An Implementation Approach Comparison of a Child Care Center-Based Obesity Prevention Program

Abstract

Objective: To compare the effectiveness of the Healthy Caregivers-Healthy Children (HC2) phase 1 (2011–2014) and 2 (2015–2018) child care center (CCC)-based obesity prevention intervention(s) on child dietary practices and body mass index percentile (PBMI) outcomes over 2 years. Phase 1 was implemented via a university-based research team, and phase 2 was delivered via a train-the-trainers approach (university-based research team trains preschool-based coaches, who in turn train CCC teachers to implement and disseminate HC2). Methods: Phase 1 and 2 were both cluster randomized controlled trials of the HC2 obesity prevention intervention. Phase 1 was composed of 1224 children in 28 CCCs (12 intervention and 16 control). Phase 2 was composed of 825 children in 24 CCCs (12 intervention and 12 control). Both phases included CCCs serving low-resource, predominantly ethnic minority families. Results: The mean rate of weekly fruit consumption significantly increased (β = 0.16, p = 0.001) in phase 1, whereas vegetable intake significantly increased (β = 0.16, p = 0.002) in phase 2 intervention CCCs. Fried (β = −0.36, p < 0.001), fast (β = −0.16, p = 0.001), and other unhealthy food (β = −0.57, p < 0.001) consumption significantly decreased in phase 1 only. The mean rate of snack food consumption significantly decreased in phase 2 (β = −0.97, p < 0.001). Mean child PBMI remained in the healthy range over 2 years for all groups in both study phases. Conclusion: A university-based research team implementation and dissemination approach seemed to be more effective than a train-the-trainers implementation method in improving dietary intake patterns. This finding suggests that CCCs may need robust educational support beyond their existing internal resources for long-term positive dietary intake pattern changes.

Assessing the scalability of healthy eating interventions within the early childhood education and care setting: secondary analysis of a Cochrane systematic review

“…Regarding the sustainability domain, only six (16 %) studies reported on the sustainability of the intervention (i.e. assessed as reporting study outcomes ≥ 12 months post intervention (32,33,39,47,52,54) . The sustainability of the required infrastructure (including funding, resources, processes and delivery workforce) for intervention delivery, however, was rarely reported.…”

“…Three ISAT domains (political and strategic context, fidelity and adaptation and reach and acceptability) contained two criteria, and therefore could receive a ‘Partial’ rating. Seventeen (45 %) studies fully reported on the political and strategic context domain of the ISAT (31,35,36,40,41,45,50,51,53,54,56,59–64) , eighteen (47 %) studies reported partial data (32–34,38,39,42–44,46–48,52,55,58,65–68) and three (8 %) studies did not report this domain at all (57,69,70) . For those studies partially reporting data, this included one study only reporting context and seventeen studies only reporting on funding sources.…”

“…Reach and acceptability were reported in full for sixteen (42 %) studies (34,37,40–42,44,45,47,48,51,53,56,59,61,64,65) , partially for eighteen (47 %) studies (31–33,35,36,38,39,46,50,52,54,55,57,58,60,63,69,70) and was not reported for four (11 %) studies (43,66–68) . For those studies partially reporting data, this included fifteen studies only reporting reach and three studies only reporting acceptability.…”