Barriers and Facilitators of Parent Engagement with Health Promotion in Child Care: A Mixed-Methods Evaluation

BACKGROUND: Early care and education providers cite lack of parent engagement as a central barrier to promoting healthy behaviors among young children. However, little research exists about factors influencing parent engagement with promoting healthy eating and activity behaviors in the this setting. AIMS: This study aimed to address this gap by examining low and high parent engagement with the Healthy Me, Healthy We campaign to identify barriers and facilitators of parent engagement with the intervention. METHOD: This comparative case study used an explanatory sequential mixed-methods approach. We created center-level parent engagement scores using process evaluation data from the effectiveness trial of Healthy Me, Healthy We. Recruitment focused on centers with the five lowest and five highest scores. Twenty-eight adults (7 directors, 9 teachers, 12 parents) from seven centers (3 low engagement, 4 high engagement) completed semistructured interviews and the Family and Provider/Teacher Relationship Quality measure. Analytic approaches included descriptive statistical analyses for surveys and a framework-informed thematic analysis for interviews. RESULTS: Prominent contrasts between low- and high-engagement groups involved center culture for parent engagement and health promotion, practices for fostering networks and communication within centers, and communication between centers and parents. Personal attributes of providers (e.g., attitudes) also differentially influenced practices for engaging parents. DISCUSSION AND CONCLUSION: Organizational characteristics and individual practices can facilitate or impede parent engagement with health promotion efforts. Assessing organizational context, gaining input from all stakeholders, and conducting capacity-building interventions may be critical for laying the foundation for positive relationships that support parent engagement in implementation of health promotion programs and beyond

A systematic review of interventions for promoting active transportation to school

<p>Abstract</p> <p>Background</p> <p>Active transportation to school is an important contributor to the total physical activity of children and adolescents. However, active school travel has declined over time, and interventions are needed to reverse this trend. The purpose of this paper is to review intervention studies related to active school transportation to guide future intervention research.</p> <p>Methods</p> <p>A systematic review was conducted to identify intervention studies of active transportation to school published in the scientific literature through January 2010. Five electronic databases and a manual search were conducted. Detailed information was extracted, including a quantitative assessment comparing the effect sizes, and a qualitative assessment using an established evaluation tool.</p> <p>Results</p> <p>We identified 14 interventions that focused on active transportation to school. These interventions mainly focused on primary school children in the United States, Australia, and the United Kingdom. Almost all the interventions used quasi-experimental designs (10/14), and most of the interventions reported a small effect size on active transportation (6/14).</p> <p>Conclusion</p> <p>More research with higher quality study designs and measures should be conducted to further evaluate interventions and to determine the most successful strategies for increasing active transportation to school.</p

Efficacy of an Enhanced Implementation Strategy to Increase Parent Engagement with a Health Promotion Program in Childcare

Previous efforts to involve parents in implementation of childcare-based health promotion interventions have yielded limited success, suggesting a need for different implementation strategies. This study evaluated the efficacy of an enhanced implementation strategy to increase parent engagement with Healthy Me, Healthy We. This quasi-experimental study included childcare centers from the second of two waves of a cluster-randomized trial. The standard approach (giving parents intervention materials, prompting participation at home, inviting participation with classroom events) was delivered in 2016–2017 (29 centers, 116 providers, and 199 parents). The enhanced approach (standard plus seeking feedback, identifying and addressing barriers to parent participation) was delivered in 2017–2018 (13 centers, 57 providers, and 114 parents). Parent engagement was evaluated at two levels. For the center-level, structured interview questions with providers throughout the intervention were systematically scored. For the parent-level, parents completed surveys following the intervention. Differences in parent engagement were evaluated using linear regression (center-level) and mixed effects (parent-level) models. Statistical significance was set at p \u3c 0.025 for two primary outcomes. There was no difference in parent engagement between approaches at the center-level, β = −1.45 (95% confidence interval, −4.76 to 1.87), p = 0.38l. However, the enhanced approach had higher parent-level scores, β = 3.60, (95% confidence interval, 1.49 to 5.75), p \u3c 0.001. In the enhanced approach group, providers consistently reported greater satisfaction with the intervention than parents (p \u3c 0.001), yet their fidelity of implementing the enhanced approach was low (less than 20%). Results show promise that parent engagement with childcare-based health promotion innovations can positively respond to appropriately designed and executed implementation strategies, but strategies need to be feasible and acceptable for all stakeholders

Effectiveness of an active commuting school-based intervention at 6-month follow-up

Active commuting to school may provide a significant source of physical activity in youth. Previous school-based intervention studies have shown a positive effect on increasing the frequency of active commuting to school in the short-term. However, how the observed effects are after the intervention remains to be investigated. The objective of the present study was to investigate the effects of a school-based intervention on active commuting to school at 6-month follow-up

Contributions of Early Care and Education Programs to Diet Quality in Children Aged 3 to 4 Years in Central North Carolina

BACKGROUND: Parents and early care and education (ECE) are the key influencers of young children\u27s diets, but there is limited information about how each contribute to children\u27s overall diet quality. OBJECTIVE: This study aimed to determine what proportion of children\u27s dietary intake occurs within the ECE setting and whether diet quality is higher at ECE centers and, consequently, on weekdays than weekends. DESIGN: This cross-sectional analysis of a larger cluster randomized controlled trial used multiple 24-hour dietary intakes measured through a combination of the Dietary Observation in Child Care protocol and parent-reported food diaries. PARTICIPANTS/SETTING: Participants (N=840) included children aged 3 to 4 years enrolled in ECE centers in central North Carolina for whom 24-hour dietary intake was captured via observation of meals and snacks consumed at ECE and parent-report of all remaining meals and snacks. Data were collected from 2015 to 2016. MAIN OUTCOME MEASURES: Diet quality at ECE and elsewhere was evaluated using the Healthy Eating Index 2015. STATISTICAL ANALYSES PERFORMED: Mixed-effects models were used to determine differences in mean Healthy Eating Index 2015 component and total scores. Models were adjusted for children\u27s age and sex and accounted for clustering within ECE centers and families. RESULTS: Children consumed approximately 40% of daily energy, nutrients, and food groups at ECE centers. The mean total Healthy Eating Index 2015 score was higher for foods and beverages consumed at ECE centers (58.3±0.6) than elsewhere (52.5±0.6) (P \u3c 0.0001). The mean total Healthy Eating Index 2015 score was also higher on weekdays (58.5±0.5) than on weekends (51.3±0.5) (P \u3c 0.0001). CONCLUSIONS: Children consume a majority of dietary intake away from ECE centers. Overall, diet quality is low, but the quality of foods consumed by children at ECE centers is higher than that consumed elsewhere. ECE centers remain an important source of nutrition and further investigation is warranted to identify ways to support both ECE centers and families to provide healthier eating environments

Change in Physical Activity Participation Among Adolescent Girls from 8th to 12th Grade

Background: Physical activity levels of girls decline in adolescence, but little is known about changes in participation in specific types of physical activity. This study examined change in participation in specific activities during adolescence in girls. Methods: Girls (N=398, age 13.6 ± 0.6 y at baseline, 58.5% African American) from 31 middle and 24 high schools in South Carolina completed the 3-Day Physical Activity Recall (3DPAR) in 8th, 9th, and 12th grades. Girls reported their predominant activity and its intensity level in each 30-min time block on the previous 3 d. Results: Vigorous physical activity declined from 45.4% in 8th grade to 34.1% in 12th grade. The probability of participating in several forms of vigorous physical activity in 12th grade was strongly associated with participation in those activities in 8th grade. Conclusion: Early-in-life participation in sports and other forms of vigorous physical activity are important to the maintenance of physical activity during adolescence in girls

Expert and Stakeholder Consensus on Priorities for Obesity Prevention Research in Early Care and Education Settings

Early childhood is a formative period for many weight-related behaviors (diet and activity), but little obesity prevention research targeting this age group has been conducted. Early care and education settings are a useful avenue for interventions targeting young children, but the limited research provides insufficient evidence upon which to base policy decisions, practice guidelines, or mobilized efforts to improve healthy eating and physical activity, and ultimately healthy weight development in these settings

A cross-sectional study of demographic, environmental and parental barriers to active school travel among children in the United States

[Background] Promoting daily routine physical activities, such as active travel to school, may have important health implications. Practitioners and policy makers must understand the variety of factors that influence whether or not a child uses active school travel. Several reviews have identified both inhibitors and promoters of active school travel, but few studies have combined these putative characteristics in one analysis. The purpose of this study is to examine associations between elementary school children’s active school travel and variables hypothesized as correlates (demographics, physical environment, perceived barriers and norms). [Methods] The current project uses the dataset from the National Evaluation of Walk to School (WTS) Project, which includes data from 4th and 5th grade children and their parents from 18 schools across the US. Measures included monthly child report of mode of school travel during the previous week (n = 10,809) and perceived barriers and social norms around active school travel by parents (n = 1,007) and children (n = 1,219). Generalized linear mixed models (GLMM) with log-link functions were used to assess bivariate and multivariate associations between hypothesized correlates and frequency of active school travel, assuming random school effect and controlling for the distance to school. [Results] The final model showed that the most relevant significant predictors of active school travel were parent’s perceived barriers, specifically child resistance (Estimate = −0.438, p < 0.0001) and safety and weather (Estimate = −0.0245, p < 0.001), as well as the school’s percentage of Hispanic students (Estimate = 0.0059, p < 0.001), after adjusting for distance and including time within school cluster as a random effect. [Conclusions] Parental concerns may be impacting children’s use of active school travel, and therefore, future interventions to promote active school travel should more actively engage parents and address these concerns. Programs like the Walk to School program, which are organized by the schools and can engage community resources such as public safety officials, could help overcome many of these perceived barriers to active transport.This study was supported by a cooperative agreement from the Centers for Disease Control and Prevention, Special Interest Project (SIP 09–02). The project was conducted out of the Center for Health Promotion and Disease Prevention, a Prevention Research Center funded through a cooperative agreement with the Centers for Disease Control and Prevention (U48-DP001944)

Measuring the Physical Activity Practices Used by Parents of Preschool Children

Parents play a critical role in shaping children’s attitudes, beliefs and behaviors, including those around physical activity and inactivity. Our ability to identify which practices effectively promote children’s physical activity and limit inactivity is limited by existing measurement instruments. This project will present a newly developed physical activity parenting practices survey, the psychometric properties of this survey’s scales, and their association with child physical activity and screen time behaviors

Reliability and validity of a nutrition and physical activity environmental self-assessment for child care

<p>Abstract</p> <p>Background</p> <p>Few assessment instruments have examined the nutrition and physical activity environments in child care, and none are self-administered. Given the emerging focus on child care settings as a target for intervention, a valid and reliable measure of the nutrition and physical activity environment is needed.</p> <p>Methods</p> <p>To measure inter-rater reliability, 59 child care center directors and 109 staff completed the self-assessment concurrently, but independently. Three weeks later, a repeat self-assessment was completed by a sub-sample of 38 directors to assess test-retest reliability. To assess criterion validity, a researcher-administered environmental assessment was conducted at 69 centers and was compared to a self-assessment completed by the director. A weighted kappa test statistic and percent agreement were calculated to assess agreement for each question on the self-assessment.</p> <p>Results</p> <p>For inter-rater reliability, kappa statistics ranged from 0.20 to 1.00 across all questions. Test-retest reliability of the self-assessment yielded kappa statistics that ranged from 0.07 to 1.00. The inter-quartile kappa statistic ranges for inter-rater and test-retest reliability were 0.45 to 0.63 and 0.27 to 0.45, respectively. When percent agreement was calculated, questions ranged from 52.6% to 100% for inter-rater reliability and 34.3% to 100% for test-retest reliability. Kappa statistics for validity ranged from -0.01 to 0.79, with an inter-quartile range of 0.08 to 0.34. Percent agreement for validity ranged from 12.9% to 93.7%.</p> <p>Conclusion</p> <p>This study provides estimates of criterion validity, inter-rater reliability and test-retest reliability for an environmental nutrition and physical activity self-assessment instrument for child care. Results indicate that the self-assessment is a stable and reasonably accurate instrument for use with child care interventions. We therefore recommend the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) instrument to researchers and practitioners interested in conducting healthy weight intervention in child care. However, a more robust, less subjective measure would be more appropriate for researchers seeking an outcome measure to assess intervention impact.</p