Big impact on small children: child-care providers’ perceptions of their role in early childhood healthy lifestyle behaviours

Barriers and Facilitators for Healthy Eating and Physical Activity: Interviews with Family Child Care Educators and Organization Staff

Introduction: Family child care (FCC) offers a promising setting for obesity prevention, yet interventions have had varied success, potentially due to insufficient stakeholder input. This study aimed to explore barriers, facilitators, and preferences for healthy eating and physical activity interventions among Australian FCC educators and organization staff. Methodology: Semi-structured interviews were conducted with 15 FCC educators and 6 staff members, using the framework method for data analysis. Results: Findings were organized according to the socioecological model. At the public policy level, regulations were seen as prioritizing risk avoidance over health benefits. At the community level, educators cited community programs and facilities as supportive of physical activity, noting that cultural and socioeconomic factors influence healthy eating. At the organizational level, adequate space promoted physical activity, but financial limitations impacted food provision and access to physical activity equipment. Some FCC organizations did not provide support for healthy practices. At the interpersonal level, educators and staff struggled to address unsupportive parental choices. Lastly, at the individual level, nutrition knowledge and education were deemed important for promoting healthy eating, with picky eating as a common obstacle. Conclusion: To enhance healthy eating and physical activity in FCC, recommended strategies include training safety assessors, educators, and parents on risky play; adapting regulations to the FCC context; reimbursing food provision; enhancing opportunities for excursions and outdoor play spaces; improving communication between educators and parents and expanding educators' knowledge of nutrition and physical activity.

Where does physical activity fit into preschool postpandemic? A qualitative exploration with parents, teachers and administrators

OBJECTIVES

During the preschool years, children depend on adult caregivers to provide opportunities for physical activity (PA). Research has focused on measuring PA in preschool, as well as barriers and facilitators to children's PA but caregiver perceptions remain largely unknown especially in light of the COVID-19 pandemic. This study aims to understand the value of PA in preschool following the pandemic from three types of adult caregivers, parents of a young child (n=7), preschool teachers (n=7) and preschool administrators (n=7).

METHODS

In-depth qualitative interviews were conducted to explore the following research questions: (a) how do caregivers describe the importance of PA in preschool postpandemic? (b) how do caregivers support and prioritise PA in preschool postpandemic and what challenges do they face in doing so? and (c) how do caregivers interact with one another to promote PA? Qualitative answers were coded using a codebook developed to answer the research questions of interest.

RESULTS

Parents, teachers and administrators all described valuing PA for preschoolers, but each caregiver type described a different way of promoting it. All the caregivers listed barriers that inhibit their ability to prioritise and promote PA, some heightened postpandemic. Lastly, there were limited caregiver interactions when it came to promoting PA, with the burden largely falling on teachers.

CONCLUSION

Our findings indicate that one particularly important area for intervention is supporting parents, teachers and preschool administrators in creating a shared understanding of the importance of PA for young children and ways to collaborate to promote it.

A controversial issue in adolescents: Is the effect of digital games on creative personality traits positive or negative?

AIM

This study aimed to determine the effect of digital games on the creativity of adolescents.

METHODS

This study was designed as a cross-sectional study using simple random sampling following the STROBE checklist. It was conducted with 384 adolescents between January and June 2022. Data were collected using the Digital Game Addiction Scale for Children and the Creative Personality Traits Scale.

RESULTS

The adolescents were at risk for digital game addiction and had moderate creativity levels. The adolescents who had a male sex, had mothers who received primary education, started playing digital games before the age of 6 years, were using the internet for >5 h a day, had no activity other than playing digital games, and preferred action, adventure, and fighting games had higher digital game addiction levels than the other adolescents. In addition, the male adolescents had higher creativity levels than the female adolescents. There was a significant negative relationship between digital game addiction and creative personality traits among the adolescents. Digital game addiction had a negative effect on creativity.

CONCLUSIONS

Adolescents are at risk for digital game addiction and have moderate creativity levels. Digital game addiction negatively affects the development of creative personality traits. Interventions should be planned to prevent digital game addiction among adolescents, and adolescents should be guided to increase awareness of the effects of digital games on their creativity.

Educator-Perceived Barriers and Facilitators to Structured-Physical Activity in Early Childhood Centres: A Systematic Review

Purpose: Physical activity (PA) and motor competence development are vital for young children, yet many early childhood education and care (ECEC) centers struggle to successfully implement PA programs, particularly those organized and led by educators. This review aimed to synthesize qualitative literature to (1) identify educator-perceived barriers and facilitators to structured-PA in ECEC centers, and (2) map these to the COM-B model and Theoretical Domains Framework (TDF). Methods: Following PRISMA guidelines, a systematic search of five databases was conducted in April 2021 and updated in August 2022. Records were screened in Covidence software using predefined eligibility criteria. Using the framework synthesis method, data extraction and synthesis were conducted in coding forms in Excel and NVivo. Results: Of 2382 records identified, 35 studies were included, representing 2,365 educators across 268 ECEC centers in 10 countries. Using the COM-B model and TDF, an evidence-informed framework was developed. Findings revealed the greatest barriers concerned educator "opportunity" (e.g. competing time and priorities, policy tensions, indoor/outdoor space constraints) and "capability" (e.g. lack of PA knowledge and practical, hands-on skills) to implement structured-PA. Although fewer studies reported factors that influenced educator "motivation", several themes intersected across the three COM-B components illustrating the complexity of behavioral determinants in this setting. Conclusions: Interventions grounded in theory that utilize a systems approach to target multiple levels of influence on educator behavior, and are flexible and adaptable locally, are recommended. Future work should seek to address societal barriers, structural challenges in the sector, and the PA educational needs of educators. PROSPERO Registration: CRD42021247977.

Assessing the scalability of evidence-based healthy eating and physical activity interventions in early childhood education and care: A cross-sectional study of end-user perspectives

OBJECTIVES

To describe early childhood education and care (ECEC) services: i) perceptions regarding the scalability of healthy eating and physical activity interventions; and ii) associations between scalability and service characteristics.

METHODS

A cross-sectional survey was conducted with a randomly selected sample of ECEC services across Australia. The scalability of 12 healthy eating and physical activity interventions was assessed using items based on the Intervention Scalability Assessment Tool. Higher scores represented higher perceived scalability.

RESULTS

From 453 participants, the highest scoring healthy eating and physical activity interventions were 'providing healthy eating education and activities for children' (M43.05) (out of 50) and 'providing sufficient opportunities for child physical activity' (M41.43). The lowest scoring was 'providing families with lunchbox guidelines' (M38.99) and 'engaging families in activities to increase child physical activity' (M38.36). Services located in rural areas, compared to urban areas, scored the overall scalability of both healthy eating and physical activity interventions significantly lower.

CONCLUSIONS

Perceptions regarding the scalability of healthy eating and physical activity interventions in the ECEC setting vary according to service characteristics.

IMPLICATIONS FOR PUBLIC HEALTH

Findings identify where government investment and implementation efforts may be prioritised to facilitate scale-up. An investigation into the barriers and support required for lower-scoring interventions is warranted.

A Convergent Mixed Methods Study to Explore Physical Activity Among Teachers and Children During the Preschool Day

Preschool teachers are uniquely positioned to impact children's physical activity levels, yet the relationship between teachers' and children's physical activity levels has not been widely investigated. The purpose of this study was to explore preschool teachers' physical activity levels, practices, and perceptions and how this relates to children's physical activity at preschool centers. This convergent mixed methods study included eight teachers and 20 children from four preschool classrooms. Accelerometers were used to measure their physical activity. Pearson correlations were used to explore the relationship between teachers' and children's physical activity levels. Direct observation was used to contextualize children's physical activity while at preschool. Teachers completed a semi-structured interview to explore their physical activity perceptions and practices. On average, teachers and children were physically active for 50.2 ± 9.3% and 29.5 ± 7.0% of their time at preschool, respectively. A significant positive correlation (p = 0.02; r = 0.98) was found between teachers' and children's percent of time at preschool per day in moderate-to-vigorous physical activity. Children mostly engaged in low-intensity activities (stationary play; light walking) during free play both indoors and outdoors and were mostly sedentary during teacher-initiated group times. All teachers stated they had a positive influence on children's physical activity. Teachers commonly reported pain or health conditions as a barrier to their physical activity. There was a positive relationship between teachers' and children's physical activity. More research is needed to confirm this relationship and to explore the impacts of high amounts of occupational physical activity on teachers' health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10643-023-01486-8.

Integration of Food-based Learning With Science in the Preschool Classroom: Implementation Gaps and Opportunities

OBJECTIVE

To explore Head Start teachers' use and integration of food-based learning (FBL) with science learning in the Head Start classroom.

DESIGN

Phenomenological approach using in-depth semistructured telephone interviews.

SETTING

North Carolina Head Start preschools.

PARTICIPANTS

Thirty-five Head Start lead and assistant teachers.

PHENOMENON OF INTEREST

All interviews were transcribed verbatim. Authors coded interview data for emergent themes.

ANALYSIS

Eleven primary themes were identified during analysis and inductively organized using the Systems Thinking Iceberg Model.

RESULTS

Teachers described most frequently using FBL during mealtimes. Teachers stated they felt successful when children were engaged and willing to try a new food. However, they struggled to connect food to science concepts. Teachers reported several motivators (eg, improving health) and barriers (eg, food waste) to integrating FBL. Teachers prioritized preparing children for kindergarten, but most teachers did not see how FBL could help them achieve this goal.

CONCLUSIONS AND IMPLICATIONS

Head Start teacher professional development programs could impact all 4 levels of the Systems Thinking Model to improve teachers' perceptions, underlying structures, and mental models regarding integrative FBL. Additional research is warranted to investigate the adoption, implementation, and potential impact of FBL on academic outcomes.

Predictors of Overweight and Obesity in Early Care and Education Teachers during COVID-19

The purpose of this cross-sectional study was to determine individual, sociocultural, policy, and economic predictors of overweight/obesity in early care and education (ECE) teachers to identify modifiable opportunities to enhance the health of this critical workforce. ECE teachers (n = 1434) in the U.S. completed an online survey in late spring to mid-summer 2020. Teachers self-reported height and weight; body mass index (BMI) and weight status were calculated. Teachers reported micro-environment variables including age, race, gender, obesogenic lifestyle behaviors, well-being, food security, personal health, stress, job stress, type of ECE, COVID-19 teaching modality, and age of children in the classroom. Logistic regression predicting overweight/obesity and linear regression predicting BMI were conducted. Teachers with more years of teaching experience (OR: 1.022: 95% CI 1.005, 1.039) and higher consumption of fast food (2.038: 1.310, 3.169) had higher odds of overweight/obesity. Teachers with higher levels of education (0.58: 0.407, 0.828) and higher physical health (0.836: 0.775, 0.902) had lower odds of overweight/obesity. Other variables were not associated with overweight/obesity. Variables significant in logistic regression were also associated with higher BMI. Additionally, Native American race (β = 2.467 SE = 1.206) and sedentary hours/day (β = 0.152 SE = 0.075) were associated with higher BMI. Implications for enhancing workplace health for these ECE teachers are emerging.

Family child care home providers' self-reported nutrition and physical activity practices, self-efficacy, barriers and knowledge: baseline findings from happy healthy homes

OBJECTIVE

Describe nutrition and physical activity practices, nutrition self-efficacy and barriers and food programme knowledge within Family Child Care Homes (FCCH) and differences by staffing.

DESIGN

Baseline, cross-sectional analyses of the Happy Healthy Homes randomised trial (NCT03560050).

SETTING

FCCH in Oklahoma, USA.

PARTICIPANTS

FCCH providers (n 49, 100 % women, 30·6 % Non-Hispanic Black, 2·0 % Hispanic, 4·1 % American Indian/Alaska Native, 51·0 % Non-Hispanic white, 44·2 ± 14·2 years of age. 53·1 % had additional staff) self-reported nutrition and physical activity practices and policies, nutrition self-efficacy and barriers and food programme knowledge. Differences between providers with and without additional staff were adjusted for multiple comparisons (P < 0·01).

RESULTS

The prevalence of meeting all nutrition and physical activity best practices ranged from 0·0-43·8 % to 4·1-16·7 %, respectively. Average nutrition and physical activity scores were 3·2 ± 0·3 and 3·0 ± 0·5 (max 4·0), respectively. Sum nutrition and physical activity scores were 137·5 ± 12·6 (max 172·0) and 48·4 ± 7·5 (max 64·0), respectively. Providers reported high nutrition self-efficacy and few barriers. The majority of providers (73·9-84·7 %) felt that they could meet food programme best practices; however, knowledge of food programme best practices was lower than anticipated (median 63-67 % accuracy). More providers with additional staff had higher self-efficacy in family-style meal service than did those who did not (P = 0·006).

CONCLUSIONS

Providers had high self-efficacy in meeting nutrition best practices and reported few barriers. While providers were successfully meeting some individual best practices, few met all. Few differences were observed between FCCH providers with and without additional staff. FCCH providers need additional nutrition training on implementation of best practices.

Physical Activity and Screen Time Practices of Family Child Care Providers: Do They Meet Best Practice Guidelines?

Background: Child care settings significantly influence children's physical activity (PA) and screen time (ST) behaviors, yet less research has been conducted in family child care homes (FCCHs) than in child care centers. While a few studies have measured family child care providers' (FCCPs') PA practices, none have used observation to assess which specific evidence-based, best practice guidelines FCCPs met or did not meet, and no previous studies have included Latinx providers. This article examines FCCPs' adherence to PA and ST best practice guidelines using primarily observational methods with diverse FCCPs (including Latinx). Methods: We examined baseline data from a cluster randomized trial including surveys and observational data collected at the FCCH to assess whether providers met specific PA and ST best practices from the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) and the American Academy of Pediatrics. Results: Providers completed a telephone survey and participated in two full-day observations (n = 127; 72% Hispanic). Overall, only 4 of 14 PA and ST best practices were met by >50% of providers including: leading a planned PA class more than once a week; no ST during meal or snack; not modeling sedentary behavior; and providing families with information about children's ST. Best practices least likely to be met (<20% of providers) include: providing children with >60 minutes of outdoor play daily; providing children with >45 minutes of adult-led PA each day; participating in outdoor PA with children; participating in indoor PA with children; prompting and praising children for being active; and talking with children informally about the importance of PA. Conclusions: While FCCPs engage in some positive PA and ST practices, many providers do not meet best practice guidelines. There is a need for more research about how to overcome providers' personal and environmental barriers for meeting these guidelines as well as interventions and supports to overcome these barriers. Clinical Trial Registration Number NCT0245645.

The Influence of Various Role Models on Children’s Pro-environmental Behaviours

Although most schoolchildren can dispose of their own litter, they are typically not sensitive to environmental issues in the school’s public areas. How do we improve children’s sensitivity to public environments and cultivate pro-environmental behaviours? Based on Bandura’s social learning theory, this study explored the effects of various role models (teachers and peers) on the pro-environmental behaviours of children aged 7–13. A field study was conducted in which examples of postprandial garbage disposal behaviours were provided using role models and the subsequent behaviours of the children were observed. We located the experiment in a real educational context and manipulated the type of role model (teacher or peer) and the behaviour being modelled (positive behaviours involving picking up litter or negative behaviours involving littering). The results showed that different role models had different effects on the subjects’ pro-environmental behaviours. Only positive demonstration by teachers significantly improved the subjects’ pro-environmental behaviours, that is, teachers’ picking up of garbage in front of children significantly improved the children’s attention to the environment and their adoption of pro-environmental behaviours. Positive demonstration by peers, negative demonstration by teachers and negative demonstration by peers had no impact on the children’s pro-environmental behaviours. The results demonstrate that teachers must be mindful of their role as role models in the educational environment and facilitate students’ development of pro-environmental behaviours.

Healthy Food Environments in Early Learning Services: An Analysis of Manager Survey Responses, Menus and Policies in Regional New Zealand Early Childhood Education and Care Centres

Healthy food environments in early childhood play an important role in establishing health-promoting nutritional behaviours for later life. We surveyed Early Learning Services (ELS) in the Hawke’s Bay region of New Zealand and describe common barriers and facilitators to providing a healthy food environment, through descriptive survey analysis and thematic analysis of open-ended questions. We used a policy analysis tool to assess the strength and comprehensiveness of the individual centre’s nutrition policies and we report on the healthiness of menus provided daily in the centres. Sixty-two centres participated and 96.7% had policies on nutrition compared to 86.7% with policies on drinks. Of the 14 full policies provided for analysis, identified strengths were providing timelines for review and encouraging role modelling by teachers. The main weaknesses were communication with parents and staff, lack of nutrition training for staff and absence of policies for special occasion and fundraising food. With regard to practices in the ELS, food for celebrations was more likely to be healthy when provided by the centre rather than brought from home. Food used in fundraising was more likely to be unhealthy than healthy, though <20% of centres reported using food in fundraising. Only 40% of menus analysed met the national guidelines by not including any ‘red’ (unhealthy) items. Centre Managers considered the biggest barriers to improving food environments to be a lack of parental support and concerns about food-related choking. These results highlight the need for future focus in three areas: policies for water and milk-only, celebration and fundraising food; increased nutrition-focused professional learning and development for teachers; and communication between the centre and parents, as a crucial pathway to improved nutrition for children attending NZ early childhood education and care centres.

COVID-19 Vaccination Status and Attitudes of Family Child Care Providers in Delaware, September 2021

Child care providers, including family child care (FCC) providers, are viewed as trusted sources of information for the parents and families they serve, and their vaccine behavior has been shown to be associated with parent beliefs and behaviors. This study sought to describe the COVID-19 vaccine behaviors and attitudes among FCC providers in Delaware. An online survey was distributed to all licensed FCC providers (N = 541) in September 2021. Survey items were drawn from validated instruments and assessed vaccination status, attitudes, and confidence in their ability to discuss COVID-19 vaccines with families. In total, 168 responses were recorded (31% response rate); 69.8% of respondents were fully vaccinated against COVID-19. The majority indicated that they would require (11.4%) or recommend (42.1%) the vaccine for children in their care, once approved by the FDA. Providers reported high levels of confidence in their ability to discuss both the benefits and risks of COVID-19 vaccines. FCC providers should be considered key messengers for the families they serve and may be helpful liaisons with state and local vaccination efforts. Input from FCC providers could be used to develop vaccine messaging and materials that are clear, consistent, and culturally responsive to the families of the children in their care.

A qualitative comparison of parent and childcare provider perceptions of communication and family engagement in children's healthy eating and physical activity

BACKGROUND

Parents and childcare providers play a substantial role in the development of health behaviours among the children they care for. In order to ensure the optimal growth and development of children, communication and family engagement in childcare is critical. Previous studies examining parent or provider perceptions about healthy eating or physical activity have explored these concepts individually and/or have only included only parents or providers. Therefore, the purpose of this study was to compare childcare provider and parent perceptions of communication regarding healthy eating and physical activity as well as use of best practice strategies on family engagement for these topics.

METHODS

Childcare providers (n = 12) in childcare centres or a family childcare home and a parent (n = 12) of a child they provide care for participated in a semi-structured interview guided by the Social Ecological Model. Interviews were transcribed verbatim and uploaded to NVivo for data analysis. Data were analysed using a directed content analysis. Three trained qualitative researchers developed a codebook and then compared responses between parents and providers.

RESULTS

Similarities in provider and parent responses included agreement on healthy eating; influences on child development; parents being the most influential on children's healthy eating; how they identified physical activity opportunities; and the use of family engagement principles. Differences that arose included parents' roles in promoting children's physical activity; challenges for parents in promoting healthy eating and physical activity; and providers' encouragement of physical activity. Importantly, few parents mentioned providers were top influences on their child's healthy eating or physical activity. Providers also mentioned having difficult conversations with parents was challenging.

CONCLUSIONS

Future efforts are needed to (1) help parents understand the providers' role in the development of their child's health behaviours and (2) strengthen efforts to engage families in healthy behaviours outside of childcare facilities.

Digital risks and adolescents: The relationships between digital game addiction, emotional eating, and aggression

Nowadays, weight gain and obesity are major health-threatening issues for children. Emotional eating, a negative health condition that can lead to obesity in children, is a defence mechanism for coping with negative emotions. This cross-sectional study aimed to evaluate the relationships between emotional eating behaviour and digital game addiction, which can cause stress and aggression in adolescents. This study was conducted with 856 adolescents from the Mediterranean region of Turkey. The data were collected using a personal information form, the Buss-Perry Aggression Questionnaire (BPAQ), the Digital Game Addiction Scale (DGAS-7), and the Emotional Eating Scale (EES). In this study, 32.4% of the adolescents were addicted to digital games. The male adolescents had higher BPAQ, DGAS, and EES mean scores. There was also a relationship between digital game addiction, aggressive behaviour, and emotional eating. This is a significant study because it shows that digital game addiction and aggressive behaviour are important determinants of emotional eating. The results of this study indicate that emotional eating is a component of digital game addiction that increases the risk of adolescent obesity.

Exploring Preschoolers' Physical Activity and Sedentary Time During Outdoor Play at Childcare: A Cross-Sectional Analysis of the Supporting Physical Activity in the Childcare Environment Study

BACKGROUND

Moderate-to-vigorous physical activity (MVPA) offers many health benefits for preschoolers (2.5-5 y). In childcare, MVPA is predominantly accumulated outdoors, with higher rates purported among children within the first few minutes outside. The Supporting Physical Activity in the Childcare Environment intervention included shorter, more frequent outdoor play sessions; this study sought to explore children's activity levels during various outdoor play schedules.

METHODS

During the final week of the Supporting Physical Activity in the Childcare Environment intervention, preschoolers wore an Actical™ accelerometer for 5 days during childcare and staff logged outdoor times. Separate linear mixed effects models were run to explore the effect of the intervention on preschoolers' physical activity (total and MVPA) and sedentary time during outdoor play. Sex was entered as an interaction effect.

RESULTS

Preschoolers (n = 292) were significantly more active in the first 10 minutes outdoors compared with remaining time (P < .0083). For total outdoor time, children in the experimental group engaged in significantly less sedentary time than those in the control group (P < .017), and experimental group boys and girls engaged in higher MVPA than boys and girls in the control group (P < .017).

CONCLUSIONS

Findings support scheduling more frequent outdoor play sessions in childcare to increase physical activity participation among young children.

Eastern North Carolina Head Start Teachers' personal and professional experiences with healthy eating and physical activity: a qualitative exploration

OBJECTIVE

Explore the interrelationship between teachers' personal and professional socio-ecological structures while examining Head Start (HS) teachers' experiences with (1) trying to eat healthy and engage in physical activity (PA) and (2) promote healthy eating and PA in their classrooms.

DESIGN

In-depth semi-structured interviews were collected from March through June 2017. Researchers designed the data collection and analysis methods using a phenomenological approach. All interviews were recorded using digital audio and transcribed verbatim.

SETTING

Seven HS centres in two rural eastern North Carolina counties.

PARTICIPANTS

Teachers (n 15) who had recently participated in a healthy eating and physical activity intervention. Participants were 100 % female, an average age of 43 years (sd 9·6) and primarily Black/African American (93·3 %).

RESULTS

Eighteen primary themes were identified providing unique insight into individual, social and environmental determinants that may influence teachers' personal health behaviours and professional health promotion practices. Findings indicated that teachers want to improve health behaviours personally (individual/family health) and professionally (children/families served); however, barriers exist at all levels impacting their ability to improve their own health and facilitate positive behaviours among the children/families they serve. Many teachers observed connections between their personal and professional experiences, but not beyond the individual level.

CONCLUSIONS

Study findings highlight the importance of considering and emphasising the potential relationship between personal and professional determinants of health when working with early childhood teachers. Findings from this study may be useful for informing the development, implementation and evaluation of future health promotion interventions using teachers as implementers.

The Development of a Psychometrically Valid and Reliable Questionnaire to Assess Nutrition Knowledge Related to Pre-Schoolers

With rising childcare enrollments, caregivers have a unique opportunity to promote children’s nutrition education and healthy eating. Accurately identifying nutrition knowledge gaps amongst caregivers is necessary for professional development planning. Our aim was to design an early childhood education and care (ECEC) teacher nutrition knowledge questionnaire that satisfies psychometric criteria of validity and reliability. Items were based on the New Zealand Ministry of Health dietary guidelines, literature and expert advice. University students in their final year of a Bachelor of Science (BSc) in Human Nutrition (n = 40), and students with no nutrition background (n = 51) completed the questionnaire to assess construct validity; 35 BSc nutrition students completed the questionnaire two weeks later to assess reliability. The Mann-Whitney-U test and a median-split table assessed construct validity; Pearson’s product-moment correlation assessed test-retest reliability. Nutrition students achieved higher total and subcategory scores (p < 0.01). All nutrition students scored above the median of the combined group; 82% of non-nutrition students scored below the median. In testing reliability, first and second administration median scores for total and subcategories were significantly correlated (r = 0.43–0.78; p < 0.01). The questionnaire achieved construct validity and test-retest reliability and measured ECEC teachers’ nutrition knowledge for preschoolers.

Knowledge, Attitudes and Practices of Australian Trainee Childcare Educators Regarding Their Role in the Feeding Behaviours of Young Children

Background: Early childhood (2-5 years) is acknowledged as a critical time for the establishment of healthy behaviours. The increasing number of children and amount of time spent in childcare provides strong rationale to explore the important role that childcare services and childcare educators play in influencing healthy eating behaviours of young children in their care. Methods: This study used a qualitative exploratory approach to describe the knowledge, attitudes and practices of Australian childcare trainee educators' regarding their role in the feeding of young children. Results: All participants agreed that feeding of young children was an important part of their role, but described challenges to the promotion of healthy eating and the adoption of responsive child feeding practices. These included personal beliefs and experiences with food, the bi-directional nature of child feeding, conflicting parental requests and/or unsupportive centre-based policies and procedures. Conclusion: Training about responsive child feeding practices within the childcare sector should include all childcare staff; aim to enhance relational efficacy and communication skills with parents; and empower childcare staff to lead organisational change. To support this, childcare centres need to provide coherent centre-based healthy eating policies inclusive of healthy food provision and desirable feeding practices.

Barriers and facilitators to obesity prevention dissemination and implementation efforts in the childcare centre setting from the provider perspective

BACKGROUND

It has been established that the childcare centre (CCC) is a setting suitable for healthy weight promotion efforts. As the field advances, it is important to understand the barriers and facilitators to early childhood obesity prevention implementation and dissemination efforts from the CCC providers' perspective. This is especially true among those who serve low-income and diverse populations to maximize scalability success.

METHODS

Focus groups were held in English or Spanish with CCC providers across six CCCs who implemented healthy caregivers-healthy children (HC2), an early childhood healthy weight promotion programme targeting 2- to 5-year-olds from low-resource backgrounds. Centres represented both rural and urban environments. Focus groups were audio recorded, transcribed, and coded. A thematic analysis that combined a deductive and inductive approach was conducted. Codes were analysed using Dedoose to identify general themes and subthemes.

RESULTS

CCC providers stated that (a) children understood the nutritional benefits of healthy foods; (b) improved cognitive development as a result of HC2; (c) parents were barriers to HC2 implementation efforts, particularly in terms of cooperative healthy lifestyle efforts; and (d) modelling healthy eating and making healthy CCC environmental changes facilitated HC2 implementation. Overall, HC2 was well received by CCC teachers, and they shared creative classroom HC2 adaptions and improvements.

CONCLUSIONS

CCC providers can provide valuable insight to guide early childhood healthy weight promotion programme dissemination and implementation efforts. Although they value the implementation of HC2 programme in their classroom settings, they perceive parents as somewhat obstructive. This information is critical to informing future healthy weight promotion efforts in this setting, especially among low-resource families. It is important to continue to include the CCC provider viewpoint in future obesity prevention efforts to maximize scalability and sustainability efforts.

The Impact of Responsive Feeding Practice Training on Teacher Feeding Behaviors in Tribal Early Care and Education: The Food Resource Equity and Sustainability for Health (FRESH) Study

BACKGROUND

Establishing healthy eating habits early affects lifelong dietary intake, which has implications for many health outcomes. With children spending time in early care and education (ECE) programs, teachers establish the daytime meal environment through their feeding practices.

OBJECTIVE

We aimed to determine the effect of a teacher-focused intervention to increase responsive feeding practices in 2 interventions, 1 focused exclusively on the teacher's feeding practices and the other focused on both the teacher's feeding practices and a nutrition classroom curriculum, in ECE teachers in a Native American (NA) community in Oklahoma.

METHODS

Nine tribally affiliated ECE programs were randomly assigned to 1 of 2 interventions: 1) a 1.5-h teacher-focused responsive feeding practice training (TEACHER; n = 4) and 2) TEACHER plus an additional 3-h training to implement a 15-wk classroom nutrition curriculum (TEACHER + CLASS; n = 5). Feeding practice observations were conducted during lunch at 1 table in 1 classroom for 2- to 5-y-olds at each program before and 1 mo after the intervention. The Mealtime Observation in Child Care (MOCC) organizes teacher behaviors into 8 subsections. Descriptive statistics and the Shapiro-Wilk test for normality were calculated. Paired t tests were calculated to determine change in each group.

RESULTS

A mean ± SD of 5.2 ± 2.0 (total n = 47) children and 1.7 ± 0.5 (total n = 14) teachers/center were observed at baseline, and 5.6 ± 1.7 (total n = 50) children and 1.7 ± 0.7 teachers (total n = 14) were observed/center postintervention. Total MOCC scores (max possible = 10) improved for TEACHER (6.1 ± 0.9 compared with 7.5 ± 0.3, t = 4.12, P = 0.026) but not for TEACHER + CLASS (6.5 ± 0.8 compared with 6.4 ± 1.0, t = -0.11, P = 0.915). No other changes were observed.

CONCLUSIONS

Teacher intervention-only programs demonstrated improvements in responsive feeding practices, whereas the programs receiving teacher and classroom training did not. Greater burden likely decreased capacity to make changes in multiple domains. We demonstrated the ability to implement interventions in NA ECE. Further research with larger communities is necessary. This trial was registered at clinicaltrials.gov as NCT03251950.

Promoting a healthy childcare environment: A focus group study of childcare providers' perspectives

Establishing healthy habits in the childcare setting for children aged 2-5 is pivotal for their healthy development and obesity prevention. The purpose of this qualitative study was to explore the perceptions and practices that childcare providers demonstrate when they promote healthy eating and physical activity among preschoolers. Four focus group interviews with 16 childcare providers were conducted in northwest Florida. A semistructured focus group guide was used. Discussions were audiorecorded and transcribed verbatim. Content analysis was performed to analyze the data with the use of ATLAS.ti software. This study followed the COREQ guidelines. Three major themes emerged from the data: (i) efforts to encourage children to eat healthfully and engage in physical activity; (ii) challenges in promoting healthy behaviors among children; and (iii) the need for more childcare provider training and parental involvement to encourage healthy eating. Regular childcare provider training and parental involvement are needed to establish a healthy environment for preschoolers.

Elementary school classroom physical activity breaks: student, teacher, and facilitator perspectives

Current physical activity (PA) guidelines recommend that children accumulate at least 60 min of PA each day, and that adults should collaborate across sectors to increase opportunities for PA. Implementing brief classroom PA breaks (CPABs) is one way to help increase daily PA. The primary purpose of this study was to determine perceptions of a 14-wk CPAB program among elementary school children, in the first through fourth grades ( n = 254), at a suburban elementary school, and their teachers ( n = 18). The CPAB program was implemented by university exercise science students, and student and teacher perceptions were assessed through surveys. The children reported that the CPABs were very fun (86%), provided them with a nice break during the school day (88%), were very good for their health (94%), helped them feel more ready to learn (71%), and learn better (50%). The teachers reported that the students really enjoyed the CPABs (100%), that encouraging students to be physically active was either very important (83%) or important (17%), and that they were either very confident (72%) or confident (28%) that they themselves could lead the CPABs. No teacher reported that the CPABs hindered classroom learning. CPABs appear to be enjoyable to both students and teachers, easy to administer, and supportive of learning. Recommendations for improvements within the present collaboration were minimal and could be easily addressed with firmer entrenchment of the program. This collaboration was beneficial and fun for the vast majority involved, and others are urged to implement similar programs.

The development of child and adult care food program best-practice menu and training for Native American head start programs: The FRESH study

New Child and Adult Care Food Program (CACFP) meal patterns and best practices were implemented nationally in 2017 to address the shift in dietary need from ensuring essential nutrient consumption to chronic disease prevention. Young American Indian (AI) children have disproportionately higher risk of chronic disease. Some AI tribes operate early care and education (ECE) programs and have the opportunity to participate in the CACFP. The purpose of this paper is to describe a CACFP best-practice menu and training developed and implemented as part of the Food Resource Equity and Sustainability for Health (FRESH) study, a community-based participatory research (CBPR) intervention implemented within ECE programs in the Osage Nation of Oklahoma. Site managers and cooks from each of the nine ECE programs attended meetings and provided investigators with feedback that shaped the best-practice menu and training. Each site participated in a three-hour training in January 2018 to discuss the best-practice menu and ways to overcome implementation barriers. Goals of the menu aimed to increase intake of fruit and vegetables and whole grains and reduce pre-fried and processed foods without increasing cook burden. Training included application activities individually and in small and large groups. Though the project is still underway, lessons learned, including the need for technical assistance, improved communication between ECE program staff and food supply vendors, and infrastructure barriers (e.g., limited space, lack of supplies) that challenge workflow, have emerged. Efforts to improve menus in rural and low-income ECE programs must consider these issues in developing feasible intervention strategies.

Preschool Environmental Factors, Parental Socioeconomic Status, and Children's Sedentary Time: An Examination of Cross-Level Interactions

Preschool children's high levels of sedentary time (ST) is a public health concern. As preschool reaches a large population of children from different socioeconomic status (SES) backgrounds, more knowledge on how the preschool setting is associated with children's ST is relevant. Our aims were to examine (1) the associations of preschool setting (covering social, physical, and organizational level) with children's ST, and (2) the moderating role of the setting on the association between parental SES and children's ST. In the cross-sectional DAGIS (increased health and wellbeing in preschools) study, the participating children (n = 864, aged 3⁻6 years) were asked to wear an accelerometer for one week. In total, 779 children had valid ST accelerometer data during preschool hours. Preschool setting and parental SES was assessed by questionnaires and observation. Multilevel linear regression models with cross-level interactions were applied to examine the associations. Early educators' practice of breaking children's ST often, more frequent physical activity (PA) theme weeks, and higher number of physical education (PE) lessons were associated with lower children's ST. Higher parental SES was associated with higher children's ST in preschools (1) with organized sedentary behavior theme weeks, (2) with a lower number of PA theme weeks, and (3) with a lower number of PE lessons. The factors identified in this study could be targeted in future interventions.

Health Care Provider's Role in Obesity Prevention and Healthy Development of Young American Indian Children

INTRODUCTION

Health care providers (HCPs) serving American Indian (AI) populations are critical stakeholders in promoting healthy weight-related behaviors of young AI children. The purpose of this study is to develop an understanding of how HCP perceive their role in the healthy development of young AI children, and how they envision working with early care and education teachers and parents to enhance children's health.

METHOD

Twenty HCP that serve young AI children in Oklahoma participated in individual interviews. Thematic analysis was conducted on coded transcripts and three main themes, each with two to four subthemes were identified.

RESULTS

HCP had limited contact with teachers, felt family health was equal or more important than child health, and parental empowerment and gradual change was essential for success.

CONCLUSION

Creating ways to involve HCP, early care and education teachers, and parents together in multilevel and multisector interventions has the potential to improve the health of young AI children.

Early Care and Education Teacher’s Role in Obesity Prevention and Healthy Development of Young American Indian Children

Introduction: The purpose of this study was to develop an understanding of how stakeholders, specifically early care and education (ECE) teachers, perceive their role in the development of young American Indian children, and envision working with health care providers and parents in order to enhance children’s health. Methodology: Twenty tribally affiliated ECE teachers from Oklahoma participated in interviews. Thematic analysis was conducted, and three main themes, each with two to three subthemes, emerged. Results: Teachers felt that nutrition and physical activity were important to children’s health. Teachers had little professional interaction with health care providers but desired more. Parental empowerment was conveyed as essential to actualize positive changes in their child’s behavior. Discussion: Teachers of tribally affiliated ECE centers are important stakeholders in promoting the health and well-being of young American Indian children. Additional efforts are needed to more effectively integrate teachers and nurses in order to create effective interventions. We propose a stakeholder partnership to guide the development of future interventions.

Pre-school nutrition-related behaviours at home and early childhood education services: findings from the Growing Up in New Zealand longitudinal study

OBJECTIVE

Pre-school nutrition-related behaviours influence diet and development of lifelong eating habits. We examined the prevalence and congruence of recommended nutrition-related behaviours (RNB) in home and early childhood education (ECE) services, exploring differences by child and ECE characteristics.

DESIGN

Telephone interviews with mothers. Online survey of ECE managers/head teachers.

SETTING

New Zealand.

SUBJECTS

Children (n 1181) aged 45 months in the Growing Up in New Zealand longitudinal study.

RESULTS

A mean 5·3 of 8 RNB were followed at home, with statistical differences by gender and ethnic group, but not socio-economic position. ECE services followed a mean 4·8 of 8 RNB, with differences by type of service and health-promotion programme participation. No congruence between adherence at home and in ECE services was found; half of children with high adherence at home attended a service with low adherence. A greater proportion of children in deprived communities attended a service with high adherence, compared with children living in the least deprived communities (20 and 12 %, respectively).

CONCLUSIONS

Children, across all socio-economic positions, may not experience RNB at home. ECE settings provide an opportunity to improve or support behaviours learned at home. Targeting of health-promotion programmes in high-deprivation areas has resulted in higher adherence to RNB at these ECE services. The lack of congruence between home and ECE behaviours suggests health-promotion messages may not be effectively communicated to parents/family. Greater support is required across the ECE sector to adhere to RNB and promote wider change that can reach into homes.