Given the widespread use of out-of-home childcare in the United States, early care and education (ECE) providers offer ideal settings to promote health behaviors, including Hispanic/Latino children whose obesity prevalence remains high. In a recent article published in Health Promotion Practice, Dr. Shih-Fan Lin, study co-investigator and research assistant professor at San Diego State University School of Public Health, Dr. Amy Binggeli-Vallarta, multiple principal investigator (MPI) and planning and evaluation specialist at Imperial County Department of Public Health, Dr. Guadalupe X. Ayala, MPI & professor at SDSU, and other colleagues found that evidence-based strategies to modify policies, systems, and environments of ECE providers can be implemented with fidelity to promote healthy eating, physical activity, water consumption, and quality sleep. The assessment of intervention activities and lessons learned were reported in the article.
In 2011, SDSU was one of three sites and an evaluation center funded by The Centers for Disease Control and Prevention (CDC) to assess multisector, and multilevel approaches to prevent and control childhood obesity among low-income and racially/ethnically diverse children 2 to 12 years old. As part of the public health intervention in the California Childhood Obesity Research Demonstration (CA-CORD) study, the following intervention activities were implemented in 14 center-based ECE providers (e.g., providers affiliated with agencies such as Head Start) and 9 private ECE providers (private, faith-based, and those without agency affiliation): Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC); Sports, Play, and Active Recreation for Kids (SPARK) physical activity trainings and materials; health behavior and body mass index (BMI) assessment trainings; and receipt of a health behavior toolkit, a cooking kit, water dispensers, and posters. Study activities occurred in two rural cities located in Imperial County, CA.
NAP SACC was delivered with good fidelity. “It is likely that the substantial technical assistance provide to ECE staff made a positive impact”, Dr. Lin said. Private ECE providers reported fewer previous physical activity trainings compared to center-based providers; however, they had greater fidelity to SPARK training than center-based providers. Thus, it is likely that private providers were motivated to receive these resources as reflected in their attendance.
BMI training was not well attended. ECE providers affiliated with agencies that already had policies to collect children’s BMI were more likely to attend the training and collect BMI data. The health behavior trainings as well as provision of the health behavior toolkit, cooking kit, water dispenser, and posters were delivered with excellent fidelity.
Nearly all ECE directors/lead teachers reported that intervention-related activities and materials helped them promote the health behaviors well or very well. Contact time with agencies affiliated with center-based providers in the study was more than anticipated. “We found the approval process to implement activities in collaboration with center-based providers required substantial management and administration interactions during the intervention period,” Dr. Lin said.
This study shows high fidelity across all intervention strategies, which suggests evidence to replicate these efforts with other ECE providers across the country. Recognizing the assets and resources that ECE providers bring to an effort will help determine the most feasible way to integrate evidence-based policy, system, and environmental strategies to promote health behaviors and prevent and control obesity. To design an effective intervention, ECE providers with less capacity are encouraged to target fewer health behaviors at once but focus on multiple levels (i.e., policy, system, and environment) of change to ensure sustainability. A provider with more capacity should also consider involving parents in SPARK and health behavior trainings to reinforce the health behaviors at home.