Abstract
BackgroundEarly care and education (ECE) settings play an important role in shaping the nutrition and physical activity habits of young children. Increasing research attention is being directed toward family child care homes (FCCHs) specifically. However, existing measures of child care nutrition and physical activity environments are limited in that they have been created for use with center-based programs and require modification for studies involving FCCHs. This paper describes the modification of the Environment and Policy Assessment and Observation (EPAO) for use in FCCHs.MethodsThe EPAO underwent a through modification process that incorporated an updated format for the data collection instrument, assessment of emerging best practices, tailoring to the FCCH environment, and creation of a new scoring rubric. The new instrument was implemented as part of a larger randomized control trial. To assess inter-rater reliability, observations on 61 different days were performed independently by two data collectors. To assess construct validity, associations between EPAO scores and measures of children’s dietary intake (Healthy Eating Index (HEI) score) and physical activity (accelerometer-measured minutes per hour of moderate to vigorous physical activity, MVPA) were examined.ResultsThe modified EPAO assesses 38 nutrition and 27 physical activity best practices, which can be summarized into 7 nutrition-related and 10 physical activity-related environmental sub- scores as well as overall nutrition and overall physical activity scores. There was generally good agreement between data collectors (ICC > 0.60). Reliability was slightly lower for feeding practices and physical activity education and professional development (ICC = 0.56 and 0.22, respectively). Child HEI was significantly correlated with the overall nutrition score (r = 0.23), foods provided (r = 0.28), beverages provided (r = 0.15), nutrition education and professional development (r = 0.21), and nutrition policy (r = 0.18). Child MVPA was significantly associated with overall time provided for activity (r = 0.18) and outdoor playtime (r = 0.20). There was also an unexpected negative association between child MVPA and screen time (−0.16) and screen time practices (r = −0.21).ConclusionsThe EPAO for the FCCH instrument is a useful tool for researchers working with this unique type of ECE setting. It has undergone rigorous development and testing and appears to have good psychometric properties.Trial registrationNCT01814215, March 15, 2013.
Highlights
Care and education (ECE) settings play an important role in shaping the nutrition and physical activity habits of young children
The Environment and Policy Assessment and Observation (EPAO) for the Family child care home (FCCH) instrument is a useful tool for researchers working with this unique type of Early care and education (ECE) setting
Early care and education (ECE) programs are increasingly recognized as important partners in public health initiatives to establish healthy eating and physical activity behaviors in young children [1, 2]
Summary
Care and education (ECE) settings play an important role in shaping the nutrition and physical activity habits of young children. Authorities in child health have published Caring for Our Children, a set of national standards for nutrition and physical activity for ECE programs [3]. FCCHs may be known as “family day care” (in Australia) or “childminders” (in the United Kingdom and across Europe). While these programs have a wide reach, providing care for approximately 1.5 million children in the US [10], they are generally subject to fewer state licensing regulations [11,12,13,14]. Observational studies suggest that children in these settings have poor diet quality [15], low levels of physical activity [16, 17], and higher risk of obesity [18, 19]
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