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Zhang D, Swindle T, Fletcher JW, Sigman-Grant M, Johnson SL. Remembered childhood mealtime experiences influence on early childcare and education staff. Appetite 2023; 190:107003. [PMID: 37595754 DOI: 10.1016/j.appet.2023.107003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 07/16/2023] [Accepted: 08/14/2023] [Indexed: 08/20/2023]
Abstract
Parent feeding styles, behaviors, beliefs, and practices are associated with developing children's eating behaviors. However, many children spend considerable time in childcare; thus, are exposed to child-feeding practices of other adults, e.g., early care and education (ECE) staff. Limited research exists on how and whether current classroom feeding practices of ECE staff associate with their own childhood experiences. The About Feeding Children survey, conducted in 2005, examined self-reported feeding practices and beliefs and personal characteristics of ECE staff in Western United States. An exploratory factor analysis of questions related to childhood experiences (N = 1189), revealed two Mealtime Factors: Remembered Adult Control and Remembered Child Autonomy Support. Structural equation modeling was conducted to examine the hypothesis that these remembered experiences would be associated with current feeding practices (Structural Mealtime Strategies, Verbal Mealtime Strategies, and Beliefs about Mealtimes). For each outcome, models had good to moderate fit. Across models, Remembered Autonomy Support was associated with less control, bribing, autonomy undermining, and concern-based control beliefs and greater support at meals and autonomy promoting beliefs in teachers' classroom feeding practices. More research is called for to consider whether reflection on remembered childhood experiences might be beneficial to consider during ECE staff training related to feeding young children.
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Affiliation(s)
- Dong Zhang
- Research and Evaluation Division, Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 521 Jack Stephens Drive #530, Little Rock, AR, 72205, USA.
| | - Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 521 Jack Stephens Drive #530, Little Rock, AR, 72205, USA.
| | - Janice Williams Fletcher
- Emerita, Child, Family, and Consumer Studies, University of Idaho, 1003 Colt Road, Moscow, ID, 83843Do, USA.
| | - Madeleine Sigman-Grant
- Maternal and Child Health Specialist, University of Nevada, Reno, 2558 S Elizabeth Street, #5, Salt Lake City, UT, 84106, USA.
| | - Susan L Johnson
- Section of Nutrition, Department of Pediatrics, CU Anschutz Medical Campus, Children's Eating Laboratory, 12631 E 17th Ave, Rm #2609, Aurora, CO, 80045, USA.
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Dixon J, Hegde AV, Goodell LS, Arnold NL, Swindle T, Dev DA, Méndez LI, McMillan VJ, Lee TD, Stage VC. Integration of Food-based Learning With Science in the Preschool Classroom: Implementation Gaps and Opportunities. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:266-284. [PMID: 37028898 PMCID: PMC10083887 DOI: 10.1016/j.jneb.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/21/2022] [Accepted: 01/04/2023] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Jocelyn Dixon
- The Food-based Early Education (FEEd) Lab, Project Coordinator, East Carolina University, Greenville, NC
| | - Archana V Hegde
- Department of Human Development and Family Science, College of Health and Human Performance, East Carolina University, Greenville, NC
| | - Lora Suzanne Goodell
- Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC
| | - Nicole L Arnold
- Ohio State University Extension, Family and Consumer Sciences, The Ohio State University, Columbus, OH
| | - Taren Swindle
- Department of Family and Preventative Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Dipti A Dev
- Childhood Health Behaviors Extension Specialist, University of Nebraska-Lincoln, Lincoln, NE
| | - Lucía I Méndez
- Department of Communication Sciences and Disorders, University of North Carolina Greensboro, Greensboro, NC
| | - Valerie J McMillan
- Department of Family and Consumer Sciences, North Carolina Agricultural and Technical State University, Greensboro, NC
| | - Tammy D Lee
- Department of Mathematics, Science, and Instructional Technology Education, College of Education, East Carolina University, Greenville, NC
| | - Virginia C Stage
- Department of Agricultural and Human Sciences, NC State Extension, North Carolina State University, Raleigh, NC.
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Swindle T, Rutledge JM, Zhang D, Martin J, Johnson SL, Selig JP, Yates AM, Gaulden DT, Curran GM. De-Implementation of Detrimental Feeding Practices in Childcare: Mixed Methods Evaluation of Community Partner Selected Strategies. Nutrients 2022; 14:nu14142861. [PMID: 35889818 PMCID: PMC9319894 DOI: 10.3390/nu14142861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/05/2022] [Accepted: 07/11/2022] [Indexed: 02/05/2023] Open
Abstract
This pilot evaluated strategies to decrease detrimental feeding practices in early care and education, which are hypothesized to compete with evidence-based feeding and obesity prevention practices. This study made two key comparisons: (1) a between-site comparison of sites receiving (a) no implementation or de-implementation strategies (i.e., Basic Support; B), (b) implementation strategies only (i.e., Enhanced Support; E), and (c) implementation and de-implementation strategies (i.e., De-implementation + Enhanced Support; D + E) and (2) a within-site pre-post comparison among sites with D + E. At nutrition lessons, the D + E group had more Positive Comments (Hedege’s g = 0.60) and higher Role Model fidelity (Hedege’s g = 1.34) compared to the E group. At meals, assistant teachers in the D + E group had higher Positive Comments than in the B group (g = 0.72). For within-group comparisons, the D + E group decreased Negative Comments (t(19) = 2.842, p = 0.01), increased Positive Comments (t(20) = 2.314, p = 0.031), and improved use of the program mascot at nutrition lessons (t(21) = 3.899, p = 0.001). At meals, lead teachers’ Negative Comments decreased (t(22) = 2.73, p = 0.01). Qualitative data identified strengths and opportunities for iteration. Despite a COVID interruption, mid-point comparisons and qualitative feedback suggest promise of the de-implementation strategy package.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (D.Z.); (J.M.); (D.T.G.)
- Correspondence:
| | - Julie M. Rutledge
- College of Applied and Natural Sciences, School of Human Ecology, Louisiana Tech University, Ruston, LA 71272, USA; (J.M.R.); (A.M.Y.)
| | - Dong Zhang
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (D.Z.); (J.M.); (D.T.G.)
| | - Janna Martin
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (D.Z.); (J.M.); (D.T.G.)
| | - Susan L. Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA;
| | - James P. Selig
- College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Amy M. Yates
- College of Applied and Natural Sciences, School of Human Ecology, Louisiana Tech University, Ruston, LA 71272, USA; (J.M.R.); (A.M.Y.)
| | - Daphne T. Gaulden
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (D.Z.); (J.M.); (D.T.G.)
| | - Geoffrey M. Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
- Central Arkansas Veterans Healthcare System, Little Rock, AR 72205, USA
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Searle BRE, Staton SS, Littlewood R, Thorpe K. Associations between food provision and feeding practices in socially disadvantaged childcare centres. Appetite 2021; 169:105811. [PMID: 34798225 DOI: 10.1016/j.appet.2021.105811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/24/2021] [Accepted: 11/14/2021] [Indexed: 12/17/2022]
Abstract
Preschool children consume a large proportion of their daily food intake in their childcare settings. These settings, therefore, provide important opportunities for children to experience food socialisation, and related positive nutrition. Yet, the extent to which these opportunities are taken, particularly in socioeconomically disadvantaged areas where risk of poor nutrition is high, is not well documented. This study focused on 10 childcare centres in socially disadvantaged locations and examined daily feeding practices via direct in-situ observation (n = 189 children observed). Centres were randomly selected based on type of food provision: centre-provided (n = 5 centres) or family-provided (n = 5 centres). Analyses showed that where food was family-provided, educators were significantly more likely to use controlling feeding practices, including pressuring children to eat, restricting food choices and rushing children into finishing meals. These practices were particularly evident during mid-morning meals, where pressuring children to eat healthy foods first, was more often observed. Further research and interventions that target feeding practices in childcare are indicated and should consider how source of food provision impacts upon these practices.
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Affiliation(s)
- Bonnie-Ria E Searle
- Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia.
| | - Sally S Staton
- Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia.
| | - Robyn Littlewood
- Health and Wellbeing Queensland, Queensland Government, 139 Coronation Drive, Milton, QLD, 4064, Australia.
| | - Karen Thorpe
- Institute for Social Science Research, The University of Queensland, 80 Meiers Rd, Indooroopilly, QLD, 4068, Australia.
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Swindle T, Phelps J, Schrick B, Johnson SL. Hungry is not safe: A mixed methods study to explore food insecurity in early care and education. Appetite 2021; 167:105626. [PMID: 34389375 DOI: 10.1016/j.appet.2021.105626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 06/09/2021] [Accepted: 08/04/2021] [Indexed: 11/25/2022]
Abstract
The early care and education (ECE) environment has the potential to affect both children and their families. Food insecurity in ECE and its management may be an important influence. Objectives of this mixed methods study were to (1) elicit prominent themes relating to teacher experiences with food insecurity (in the classroom) through qualitative interviews; (2) translate interview themes into survey items and analyze survey data to explore generalizability of the qualitative findings; and (3) provide preliminary data on properties of a new tool to study the influence of food insecurity in the ECE setting. An exploratory sequential mixed methods design (QUAL → quant) was used. Twenty-eight interviews about teacher experiences with food insecurity were followed by 781 surveys to assess generalizability of interview findings. Qualitative themes highlighted that ECE teachers are concerned about children's food insecurity in their classroom; ECE teachers have developed their own set of strategies to manage their concern; and teachers often struggle with what to do. Quantitative results demonstrated many teachers had the same concerns and used the strategies described in the interviews. Further, in exploratory analyses, ECE teachers with Food Insecurity scored significantly higher on all scales (e.g., Food Insecurity Concerns, Struggle with Addressing Food Security) in both adjusted and unadjusted analyses. ECE teachers with Food Acquisition Stress had higher scores on Strategies to Address Food Insecurity with Families in adjusted analyses.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA.
| | - Joshua Phelps
- Cooperative Extension, Division of Agriculture, University of Arkansas, 2301 S University Ave, Little Rock, AR, 72204, USA
| | - Britney Schrick
- Cooperative Extension, Division of Agriculture, University of Arkansas, 2301 S University Ave, Little Rock, AR, 72204, USA
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado, 12631 East 17th Avenue, Mail Stop F-561 Academic Office Building, Aurora, CO, 80045, USA
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Swindle T, Phelps J, McBride NM, Selig JP, Rutledge JM, Manyam S. Table Talk: revision of an observational tool to characterize the feeding environment in early care and education settings. BMC Public Health 2021; 21:80. [PMID: 33413240 PMCID: PMC7792155 DOI: 10.1186/s12889-020-10087-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/17/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The Table Talk tool is an observational assessment of early care and education teacher (ECET) mealtime practices. The Table Talk Revised (TT-R) tool incorporates new constructs that emerged from qualitative research and teases apart existing categories to improve nuance of data capture. The objective of this study was to evaluate the TT-R, document interrater reliability for the TT-R, and report on ECET feeding communications in broader settings than previously studied (i.e., beyond a single Lunch and Head Start only). Methods Trained observers conducted mealtime observations in classrooms (Nclassroms = 63, 10 sites) during Breakfast and two Lunches for both Lead and Assistant ECETs (N = 126). Classrooms were spread across Head Start in an urban area (60%), Head Starts in a rural area (24%), and a state-funded preschool (16%). Results On average, there were 22.17 (SD = 10.92) total verbal feeding communications at Breakfast, 37.72 (SD = 15.83) at Lunch1, and 34.39 (SD = 15.05) at Lunch2 with meals averaging 25 min. The most commonly observed supportive statement category was Exploring Foods for Lead (Breakfast = 1.61, Lunch1 = 3.23, Lunch2 = 2.70) and Assistant ECETs (Breakfast = .89, Lunch1 = 2.03) except for Lunch2 which was Encourages Trying in a Positive Way (Lunch2 = 1.30). The most commonly observed unsupportive statement category was Firm Behavioral Control for both Lead (Breakfast = 3.61, Lunch1 = 5.84, Lunch2 = 5.51) and Assistants ECETs (Breakfast = 3.11, Lunch1 = 6.38, Lunch2 = 4.32). The majority of Interclass Correlation Coefficients indicating interrater reliability were in the excellent range (64%) for commonly occurring statement categories, and 14 of the 19 low frequency statement categories had > 80% agreement. Conclusions and implications Overall, items added to the Table Talk tool performed well, and interrater reliability was favorable. Our study also documented differences between Lead and Assistant teachers in mealtime practices and illustrated differing patterns of interaction between lunches and breakfast, important findings to inform future research and practice. The TT-R may be a useful measurement tool for monitoring and evaluating ECET practices in mealtime environments as well as informing intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-10087-8.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA.
| | - Josh Phelps
- Department of Dietetics and Nutrition, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA
| | - Nicole M McBride
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA
| | - James P Selig
- College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA
| | - Julie M Rutledge
- School of Human Ecology, Louisiana Tech University, P.O. Box 3167, Ruston, LA, 71272, USA
| | - Swapna Manyam
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199, USA
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Swindle T, Rutledge J. Measuring feeding practices among early care and education teachers and examining relations with food insecurity. Appetite 2020; 155:104806. [PMID: 32735955 DOI: 10.1016/j.appet.2020.104806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
Early care and education teachers' (ECETs) dietary and feeding behaviors have the potential to influence children's health outcomes. This study sought to: (1) gather data on the properties and performance of the CFQ and CFSQ in an ECET sample and compare properties to published parent samples and (2) examine relations between FI experiences by ECETs and reported feeding practices, and (3) examine relations between FI experiences by ECETs and reported feeding practices. ECETs completed 506 cross-sectional surveys. Mean patterns, ranges, and internal consistency values on the adapted instruments for ECETs were consistent with those published for parents. Significant mean differences between parents and ECETs on established scales using one-sample t-tests were prevalent with medium to large effect sizes despite small, relative differences. The majority of ECETs were authoritarian (35.6%), followed by indulgent (29.2%), authoritative (17.9%), and uninvolved (17.3%). T-tests indicated that ECETs who were currently food insecure were significantly higher than teachers who were currently food secure on scales of perceived responsibility, concern about child weight, restriction, pressure to eat, monitoring, demandingness, and responsiveness (all p < .001). Chi-square tests found that food insecurity was not independent from ECET feeding style, with a greater occurrence of authoritarian and less of indulgent feeding styles for ECETs who were food insecure. Overall, analyses support that two popular measures of feeding practices function similarly in ECETs as they do in parents. Additionally, results demonstrate associations between food insecurity and ECETs' feeding practices.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR, 72205-7199; USA.
| | - Julie Rutledge
- School of Human Ecology; Louisiana Tech University, P.O. Box 3167, Ruston, LA, 71272, USA
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Eastern North Carolina Head Start Teachers' personal and professional experiences with healthy eating and physical activity: a qualitative exploration. Public Health Nutr 2020; 24:3460-3476. [PMID: 33190662 DOI: 10.1017/s1368980020003687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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.
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Love P, Walsh M, Campbell KJ. Knowledge, Attitudes and Practices of Australian Trainee Childcare Educators Regarding Their Role in the Feeding Behaviours of Young Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103712. [PMID: 32466111 PMCID: PMC7277710 DOI: 10.3390/ijerph17103712] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 02/08/2023]
Abstract
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.
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Affiliation(s)
- Penelope Love
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3216, Australia;
- Centre of Research Excellence, Early Prevention of Obesity in Childhood (EPOCH), Sydney 2007, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3216, Australia;
- Correspondence:
| | - Melissa Walsh
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3216, Australia;
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, Deakin University, Geelong 3216, Australia;
- Centre of Research Excellence, Early Prevention of Obesity in Childhood (EPOCH), Sydney 2007, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Geelong 3216, Australia;
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Prusaczyk B, Swindle T, Curran G. Defining and conceptualizing outcomes for de-implementation: key distinctions from implementation outcomes. Implement Sci Commun 2020; 1:43. [PMID: 32885200 PMCID: PMC7427870 DOI: 10.1186/s43058-020-00035-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Increasingly, scholars argue that de-implementation is a distinct concept from implementation; factors contributing to stopping a current practice might be distinct from those that encourage adoption of a new one. One such distinction is related to de-implementation outcomes. We offer preliminary analysis and guidance on de-implementation outcomes, including how they may differ from or overlap with implementation outcomes, how they may be conceptualized and measured, and how they could be measured in different settings such as clinical care vs. community programs. CONCEPTUALIZATION OF OUTCOMES We conceptualize each of the outcomes from Proctor and colleagues' taxonomy of implementation outcomes for de-implementation research. First, we suggest key considerations for researchers assessing de-implementation outcomes, such as considering how the cultural or historical significance to the practice may impact de-implementation success and, as others have stated, the importance of the patient in driving healthcare overuse. Second, we conceptualize de-implementation outcomes, paying attention to a number of factors such as the importance of measuring outcomes not only of the targeted practice but of the de-implementation process as well. Also, the degree to which a practice should be de-implemented must be distinguished, as well as if there are thresholds that certain outcomes must reach before action is taken. We include a number of examples across all outcomes, both from clinical and community settings, to demonstrate the importance of these considerations. We also discuss how the concepts of health disparities, cultural or community relevance, and altruism impact the assessment of de-implementation outcomes. CONCLUSION We conceptualized existing implementation outcomes within the context of de-implementation, noted where there are similarities and differences to implementation research, and recommended a clear distinction between the target for de-implementation and the strategies used to promote de-implementation. This critical analysis can serve as a building block for others working to understand de-implementation processes and de-implement practices in real-world settings.
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Affiliation(s)
- Beth Prusaczyk
- Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, St. Louis, MO 63110 USA
| | - Taren Swindle
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 77205 USA
| | - Geoffrey Curran
- University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 77205 USA
- Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR 72114 USA
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Swindle TM, Phelps J, Schrick B, Selig J, Hu Z, Kopparapu A, Johnson S. Identifying a Fine Line between Food Insecurity and Food Acquisition Stress: A Mixed Methods Exploration. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019; 16:45-63. [PMID: 33868533 DOI: 10.1080/19320248.2019.1697407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study introduces the concept of Food Acquisition Stress (FAS), stress associated with food acquisition among those who do not necessarily screen positive for food insecurity.. This study used an exploratory sequential mixed methods approach among a sample of predominantly early childhood educators to develop a 7-item tool for measuring current and retrospective FAS. Using this tool, we identified that 61% of individuals who had FAS did not meet criteria for food insecurity. Capturing FAS, even among those categorized as food secure, has the potential to identify individuals who may need supportive interventions. Future research can explore how FAS is related to health behaviors.
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Affiliation(s)
- Taren M Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences
| | - Josh Phelps
- College of Health Profession, University of Arkansas for Medical Sciences
| | - Brittney Schrick
- Cooperative Extension, Division of Agriculture, University of Arkansas
| | - James Selig
- College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences
| | - Zhuopei Hu
- College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences
| | - Anil Kopparapu
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences
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Swindle T, Johnson SL, Davenport K, Whiteside-Mansell L, Thirunavukarasu T, Sadasavin G, Curran GM. A Mixed-Methods Exploration of Barriers and Facilitators to Evidence-Based Practices for Obesity Prevention in Head Start. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1067-1079.e1. [PMID: 31350198 PMCID: PMC6788974 DOI: 10.1016/j.jneb.2019.06.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/14/2019] [Accepted: 06/17/2019] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To identify positive and negative deviant cases using quantitative fidelity data from a previous implementation of a nutrition intervention, Together, We Inspire Smart Eating (WISE), and to determine barriers and facilitators to fidelity by conducting qualitative interviews with deviant cases. DESIGN Explanatory sequential mixed methods. SETTING Head Start Program agencies in 2 southern US states. PARTICIPANTS Quantitative fidelity data were collected in 42 Head Start classrooms. Recruitment for qualitative interviews prioritized those who were positive or negative deviants across fidelity components (African American, n = 21; white, n = 19; and Hispanic, n = 3). INTERVENTION WISE introduces children to fruits and vegetables using evidence-based practices of role modeling, positive feeding, mascot use, and hands-on exposure. ANALYSIS A directed content analysis approach informed by the integrated Promoting Action on Research Implementation in Health Service framework. PHENOMENON OF INTEREST Barriers and facilitators to WISE evidence-based practices implementation. RESULTS Qualitative analyses identified themes of culture, leadership support, and mechanisms for embedding change as key contextual factors. Key findings related to recipient characteristics were beliefs about what works, personalized strategies to use WISE, and classroom management. Primary themes for the innovation construct were time and preparation, degree of fit, and WISE advantage. Finally, findings relative to the construct of facilitation included trainer support and desire for additional training. CONCLUSIONS AND IMPLICATIONS The study of cases at the extreme ends of the fidelity spectrum can provide unique perspectives on barriers and facilitators to implementation of interventions.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Susan L Johnson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Karen Davenport
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Leanne Whiteside-Mansell
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Gireesh Sadasavin
- Regional Family Medicine Center, University of Arkansas for Medical Sciences, Pine Bluff, AR
| | - Geoffrey M Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR
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Swindle T, Sigman-Grant M, Branen LJ, Fletcher J, Johnson SL. About feeding children: factor structure and internal reliability of a survey to assess mealtime strategies and beliefs of early childhood education teachers. Int J Behav Nutr Phys Act 2018; 15:85. [PMID: 30200993 PMCID: PMC6131865 DOI: 10.1186/s12966-018-0717-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 08/27/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Children spend a substantial amount of time in early care and education (ECE) settings and may eat a majority of their diet in this setting. While there are several instruments focused on measuring factors of the ECE environment that may influence diet and weight outcomes, there are few comprehensive, valid, and reliable measures for collecting self-report of ECE providers' feeding practices. The purpose of this study was to establish the factor structure and internal reliability of a survey developed to measure practices and beliefs of ECE providers relative to feeding children. METHODS Licensed ECE centers from CA, CO, ID and NV were included in this cross-sectional survey study. The sample was stratified by states and census regions to yield equal numbers of centers from each category. The total sample distribution included 1600 randomly selected centers and up to 8000 staff members (who represented teachers, aides, assistants, or cooks); 1178 surveys were completed. We conducted an exploratory, unrestricted factor analysis as well as parallel analyses to inform the number of factors to be extracted. RESULTS Factors within Structural Mealtime Strategies included Adult Control of Foods Consumed (Kuder-Richardson [KR] = 0.67), Bribing with Sweet Foods (KR = 0.70), and Supportive Adult Roles at Mealtime (KR = 0.55). Factors in Verbal Mealtime Strategies included Supporting Children's Eating Self-regulation (KR =0.61), Pressure to Eat (KR = 0.58), and Social Comparisons (KR = 0.59). Beliefs about Mealtime factors were Autonomy Promoting (α = 0.64), Coercive Beliefs (α = 0.77), and Concern-Based Control (α = 0.60). CONCLUSIONS The AFC Strategies and Beliefs Survey provides a promising self-report instrument with a strong factor structure consistent with the extant literature to measure practices and beliefs related to feeding and mealtimes in the ECE setting. Feeding young children in group settings differs in many ways from feeding in a family setting; hence it is important that measures such as the AFC Strategies and Beliefs Survey capture unique aspects of the ECE feeding environment.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 521 Jack Stephens Drive, Little Rock, AR, 72205, USA.
| | - Madeleine Sigman-Grant
- University of Nevada Cooperative Extension, 2558 So Elizabeth Street, Salt Lake City, UT, 85406, USA
| | - Laurel J Branen
- Food and Nutrition, University of Idaho, Moscow, ID, 83844-3183, USA
| | - Janice Fletcher
- Child, Family and Consumer Studies, Center on Disabilities and Human Development, University of Idaho, 1187 Alturas Drive, Moscow, ID, 83844-1187, USA
| | - Susan L Johnson
- Department of Pediatrics, Anschutz Medical Campus, Section of Nutrition, F-561, University of Colorado-Denver, 12,631 E 17th Ave, Rm #2609, Aurora, CO, 80045, USA
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Swindle T, Phelps J. How Does Context Relate to Nutrition Promotion and Mealtime Practice in Early Care and Education Settings? A Qualitative Exploration. J Acad Nutr Diet 2018; 118:2081-2093. [PMID: 30064879 DOI: 10.1016/j.jand.2018.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/01/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Early childhood educators have the potential to influence children's dietary outcomes through daily interactions. However, existing research suggests that educator practices are often suboptimal. Previous research has often focused on individual characteristics that affect practices. There is less study of contextual influences of practices of early childhood educators. OBJECTIVE The purpose of this study was to understand and describe contextual factors evident in narratives of early childhood educators influencing mealtime and nutrition promotion practices. We use the Promoting Action on Research Implementation in Health Services framework to consider how contextual factors related to practices of early childhood educators. DESIGN This cross-sectional, qualitative study collected data through in-depth interviews with early childhood educators. Analyses of the data reflected a factist perspective and semantic approach to complete thematic content analysis of in-depth interviews. PARTICIPANTS The study used a stratified purposive sampling approach to recruit 28 educators to balance across educator role, agency type (Head Start vs state-funded), and obesity prevalence in the community. Early childhood educators were mostly lead teachers (62%), between the ages of 30 and 49 (82.1%), and white (75%) or African American (14.3%). RESULTS The coders identified three primary themes: Mealtime Structures, Resources, and Classroom/Center Atmosphere. Mealtime Structures associated with detrimental practices included cafeteria meals with rigid schedules. Mealtime Structures associated with evidence-based practices (EBPs) included classroom meal service. Resources associated with detrimental practices included limited funding. Resources associated with EBPs included meals paid for early childhood educators and classroom food experiences. Classroom/Center Atmosphere factors associated with detrimental practices included poor food offerings and policies that conflicted (eg, allowing children to bring in outside foods). Classroom/Center Atmosphere factors associated with EBPs included clarity around meal service rules and healthy, appealing food offerings. CONCLUSIONS This study highlighted that it may be difficult for an early childhood educator to adopt and maintain EBPs in certain contexts.
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Chapman-Novakofski K. Nutrition Economics. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2017; 49:614. [PMID: 28889849 DOI: 10.1016/j.jneb.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Table Talk: development of an observational tool to assess verbal feeding communications in early care and education settings. Public Health Nutr 2017; 20:2869-2877. [PMID: 28803584 DOI: 10.1017/s1368980017001896] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Children's dietary intake impacts weight status and a range of short- and long-term health outcomes. Accurate measurement of factors that influence children's diet is critical to the development and evaluation of interventions designed to improve children's diets. The purpose of the current paper is to present the development of the Table Talk observational tool to measure early care and education teachers' (ECET) verbal feeding communications. DESIGN An observational tool to assess ECET verbal communication at mealtimes was deigned based on the extant literature. Trained observers conducted observations using the tool during lunch for both lead and assistant ECET. Descriptive statistics, test-retest for a subgroup, interclass correlations for each item, and comparisons between leads and assistants were conducted. SETTING Head Start centres, Southern USA. SUBJECTS Seventy-five Head Start educators. RESULTS On average, 17·2 total verbal feeding communications (sd 8·9) were observed per ECET. For lead ECET, the most prevalent Supportive Comment was Exploring Foods whereas for assistants Making Positive Comments was the most prevalent. Overall, lead ECET enacted more Supportive Comments than assistant ECET (F(2,72)=4·8, P=0·03). The most common Unsupportive Comment was Pressuring to Eat, with a mean of 3·8 (sd 4·3) and a maximum of 25. There was no difference in Unsupportive Comments between lead and assistant ECET. CONCLUSIONS Table Talk may be a useful tool to assess verbal feeding communications of ECET, with potential applications such as informing ECET training and assessing intervention efforts.
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