The Childcare Center: an Untapped Opportunity to Engage and Educate Families in Healthy Behaviors

Abstract

Obesity rates in preschool children are high and disproportionately affect low-income children of color in the USA. Since 80% of preschool children spend ∼40 h/week in out-of-the home childcare, childcare centers are promising sites for obesity prevention interventions. Mixed methods were used to develop, implement, and assess the feasibility of an obesity prevention program for children 2-5 years. The intervention which consisted of brief (1-3 min), interactive, educational modules was developed by content experts and parents (n = 20) and targeted four areas (milk, sugar sweetened beverages, screen time, and physical activity). The modules were delivered by community health workers in the childcare center during pick-up and drop-off times, in small groups and home visits upon request. Focus groups with childcare center staff (n = 28) assessed satisfaction and interest in incorporating the intervention into care. Between February 2013 and March 2014, 354 caregivers (∼73%) at six centers participated in one or more educational sessions. Of children, 37.4% in 2013 and 35.9% in 2014 were overweight or obese. Children entering preschool in 2014 were more likely to be overweight/obese than children who had been in the center since 2013 (36.2 vs 23.2%, p < 0.05). Childcare staff endorsed the intervention and received training to continue the program. Brief, interactive health-related behavior-change interventions engaged large numbers of low-income caregivers at childcare centers and resonated with center staff. Childcare center staff represent an underutilized resource to combat the childhood obesity epidemic.

The role and impact of community health workers in childhood obesity interventions: a systematic review and meta‐analysis

“…Most interventions were delivered in the United States, with the exception of two studies that were based in Auckland, New Zealand and Melbourne, Australia . Three of the American studies were based in California , and three were based in New England ; most American studies were based in urban settings . Sample sizes varied, ranging from 33 to 3,765 (mean 792, SD 72; 9 with samples <1,000).…”

“…Sample sizes varied, ranging from 33 to 3,765 (mean 792, SD 72; 9 with samples <1,000). Target ages included children from throughout the developmental spectrum; sample ages ranged from 24 months (mothers recruited during pregnancy) , young children (3–5 years) , school age (5–12 years) , to adolescents . No intervention was gender‐specific.…”

“…No intervention was gender‐specific. Other sample characteristics included Latino/Latina , American Indian , African American , from low income households and/or receiving care at Federally Qualified Health Center , or diagnosed with asthma . The intervention based in New Zealand contained approximately 50% children of Maori/Pacific ethnicity .…”

“…Six of the 11 interventions focused on children with overweight and obesity or obesity only . Most interventions lasted 6–12 months (mean 15.8 months, SD 1.4 months), although the shortest lasted 10 weeks and the longest lasted 3.5 years . Theoretical models and frameworks guiding interventions included Social Cognitive Theory , the Chronic Care Model , Health Belief Model , Transtheoretical Model , behavioural economics , the Warnecke Model for Analysis of Population Health and Health Disparities , the World Health Organization Health Promoting Schools Framework and the International Obesity Task Force 10 Guiding Principles for Obesity Prevention .…”

“…CHW played various roles in interventions. In almost all interventions, they delivered health behaviour education or counselling and connected children and families to relevant resources . In some studies, CHW also helped coordinate interventions and worked with school staff or community partners to facilitate systems‐level change .…”