Assessment of nutrition and physical activity environments in family child care homes: modification and psychometric testing of the Environment and Policy Assessment and Observation

Abstract

BackgroundEarly care and education (ECE) settings play an important role in shaping the nutrition and physical activity habits of young children. Increasing research attention is being directed toward family child care homes (FCCHs) specifically. However, existing measures of child care nutrition and physical activity environments are limited in that they have been created for use with center-based programs and require modification for studies involving FCCHs. This paper describes the modification of the Environment and Policy Assessment and Observation (EPAO) for use in FCCHs.MethodsThe EPAO underwent a through modification process that incorporated an updated format for the data collection instrument, assessment of emerging best practices, tailoring to the FCCH environment, and creation of a new scoring rubric. The new instrument was implemented as part of a larger randomized control trial. To assess inter-rater reliability, observations on 61 different days were performed independently by two data collectors. To assess construct validity, associations between EPAO scores and measures of children’s dietary intake (Healthy Eating Index (HEI) score) and physical activity (accelerometer-measured minutes per hour of moderate to vigorous physical activity, MVPA) were examined.ResultsThe modified EPAO assesses 38 nutrition and 27 physical activity best practices, which can be summarized into 7 nutrition-related and 10 physical activity-related environmental sub- scores as well as overall nutrition and overall physical activity scores. There was generally good agreement between data collectors (ICC > 0.60). Reliability was slightly lower for feeding practices and physical activity education and professional development (ICC = 0.56 and 0.22, respectively). Child HEI was significantly correlated with the overall nutrition score (r = 0.23), foods provided (r = 0.28), beverages provided (r = 0.15), nutrition education and professional development (r = 0.21), and nutrition policy (r = 0.18). Child MVPA was significantly associated with overall time provided for activity (r = 0.18) and outdoor playtime (r = 0.20). There was also an unexpected negative association between child MVPA and screen time (−0.16) and screen time practices (r = −0.21).ConclusionsThe EPAO for the FCCH instrument is a useful tool for researchers working with this unique type of ECE setting. It has undergone rigorous development and testing and appears to have good psychometric properties.Trial registration NCT01814215, March 15, 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4686-9) contains supplementary material, which is available to authorized users.

Nutrition-Related Practices of Family Child Care Providers and Differences by Ethnicity

“…30,[43][44][45][46][47] We used the adapted EPAO for FCCH, which has good inter-rater reliability between data collectors for most nutrition measures. 48 Based on formative research, we made additional modifications to reflect cultural differences in our population. For example, we added food items such as plantains, yautia, and yucca as starches in the ''Potatoes'' section and ''other sugary drinks'' to the ''Beverages'' section to capture homemade sugary beverages.…”

“…Field observers underwent intensive multiday training, including video scenarios and mock practice field observations. 44,48 To receive EPAO certification, field observers had to achieve 85% agreement with ''gold standard'' staff from the University of North Carolina who developed the EPAO. Extensive quality control and retraining were conducted on an ongoing basis.…”

“…Extensive quality control and retraining were conducted on an ongoing basis. 44,48 Meeting NAP SACC guidelines. To determine whether FCCPs met NAP SACC nutrition guidelines, we developed algorithms to compare each observed nutrition practice with its associated NAP SACC guideline (Table 3).…”

The family child care home environment and children's diet quality

“…We used the previously developed Environment and Policy Assessment and Observation (EPAO) (Ward et al, 2008) instrument that was modified to assess the family child care home nutrition environment (Vaughn et al, 2017). The instrument has been used in numerous previous studies to assess child care environments (Benjamin Neelon et al, 2016b; Messiah et al, 2017; LaRowe et al, 2016; O’Neill, Dowda, Benjamin Neelon, Neelon, & Pate, 2017).…”

Activating Childcare Environments for All Children: the Importance of Children’s Individual Needs

“…At each childcare center, the physical environment regarding SB and PA was assessed by a trained research assistant. A standardized observation protocol was applied, based on the updated Environment and Policy and Assessment Observation (EPAO; [ 27 ]). Portable and fixed play equipment were separately rated for indoors or outdoors, as either present or not.…”