ABSTRACT
Physical activity is a critical component of obesity prevention, but few interventions targeting early childhood have been described. The Active Early guide was designed to increase physical activity in early care and education (ECE) settings. The purpose of Active Early 2.0 was to evaluate the effectiveness of Active Early along with provider training, microgrant support, and technical assistance over 2 years (2012-2014) to increase physical activity and related behaviors (e.g., nutrition) in settings serving a high proportion of children from underserved groups in recognition of significant disparities in obesity and challenges meeting physical activity recommendations in low-resource settings. The physical activity and nutrition environment were assessed before and after the intervention in 15 ECE settings in Wisconsin using the Environment and Policy Observation Assessment tool, and interviews were conducted with providers and technical consultants. There was no significant change in Total Physical Activity Score or any EPAO subscale over the intervention period; however, significant improvements in the Total Nutrition Score and the several Nutrition subscales were observed. Additionally, the percentage of sites with written activity policies significantly increased. Overall minutes of teacher-led physical activity increased to 61.5 ± 29.0 min (p < 0.05). Interviews identified key benefits to children (i.e., more energy, better rest, improved behavior) and significant barriers, most notably care provider and child turnover and low parent engagement. Moderate policy and environmental improvements in physical activity and nutrition were achieved with this intervention, but more work is needed to understand and address barriers and to support sustained changes in lower-resource ECE settings.
ABSTRACT
INTRODUCTION: The Wisconsin Early Childhood Obesity Prevention Initiative (Initiative), established in 2007, seeks to address and prevent obesity in the early care and education system through nutrition and physical activity environmental and policy changes. The collaborative includes professionals from 3 state of Wisconsin Departments, the University of Wisconsin-Extension, the University of Wisconsin-Madison, and public health and early care and education organizations. This paper explores the efforts of the Initiative to advance our understanding of collective impact in practice and its value to health promotion efforts. METHODS: Evaluators conducted a mixed methods case study to evaluate the application of collective impact principles by the Initiative. This included a survey of Initiative partners, review of archival documents, and qualitative interviews with Initiative leaders. RESULTS: Initiative partners noted progress in establishing the conditions for collective impact. Archival documents and interviews describe both formal and informal practices that helped set a common agenda, align and coordinate partner activities, and promote communication among Initiative leaders. Results also detail the important current and potential roles of "backbone" staff from healthTIDE to support the Initiative. Additionally, results suggest particularly challenging aspects of the Initiative's impact model related to shared measurement and broader stakeholder communication. While the Initiative is still setting in place the conditions for collective impact, it has achieved significant policy, systems, and environment changes since its formation. Inclusion of nutrition and physical activity criteria in the state's quality rating improvement system for child care centers is one of its outcomes. CONCLUSIONS: This case study offers several important insights about the application of collective impact in health promotion efforts, particularly in relation to the transition from previous collaborative activities, the value of establishing a clear common agenda among partners, the roles of backbone staff, and time and partner relationships in collective impact.
