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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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Siegel L, Asada Y, Lin S, Fitzgibbon ML, Kong A. Perceived factors that influence adoption, implementation and sustainability of an evidence-based intervention promoting healthful eating and physical activity in childcare centers in an urban area in the United States serving children from low-income, racially/ethnically diverse families. FRONTIERS IN HEALTH SERVICES 2022; 2:980827. [PMID: 36925814 PMCID: PMC10012626 DOI: 10.3389/frhs.2022.980827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Introduction Early childcare centers offer optimal settings to provide healthy built environments where preschool age children spend a majority of their week. Many evidence-based interventions (EBIs) promoting healthful eating and physical activity for early childcare settings exist, but there is a limited understanding of how best to support adoption, implementation and sustainability in community settings. This study examined how early childcare teachers and administrators from Chicago-area childcare centers serving children from low-income, racially/ethnically diverse communities viewed an EBI called Hip to Health (H3), and the factors they perceived as relevant for EBI adoption, implementation, and sustainability. Methods A multiple methods study including key informant interviews and a brief survey was conducted. Key informant interviews with teachers and administrators from childcare centers located in Chicago, IL were completed between December 2020 and May 2021. An interview guide and coding guide based on the Consolidated Framework for Implementation Research (CFIR) was developed. Interview transcripts were team coded in MAXQDA Qualitative Data Analysis software. Thematic analysis was used to identify findings specific to adoption, implementation, and sustainability. Participants were also asked to respond to survey measures about the acceptability, feasibility, and appropriateness of H3. Results Overall, teachers (n = 20) and administrators (n = 16) agreed that H3 was acceptable, appropriate, and feasible. Low start-up costs, ease-of-use, adaptability, trialability, compatibility, and leadership engagement were important to EBI adoption. Timely and flexible training was critical to implementation. Participants noted sustainability was tied to low ongoing costs, access to ongoing support, and positive observable benefits for children and positive feedback from parents. Conclusions These findings suggest that EBIs suitable for adoption, implementation, and sustainment in childcare centers serving racially/ethnically diverse, low-income families should be adaptable, easy to use, and low-cost (initial and ongoing). There is also some evidence from these findings of the heterogeneity that exists among childcare centers serving low-income families in that smaller, less resourced centers are often less aware of EBIs, and the preparation needed to implement EBIs. Future research should examine how to better support EBI dissemination and implementation to these settings.
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Affiliation(s)
- Leilah Siegel
- 4-H Youth Development, University of Illinois Extension, St. Charles, IL, United States
| | - Yuka Asada
- Community Health Sciences, School of Public Health, University of Illinois Chicago, Chicago, IL, United States
| | - Shuhao Lin
- Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, United States
| | - Marian L. Fitzgibbon
- Institute for Health Research and Policy, University of Illinois Chicago, Chicago, IL, United States
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, IL, United States
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3
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Swindle T, Rutledge JM, Martin J, Curran GM. Implementation fidelity, attitudes, and influence: a novel approach to classifying implementer behavior. Implement Sci Commun 2022; 3:60. [PMID: 35668517 PMCID: PMC9171954 DOI: 10.1186/s43058-022-00307-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 05/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background The current study sought to (1) describe a new classification approach for types of implementer behavior and (2) explore the implementer behavior change in response to tailored implementation facilitation based on the classifications. Methods A small-scale, cluster-randomized hybrid type III implementation trial was conducted in 38 early care and education classrooms that were part of the Together, We Inspire Smart Eating (WISE) program. WISE focuses on 4 evidence-based practices (EBPs), which are implemented by teachers to promote nutrition. External facilitators (N = 3) used a modified Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) to complete immersion (i.e., observations) and thematic content analyses of interviews to identify the characteristics of teachers’ behavior at varying levels of implementation fidelity. Three key factors—attitudes toward the innovation, fidelity/adaptations, and influence—were identified that the research team used to classify teachers’ implementation behavior. This process resulted in a novel classification approach. To assess the reliability of applying the classification approach, we assessed the percent agreement between the facilitators. Based on the teachers’ classification, the research team developed a tailored facilitation response. To explore behavior change related to the tailored facilitation, change in fidelity and classification across the school year were evaluated. Results The classifications include (1) enthusiastic adopters (positive attitude, meeting fidelity targets, active influence), (2) over-adapting adopters (positive attitude, not meeting fidelity targets, active influence), (3) passive non-adopters (negative attitude, not meeting fidelity targets, passive influence), and (4) active non-adopters (negative attitudes, not meeting fidelity targets, active influence). The average percent agreement among the three facilitators for classification was 75%. Qualitative data support distinct patterns of perceptions across the classifications. A positive shift in classification was observed for 67% of cases between the mid-point and final classification. Finally, we generated an expanded classification approach to consider additional combinations of the three factors beyond those observed in this study. Conclusions Data from this study support the ability to apply the classification approach with moderate to high reliability and to use the approach to tailor facilitation toward improved implementation. Findings suggest the potential of our approach for wider application and potential to improve tailoring of implementation strategies such as facilitation.
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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 M Rutledge
- Education and Research in Children's Health Center, College of Applied and Natural Sciences, Louisiana Tech University, Ruston, USA
| | - Janna Martin
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., #530, Little Rock, AR, 72205-7199, USA
| | - Geoffrey M Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, #522-472205-7199, USA.,Central Arkansas Veterans Healthcare System, 4300 W 7th St, Little Rock, AR, 72205, USA
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4
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Obesity prevention practices in early care and education settings: an adaptive implementation trial. Implement Sci 2022; 17:25. [PMID: 35303894 PMCID: PMC8932138 DOI: 10.1186/s13012-021-01185-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Despite the potential for Early Care and Education (ECE) settings to promote healthy habits, a gap exists between current practices and evidence-based practices (EBPs) for obesity prevention in childhood. Methods We will use an enhanced non-responder trial design to determine the effectiveness and incremental cost-effectiveness of an adaptive implementation strategy for Together, We Inspire Smart Eating (WISE), while examining moderators and mediators of the strategy effect. WISE is a curriculum that aims to increase children’s intake of carotenoid-rich fruits and vegetables through four evidence-based practices in the early care and education setting. In this trial, we will randomize sites that do not respond to low-intensity strategies to either (a) continue receiving low-intensity strategies or (b) receive high-intensity strategies. This design will determine the effect of an adaptive implementation strategy that adds high-intensity versus one that continues with low-intensity among non-responder sites. We will also apply explanatory, sequential mixed methods to provide a nuanced understanding of implementation mechanisms, contextual factors, and characteristics of sites that respond to differing intensities of implementation strategies. Finally, we will conduct a cost effectiveness analysis to estimate the incremental effect of augmenting implementation with high-intensity strategies compared to continuing low-intensity strategies on costs, fidelity, and child health outcomes. Discussion We expect our study to contribute to an evidence base for structuring implementation support in real-world ECE contexts, ultimately providing a guide for applying the adaptive implementation strategy in ECE for WISE scale-up. Our work will also provide data to guide implementation decisions of other interventions in ECE. Finally, we will provide the first estimate of relative value for different implementation strategies in this setting. Trial registration NCT05050539; 9/20/21.
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Meshkovska B, Scheller DA, Wendt J, Jilani H, Scheidmeir M, Stratil JM, Lien N. Barriers and facilitators to implementation of direct fruit and vegetables provision interventions in kindergartens and schools: a qualitative systematic review applying the consolidated framework for implementation research (CFIR). Int J Behav Nutr Phys Act 2022; 19:11. [PMID: 35101084 PMCID: PMC8805256 DOI: 10.1186/s12966-022-01246-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although children's intake of fruit and vegetables has seen a recent rise, almost half of adolescents do not eat even one piece of fruit or vegetables per day. One way to address this problem is through interventions that provide fruit and vegetables directly to children in kindergartens and schools. For such interventions to meet their intended goals, what is important to consider in addition to impact is implementation. Our objective is to systematically review qualitative results reporting on the determinants (barriers and facilitators) to implementation of interventions that entail direct provision of fruit and vegetables in kindergarten and school settings and conduct a framework analysis of those results using the Consolidated Framework for Implementation Research (CFIR). METHODS A systematic search was designed and run in November 2019 for: MEDLINE (Ovid), Embase (Ovid), PsychINFO (Ovid), ERIC (Ovid), Cochrane Library Reviews and Cochrane Library Trials. A keyword search of the journal Implementation Science was completed. Screening of titles and abstracts (n = 5427) and full texts (n = 227), led to 14 included articles. Coding and analysis were done using the framework method and CFIR. RESULTS The following CFIR constructs were found relevant: 1) intervention characteristics domain: 'design quality and packaging', 'adaptability' 'cost'; 2) outer setting: 'cosmopolitanism', 'external policy and incentives' 'patients' needs and resources'; 3) inner setting: 'implementation climate', 'readiness for implementation' and 'structural characteristics'; 4) characteristics of individuals: 'individual stage of change', 'knowledge and beliefs about the intervention' 5) process: 'engaging', 'executing' and 'reflecting and evaluating'. The review stresses the dual role of parents as both supporting the implementation and targets of the intervention, which could have implications for the design and implementation of future fruit and vegetables interventions. Positive child perceptions of the value of the intervention and perceived behavior change due to the intervention were reported as relevant facilitators to implementation across several studies, and should be taken into consideration in future design efforts. CONCLUSIONS CFIR offers a systematic way to identify and organize barriers and facilitators to implementation of interventions in the kindergarten and school setting. Revisions are encouraged to allow adequate space for perceptions of various implementation actors and the target group. PROSPERO REGISTRATION CRD42020167697.
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Affiliation(s)
| | - Daniel A. Scheller
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
| | - Janine Wendt
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
| | - Hannah Jilani
- Institute of Public Health and Nursing Research - IPP, University of Bremen and Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Marie Scheidmeir
- Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jan M. Stratil
- Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
| | - Nanna Lien
- Department of Nutrition, University of Oslo, Oslo, Norway
| | - on behalf of the PEN Consortium
- Department of Nutrition, University of Oslo, Oslo, Norway
- Division of Sports and Rehabilitation, Department of Internal Medicine II, Ulm University Medical Centre, Ulm, Germany
- Institute of Public Health and Nursing Research - IPP, University of Bremen and Epidemiological Methods and Etiological Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Department of Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology – IBE, Chair of Public Health and Health Services Research, LMU Munich, Munich, Germany
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Calvert HG, Lane HG, McQuilkin M, Wenner JA, Turner L. Elementary Schools' Response to Student Wellness Needs during the COVID-19 Shutdown: A Qualitative Exploration Using the R = MC 2 Readiness Heuristic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:279. [PMID: 35010539 PMCID: PMC8750629 DOI: 10.3390/ijerph19010279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/22/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
During spring of 2020, the COVID-19 pandemic and accompanying public health advisories forced K-12 schools throughout the United States to suspend in-person instruction. School personnel rapidly transitioned to remote provision of academic instruction and wellness services such as school meals and counseling services. The aim of this study was to investigate how schools responded to the transition to remote supports, including assessment of what readiness characteristics schools leveraged or developed to facilitate those transitions. Semi-structured interviews informed by school wellness implementation literature were conducted in the spring of 2020. Personnel (n = 50) from 39 urban and rural elementary schools nationwide participated. The readiness = motivation capacity2 (R = MC2) heuristic, developed by Scaccia and colleagues, guided coding to determine themes related to schools' readiness to support student wellness in innovative ways during the pandemic closure. Two distinct code sets emerged, defined according to the R = MC2 heuristic (1) Innovations: roles that schools took on during the pandemic response, and (2) Readiness: factors influencing schools' motivation and capacity to carry out those roles. Schools demonstrated unprecedented capacity and motivation to provide crucial wellness support to students and families early in the COVID-19 pandemic. These efforts can inform future resource allocation and new strategies to implement school wellness practices when schools resume normal operations.
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Affiliation(s)
- Hannah G. Calvert
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725-1742, USA; (M.M.); (L.T.)
| | - Hannah G. Lane
- Department of Population Health Sciences, School of Medicine, Duke University, 705 Broad Street, Durham, NC 27705, USA;
| | - Michaela McQuilkin
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725-1742, USA; (M.M.); (L.T.)
| | - Julianne A. Wenner
- Department of Teaching and Learning, College of Education, Clemson University, 405 Gantt Circle, Clemson, SC 29634, USA;
| | - Lindsey Turner
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 University Drive, Boise, ID 83725-1742, USA; (M.M.); (L.T.)
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Kerins C, Kelly C, Reardon CM, Houghton C, Toomey E, Hayes CB, Geaney F, Perry IJ, McSharry J, McHugh S. Factors Influencing Fidelity to a Calorie Posting Policy in Public Hospitals: A Mixed Methods Study. Front Public Health 2021; 9:707668. [PMID: 34485232 PMCID: PMC8414889 DOI: 10.3389/fpubh.2021.707668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/14/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Labelling menus with nutrition information has increasingly become an important obesity policy option. While much research to-date has focused on determining its effectiveness, few studies report the extent to which menu labelling is implemented as designed. The aim of this study was to explore factors influencing fidelity to a calorie posting policy in Irish acute public hospitals. Methods: A mixed methods sequential explanatory study design was employed, with a nested case study for the qualitative component. Quantitative data on implementation fidelity at hospitals were analysed first and informed case sampling in the follow-on qualitative phase. Maximum variation sampling was used to select four hospitals with high and low levels of implementation and variation in terms of geographic location, hospital size, complexity of care provided and hospital type. Data were collected using structured observations, unstructured non-participant observations and in-depth semi-structured interviews. The Consolidated Framework for Implementation Research guided qualitative data collection and analysis. Using framework analysis, factors influencing implementation were identified. A triangulation protocol was used to integrate fidelity findings from multiple sources. Data on influencing factors and fidelity were then combined using joint displays for within and cross-case analysis. Results: Quantitative fidelity data showed seven hospitals were categorised as low implementers and 28 hospitals were high implementers of the policy. Across the four hospitals selected as cases, qualitative analysis revealed factors influencing implementation and fidelity were multiple, and operated independently and in combination. Factors were related to the internal hospital environment (e.g., leadership support, access to knowledge and information, perceived importance of calorie posting implementation), external hospital environment (e.g., national policy, monitoring), features of the calorie posting policy (e.g., availability of supporting materials), and the implementation process (e.g., engaging relevant stakeholders). Integrated analysis of fidelity indicated a pattern of partial adherence to the calorie posting policy across the four hospitals. Across all hospitals, there was a consistent pattern of low adherence to calorie posting across all menu items on sale, low adherence to calorie information displayed per standard portion or per meal, low adherence to standardised recipes/portions, and inaccurate calorie information. Conclusion: Efforts to maximise fidelity require multi-level, multi-component strategies in order to reduce or mitigate barriers and to leverage facilitators. Future research should examine the relative importance of calorie posting determinants and the association between implementation strategies and shifts in fidelity to intervention core components.
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Affiliation(s)
- Claire Kerins
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Colette Kelly
- Discipline of Health Promotion, School of Health Sciences, National University of Ireland Galway, Galway, Ireland
| | - Caitlin M Reardon
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Elaine Toomey
- Faculty of Education and Health Sciences, School of Allied Health, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - Catherine B Hayes
- Public Health and Primary Care, Institute of Population Health, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Fiona Geaney
- School of Public Health, University College Cork, Cork, Ireland
| | - Ivan J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
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8
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Swindle T, McBride NM, Selig JP, Johnson SL, Whiteside-Mansell L, Martin J, Staley A, Curran GM. Stakeholder selected strategies for obesity prevention in childcare: results from a small-scale cluster randomized hybrid type III trial. Implement Sci 2021; 16:48. [PMID: 33933130 PMCID: PMC8088574 DOI: 10.1186/s13012-021-01119-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Together, We Inspire Smart Eating (WISE) is an intervention for the early care and education setting to support children's exposure to and intake of fruits and vegetables. WISE emphasizes 4 evidence-based practices (EBPs): (1) use of a mascot; (2) educators' role modeling; (3) positive feeding practices; and (4) hands-on exposures. The current study reports on a small-scale implementation trial aimed at improving the use of WISE EBPs by teachers. METHODS A Hybrid Type III Cluster Randomized Design compared a Basic and Enhanced implementation strategy. The Basic Strategy included training and reminders only; the Enhanced strategy was a multi-faceted package of stakeholder-selected strategies including a leadership commitment, an implementation blueprint, a local champion, an environmental reminder of the EBPs, facilitation, and tailored educational resources and incentives. All study sites were Head Starts. Sites were randomized using a balancing technique that considered site characteristics; 4 sites (20 classrooms, 39 educators, 305 children) received Enhanced support; 5 sites (18 classrooms, 36 educators, 316 children) received Basic support. RE-AIM guided the evaluation, and implementation fidelity was the primary outcome. Strategies were assessed using examination of data distributions and unadjusted comparisons (t tests) as well as general linear and mixed effects models controlling for covariates. RESULTS For the primary outcome of fidelity, the Enhanced group had significantly higher means for 3 of 4 EBPs. Multivariate models explained a significant portion of variance for both mascot use and hands-on exposure with a significant positive effect observed for treatment condition. The Enhanced group also had higher rates of Appropriateness and Organizational Readiness for Implementing Change (as indicators of implementation and adoption, respectively). There was no significant difference between groups for indicators of Reach, Effectiveness or Maintenance. Formative interviews indicated key targets for iteration and potential mechanisms. Key events were catalogued to provide context for interpretation (e.g., 61% of classrooms with turnover). CONCLUSIONS Findings were mixed but suggested promise for the Enhanced strategy, especially considering key events of the study. Implementation fidelity improvements occurred mainly in the last 3 months of the school year; additional time may be needed to translate to improvements in child outcomes. TRIAL REGISTRATION NCT03075085 Registered 20 February 2017.
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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
| | - Nicole M. McBride
- Embedded Preventive Behavioral Health Capability, Marine Corps Community Services, III MEF, United State Marine Corps, Okinawa, Japan
| | - James P. Selig
- College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences, 4301 W. Markham St., #781, Little Rock, AR 72205 USA
| | - Susan L. Johnson
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue Box C225, Aurora, CO 80045 USA
| | - Leanne Whiteside-Mansell
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR 72205-7199 USA
| | - Janna Martin
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR 72205-7199 USA
| | - Audra Staley
- College of Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR 72205-7199 USA
| | - Geoffrey M. Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, #522-4, Little Rock, AR 72205-7199 USA
- Central Arkansas Veterans Healthcare System, North Little Rock, AR 72114 USA
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9
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Yoong SL, Jones J, Pearson N, Swindle T, Barnes C, Delaney T, Lum M, Golley R, Matwiejczyk L, Kelly B, Kerr E, Love P, Esdaile E, Ward D, Grady A. An Overview of Research Opportunities to Increase the Impact of Nutrition Intervention Research in Early Childhood and Education Care Settings According to the RE-AIM Framework. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2745. [PMID: 33800463 PMCID: PMC7967470 DOI: 10.3390/ijerph18052745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/18/2021] [Accepted: 02/24/2021] [Indexed: 12/26/2022]
Abstract
Objective: To highlight opportunities for future nutrition intervention research within early childhood and education care (ECEC) settings, with a focus on generating evidence that has applicability to real-world policy and practice. Methods: An overview of opportunities to progress the field was developed by the authors using a collaborative writing approach and informed by recent research in the field. The group developed a list of recommendations aligned with the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework. Pairs of authors drafted individual sections of the manuscript, which were then reviewed by a separate pair. The first and senior author consolidated all sections of the manuscript and sought critical input on the draft iterations of the manuscript. Results: Interventions that employ digital platforms (reach) in ECEC settings, as well as research in the family day care setting (effectiveness) were identified as areas of opportunities. Research understanding the determinants of and effective strategies for dissemination (adoption), the implementation of nutrition programs, in addition to de-implementation (implementation) of inappropriate nutrition practices, is warranted. For maintenance, there is a need to better understand sustainability and the sustainment of interventions, in addition to undertaking policy-relevant research. Conclusions: The ECEC setting is prime for innovative and practical nutrition intervention research.
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Affiliation(s)
- Sze Lin Yoong
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- School of Health Science, Swinburne University of Technology, Melbourne, VIC 3122, Australia
| | - Jannah Jones
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Nicole Pearson
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Taren Swindle
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Courtney Barnes
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Tessa Delaney
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Melanie Lum
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
| | - Rebecca Golley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.G.); (L.M.)
| | - Louisa Matwiejczyk
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA 5042, Australia; (R.G.); (L.M.)
| | - Bridget Kelly
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia; (B.K.); (E.K.)
| | - Erin Kerr
- Early Start, School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia; (B.K.); (E.K.)
| | - Penelope Love
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3217, Australia;
| | - Emma Esdaile
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia;
| | - Dianne Ward
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, CA 27516, USA;
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, CA 27514, USA
| | - Alice Grady
- Hunter New England Population Health, Wallsend, NSW 2287, Australia; (J.J.); (N.P.); (C.B.); (T.D.); (M.L.); (A.G.)
- Priority Research Centre for Health Behaviour, The University of Newcastle, Callaghan, NSW 2308, Australia
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Golden CA, Hill JL, Heelan KA, Bartee RT, Abbey BM, Malmkar A, Estabrooks PA. A Dissemination Strategy to Identify Communities Ready to Implement a Pediatric Weight Management Intervention in Medically Underserved Areas. Prev Chronic Dis 2021; 18:E10. [PMID: 33571083 PMCID: PMC7879964 DOI: 10.5888/pcd18.200248] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Purpose and Objectives We developed a competitive application process to test the feasibility of a fund and contract dissemination strategy to identify and engage communities that demonstrated the necessary resources and motivation to adopt, implement, and sustain a pediatric weight management intervention, Building Healthy Families, in rural and micropolitan (<50,000 residents) communities in Nebraska. Intervention Approach From April through December 2019, a community advisory board with representation from rural and micropolitan clinical, public health, education, and recreational organizations collaboratively developed a request for applications, as a fund and contract dissemination strategy, to encourage community adoption of Building Healthy Families. Evaluation Methods Quantitative assessments included determining the distribution of requests for applications, evaluating organizational readiness to change assessment (ORCA) ratings (on a scale of 1 to 5, from strongly disagree to strongly agree that the organization is ready to change), and reviewing community advisory board member ratings of applications. We gathered qualitative data from community narratives provided in response to the request for applications and community advisory board reviews of the applications. Results The request for applications was distributed to all 93 counties in Nebraska. Of the 8 communities that submitted a letter of intent, 7 submitted a community narrative. Across the 8 communities, 31 ORCAs were completed by the organizational decision makers (n = 15) and staff members (n = 16) who would be responsible for screening, recruiting, or implementing the intervention. Overall mean ORCA scores varied by ratings of evidence (4.1–4.6), context (4.2–4.9), and facilitation (4.3–4.8), indicating a high degree of readiness. Community advisory board ratings of applications ranged from 2.3 to 3.4 of 4 points. Qualitative data indicated that lower community narrative scores were primarily caused by weak implementation and sustainability plans. Implications for Public Health Findings provide guidance for translating pediatric weight management programs in medically underserved geographic areas by maximizing the probability of successful adoption and implementation through a fund and contract dissemination strategy.
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Affiliation(s)
- Caitlin A Golden
- University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365.
| | - Jennie L Hill
- University of Nebraska Medical Center, Omaha, Nebraska
| | - Kate A Heelan
- University of Nebraska at Kearney, Kearney, Nebraska
| | - R Todd Bartee
- University of Nebraska at Kearney, Kearney, Nebraska
| | - Bryce M Abbey
- University of Nebraska at Kearney, Kearney, Nebraska
| | - Ali Malmkar
- University of Nebraska at Kearney, Kearney, Nebraska
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11
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Swindle T, Rutledge JM, Johnson SL, Selig JP, Curran GM. De-implementation of detrimental feeding practices: a pilot protocol. Pilot Feasibility Stud 2020; 6:181. [PMID: 33292711 PMCID: PMC7678218 DOI: 10.1186/s40814-020-00720-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/03/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Early childhood educators (ECEs) often use detrimental feeding practices and are slow to implement positive feeding practices. Nevertheless, few studies have aimed to understand and change ECEs' feeding practices. This gap needs to be addressed because implementation (i.e., adding new, evidence-based practices) and de-implementation (i.e., stopping low-value or harmful practices) are distinct processes that require unique strategies. METHODS We will develop a de-implementation strategy for detrimental feeding practices using evidence-based quality improvement (EBQI) sessions to engage stakeholders and draw on the Niven process model for de-implementation. Then, we will investigate the effects of the de-implementation strategy in a proof-of-principle study. The de-implementation strategy will be evaluated in 2 partnering childcare agencies using a pre-post, within-site design. For our primary outcome, we will interview educators throughout the school year to assess the feasibility and acceptability of the intervention and survey them with standard measures for assessing feasibility and acceptability. For secondary outcomes, we will investigate its effects on the use of detrimental and evidence-based feeding practices by teachers and impacts on child BMI and diet. DISCUSSION The current study will establish the feasibility and acceptability of our de-implementation approach and will provide preliminary data toward 3 predicted secondary outcomes: (1) decreased detrimental feeding practices by ECEs, (2) increased adoption of and fidelity to nutrition promotion practices, and (3) improved child dietary outcomes. These results are expected to contribute to the uptake and sustainability of mealtime interventions to improve the diets of young children. Results will also apply to the field of implementation science by informing processes for developing de-implementation approaches in a community setting.
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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 M. Rutledge
- College of Applied and Natural Sciences, Louisiana Tech University, Ruston, USA
| | - Susan L. Johnson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, USA
| | - James P. Selig
- College of Public Health, Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Geoff M. Curran
- Department of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Central Arkansas Veterans Healthcare System, Little Rock, USA
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Chapman-Novakofski K. It's a GEM! JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:1036. [PMID: 31601419 DOI: 10.1016/j.jneb.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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