Barriers and facilitators to obesity prevention dissemination and implementation efforts in the childcare centre setting from the provider perspective

Abstract

Background It has been established that the childcare centre (CCC) is a setting suitable for healthy weight promotion efforts. As the field advances, it is important to understand the barriers and facilitators to early childhood obesity prevention implementation and dissemination efforts from the CCC providers' perspective. This is especially true among those who serve low‐income and diverse populations to maximize scalability success. Methods Focus groups were held in English or Spanish with CCC providers across six CCCs who implemented healthy caregivers–healthy children (HC2), an early childhood healthy weight promotion programme targeting 2‐ to 5‐year‐olds from low‐resource backgrounds. Centres represented both rural and urban environments. Focus groups were audio recorded, transcribed, and coded. A thematic analysis that combined a deductive and inductive approach was conducted. Codes were analysed using Dedoose to identify general themes and subthemes. Results CCC providers stated that (a) children understood the nutritional benefits of healthy foods; (b) improved cognitive development as a result of HC2; (c) parents were barriers to HC2 implementation efforts, particularly in terms of cooperative healthy lifestyle efforts; and (d) modelling healthy eating and making healthy CCC environmental changes facilitated HC2 implementation. Overall, HC2 was well received by CCC teachers, and they shared creative classroom HC2 adaptions and improvements. Conclusions CCC providers can provide valuable insight to guide early childhood healthy weight promotion programme dissemination and implementation efforts. Although they value the implementation of HC2 programme in their classroom settings, they perceive parents as somewhat obstructive. This information is critical to informing future healthy weight promotion efforts in this setting, especially among low‐resource families. It is important to continue to include the CCC provider viewpoint in future obesity prevention efforts to maximize scalability and sustainability efforts.

Perceived factors that influence adoption, implementation and sustainability of an evidence-based intervention promoting healthful eating and physical activity in childcare centers in an urban area in the United States serving children from low-income, racially/ethnically diverse families

“…In most cases, centers were already promoting physical activity and healthful eating in some form; therefore, many viewed the EBI as compatible with existing practices and could reinforce what they were already doing. Compatibility has been recognized as a facilitator to program adoption based on previous studies of physical activity and nutrition interventions delivered in childcare settings (22)(23)(24)(25)(26)(27)(28)(29)(30). For example, EBIs that "fit well within existing curricula"), "enhanced the classroom, " or were aligned with existing "preschool and government health objectives" were considered facilitators to implementation (23, 24, 27).…”

“…Similar adaptations have been identified in previous studies. These studies included settings with predominantly white populations (e.g., Sweden and Scotland); however, the income status of families with children enrolled in the centers was not reported (23,27,31,32) as is often the case in many of these studies. The theme of adaptability was also found in studies conducted in Head Start centers which serve low-income families (26, 33, 34), which is more similar to the target population in our study.…”

Information and communication technologies vs. traditional approaches targeting parents to improve healthy diet or body mass index in preschoolers: a systematic review

“…Moreover, studies had fictional characters as fruits and vegetables for its stories, but the characters used in the intervention with positive effects, were preschool-aged children and animals. Information and communication technologies vs. traditional approaches targeting parents to improve healthy diet or body mass index in preschoolers: a systematic review been previously described as a barrier to obesity prevention in childcare settings instead of being a facilitator, because some parents did nothing for their children to eat healthier when only received information 31 .…”

How involved are parents in their child's early years setting's food decisions and practices?

“…Thus there is a need to strengthen the limited evidence available on parents' experience of ‘being involved’ ‘participating’ or ‘engaged’ in their child's food and nutrition in EYS, or of their perception of their roles and responsibility in this ( Briley et al., 1999 ; Lloyd-Williams et al., 2011 ; Moore et al., 2005 ). Existing studies report that barriers and tensions exist on both sides, with parents feeling patronized by EYS staff ‘educating’ them, or viewing EYS staff as ‘too busy’ to engage in conversations on food; and EYS staff being unsure of how to communicate about good nutrition without offending parents, and viewing parents as an obstacle to healthy eating by continuing to supply their child with unhealthy snacks and food options ( Dev et al., 2017 ; Drake, 1991 ; Lebron et al., 2020 ; McSweeney et al., 2016 ; Moore et al., 2005 ).…”