Child Obesity, Nutrition, Healthy
Conditions
Brief summary
The preschool years are a critical time for shaping food preferences and eating behaviors, which affect dietary behaviors in adults and life-long risks for obesity, diabetes, cardiovascular disease, and other chronic conditions. Unfortunately, many US children, especially low-income and ethnic minorities, have dietary patterns associated with obesity and increased morbidity. Thus, to improve child diet quality, it is essential to develop effective targeted interventions in settings where children (especially higher-risk children) spend time. The investigators build upon our efficacious Healthy Start intervention with family childcare home (FCCH) providers (FCCP) to pilot a novel, 8-month multilevel tailored intervention to reach families through FCCH. This would be the first study to incorporate family-based intervention components into FCCH. The 8-month intervention will include an adapted version of the Healthy Start intervention as well as FCCP training to deliver nutrition messages to parents using an existing childcare App, complemented with FCCH environmental cues and tailored print and videos for parents. In sum, feasible and effective interventions to improve young children's diets are urgently needed. The FCCH is a novel and untapped setting to intervene with both FCCP and parents simultaneously to affect children's diets in both childcare and home settings, which has the potential to more fully impact the child's overall diet and weight status.
Detailed description
The preschool years are a critical time for shaping food preferences and eating behaviors which, in turn, affect dietary behaviors in adults and life-long risks for obesity, diabetes, cardiovascular disease and other chronic conditions. Unfortunately, many US children, especially low-income and ethnic minorities, have dietary patterns associated with obesity and increased morbidity. Thus, to improve child diet quality, it is essential to develop effective targeted interventions in settings where children (especially higher risk children) spend time. There is a national call for dietary interventions that span multiple settings including the childcare and home environments. In response to PAS-20-160, the investigators build upon our efficacious Healthy Start intervention with family childcare home (FCCH) providers (FCCP) to pilot a novel, multilevel tailored intervention to reach families through FCCH. This would be the first study to incorporate family-based intervention components into FCCH. FCCH are a promising intervention setting as parents trust FCCPs as extended family members and FCCP feel comfortable talking to parents about children's diet, but want more training to do so effectively. The intervention will include an adapted version of the Healthy Start intervention for English and Spanish-speaking FCCP as well as FCCP training to deliver nutrition messages to parents using an existing childcare App, complemented with FCCH environmental cues and tailored print and videos for parents. Specific Aims are to: SA.1. Conduct formative research with FCCP and parents to inform refinement of the multi-level intervention. SA.2. Conduct a pilot trial with 40 FCCP and 80 parents with 18-54-month-old children to evaluate feasibility and acceptability of intervention and study protocols, and preliminary efficacy of the nutrition intervention compared to an attention-matched control on: a). children's dietary quality at FCCH and home, b). social/physical FCCH and home food environments, c). children's dermal carotenoid levels and z-BMI scores. SA3. Conduct post qualitative interviews with parents, FCCP, coaches, staff & partners to assess the intervention's acceptability and suggestions for improvement. In sum, feasible and effective interventions to improve young children's diets are urgently needed. The FCCH is a novel and untapped setting to intervene with both FCCP and parents simultaneously to affect children's diets in both the childcare and home settings, which has the potential to more fully impact the child's overall diet and weight status. This pilot feasibility research of a novel, multi-level intervention will inform a future full-scale cluster RCT, which will fill important research gaps and move the frontier of nutrition research forward.
Interventions
BEHAVIORALHealthy Eating: Provider and Parent Components
Healthy Eating intervention for child care providers: Peer coaching using brief MI online, tailored materials, coach-led online support groups for FCCP and children's tableware and food toys; 2) Brief training on using and scheduling messages within the Classtag App; 3) Posters for the FCCH. Also for parents, healthy eating encoragement and communication from childcare providers including via the Classtag App, newsletters, videos and tableware/food toys focused on child diet at home.
BEHAVIORALHealthy Start: Reading Readiness Childcare Proiver and Parent Materials
Reading readiness intervention for child care providers: Peer coaching using brief MI online, tailored materials, coach-led online support groups for FCCP and children's books; 2) Brief training on using and scheduling messages within the Classtag App; 3) Posters for the FCCH. Also for parents, reading readiness encoragement and communication from childcare providers including via the Classtag App, newsletters, books focused for use at home.
Sponsors
Brown University
University of Connecticut
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Masking description
Staff who conduct evaluation in the family childcare homes will not be told which experimental condition is being provided to that home.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Providers: Inclusion Criteria: * English and/or Spanish-speaking and reading * State licensed family childcare providers (FCCP) * FCCP that care for 18-54 month-old children, * Plan for FCCH to be in operation for the next year * Willing to be randomized to either study arm, * Have at least 2 eligible children in their care with at least 1 parent-child dyad consenting to participate
Exclusion criteria
* Participation in the prior Healthy Start Project Parents: Inclusion Criteria: * English and/or Spanish-speaking and reading * Legal guardian of child(ren) who receive care in a participating FCCH * Child(ren) must be 18-54 months-old * Care must be for at least 15 hrs./wk * Plan to continue childcare with their current FCCP for the next 9 months * Be the caregiver mainly responsible for the child's eating at home * Willing to be randomized (with the FCCP) to either study arm
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Feasibility Score | 9 Months | Feasibility Score Recruitment and retention success will be measured and scored. Higher scores will indicate higher recruitment and retention. |
| Acceptability Score | 9 months | Acceptability Score Participant providers and parents rate the intervention as acceptable, which will be coded as a score. Higher score will indicate higher acceptability of the intervention. |
| Child diet at home | Baseline and 9 months | HEI Score - Diet Quality at Home Parents will be called on two randomly selected days (at least one weekend day) and asked to recall child's food intake in previous 24-hours using gold standard multiple-pass method. Parents will report child's foods and beverage intake on the previous day (excluding child intake while outside their care) using established methods as in our Healthy Start diversity supplement. Data will be entered into the NDSR program, which will be used to average data across both days and then calculate HEI-2015 score using same methods as for childcare. |
| Dietary Observation in Child Care | Baseline and 9 months | HEI Score - Diet Quality in Childcare Dietary Observation for Childcare (DOCC) is a validated visual observation technique that minimizes observer intrusion, so children don't know intake is being observed. Observers visually estimate and record amount /type of foods/beverages served to children in meals/snacks. Foods not easily discerned will be clarified with FCCP (e.g. food prep, brand names). Amount of food wasted (e.g. dropped, spilled, traded) and remaining will be recorded and amount of food consumed will be estimated as amount served - amount remaining. -Both days of observation data will be entered into NDSR, and averaged to estimate daily nutrient and food data. -Nutrient content, HEI-2015 total and component scores will be derived |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Veggie Meter | Baseline and 9 months | Carotenoid Score Provides an objective measure of F\&V intake using reflection spectroscopy to detect non-invasively, the level of carotenoids in the child's skin. |
| Environment and Policy Assessment and Observation Tool | Baseline and 9 months | EPAO Score Measures childcare nutrition environments and practices over a full-day. |
| Child Weight | Baseline and 9 months | Weight (kg) Investigators will use standard techniques for measuring child weight in kilograms |
| Child Height | Baseline and 9 months | Height (cm) Investigators will use standard techniques for measuring child height in cm. |
| Feeding Practices | Baseline and 9 months | CFPQ Score Parents will be surveyed about their feeding practices of their own children at home. 32 questions from the Comprehensive Feeding Practices Questionnaire (CFPQ) will be used. |
| Beverage Intake Questionnaire (BEVQ-PS) | Baseline and 9 months | BEVQ-PS is a valid instrument used to assess SSB, water, and whole-milk intake. |
| Rapid Prime Diet Quality Score (rPDQS) | Baseline and 9 months | rPDQS Score The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. |
Countries
United States
Contacts
PRINCIPAL_INVESTIGATORPatricia M Risica, DrPH
Brown School of Public Health
Outcome results
None listed