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May TA, Koskey KLK, Provinzano K. Developing and Validating the Preschool Nutrition Education Practices Survey. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2024:S1499-4046(24)00053-8. [PMID: 38691080 DOI: 10.1016/j.jneb.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 03/10/2024] [Accepted: 03/12/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Validate the Preschool Nutrition Education Practices Survey. DESIGN Iterative approach combining design-based research and Standards for Educational and Psychological Testing. SETTING Los Angeles, CA and Philadelphia, PA Early Care and Education (ECE) classrooms. PARTICIPANTS Expert panel members (n = 7); ECE teachers: interviews (n = 8), pilot survey (n = 31), and final survey (n = 136). VARIABLES MEASURED Early care and education nutrition education practices used in the classroom either during class time or mealtime. ANALYSIS Qualitative content analysis was implemented for content, response process, and consequences of testing validity evidence. Rasch rating scale analysis was conducted for the response process and internal structure validity and reliability evidence. RESULTS Qualitative field-testing produced strong content, response process, and consequences of testing validity evidence to inform survey modifications. Quantitative field-testing generated a psychometrically sound, well-targeted 12-item survey on a 4-point frequency scale with excellent item and person reliability (0.97 and 0.93 respectively) and separation (5.36 and 3.77 respectively); good Rasch Principal Components Analysis findings (60.3%); and productive item fit statistics (0.50-1.50 logits). CONCLUSIONS AND IMPLICATIONS Robust validity (content, response process, consequences of testing, internal structure) and reliability evidence were demonstrated for using the Preschool Nutrition Education Practices Survey to assess ECE teachers' use of nutrition education practices. Future research is needed to examine its relationship to other variables, such as nutrition teaching efficacy, and to determine its ability to detect change in ECE nutrition education practices over time and across groups.
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Affiliation(s)
- Toni A May
- School of Education, Drexel University, Philadelphia, PA.
| | | | - Kathleen Provinzano
- Departments of Teaching, Learning, and Educational Leadership and Social Work, College of Community and Public Affairs, The State University of New York - Binghamton University, Binghamton, NY
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Chan J, Conroy P, Phongsavan P, Raubenheimer D, Allman-Farinelli M. Systems map of interventions to improve dietary intake of pre-school aged children: A scoping review. Prev Med 2023; 177:107727. [PMID: 37848165 DOI: 10.1016/j.ypmed.2023.107727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
Implementation and sustaining impact of early childhood nutrition interventions in practice remains a challenge. An understanding of the extent to which determinants across multiple levels of the food system are being addressed may improve success. This literature review aimed to synthesise the evidence on interventions targeting dietary intake and eating behaviours in preschool children using a systems approach. Eligible studies included intervention studies targeting the dietary intake of preschool children aged 2-5 years in high income countries, published in English after January 2000. Interventions were categorised to the Determinants of Nutrition and Eating (DONE) framework for children developed and evaluated by experts across multiple fields. The framework maps and ranks 411 factors driving eating behaviours and nutrition and can be used to systematically summarise determinants. DONE ranks each determinant for its perceived research priority. A total of 160 eligible studies were identified. Most interventions targeted interpersonal (n = 101, 63.1%) and individual (n = 85, 53.1%) level determinants, with fewer targeting environmental (n = 55, 34.4%) and policy level (n = 17, 10.6%) determinants. The most frequently addressed determinants were Parental Resources and Risk Factors (n = 85) and Children's Food Knowledge, Skills and Abilities (n = 67). These determinants had a Moderate research priority rating. Home Food Availability and Accessibility at the environmental level is classified as the highest research priority, however, only 15 of 160 interventions addressed this determinant. This review highlights home food availability and accessibility as potential leverage points for future interventions to improve children's dietary intake and eating behaviours.
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Affiliation(s)
- Jacqueline Chan
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia.
| | - Patrick Conroy
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Philayrath Phongsavan
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Raubenheimer
- Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia; School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia
| | - Margaret Allman-Farinelli
- Nutrition and Dietetics Group, Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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Violant-Holz V, Rodríguez-Silva C, Rodríguez MJ. Preschool teachers display a flexible pattern of pedagogical actions in promoting healthy habits in children. Front Psychol 2023; 14:1172460. [PMID: 37168422 PMCID: PMC10165009 DOI: 10.3389/fpsyg.2023.1172460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 03/30/2023] [Indexed: 05/13/2023] Open
Abstract
The school represents the optimal setting for promoting the physical, emotional, and social health of children, especially during the first years of life. Understanding the pedagogical actions of teachers to address health education is an important first step in promoting healthy behaviors in children. We inhere analyzed the pedagogical action patterns in the preschool teaching of healthy habits from a holistic health perspective. We used photography as a strategy for data collection and applied a Chi-square automatic interaction detection (CHAID) classification tree, a data mining procedure, to generate a pattern model. We found that the school space and the learning playfulness strategies for the development of executive functions, classified according to the exercise, symbolic, assembly, rules (ESAR) model, were the main factors that influence the pedagogical actions fostering healthy habits. By contrast, the school and the pedagogical resources of the classroom are factors with a much smaller impact on working with healthy habits. This pedagogical action pattern is flexible, since teachers conduct a multiplicity of pedagogical actions through different strategies, in different school spaces, at any time. In conclusion, our results unmask the interdependent relationships between the different factors that determine the teacher's actions at the preschool. It also contributes to the understanding of the teacher's practices in fostering healthy habits in a healthy learning environment.
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Affiliation(s)
- Verónica Violant-Holz
- Department of Didactics and Educative Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain
- International Observatory in Hospital Pedagogy, Universitat de Barcelona, Barcelona, Spain
- Research Group and Innovation in Designs (GRID), Technology and Multimedia and Digital Application to Observational Designs, Thematic Core, Hospital Pedagogy, Barcelona, Spain
- *Correspondence: Verónica Violant-Holz,
| | - Carlota Rodríguez-Silva
- Department of Didactics and Educative Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain
- International Observatory in Hospital Pedagogy, Universitat de Barcelona, Barcelona, Spain
- Research Group and Innovation in Designs (GRID), Technology and Multimedia and Digital Application to Observational Designs, Thematic Core, Hospital Pedagogy, Barcelona, Spain
| | - Manuel J. Rodríguez
- Department of Biomedical Sciences, Institute of Neurosciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Manuel J. Rodríguez,
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Wicaksono WA, Buko A, Kusstatscher P, Sinkkonen A, Laitinen OH, Virtanen SM, Hyöty H, Cernava T, Berg G. Modulation of the food microbiome by apple fruit processing. Food Microbiol 2022; 108:104103. [DOI: 10.1016/j.fm.2022.104103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/04/2022]
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Scrivano RM, Juris JJ, Jarrott SE, Lobb JM. Extending the Together, We Inspire Smart Eating Curriculum to Intergenerational Nutrition Education: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19158935. [PMID: 35897305 PMCID: PMC9332355 DOI: 10.3390/ijerph19158935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/14/2022] [Accepted: 07/21/2022] [Indexed: 02/04/2023]
Abstract
The COVID-19 pandemic has made accessing nutritious foods difficult for older adults and children living in low-income households. The evidence-based preschool nutrition education curriculum Together, We Inspire Smart Eating (WISE) can be used to encourage children to try healthy foods. Written as a single generation curriculum, inviting older adult community members to WISE programming for an intergenerational experience may provide further supports and mutual benefits as participants cooperate towards a common goal. While creators have evaluated implementation of WISE, research has yet to explore factors that influence WISE adoption within an intergenerational setting. We conducted a pilot study using the implementation evaluation framework to explore WISE implementation within single generation and intergenerational settings by measuring five implementation outcomes (fidelity, acceptability, appropriateness, feasibility, and sustainability) through three methods: (1) direct assessment of program fidelity via video coding; (2) indirect assessment of stakeholders’ perceptions of WISE implementation, and (3) a directed qualitative content analysis on annual interview data. Fidelity scores were comparable between the two settings and stakeholder ratings of appropriateness, acceptability, and feasibility of WISE were high. Qualitative data revealed that aspects of WISE are less appropriate for older participants and reiterated known logistical barriers of intergenerational programming that may challenge program sustainability.
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Affiliation(s)
- Rachel M. Scrivano
- The College of Social Work, The Ohio State University, Columbus, OH 43210, USA;
- Correspondence:
| | - Jill J. Juris
- Beaver College of Health Sciences, Appalachian State University, Boone, NC 28608, USA;
| | - Shannon E. Jarrott
- The College of Social Work, The Ohio State University, Columbus, OH 43210, USA;
| | - Jennifer M. Lobb
- College of Food, Agricultural, and Environmental Sciences, The Ohio State University, Columbus, OH 43210, USA;
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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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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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Swindle T, Bellows LL, Mitchell V, Johnson SL, Shakya S, Zhang D, Selig JP, Whiteside-Mansell L, Curran GM. Predictors of sustainment of two distinct nutrition and physical activity programs in early care and education. FRONTIERS IN HEALTH SERVICES 2022; 2:1010305. [PMID: 36925855 PMCID: PMC10012648 DOI: 10.3389/frhs.2022.1010305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
Introduction The goal of the present study was to investigate factors associated with sustainment of two evidence-based programs for nutrition promotion in early care and education (ECE) settings - Food Friends (FF) and Together, We Inspire Smart Eating (WISE). Materials and methods In a cross-sectional study design, ECE directors (N = 55) from centers that had previously been trained in WISE or FF completed a survey. Program-specific measures included Steckler's Perception of Innovations, the Program Sustainability Assessment Tool (PSAT), and the Organizational Readiness for Change Assessment (ORCA). For our primary outcomes, two measures of sustainment were examined: Nutrition Continued Practice (i.e., the use of or general focus on nutrition programs) and Program Fidelity (i.e., how well centers used specific evidence-based practices of WISE or FF). Multiple regression was used to determine the association of these outcomes with program, years since last implementation, and overall scores on predictors. Follow-up correlation analyses were used to investigate outcome relationships with context submeasures due to high intercorrelations between predictor submeasures. Results Nutrition Continued Practice was significantly predicted by program and overall PSAT score. WISE programs had significantly higher Nutrition Continued Practice scores than FF program (p = 0.03). All subscales of the PSAT (e.g., environmental support, funding stability, organizational capacity, program adaptation, communications, and strategic planning) were significantly correlated with Nutrition Continued Practice (all rs > 0.30, all ps < 0.03). Program Fidelity was significantly predicted by PSAT and Steckler Perception of Innovation scores. All subscales of the PSAT were strongly positively correlated with Program Fidelity (all rs > 0.48, all ps < 0.001); relative advantage (r = 0.54, p < 0.001) and level of institutionalization (r = 0.61, p < 0.001) were positively correlated with Program Fidelity. Conclusion This study suggests that factors associated with the continued practice of program principles are partially distinct from those that are associated with the sustainment of specific practices driving program fidelity. Results suggest capacity building strategies may be important for both continued attention to nutrition and physical activity as well as sustaining fidelity to specific evidence-based practices.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Laura L Bellows
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | | | - Susan L Johnson
- Section of Nutrition, Department of Pediatrics, University of Colorado Anschutz, Aurora, CO, United States
| | - Samjhana Shakya
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Dong Zhang
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - James P Selig
- Department of Biostatistics, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Leanne Whiteside-Mansell
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Geoffrey M Curran
- Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, United States.,Center for Mental Health and Outcomes Research, Central Arkansas Veterans Heathcare System, Little Rock, AR, United States
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Violant-Holz V, Rodríguez-Silva C, Carol M, Rodríguez MJ. Impact of cocreation training capsules for preschool teachers on children's healthy habits: a pilot study conducted in Barcelona, Spain. BMC Public Health 2021; 21:2089. [PMID: 34774028 PMCID: PMC8590630 DOI: 10.1186/s12889-021-12160-2] [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: 04/30/2021] [Accepted: 11/02/2021] [Indexed: 11/25/2022] Open
Abstract
Background Healthy habits are essential for preschoolers to have a healthy lifestyle. The promotion of these healthy habits from a holistic approach by preschool teachers guarantees a better quality of life and a healthier society. Using cocreation, we designed training for healthy habit promotion for preschool teachers (all@once). Then, we implemented the training and evaluated its impact on classroom teaching strategies. Methods This study presents the all@once training design and its implementation and evaluation during 2019. The cocreation process involved 8 parents, 9 preschool teachers and 9 health professionals (selected by a nonprobabilistic sampling system according to quotas) to design training from a holistic perspective. To evaluate the all@once impact in classroom practice, a pilot study was undertaken in four public schools in Barcelona (Spain). All@once was implemented with 16 volunteer teachers selected by convenience sampling and 328 children. A mixed methods approach was chosen to collect data based on direct nonparticipating naturalist systematic observations in June and October 2019. After qualitative data categorization, changes in health routines and actions at school were assessed by either contingency table analysis of frequency distributions or nonparametric comparisons of two related samples. Results The cocreation process provided training organized into online capsules with a holistic view of health in four main dimensions (nutrition, hygiene, physical activity and emotional health). Of these dimensions, the emotional health dimension comprised half of the training content. Pilot testing of the impact of all@once on classroom health-related activities evidenced an increase in the likelihood of observing fruit consumption by children, healthy habit promotion and hand washing. The most significant all@once-induced changes that we observed were related to teaching strategies concerning the emotional health dimension of the training. Conclusions This pilot study provides evidence of cocreation being a productive way to design training for preschool teachers regarding inclusive education in integral health. This approach collects the needs of the school community, provides training with a holistic concept of health and effectively impacts classroom routines and family health habits in the short term.
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Affiliation(s)
- Verónica Violant-Holz
- Department of Didactic and Educational Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain.,International Observatory in Hospital Pedagogy, Universitat de Barcelona, Barcelona, Spain
| | - Carlota Rodríguez-Silva
- Department of Didactic and Educational Organization, Faculty of Education, Universitat de Barcelona, Barcelona, Spain
| | - María Carol
- Institute for Lifelong Learning Foundation (IL3-UB), Universitat de Barcelona, Barcelona, Spain.,Current address: Academic Area, Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Manuel J Rodríguez
- Department Biomedical Sciences, Institute of Neurosciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona, c/Casanova 143, E-08036, Barcelona, Spain. .,August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain. .,Networked Biomedical Research Centre for Neurodegenerative Disorders (CIBERNED), Barcelona, Spain.
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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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Bayles J, Peterson AD, Jilcott Pitts S, Bian H, Goodell LS, Burkholder S, Hegde AV, Stage VC. Food-Based Science, Technology, Engineering, Arts, and Mathematics (STEAM) Learning Activities May Reduce Decline in Preschoolers' Skin Carotenoid Status. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:343-351. [PMID: 33349594 PMCID: PMC8044028 DOI: 10.1016/j.jneb.2020.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To assess the effectiveness of food-based science, technology, engineering, arts, and mathematics (STEAM) learning activities on preschoolers' liking of 9 target vegetables and objectively-assessed fruit and vegetable (FV) intake. METHODS Seven hands-on, food-based STEAM learning activities were implemented to expose children to 9 target vegetables in 3 Head Start preschools (11 classrooms) across North Carolina. Child-reported vegetable liking scores and skin carotenoid status (SCS) were dependent variables collected at baseline, midpoint, and posttest. Adjusted repeated-measures ANOVA was used to examine intervention impact. RESULTS A total of 113 children (intervention = 49; comparison = 64) participated. Children were an average age of 3.7 ± 0.57 years at baseline. Mean target vegetable liking scores for the intervention and comparison groups, respectively, were 3.2 ± 0.19 and 3.2 ± 0.17 at baseline, 2.9 ± 0.17 and 3.1 ± 0.15 at midpoint, and 2.8 ± 0.15 and 3.1 ± 0.13 at posttest. A time × group interaction was not significant for target vegetable liking scores. Mean SCS were 268.6 ± 13.24 and 270.9 ± 12.13 at baseline, 271.3 ± 12.50 and 275.6 ± 11.46 at midpoint, and 267.8 ± 11.26 and 229.6 ± 10.32 at posttest for the intervention and comparison groups, respectively. A time × group interaction was significant for SCS (F1,77 = 3.98; P = 0.02; r = 0.10). Both groups declined from baseline to posttest (intervention = 0.06%; comparison = 15.09%), which occurred after winter break, with a smaller decline observed in the intervention group (P = 0.02). CONCLUSIONS AND IMPLICATIONS Food-based STEAM learning activities may present a unique opportunity to affect FV intake while meeting academic standards. More research is needed to understand how liking for familiar FV changes over time and its relationship with consumption. In addition, more implementation research featuring larger sample sizes, teachers as the interventionist, and a longer study duration is needed to confirm the outcomes of food-based STEAM learning observed in the current study and the long-term impact this approach may have on children's' dietary quality.
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Affiliation(s)
- Jocelyn Bayles
- Food-based Early Education (FEEd) Lab, Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Amanda D Peterson
- Food-based Early Education (FEEd) Lab, Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
| | - Stephanie Jilcott Pitts
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC
| | - Hui Bian
- Office for Faculty Excellence, East Carolina University, Greenville, NC
| | - L Suzanne Goodell
- Department of Food, Bioprocessing, and Nutrition Sciences, North Carolina State University, Raleigh, NC
| | - Sarah Burkholder
- Food-based Early Education (FEEd) Lab, Department of Nutrition Science, College of Allied Health Sciences, 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
| | - Virginia C Stage
- Food-based Early Education (FEEd) Lab, Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC.
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Swindle T, Zhang D, Johnson SL, Whiteside-Mansell L, Curran GM, Martin J, Selig JP, Bellows LL. A mixed-methods protocol for identifying successful sustainability strategies for nutrition and physical activity interventions in childcare. Implement Sci Commun 2021; 2:8. [PMID: 33446280 PMCID: PMC7807398 DOI: 10.1186/s43058-021-00108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the importance of sustainability for nutrition and physical activity in public health interventions, limited studies have explored the factors that promote and inhibit evidence-based program sustainment in the childcare setting. This study protocol describes a mixed-methods approach to develop novel sustainability strategies based on real-world settings and stakeholder feedback, with the goal of providing support for future obesity prevention programs and related studies on intervention sustainability. Two interventions, Together, We Inspire Smart Eating (WISE) and The Food Friends' (FF) Fun with New Foods and Get Movin' with Might Moves, are studied to this end. METHODS The study will deploy an explanatory, sequential mixed-methods design. First, the research team will collect a quantitative survey to assess rates of sustainment among WISE and Food Friends sites. We expect to collect 150 surveys from WISE and FF sites combined. Data from these surveys will be used to purposively sample sites for 12 to 18 site visits. Specifically, we will purposively sample low, partial, and high sustaining sites where we will conduct key informant interviews and focus groups as well as validate self-reports on sustainability. Survey content, qualitative interviews, and coding will be based on the Dynamic Sustainability Framework. We will draw on findings from the quantitative survey on predictors of sustainment and the qualitative site visits to understand varying levels of program sustainment. Then, we will utilize evidence-based quality improvement sessions to engage stakeholders in developing a multi-component sustainability strategy. DISCUSSION This study will provide a stakeholder-informed sustainability strategy ready for testing in a full-scale trial examining effects on sustainment of evidence-based nutrition and physical activity practices in childcare. We expect this strategy to be relevant for educators and consistent with the views of administrators as a guide for future practice for the targeted nutrition and physical activity interventions and beyond.
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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
| | - Dong Zhang
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR 72205-7199 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
| | - Geoff 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
| | - 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
| | - James P. Selig
- Department of Biostatistics, University of Arkansas for Medical Sciences, 220 UAMS Campus Dr., #781, Little Rock, AR 72205-7199 USA
| | - Laura L. Bellows
- Division of Nutritional Sciences, Cornell University, Martha Van Rensselaer Hall, Ithaca, NY 14853 USA
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Swindle T, McBride NM, Staley A, Phillips CA, Rutledge JM, Martin JR, Whiteside-Mansell L. Pester Power: Examining Children's Influence as an Active Intervention Ingredient. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:801-807. [PMID: 32773131 PMCID: PMC7422920 DOI: 10.1016/j.jneb.2020.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 06/05/2020] [Accepted: 06/05/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To determine if children's pester power related to a classroom-based nutrition program, Together, We Inspire Smart Eating (WISE), is related to familial dietary habits and parental food purchases and practices. METHODS Classroom teachers delivered weekly WISE lessons at 7 Head Start sites across 2 states in the southern US. Before and after the intervention, parents were interviewed on the consumption of WISE fruits and vegetables, intake of nutrient-poor foods, parenting practices related to food, and exposure to WISE through the child's pester power. RESULTS After controlling for baseline levels of outcome variables, child willingness to try new foods at baseline, and the effect of state, pester power predicated significant variance in the outcomes of consumption of WISE foods (F3, 229 = 34.7, P < .001, ΔR2 = 0.03, P = .002) and parenting practices that support healthy dietary intake and attitudes for young children (F2, 264 = 77.2, P < .001, ΔR2 = 0.02, P = .006). CONCLUSIONS AND IMPLICATIONS The findings of this study highlight the potential for children's influence on food consumption and habits at home.
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Affiliation(s)
- Taren Swindle
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
| | - Nicole M McBride
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Audra Staley
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Collin A Phillips
- Department of Psychology, The University of Texas at Arlington, Arlington, TX
| | - Julie M Rutledge
- Department of Human Ecology, College of Applied and Natural Sciences, Louisiana Tech University, Ruston, LA
| | - Janna R Martin
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Leanne Whiteside-Mansell
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
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Caregiver's Self-Confidence in Food Resource Management Is Associated with Lower Risk of Household Food Insecurity among SNAP-Ed-Eligible Head Start Families. Nutrients 2020; 12:nu12082304. [PMID: 32751930 PMCID: PMC7468708 DOI: 10.3390/nu12082304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/24/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022] Open
Abstract
Food resource management (FRM) behaviors are key components within nutrition education programs designed to help food insecure households maximize their food dollars. However, little is known about the association between FRM self-confidence and financial practices with household food insecurity (HFI) among families with young children. Using a sample of SNAP-Ed-eligible Head Start families, this study examined associations between FRM self-confidence, FRM behaviors and financial practices by HFI. A needs assessment survey was conducted with caregivers of Head Start children (n = 365). HFI was measured using the US Household Food Security Survey Module. Chi-square and logistic regression analyses were conducted to examine if FRM self-confidence, FRM behaviors, and financial practices differed by HFI. Participants with high FRM self-confidence had lower odds of HFI (OR = 0.54, 95%CI: 0.33, 0.87), yet FRM behaviors, financial practices, and HFI were not related after adjusting for covariates. All FRM self-confidence questions significantly differed by HFI, whereas only one of six FRM behaviors and two of three financial practices differed by HFI (all p-values < 0.05). Promoting caregivers' self-confidence in FRM skills within nutrition education programs may be explored as a potential strategy to assist low-income households to stretch their food dollars in an attempt to address HFI.
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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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Evaluation of "Together, We Inspire Smart Eating" (WISE) nutrition intervention for young children: Assessment of fruit and vegetable consumption with parent reports and measurements of skin carotenoids as biomarkers. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2019; 2019. [PMID: 33133327 DOI: 10.1080/19320248.2019.1652127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Resonance Raman spectroscopy (RRS) and parent report were used to assess dietary intake of fruit and vegetable (FV) consumption among young children experiencing a nutrition intervention. The nutrition intervention was "Together, We Inspire Smart Eating" (WISE). The study followed a convenience sample of low-income children in preschool (N=175) and early elementary (N=199) classrooms over an academic school year. Data were collected in a Southern, rural U.S state. Results of pre- and post-assessments indicated statistically improved consumption of FV at follow-up compared to baseline. Results were consistent using both assessment methods supporting the use of either assessment method.
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