Interventions to promote healthy environments in family child care homes in Oklahoma—Happy Healthy Homes: study protocol for a randomized controlled trial

Abstract

Background Early childhood is a critical period of development. Caregivers, including providers of early care and education (ECE), have a substantial influence on the health of young children. Family child care homes (FCCHs), which are small, licensed ECE businesses operated out of the residences of providers, are important settings for promoting child health. However, to date, few interventions to promote the health of children have been developed for FCCHs. The purpose of this article is to describe the protocol for Happy Healthy Homes, a pilot interdisciplinary, community-based study to improve FCCH environments and the health of children in Oklahoma. We describe the development and evaluation of two interventions to be tested in a matched attention randomized controlled trial: 1) a nutrition intervention aimed at enhancing the nutritional quality of meals served to young children, incorporating the Child and Adult Care Food Program best practices, and improving nutritional self-efficacy of providers; and 2) an environmental intervention aimed at increasing providers’ environmental health literacy, self-efficacy for integrated pest management (IPM), and awareness of less toxic cleaning practices and FCCH provider cleaning behaviors. Methods Both interventions are informed by common theoretical principles and are matched in attention (i.e., 6 h), format (i.e., two individual 90-min educational home visits and a 3-h small group class) and materials (i.e., tool kit of educational materials and supplies tailored to the allocated intervention). A randomized trial of both interventions is currently underway with 52 FCCH providers in the Oklahoma City metropolitan area who participate in the Child and Adult Care Food Program. Observed and self-reported measures will be collected at baseline, and 3 months and 12 months after baseline measurements. Randomization to one of the two interventions will occur after baseline data collection. Discussion This study aims to support FCCH providers in creating healthier FCCH environments for nutrition and environmental health. Successful completion will provide critical information about the nutritional quality and the environmental health of children in FCCHs, as well as much needed evidence about the efficacy of two community-based interventions to improve the nutrition and environmental health of children in home-based ECE settings. Trial registration Clinicaltrials.gov, NCT03560050 . Retrospectively registered on 23 May 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3616-9) contains supplementary material, which is available to authorized users.

Quality of Nutrition Environments, Menus and Foods Served, and Food Program Achievement in Oklahoma Family Child Care Homes

“…Our findings are consistent with previous literature reporting lower implementation of recommended nutrition practices in FCCHs than in other ECE contexts [44,45]. To date, there have been few nutrition education interventions offered to and evaluated specifically for FCCHs [34,46]. Our findings and those from previous research indicate a need for tailored interventions that will support FCCH providers in overcoming context-specific barriers for nutrition practices with lowest implementation.…”

“…This a cross-sectional analysis of baseline data collected in Happy Healthy Homes, a study of interventions to promote healthier FCCH environments [34]. To be eligible for this study, providers were required to: (1) be a licensed FCCH enrolled in the Child and Adult Care Food Program (CACFP); (2) provide care for at least one child between the ages of 2-5 years; (3) be located within a 60 mile radius of the University of Oklahoma Health Sciences Oklahoma City campus; and (4) prepare and serve meals for the children in their care.…”

Cleaning Products Commonly Used in Oklahoma Family Child Care Homes: Implications for Respiratory Risk and Children’s Health

“…This study used baseline data collected in Happy Healthy Homes, a randomized, matched-attention, controlled intervention trial aimed at FCCH providers ( n = 50); a detailed study protocol has been previously published [ 40 ] and the trial is registered with Clinicaltrials.gov (NCT03560050). FCCH providers were: (i) licensed FCCHs serving at least one 2-to-5-year-old child; (ii) caring for low-income children and participating in the Child and Adult Care Food Program; (iii) located within the Oklahoma City metropolitan area (approximately a 60-mile radius); and (iv) planning to remain in business for at least 12 months.…”

Family child care home providers’ self-reported nutrition and physical activity practices, self-efficacy, barriers and knowledge: baseline findings from happy healthy homes

“…The current study examined baseline measures of Happy Healthy Homes, a randomised attention-matched controlled trial of FCCH providers, described elsewhere (27) . Providers were recruited through food programme sponsoring organisations and direct phone calls to FCCH.…”

“…Inclusion criteria were participation in the food programme, serving at least one child who was 2-to-5 years old, being located within 60 miles of the metro area, and planning to remain in business for at least 12 months. Recruitment goals were based on the necessary power for the intervention effect (27) . A financial incentive of $30 was provided for baseline.…”