Interventions to promote healthy environments in family child care homes in Oklahoma-Happy Healthy Homes: study protocol for a randomized controlled trial.

BACKGROUND: Early childhood is a critical period of development. Caregivers, including providers of early care and education (ECE), have a substantial influence on the health of young children. Family child care homes (FCCHs), which are small, licensed ECE businesses operated out of the residences of providers, are important settings for promoting child health. However, to date, few interventions to promote the health of children have been developed for FCCHs. The purpose of this article is to describe the protocol for Happy Healthy Homes, a pilot interdisciplinary, community-based study to improve FCCH environments and the health of children in Oklahoma. We describe the development and evaluation of two interventions to be tested in a matched attention randomized controlled trial: 1) a nutrition intervention aimed at enhancing the nutritional quality of meals served to young children, incorporating the Child and Adult Care Food Program best practices, and improving nutritional self-efficacy of providers; and 2) an environmental intervention aimed at increasing providers' environmental health literacy, self-efficacy for integrated pest management (IPM), and awareness of less toxic cleaning practices and FCCH provider cleaning behaviors. METHODS: Both interventions are informed by common theoretical principles and are matched in attention (i.e., 6 h), format (i.e., two individual 90-min educational home visits and a 3-h small group class) and materials (i.e., tool kit of educational materials and supplies tailored to the allocated intervention). A randomized trial of both interventions is currently underway with 52 FCCH providers in the Oklahoma City metropolitan area who participate in the Child and Adult Care Food Program. Observed and self-reported measures will be collected at baseline, and 3 months and 12 months after baseline measurements. Randomization to one of the two interventions will occur after baseline data collection. DISCUSSION: This study aims to support FCCH providers in creating healthier FCCH environments for nutrition and environmental health. Successful completion will provide critical information about the nutritional quality and the environmental health of children in FCCHs, as well as much needed evidence about the efficacy of two community-based interventions to improve the nutrition and environmental health of children in home-based ECE settings. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03560050 . Retrospectively registered on 23 May 2018.

Use of Community Readiness Model to Develop and Evaluate a Pilot Culinary Training Program for School Nutrition Staff.

OBJECTIVE: Use the Community Readiness Model (CRM) to develop and evaluate a contextually appropriate pilot culinary training program for school nutrition staff members. DESIGN: Mixed methods to guide intervention development. SETTINGS: Six school districts in rural and urban areas of a southwestern state. PARTICIPANTS: School nutrition staff (n = 36; female; <1 to >20 years' experience). INTERVENTION: Pre- and post-training assessments used the CRM. Findings from the pre-assessment were used to develop the pilot culinary training intervention. MAIN OUTCOME MEASURE: Readiness to integrate new food preparation methods into existing practices. ANALYSIS: The researchers used t and Wilcoxon tests to compare overall readiness and dimension scores (P ≤ .05). Thematic analysis was used to identify themes from the discussion component of the assessments. RESULTS: Overall readiness increased from vague awareness to preparation (P = .02). Improved dimensions were knowledge of efforts (P = .004), leadership (P = .05), and knowledge of issues (P = .04). Themes included barriers, leadership, and motivation. CONCLUSIONS AND IMPLICATIONS: The CRM was useful for developing and evaluating a contextually appropriate and effective culinary training program for school nutrition staff. Future efforts should address the provision of additional resources such as on-site chefs, small equipment grants, and engaging school stakeholders.