Childhood obesity is a major epidemic in the United States with one in four preschool children being overweight or obese (CDC 2018). Five-year-old children who are overweight are four times more likely to become obese by eighth grade than normal weight children (Cunningham et al. 2014). This trend continues into adulthood and is associated
Obesity and overweight in early childhood have detrimental impacts on children’s health and development. Changing policy, system and environmental features focused on physical activity and healthy eating behaviors as part of health promotion interventions can play a key role in prevention strategies in early childhood education settings. These types of changes can have broad reach and are often sustained over time, which allows for impact on children who enter the early childhood education setting year after year. However, there is currently a gap between the generation of evidence for health promotion programs and their application into practice. This study used qualitative methods to evaluate intervention-, organizational- and individual-level factors within a dissemination and implementation framework that may be related to the implementation of a health-promoting intervention in early childhood education settings. Intervention-level factors, including feasibility and adaptability, organizational-level factors, including staff and leadership engagement, and individual-level factors, including attitudes, skills and knowledge, were identified as constructs that impacted the successful implementation of the intervention. These findings provide insight into core dissemination and implementation constructs that should be targeted by obesity prevention interventions in early childhood education settings to ensure maximum impact on sustainable behavior change.
Background: Early childhood education (ECE) working environments often contribute to poor health outcomes. The purpose of this study was to describe healthy eating–related and physical activity–related awareness and adoption of behavior change of ECE providers after participating in a workplace wellness (WW) program and to explore facilitators and barriers to ECE provider participation in WW program. Methods: The WW program offered healthy eating and physical activity challenges to promote ECE provider health and well-being. Approximately 1,000 ECE providers in Colorado from 35 ECE settings were invited to participate. After the intervention, ECE providers completed two surveys: (a) a provider postsurvey and (b) a WW challenge survey. Multivariable logistic regression modeling was used to examine factors associated with percent agreement that participation in the WW program increased awareness and adoption of health behaviors. Findings: A total of 250 (25%) ECE providers participated in WW program from 2015 to 2017. After participation, approximately 84% of respondents agreed they were more aware of the importance of eating fruits and vegetables and of being physically active, while 81% reported eating more fruits and vegetables, and 80% reported being more physically active in the workplace. Logistic regression models found that the length of time teaching in ECE settings was positively and significantly associated (odds ratio [OR] = 1.10, 95% confidence interval [CI] = [1.00, 1.21]) with the odds of providers agreeing that participation in the WW program increased their awareness of health behaviors. Conclusion/Application to Practice: The design and implementation of WW programs that emphasize facilitators, such as intrinsic and extrinsic motivation, as well as reduce barriers, such as time constraints and unachievable goal setting, may increase the awareness and adoptions of healthy eating–related and physical activity–related behaviors among ECE work settings.
Research Findings. Application of mixed methods in a dissemination and implementation framework can give researchers a better understanding of the reach and delivery of early childhood obesity prevention programs in preschool settings, as well as potential facilitators and barriers related to implementation and sustainability. This study utilized a simultaneous, exploratory, mixed-methods design to investigate individual-, organizational-, and intervention-level factors that were related to the implementation and sustainability of policy, system, and environment (PSE) changes as part of a larger obesity prevention program in a randomly selected sample of preschool centers ( n = 20). Individual-level factors, and specifically the attitudes and skills of preschool providers, were identified in both the qualitative and quantitative data as important factors related to the sustainability of PSE changes ( r = .56, p < .01). Staff and leadership engagement and adaptability of the program were also identified as important factors related to the implementation and sustainability of PSE changes. Practice or Policy. These findings highlight the complexity of implementation success and suggest PSE obesity prevention interventions in preschool centers require the consideration of numerous, multilevel factors to ensure programming is impactful and sustained over time.
Objective: The Healthy Environment Project (HEP) was designed to improve familiarity with attitudes, confidence and knowledge related to health-promoting best practices, as well as the implementation of health-promoting policy, system and environment best practice change in diverse early childhood education settings. Design: Pre–post study design to assess the outcomes of the HEP intervention. Setting: Early childhood education providers representing 14 centres ( n = 117) and 30 homes ( n = 30) in Colorado, USA. Method: The Policy, System and Environment Change Process, which is an evidence-based strategic planning process based on intervention mapping, was facilitated in a professional development training format in 44 early childhood education settings. Results: Pre–post survey data ( n = 125) suggest that early childhood education providers’ familiarity with, knowledge of, and confidence related to the implementation of health-promoting policy, system and environment change significantly increased after the professional development training ( p < .05). No significant differences in these individual-level constructs were found between centre-based and home-based providers. The HEP also resulted in significant changes in environmental-level constructs; 154 total health-promoting changes (averaging 3.5 changes/setting) were implemented in 44 early childhood education settings. Conclusion: Facilitation of a strategic planning process in a professional development training format resulted in improvements in individual- and environmental-level constructs related to healthy eating and physical activity behaviours and provides a novel way to foster sustainable health-promoting environments in early childhood education centres and homes.
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