Volunteering Trial registration: ISRCTN17586238. Health-promotion interventions that increase engagement in lifestyle changes can offer potential health benefits across the lifespan, including to people with severe mental illness (SMI) . AmongstA study investigating the choice of technology-based communication tools  described it as dependent on their skills, modality availability and location of their contacts . PatientTo explore this, the “Phone Pal” intervention has been designed following the person-based approach and the Medical Research Council (MRC) framework for the development and evaluation of complex interventions . The “PhAccording to the MRC guidelines, a feasibility study should be the next step to elucidate how the intervention works in practice. It is typical for feasibility studies to use more flexible methodology, such as an observational design, since the aims focus on evaluating acceptability and feasibility of intervention and study procedures . It is tThe aim of this mixed methods feasibility study has been to address the uncertainties regarding the feasibility of the intervention and the study procedures.The specific objectives have been as follows:To evaluate the feasibility of the following study procedures:– recruitment, including time to recruit– eligibility criteria and resulting sample characteristics– matching patients and volunteers– study retention and follow-up– data collection procedures and outcome measures, including missing data.To explore the usage of the intervention in terms of:– acceptability of, and adherence to, the intervention– patterns of intervention use.To investigate the acceptability of, and participants' response to the intervention by assessment of:– changes in outcome data and estimate of the variability of outcome measurement– participants' views and experiences of the intervention relating to the initial training received, access to support throughout the study, and the wider study procedures.A single center, pre-post, single arm, mixed methods feasibility study with two phases. The first with a small sample of patients and volunteers recruited in London; the second phase incorporating a larger sample with volunteers recruited nationwide.A pre-post design with some process measures was chosen as the most appropriate method for addressing the study objectives. Since this has been within the initial stage of intervention development and testing, a single center was deemed as the most practicable setting. The follow-up involved quantitative assessments, data usage analysis and in-depth qualitative interviews. This evaluation planned to cover the perspective of the participants , and a system analysis of smart-phone data usage collected by two apps “mspy” and “accupedo pedometer—step counter”. The utilization of multiple methods allows for a more complete and thorough understanding of feasibility questions in the target population , 15, usin = 3 patients, n = 3 volunteers). If feasible, and allowing for further refinements provided by participants' feedback, a subsequent full study with another 30 participants  would be carried out.The first phase included 6 participants  and local Principal Investigator (PI), with the Health Research Authority (HRA) and local governance office of East London NHS Foundation Trust (ELFT).The lead author presented the study to the East of England—Cambridgeshire and Hertfordshire Research Ethics Committee (REC reference: 18/EE/0196) on 12 June 2018. HRA approval was received on 7 September 2018. The study was then registered in the International Standard RCT Number (ISRCTN) database (ISRCTN17586238).Further to the first stage of this study, and given the wide expression of interests received from volunteers from outside London, a minor amendment was requested on 20 February 2019 and approved on 1 March 2019 to recruit volunteers across the country, and to have support from other researchers to undertake participants' assessments.Owing to the nature of the intervention, aiming to connect people in the community, it was most appropriate to recruit people with psychosis who are followed in outpatient community services, together with community volunteers. A range of recruitment strategies have been used . All patPreparations were made well in advance, recruitment activities were discussed with the NHS Trust and the volunteering associations at the development stage of this work.Scripts were developed containing key instructions for approaching potential patient participants, and for training them on the intervention usage. The lead author provided these to the two researchers trained by the lead author to provide support with patient assessments.In addition, all researchers received training in the Brief Psychiatric Rating Scale (BPRS) in order to be able to assess patients. The training consisted of: (i) formal teaching with the support of PowerPoint presentations that introduced the BPRS rationale, interview characteristics, description and scoring items, and (ii) video-training comprising four video-taped BPRS clinical case interviews with reference “standard” ratings previously defined. For quality assurance each BPRS interview was discussed with the lead author.www.noclor.nhs.uk) from three separate local boroughs, i.e., City and Hackney, Tower Hamlets and Newham to recruit people with psychosis followed in these community mental health teams (CMHTs).The study was set up in ELFT, with the lead author as local Principal Investigator (PI). The lead author attained approvals through NOCLOR research support Interested in having a volunteer with whom they would be in contact primarily through a smart-phone for 12 weeksReceiving care in secondary NHS mental health servicesHave the capacity to provide informed consentSufficient command of English to complete the measures.18 years or overInterested in having a patient with whom they would be in contact primarily through a smart-phone for 12 weeksHave the capacity to provide informed consentSufficient command of English to complete the measures.Failure to meet any of the inclusion criteriaUnable to use smart-phones even if provided with appropriate assistive technology.A screening log has been maintained throughout the study, using Microsoft Excel 2010, to monitor participants' progress and the feasibility of recruitment and retention.Potential patient participants have been identified by the clinical team, the clinical study officers and the researchers or could self-refer.Clinicians have been provided with the study information sheet containing the contact details of the researcher and have been encouraged to approach patients with psychosis directly. Clinicians informed patients about the study during routine clinical meetings and invited patients to take part.Clinical study officers screened RiO, the electronic patient record system used at ELFT, for patients with psychosis. On meeting these patients in person in CMHTs, they invited them to take part in the study. Clinicians and clinical study officers could pass on patient details to the researcher or could encourage patients to self-refer.A purposive sample of patients from ELFT outpatient services who had already expressed willingness for future contact in future research were contacted over the phone by the lead author and invited to take part in the Phone Pal study.Patients that saw the advert in the CMHT could also self-refer to the study. After speaking with the patients over the phone, the researcher would check in RiO to establish whether the patient met the study inclusion criteria, and then contact patients back to confirm.Over the phone, the researcher explained the content of the study, covering the information described in the information sheet. Patients were invited to take part and were provided with an opportunity to discuss the study and to ask questions. Patients that were interested in the study were then invited to meet the researcher in person.via e-mail to express their interest.Potential volunteer participants that saw the advert and were interested in the study have been able to self-refer and to contact the researcher over the phone or via e-mail. Individuals that met the inclusion criteria and maintained interest in the study were invited to meet the researcher in person.Over the phone, the researcher explained the content of the Phone Pal study, covering the information described in the information sheet. Potential volunteers were invited to participate and were provided with an opportunity to discuss the study and ask questions. Information sheets were sent In the face-to-face interview with the researcher, the patient was taken through the study information sheet and received detailed explanations about the intervention. It was ensured that they understood what their participation involved and that they agreed that their study-provided smart-phone communication with the volunteer was going to be checked .At this initial face-to-face meeting, which occurred at ELFT facilities or other location of their convenience, participants also provided written informed consent. As further described, this was followed by the collection of baseline measures including communication usage and preferences, training and receiving £10 as a token of appreciation. The patient participant was then enrolled in the study and paired with their matched volunteer.In the face-to-face interview with the researcher, each individual was taken through the study information sheet, and received detailed explanations about the intervention and their role as a volunteer. They were also assessed for their suitability to participate. It was ensured that they understood what their participation involved and that their study-provided smart-phone communication with the patient was going to be checked .At this initial face-to-face meeting, which occurred in the facilities of ELFT, Queen Mary University of London (QMUL), or other location of their convenience, participants provided written informed consent. This was followed by the collection of baseline measures, including communication usage and preferences, training and receiving £10 as a token of appreciation. The volunteer participant was then enrolled in the study and paired with their matched patient.In the first phase of the study, the lead author provided individual one-to-one face-to-face training for all patient participants, which lasted between 1 and 2 h, responding to the individual queries of each patient participant. In the full study, two researchers supported the lead author in enrolling the patients, conducting baseline measures, providing them training and performing the follow-up measures and interviews.Patients' training covered an overview of the study, the intervention and its aims, the role and responsibilities of the volunteer, and guidance to engage and interact with their paired volunteer. It also included communication and listening skills, suggestions for the conversation content, confidentiality and when this could be breached, relationship boundaries, and contact information for them to have access to support and help in an emergency. The printed handouts of this training presentation were given to patient participants to keep.On completion, patients received a smart-phone, and were trained and guided in its use by sending a text message, a WhatsApp message and an e-mail to the lead author's study phone. Patient participants were provided with the details of the Gmail account that was created for them.Volunteers' training covered an overview of the study, the intervention and its aims, the role and responsibilities of the volunteer, and guidance to engage and interact with their paired patient. It also included communication and listening skills, suggestions for the conversation content, confidentiality and when this should be breached, relationship boundaries, the potential communication and behavior problems of patients with psychosis, procedures to assess risk and to safeguard vulnerable people and report abuse, and contact information to have access to support and help in an emergency. The printed handouts of this training presentation were given to volunteer participants to keep.This training was provided individually to all volunteers by the lead author and lasted between 1 and 2 h; all individual queries were answered. At the end of the training the volunteers were asked to sign a confidentiality agreement.On completion, volunteers received a smart-phone, and were trained and guided in its use, testing it in the same way as the patients (see above). Volunteer participants were provided with the details of the Gmail account that was created for them.The lead author matched patients and volunteers in a pragmatic way, matching the first patient with the first volunteer available throughout the recruitment period. Each volunteer only had one assigned patient.Once they were matched, participants were sent a text message in which they were given their match contact details, i.e., study phone contact number and e-mail account details. They also received information about the general availability of their paired match in a typical week, with their preferred hours to communicate.Participants were matched on the same day as the face-to-face meeting with the researcher, or as soon as possible and within a maximum of 2 weeks. If in the first 2 weeks after being matched, one of the participants was not satisfied with the communication with their match, the lead author would re-match those participants within a further 2 weeks.All participants were given the study contact phone number and e-mail of the lead author. Throughout the study, the researchers followed the “ELFT Policy for Safeguarding Vulnerable Adults” and the department's “Lone Workers Policy”.The lead author proactively contacted all participants once per month to check on them. In addition, during the course of the study, participants had access to support and supervision from the lead author for any questions or concerns; they could also book a face-to-face appointment with the lead author if required on weekdays during working hours. This could be useful if during the communication with their match, participants had heard or read something that they found emotionally distressing. Participants were informed about the mental health crisis and emergency contacts that they could call in case they had a mental health emergency, when they could be placing themselves or others at risk.At the end of the 12 weeks, participants were telephoned to arrange a follow-up interview and asked to meet the researcher within a 2 week interval. If participants did not respond to the phone call, they were sent an SMS. In order to acknowledge participants' time, £10 was provided for completion of each assessment, i.e., at baseline and follow-up in alignment with research suggesting that this level of compensation can increase follow-up rates in digital trials .Participants could decide to drop out of the study at any time. Participants who wanted to withdraw from the intervention would be asked if they also wanted to withdraw from follow-up data collection. Those that refused to take part in further data collection would be withdrawn, but their existing data would be included in the analysis unless they requested otherwise. Reasons for withdrawal would be documented.n = 3 patients and n = 3 volunteers) in the first phase, and an additional 30 participants (n = 15 patients and n = 15 volunteers) in the second phase. These numbers were based on a pragmatic assessment; a sample of 36 participants was deemed still manageable for the lead author, whilst allowing for estimates of variability in outcome measurements and trial parameters. Of note is that this feasibility study was not designed for testing effectiveness of the intervention with a pre-determined effect size  ( (MANSA) , which iPhysical activity has been measured with the International Physical Activity Questionnaire (IPAQ) Short-Form (www.ipaq.ki.se). Reliability and validity, calculated in a sample of outpatients with the clinical diagnosis of schizophrenia, reported correlation coefficients of 0.68 and 0.37 for criterion validity of the reported minutes of physical activity  (SERS-SF) , which wSERS-SF)  and coveSERS-SF) .Self-perceptions of social rank and relative social standing has been assessed through the Social Comparison Scale  (n (RAAS) . This isn (RAAS) . The intn (RAAS) , 31.Social contacts in the past week have been assessed through the 7 days Social Contacts Assessment  utilizing the 24-item version . This was an adaptation of the STAR scale  measured at baseline and follow-up. If some of the clinical features were present that would be classified as risk, e.g., suicidality, this would be addressed accordingly in line with ELFT clinical safeguarding and incident procedures. If patients endorsed this item or if the researchers were made aware of any risk during the initial assessment, patients would be advised to contact a health professional immediately and would be followed-up with a telephone call, which is in keeping with recommendations for when suicidal ideation is expressed .If an adverse event (AE) would arise during smart-phone communication, it was the participant's responsibility to contact the lead author. She would then follow up the AE with the participant, establishing whether the AE had been resolved or continued, and record the event in the AE log. When the AE occurred or was identified during the assessment, then it was the researcher's responsibility to follow the same procedure. The AE would be assessed to establish whether or not it should be classified as a serious adverse event (SAE).A SAE would be classified as: (i) “related”, when it resulted from the administration of any of the research procedures, and (ii) “unexpected”, when the type of event is not listed in the protocol as an expected occurrence. A SAE that is considered to be related and unexpected would be reported to the sponsor within 24 h of learning of the event and to the main REC within 15 days in line with the required timeframe.The quantitative data would be analyzed through descriptive analysis for participants who completed the baseline and follow-up measures, regardless of whether they completed the intervention or withdrew . Outcome measures would be assessed for completeness and the percentage of missing responses reported. To enable the calculation of the overall scales, individual mean imputation would be performed, imputing the calculated mean for a participant to the responses to the other questions .Normally, in a single-group feasibility study, only a within-group estimate is possible , reportiThe qualitative data from the semi-structured interviews would be analyzed through thematic analysis .via smart-phone for people with psychosis, exploring the feasibility of recruitment, retention and data collection procedures, the usage of the intervention, and the acceptability of, and participants response to the intervention.This is the first study to investigate volunteering Wide inclusion criteria were employed in line with one of the study objectives, which was to assess how acceptable the intervention was. No pre-defined stop-go criteria were set, since the purpose has been to identify any potential barriers and facilitators to performing a larger trial relating to this intervention. Commonly, progression criteria can range and encompass figures of recruitment, retention, programme implementation, achieved measures, fidelity, factors affecting protocol adherence and acceptability .Importantly, this study uses only two discrete temporal assessments, at the beginning and end of the study. Only one follow-up limits understanding of how participants' outcomes may change with time and whether those changes are sustained. Future research should consider additional time points for follow-ups.Other studies reported unplanned absences from volunteers and high levels of volunteer attrition , 48. It The lead author aimed to develop a team mind-set of the “Phone Pal study” with the two researchers that have been helping in the study. A team-based approach is important in establishing a cohesive longitudinal research framework , 51. SomIt has been raised that during intervention development, new measures may need to be designed that align with the theoretical perspectives and hypothesized mechanisms of change reflected in the intervention. If researchers move too soon to adopt an outcome measure in an RCT and the trial is not effective, the main problem may be the selection of an outcome measure that is insensitive to change or incongruent with the logic model of the intervention. Performance of feasibility studies to assess measures prior to larger trials is recommended to improve subsequent RCT data interpretation .In the Phone Pal study, a range of observer rated  have been utilized, some of them concerning behavioral outcomes .via smart-phone for people with psychosis as an intervention, and whether a future trial should be conducted to explore its effectiveness and cost-effectiveness.The publication of the quantitative and qualitative data of the Phone Pal study will shed light on volunteering The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author/s.This study was reviewed and approved by the Research Ethics Committee East of England—Cambridgeshire and Hertfordshire (REC reference: 18/EE/0196) and the Health Research Authority in the UK. The patients/participants provided their written informed consent to participate in this study.MPC wrote the protocol, sought ethical approval of the study and has been the Chief Investigator and the Principal Investigator of the Phone Pal study. The Phone Pal Advisory Groups provided advice to the Chief Investigator. The authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


This resulted in an instrument consisting of 33 questions and 5 specific clinical case descriptions for both disciplines. Based on the assumption of an a priori difference in knowledge between midwives and pediatric nurses related to their curricula , high construct validity was demonstrated in a pilot survey . We therefore conclude that a valid instrument to assess knowledge on lactation-related exposure to analgesics was generated, which could be further validated and used for research and educational purposes. As these pilot findings suggest suboptimal knowledge for both professions on this topic, adaptations to their curricula and postgraduate training might be warranted.There is a need to assess the knowledge of healthcare providers on the use of maternal analgesics during lactation; however, valid instruments are not yet available. This study aimed to develop and test a valid questionnaire on the knowledge of analgesics  during lactation, using a structured, stepwise approach. As a first step, literature was screened to generate a preliminary version consisting of a pool of item subgroups. This preliminary version was subsequently reviewed during two focus groups (midwives:  Breastfeeding has multiple benefits for both mother  and infant  . The useLactating women are still often advised to discontinue or even stop nursing while taking medicines, although there are only a limited number of medicines that are identified as potentially or likely harmful to the breastfed infant ,4,5. UsiWorldwide, a relevant number of the marketed analgesics can be purchased or dispensed without prescription . This includes acetaminophen (paracetamol), aspirin and non-steroidal anti-inflammatory drugs (NSAIDs). Currently, acetaminophen is considered to be the most commonly used medicine in the pregnant and breastfeeding population ,11,12,13Consequently, there is a need to assess the knowledge and possible deficits on analgesics during lactation among HCPs. However, no existing validated knowledge instruments are available in the literature to provide these insights. This study therefore aimed to develop and pilot test a valid (the extent to which an instrument measures what it claims to measure) instrument to evaluate the knowledge of midwives and pediatric nurses about the use of analgesics during lactation . This knThe study consisted of three parts: (1) development of an instrument to assess the knowledge of midwives and pediatric nurses on the use of analgesics during lactation ; (2) content validation of this instrument ; (3) pilot use of this instrument in a cohort of midwives and pediatric nurses . The study obtained ethical approval from the competent ethics committees involved ; 210202MASTER; 9 February 2021). Participants provided informed consent prior to study contribution.The knowledge instrument was developed based on a literature search (step 1), followed by focus group discussions with both target populations  (step 2).To generate a pool of potentially relevant themes and items for a preliminary questionnaire, a literature scanning and assessment was performed. To perform this, PubMed and Limo  were assessed by two researchers (I.J. and M.V.H.) with focus on perceived or reported knowledge (gaps) of either mothers or HCPs on the use of analgesics during lactation. In this explorative search, we used Boolean operators ‘AND’ or ‘OR’ to combine the search words as follows: (knowledge or perception or vision) AND (midwives or nurses or caregivers or mothers or parents) AND  AND (risk or harmful effects) AND (breastfeeding). Included papers described aspects or items related to knowledge (deficiencies) or perceptions of mothers or HCPs on the use of analgesics (non-opioids or opioids) during lactation. Exclusion criteria were any other type of medicines or any other indication (such as abstinence syndrome prevention or treatment). The snowball method was applied to the papers retained, and agreement between both researchers was sought. Information from the selected papers provided input for the development of a preliminary questionnaire with different item subgroups, which were covered by multiple choice questions and clinical case descriptions.This preliminary questionnaire was subsequently reviewed during two focus groups consisting of certified and professionally active midwives or pediatric nurses, respectively. To do so, convenience sampling was used to recruit midwives working at the maternity ward of the University Hospitals Leuven, Belgium, and pediatric nurses employed at the general pediatric ward of the GZA hospital, campus St. Augustinus, Antwerp, Belgium. These colleagues were questioned about their views and perceptions on the item subgroups, the preliminary set of questions and the clinical case descriptions. The language level and comprehensibility for the target groups were also verified by these participants.To determine content validity (step 3), an expert panel was composed, covering both content  and methodological expertise on questionnaire development. The current version of the questionnaire, which was available after step 2 of the development process, was assessed by experts in step 3 in a two round e-Delphi approach.In the first round, content validity was first assessed by all individual experts, scoring all items using a Likert scale approach . Based on the individual assessments, the item-level content validity index (I-CVI) [(number of experts with a score 3 or 4)/], with a targeted index > 0.78 was calculated . Items wIn the second round, re-assessment of the content validity in the retained items was carried out by experts who were selected from the initial group. Selection criteria hereby were the absence of ‘outlier’ assessment in the first round . Based on their assessment, the I-CVI was recalculated with subsequent assessment of the scale content validity index (S-CVI) [/(the number of items)] with a targeted index > 0.90 .www.qualtrics.com, accessed on 1 April 2021) (step 4). To do so, the same criteria on sampling were applied as in step 2 . Personal social media channels and direct e-mailing were hereby used to attain a relevant number of responses within a two-week study period. Based on the results obtained in the e-survey, construct validity was assessed assuming an a priori difference in knowledge between midwives and pediatric nurses related to their curricula  (midwives) and 7 (pediatric nurses) clinical case descriptions (first version) to [(33 + 2) × 5] clinical case descriptions . In addition, further optimizations with regard to the language used, content, maximal doses or additional options were suggested and subsequently applied in different versions of the instrument. After the e-pilot testing, two case descriptions were perceived by the test public to be insufficiently discrimitive, and we therefore decided to add minor changes to the e-pilot tested version  relationship with and professional interest in recent mothers and breastfeeding women compared to pediatric nurses who primarily focus on the wellbeing of infants. Despite the observed differences, however, we noted that both groups still have insufficient knowledge, mainly with regard to narcotic analgesics. Given that HCPs with more interest in the use of analgesics during lactation may have been more likely to participate in the pilot study, the knowledge scores could actually be an overestimation of the actual situation in current practice. Hence, the findings point towards a clear need for more attention to this topic in the curricula and postgraduate training of both disciplines.Finally, during the analysis of the pilot data, it turned out that respondents perceived the phrasing of some response categories of two clinical case descriptions as complex and/or contradicting . Based on their comments, a minor update in the answer options of both cases was provided, as highlighted in the instrument provided in the This study has its strengths. First, the study resulted in the development of a valid instrument to assess the knowledge of, specifically, midwives and pediatric nurses on the use of analgesics during lactation. To the best of our knowledge, this is the first instrument developed on this topic so far. The involvement of practicing midwives and pediatric nurses, as well as experts, during the development phase enhanced the applicability of the instrument in the daily setting, integrating their perspectives, reflections and experiences. Second, the instrument was tested by more than 150 practicing HCPs. The 70% completion rate hereby suggested that HCPs considered the burden related to the completion of the questionnaire acceptable and feasible. The duration taken to complete the questionnaire has been recorded, but was based on the first activity until final submission and was sometimes >10 h or >1 day, as the questionnaire completion could be interrupted.The study also had some limitations that need to be taken into account. First, the instrument was developed in Belgium, involving only Dutch speaking HCPs and experts and aimed at assessing the knowledge of midwives and pediatric nurses in particular. This limited its generalizability to other settings, types of HCPs and countries where other guidelines exist. Second, additional testing and validation, for example with regard to internal consistency, is needed before the instrument becomes a widely accepted tool for research and educational purposes in the context of analgesics use during lactation. From a methodological perspective, we suggest that further validation should focus on exploring additional possibilities of reliability analyses, such as test–retest approaches, preferably in another cohort with similar characteristics to avoid bias related to recall or memory effects. Third, depending on the applicable guidelines on the use of analgesics during lactation in other countries, the correct answers on the knowledge questions may—slightly—differ across countries. For example, it is well known that therapeutic doses of ibuprofen are associated with an increased risk of bleeding due to platelet mediated effects, but we assessed that this is not of clinical relevance in the setting of lactation related exposure . Hence, prior to the application of the instrument in other countries or settings, attention should be paid to the identification of the correct answers. Finally, respondents of the pilot test were recruited via social media and direct e-mailing. As a result, the risk of selection bias cannot be excluded in this sample and should be taken into account when interpreting the results of the pilot testing.Obviously, the development of an instrument is only a first step, as instruments are intended to be either further developed and validated and subsequently used to guide education and clinical research. Reflections on further development and validation have been provided in the limitations section see .From an implementation perspective, the analysis of the pilot results confirmed that there is a difference in knowledge level between midwives and pediatric nurses, with midwives scoring better. However, irrespective of the group allocation, the knowledge scores for both midwives and pediatric nurses were low. As analgesics are commonly used during lactation, it seems that further investment in knowledge diffusion, implementation and access to knowledge is needed. We hereby assume that these needs are not restricted to analgesics, but likely also apply to other groups of commonly used medicines in this setting, including but not limited to antibiotics, antihistamines, sedatives, antidepressants and anti-epileptics . ProvidiHowever, as has been already mentioned as a limitation, we should realize that there is also still a relevant portion of uncertainties and diversity in guidelines. In a recent assessment of discrepancies with regard to information on the safety of medicines during pregnancy and lactation, Teratology Information Services’ (TIS) recommendations were consistent in only 15/22 of the cases but were more aligned compared to regulatory sources . These iIt is therefore recommended that, besides additional validation, further research has to be conducted with this instrument on a larger scale and in various settings to identify the knowledge level and potential differences between HCPs. Such insight is vital to identify discrepancies, to provide targeted training or support, to streamline recommendations and to provide guidance on how to improve the relevant curricula. Related to this last point, it became clear that, at least Dutch speaking, midwives and pediatric nurses in Belgium feel that insufficient education on the use of analgesics during lactation was provided during their training . This resulted in insufficient knowledge among both groups, again especially related to narcotics. These findings provide a strong call for further curriculum development in this clinical area in the different HCPs disciplines involved in care for lactating women and their infants.This paper reports on the development and pilot use of an instrument to assess the knowledge of midwives and pediatric nurses on maternal use of analgesics during lactation and the potential risks for the nursing infant. Therefore, a structured, stepwise approach with the consecutive use of a literature search, focus groups with practicing HCPs, a two-round e-Delphi with experts for item and score content validity and a pilot survey to test construct validity was applied. This multifaceted approach resulted in a valid instrument consisting of 33 questions and five specific clinical case descriptions for both disciplines. In the future, the instrument could be further validated in different settings and used on a large scale for research and educational purposes. As these pilot findings suggest suboptimal knowledge for both professions on this topic, adaptations to their postgraduate curricula and postgraduate training might be warranted.


Growth stunting is when children tend to be shorter than their peers through the World Health Organization child growth standard measurement. The condition may affect the development of the brain and other parts of the body, including the oral cavity, which manifests in oral hygiene and overall oral health. This systematic approach literature study aimed to evaluate the correlation between growth stunting and oral health in children. This study was conducted by using a literature review method with a systematic approach by searching for articles related to research topics on PubMed and Google Scholar. The search was adjusted to the inclusion category, which is research that discusses malnutrition and oral health published between 2010 and 2020—research conducted on boys and girls—from birth to 18 years. The exclusion categories used were articles that did not discuss growth stunting and oral health, and grey literature was excluded. The selection of articles was carried out by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach and resulted in 10 selected articles with details as follows: the correlation between growth stunting and oral health in three articles. A high plaque index in growth stunting children was found in two articles, and a decrease in saliva composition in growth stunting children was also found in two articles. Four articles showed a relationship between growth stunting and salivary flow rate. Lastly, one article showed the relationship between growth stunting and the incidence of dental caries. Despite the limitation of the review, the correlation between growth stunting and overall oral health in children can be seen through the oral hygiene index as moderate to low, high plaque index, decreased salivary flow rate, salivary composition, and dental caries in children with growth stunting. Growth stunting is a form of growth failure in the body and brain in children caused by long-term malnutrition or recurrent infections so that children tend to be shorter than their peers and have delays in thinking processes.Clinical manifestations of growth stunting generally affect motoric and mental development.Caries and other oral diseases may develop from plaque deposits that resulted from the inability of a child to brush their teeth due to inadequate psychomotor development. Problems in psychomotor development are often seen as the later effects of growth stunting.The primary outcome of this systemic review is to evaluate the correlation between growth stunting and oral health in children aged up to 5 years old with a history of stunting.The eligibility criteria were defined by a selection of articles in inclusion and exclusion criteria. The articles were identified as already in the correct population, using appropriate interventions, and relevant to the research topic.Articles that report a study that did not examine the association of stunting with oral health in children were excluded. Materials and research produced by an organization outside of the traditional commercial or academic publishing and distribution channels were also excluded; these articles were known as grey literature. Common grey literature publication types include reports , working papers, or government documents.A comprehensive search of the PubMed and Google Scholar databases from its inception to December 2020 was conducted to identify studies that evaluated the main topic of this systematic review. The search was carried out by using keywords or MESH terms and the article text for the following search terms: (“stunting”), , , and .” These keywords were then used together with the Boolean operators (OR and AND) to combine the search. The filters used in PubMed were the publication year filter, which is 2010 to 2020, and the age filter for children (0–18 years), while the filters used in Google Scholar were the year of publication filter within the same period.The articles resulting from this search were screened manually—first based on the title, then the abstract, and finally, the complete manuscript—to determine their appropriateness for inclusion in the literature review. References cited in the included articles were also reviewed to identify additional published articles not identified by the database search.Selected publications were independently reviewed by two investigators (Z.J. and R.A.). The extracted data included information about the study design characteristics, group, and subjects characteristics. The data also include the author’s name, country, year of publication, keywords, research method, sample, assessment, research results, conclusions, and the quality level of each article. Disagreements between the authors were resolved through consensus.Quality assessment of all included articles was performed independently by a reviewer as part of the data extraction process. Quality assessment or critical appraisal is a systematic assessment and interpretation of research results to consider the validity, results, and relevance of research.The quality of the reported information included in each article was assessed by following the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA).n= 2), describe the body mass index , exceed the inclusion age criteria, do not mention the state of oral health (n= 4), grey literature, and do not directly associate growth stunting with oral health (n= 2). Eventually, 10 articles were included in the literature research , salivary flow rate, and content. Oral hygiene was measured by using OHI-S by three authors.Since Saliva plays a vital role in maintaining oral health and functions,In chronic malnutrition, which reflects growth stunting, the flow rate of saliva tends to decrease, leading to disruption of the protective function of Saliva in the oral cavity. This may reduce the ability of the oral cavity to withstand infection and the acid-buffering capacity of plaque that is directly related to caries.The pH test of saliva by Hashem et al and Hasan et al showed different results. Hashem stated that the pH of saliva in children with growth stunting was not affected, while Hasan stated that the mean pH value was significantly lower in stunted children than in well-nourished children.Apart from examining the pH of saliva, Hasan et al also examined the inorganic content of saliva, which was phosphorus, calcium, copper, and lead.Vitamins A, C, E, and total protein, such as other content of saliva, were investigated by Radhi et al. The results showed that the value of vitamins and total salivary protein was significantly lower in malnourished children than in well-nourished children. Vitamins A, C, and E in malnourished children negatively correlated with the plaque index, while protein positively correlates with the plaque index.The results of the above studies are in line with the review conducted by Achmad et al. The conclusion retrieved from various previous articles was that there was a relationship between dental conditions and stunting in children. Malnourished children have atrophic salivary glands that reduce salivary secretion and interfere with saliva’s function to buffer and cleanse the oral cavity.Based on the description above, it can be concluded that there is a correlation between growth stunting and oral health in children. This can be seen through the oral hygiene categorizing as moderate-poor through the OHI-S examination and the high plaque index found in selected studies. Also, it was found that there was a decrease in salivary flow rate and the composition of saliva in children with growth stunting. Dental caries is the most common contributor to oral disease, which implies decreased oral health and is correlated in children with growth stunting.


The differences were considered significant at p < 0.05. After education, a significant increase in the supply of water as a beverage served with meals was observed in all nurseries , both in public  and non-public  ones. Moreover, a decrease in served tea was noted: in all nurseries  and in public nurseries . Water was available between meals in almost all nurseries. Nutritional education for staff is an important tool for improving adherence to the nutritional recommendation in the case of core beverage supply in Polish nurseries.The aim of the study was to assess the impact of education on improving the assortment of beverages served in nurseries in Poland. This analysis focused on beverages served to children with meals and between meals. We examined: water, tea, juices, soft/fruit drinks, compote, milk, cocoa, and coffee substitute. The study involved 93 nurseries enrolled in the Eating Healthy, Growing Healthy project and was conducted from 2015 to 2017. Nutritional education was carried out by dieticians or nutritionists and included 24 h of lectures given to the staff of nurseries. Training was conducted in a form of workshops that were divided into 12 topics. Additionally, consultations regarding infants and young children nutrition were available to the staff. Typically, education training was completed within 1–2 months in each nursery. The effectiveness of education was verified based on data on beverage supply in 186 ten-day menus, 1860 daily inventory reports before (at baseline), and 3–6 months after staff training (post baseline). Data were analyzed in a total group, and separately for public and non-public nurseries. Statistical analyses for categorical variables were done with Chi The period of the first three years of a child’s life is a time of very intensive growth and development. Nutrition of children at this age should be characterized not only by an adequate supply of calories and dietary nutritional value ,2, but aThe healthy nutrition of a child is the responsibility of parents, who are models for their children , and teaPlanning a healthy diet for a young child is challenging—it is important to be familiar with the current recommendations ,2,3,4,5 Nutrition education was the basis of our program Eating Healthy, Growing Healthy (EHGH) . The uniThe data presented in this article are a part of the EHGH program. The aim of this study was to assess the impact of staff education on improving the assortment of beverages served in nurseries in Poland. Data were also analyzed with respect to the type of nurseries: public vs. non-public.The EHGH project was dedicated to nurseries and kindergartens from across Poland. It was implemented from January of 2015 to December 2017 and funded by the Danone Ecosystem Fund. The purpose of the project was to improve the quality of menus in day-care centers (DCCs) by providing nutrition education to staff. It was conducted directly in person  and online . The overview of the EHGH project is presented as The scheme for selecting the samples of the present study is presented in Due to the criteria for inclusion, results only from directly participating nurseries (public and non-public) are considered. The inclusion criteria for nurseries were: cooperation of the center with an educator from EHGH, providing of ten-day menus and inventory documents, working full-time (more than 5 h a day), providing full-board nutrition  and one snack).The next step was to select nurseries with access to drinking tap water. Drinking water, also known as potable water, is water that is safe to drink. According to the World Health Organization’s 2017 report, safe drinking water is water that does not represent any significant risk to health over a lifetime of consumption, including different sensitivities that may occur between stages of life . DrinkinThe next inclusion criteria was completion of the entire planned direct nutrition education program, which included 24 h of lectures conducted in a form of workshops that were divided into 12 topics and additional consultations on the subject of nutrition for infants and young children. The nutritional education was prepared by experts such as dieticians and nutritionists as well as behavioral scientists and healthcare practitioners. The nutritional education was conducted by 180 trained educators. The educators were people with higher education, who completed their studies in the field of dietetics or human nutrition. These people were specially recruited for the EHGH program and underwent 6 months of training before the program began. The whole course was completed with an exam, verification of acquired knowledge, and obtaining the EHGH Educator certificate.The curriculum of the 12 topics included: general recommendations of balanced nutrition; water and its role in children’s diet; sugar in children diet; prevention of food allergies; fussy eaters or food neophobic; strong bones and teeth—the role of vitamin D and calcium; salt in children’s diets; attractive presentation of the meals; plump, overweight, obese—how to recognize the problem; limits of child’s choice; involving kids in cooking; serving size-self-eating, self-deciding. The last three classes concerned psychological aspect. Moreover, topics included problems such as: who makes decisions on the choice of products for a child, encouraging—yes or no to independent choices, and where and what are the limits of child’s choices (child’s role vs. caregiver’s role)? This topic underlined the fact that children can also take decisions about their meals; it is a simple way to educate them in nutrition. Surveys regarding the satisfaction of nurseries from participating in the EHGH project showed that the topic about water and its role in children’s diet drew great interest . Before Evaluation of the nutritional education was based on the assortment of beverages served in 93 nurseries. The assessment was based on ten-day menus (10 consecutive days) and daily inventory documents. The inventory reports included all food products used in the kitchen to prepare all meals and beverages for children. The example of a daily inventory report is included in another publication as a This analysis focused on the assortment (defined as presence/absence) of beverages served with meals or available to children between meals. We took into account beverages served with meals, such as water, tea (regular/black), herbal/fruit tea, juices , soft/fruit drink, compote , milk, cocoa, and coffee substitute , as well as water between meals. Recipes of the traditional Polish beverages and their average nutritional value are included in another publication . Based o2 Pearson test. In the case of continuous variables, the Shapiro–Wilk statistic test for testing the normality was used. Due to the lack of normal distribution of continuous data, the U Mann–Whitney test was used to check for significant differences. The differences were considered significant at p < 0.05.All data were processed statistically using Statistica version 13.1 . Means, standard deviations (SD), medians, minima, and maxima were calculated for the continuous data such as: total number of children attending nurseries including children < 1 year of age or the financial fee (applies only to nutrition fees—it is the cost of purchasing food products). For the categorical data such as type of catering* (definition below) only numbers and percentages of the participating nurseries are presented. All data were analyzed across the total group and by the type of nursery (public vs. non-public). Statistical significance for categorical variables was determined by the Chi*Type of catering—a way of organizing nutrition for children. It depends on the type of nursery and catering facilities, including the possession of a kitchen and employment of kitchen staff. Defining and characterizing subcategories for statistics:Own kitchen—meals are prepared for children in the nursery from scratch.Internal catering—meals are prepared by the kitchen of one nursery, and are distributed to others.External catering—meals are purchased from an external company.Mixed —selected meals are prepared by the nursery from scratch , and others  are purchased from external catering.The study involved 93 nurseries from all over Poland, attended by 6.099 children under the age of 3; infants accounted for only 5% of the total group. Significant differences between types of nurseries were noted in terms of the number of children, type of catering, and financial fee. The public nurseries compared to the non-public ones were characterized by a higher average number of attended children, more often they run own kitchen, but they also had lower fees for child nutrition.The assortments of beverages offered to children in nurseries both before and after nutritional education for the total group of nurseries and different types of nurseries are presented in p ≥ 0.05).Considering the total number of nurseries after education, the percentage of nurseries providing water increased by 19% and supplying tea (regular/black) decreased by 27%. The compote and milk remained the beverages served most often to children with meals. Considering the type of nursery, in public nurseries the same significant changes were noted as for the total number of nurseries. In the case of non-public nurseries, the significant differences were seen only for the serving of water. The slight reduction observed in the number of nurseries offering children tea to drink was not statistically significant  water was available to children to drink between the meals. Another study ,32 reporTea was another drink for which supply has changed as a result of education. In this case a decrease in supply was recorded. Tea is not a drink recommended for children due to its composition. This kind of beverage contains the most active ingredients such as polyphenols or caffeine. In Poland, even infants and young children are served tea . AuthorsBefore education in nurseries, the most popular drink served with meals was compote. A study conducted in preschools also showed that compote, not water, was given to children most often . In the No change in the supply of SSBs after education of the staff is directly translated into their planning of child nutrition, and eventually higher sugar consumption by children. The World Health Organization (WHO)  is payinIn planning nutrition education, one should take into account all individuals engaged in the child’s nutrition. The role of parents and the family environment is crucial here. Children identify with family members and adopt all patterns, views, and eating habits from them. The relationship between the children, parents, and other caregivers in nutritional behavior has been raised in many studies ,49,50.The presented research has several strengths and some limitations. A major strength of this study was the large sample of nurseries from across Poland—the majority of surveys available in Poland cover only individual nurseries from selected regions of the country. Moreover, the study included both public and non-public institutions. The method of data collection, a large number of documents (ten-day menus from 10 consecutive days and daily inventory reports), acquired from nurseries was also unique. Our research had some limitations. Although the study covered a large number of nurseries (public and non-public) from all over the country, these were not representative of all nurseries in Poland due to our inclusion methods (DCCs enrolled to the program). The introduced changes were assessed only once; it would be beneficial to repeat the assessment after a longer time period . Another limitation of the conducted study was the lack of a control group , which may to some extent limit the final conclusions.Nutritional education for staff is an important tool for improving compliance to the nutritional recommendation in the case of water and tea. After education, a significant increase in water and decrease in tea servings with meals to children in all nurseries were noted. Water was available between meals in almost all nurseries. However, in the nutrition education plan, it is worth taking into account the type of institution (public vs. non-public), because it is connected with the number of children, the type of catering, and the financial fee, which determine the planning of children’s nutrition. Well-planned nutrition with the proper choice of beverages in a nursery has crucial importance for healthy growth and development of children. There is a constant need for continuing education for people responsible for infants’ and toddlers’ nutrition in Poland. To increase its effectiveness, there is a need to develop practical recommendations and guidelines to implement in DCCs.