Modifying the Environment and Policy Assessment and Observation (EPAO) to better capture feeding practices of family childcare home providers

Abstract

Objective: To describe the modification and validation of an existing instrument, the Environment and Policy Assessment and Observation (EPAO), to better capture provider feeding practices. Design: Modifications to the EPAO were made, validity assessed through expert review, pilot tested and then used to collect follow-up data during a two-day home visit from an ongoing cluster-randomized trial. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. To test predictive validity of the factors, multi-level mixed models examined associations between factors and child’s diet quality as captured by the Healthy Eating Index (HEI) score (measured via the Dietary Observation in Childcare Protocol). Setting: Family child care homes (FCCH) in Rhode Island and North Carolina. Subjects: The modified EPAO was pilot tested with 53 FCCH and then used to collect data in 133 FCCH. Results: “The final 3-factor solution captured 43% of total variance: coercive control and indulgent feeding practices, autonomy supportive practices, and negative role modeling. In multi-level mixed models adjusted for covariates, autonomy supportive practices was positively associated with children’s diet quality. A 1-unit increase in the use of autonomy supportive practices was associated with a 9.4 unit increase in child HEI score (p=0.001). Conclusions: Similar to the parenting literature, constructs which describe coercive controlling practices and those which describe autonomy supportive practices emerged. Given that diets of preschoolers in the US remain suboptimal, teaching childcare providers about supportive feeding practices may help improve children’s diet quality.

Providers’ response to child eating behaviors: A direct observation study

“…playing with food, talking, leaving the table, “all done”). These examples were identified based on previous work video-taping provider-child interactions in FCCHs in Rhode Island (Tovar A, June 2015) and discussions between investigators and experienced data collectors. While these specific examples were given to data collectors to provide guidance around appropriate types of interaction to capture, data collectors were also instructed to capture descriptions of any observed interactions they thought might be relevant.…”

Feeding practices in Australian early childhood education and care settings

“…There are also limitations regarding the use of EPAO-2017 (19) . New items were recently developed and tested in family day-care homes, to capture educator feeding practices more comprehensively across the domains of autonomy support, structure and coercive control (33) . The EPAO-2017 also does not consider the frequency with which a practice occurs during an eating occasion.…”

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

“…Various nutrition practices are recommended to enhance the quality of the overall ECE classroom "nutrition environment," with ultimate goals to improve appropriate dietary intake, food preference, and lifelong health outcomes for young children. Specific practices to improve the nutrition environment include serving high-quality and a variety of foods [6][7][8]; providing healthy lifestyle learning materials in the classroom, such as nutrition-promoting books and posters [6]; and implementing staff nutrition behaviors [9]. Staff nutrition behaviors, also referred to as mealtime best practices, may include sitting with children during meals [9], enthusiastic role modeling of consuming healthful foods [10][11][12], involving children in meal preparation [13], and talking with children about healthy foods [14,15].…”