Evaluating the Keystones of Development - An Online Curriculum for Residents to Promote Positive Parenting in Primary Care.

OBJECTIVE: This pilot outcome evaluation assesses the effectiveness of an online curriculum, the Keystones of Development, aimed at improving residents' knowledge, attitudes, and reported behaviors around promoting positive parenting and childhood development in well-child visits. METHODS: We used an explanatory mixed-methods approach, including a single-arm pre-posttest of intervention effects on self-reported behavioral outcomes (discussing, modeling, and praising) and secondary outcomes (knowledge, perceived barriers, attitudes, and self-efficacy). Following this, a subset of residents participated in in-depth interviews to describe participant responses to the intervention. RESULTS: The study was conducted at 8 pediatric residency programs across the United States with 67 pediatric residents (mean age = 29; 79% female; 57% PGY1). Within one month postintervention, there was a statistically significant increase in the behaviors that promote positive parenting: discussing (P < .01;d = 0.73) and modeling (P < .01;d = 0.61) but not praising (P = .05; d = 0.3). Significant changes in the secondary outcomes: knowledge (P < .01), perceived barriers, (P < .01), and retrospective self-efficacy (P < .01) were seen. Interviews revealed that integration of curriculum content into clinical practice was due to the relevance of the material to primary care and the modeling of how to apply in the clinical setting. Curriculum format, content, and clinical application helped participants weave recommendations into the well-child visit. CONCLUSIONS: In this study, we demonstrated that the online curriculum, Keystones of Development, increased resident behaviors, knowledge, and self-efficacy, and decreased perceived barriers to promote parenting behaviors associated with improved child development outcomes in well-child visits. These findings were observed across participants demonstrating equal success regardless of demographic characteristics or study site.

In Defense of Food Curriculum: A Mixed Methods Outcome Evaluation in Afterschool.

Background. Highly processed foods are inexpensive and abundant in our food supply, nutritionally poor, and disproportionately marketed to minority youth. This study is part of a curriculum development project to develop, implement, and evaluate the In Defense of Food (IDOF) curriculum designed to increase intake of whole/minimally processed foods and decrease intake of highly processed foods in youth. Aims. This pilot outcome evaluation was undertaken to assess initial effectiveness and to provide an in-depth understanding of changes in behavioral outcomes and psychosocial mediators. Methods. We used an explanatory mixed method approach, including a single-arm pretest-posttest of intervention effect, followed by a food rules assessment and in-depth interviews to describe participant responses to the intervention in more detail. The study was conducted in three afterschool classrooms in urban low-income neighborhoods with 32 multiethnic middle-school youth, receiving 10 weekly 2-hour sessions. Results. Two weeks postintervention, there was a large positive significant increase in whole/minimally processed food intake (p < .01; d = 0.59) and a small decrease in consumption of highly-processed foods (p = ns; d = 0.06), compared with baseline. Significant increases in psychosocial mediators: Self-efficacy and positive outcomes expectations were seen; others were not significant but changed in the desired direction. Qualitative assessments suggest that the intervention promoted skill building, but environmental barriers made these difficult to use. Discussion. The IDOF curriculum may be most effective for promoting consumption of fruits and vegetables, rather than decreasing intake of highly processed foods. In addition, in this young age-group, short actionable food rules may support self-regulation and behavior change. Conclusion. Among adolescent students in low-income urban neighborhoods, the IDOF afterschool curriculum may help promote self-efficacy and positive outcome expectancies and increase fruit and vegetable intake. Focusing on food processing and using "Food Rules" may be promising to elicit behavior change in youth; however, greater supports are needed to overcome social and environmental barriers.

Context Considerations for Developing the In Defense of Food Nutrition Education Curriculum.

OBJECTIVE: To examine perceptions of teachers and afterschool program staff related to the positive aspects and challenges of afterschool education for youth to guide the development of the "In Defense of Food" nutrition education curriculum. METHODS: Semi-structured in-depth interviews with a convenience sample of teachers and afterschool program staff experienced serving at-risk youth were conducted in New York, NY. They were audio-recorded, transcribed verbatim, and analyzed using inductive summative content analysis to identify, count, and compare themes. RESULTS: Interviews (n = 12) generated 2 meta-themes (Pedagogical Elements for Successful Learning and Pragmatic Considerations for hosting health promotion programs in the afterschool context). Learner-centered and tailored approaches and building social connection were considered important for fostering learning in the afterschool context. CONCLUSIONS AND IMPLICATIONS: This study emphasizes the importance of considering pedagogical elements related to delivery that minimizes didactic instruction and focuses on learner-centered approaches. Further research is needed to compare outcomes and process measures common approaches used in designing nutrition education curricula with those that have been described in this study.

Challenges and Facilitators to Promoting a Healthy Food Environment and Communicating Effectively with Parents to Improve Food Behaviors of School Children.

Background Childhood obesity is a major public health concern and families play an important role. Improving strategies to reach parents and directing tailored nutrition education to them is needed. Purpose To investigate the challenges and facilitators to promoting a healthy environment at home and to identify communication preferences to inform intervention strategies for effectively reaching low-income urban minority families. Procedure Semi-structured focus group interviews were conducted with four groups involving 16 low-income urban parents (94% female; 88% Hispanic/Latino, 12% African American) of elementary school children. Interviews were transcribed and analyzed applying Social Cognitive Theory and using in-vivo coding. Main Findings The most common barriers to parents providing healthy foods to their children were accommodating child preferences and familial opposition. Parents showed intentionality to engage in healthy behaviors, and often shared procedural knowledge for reaching health goals. The analyses of desired communication channels yielded major preferences: tailored information, information provided through multiple mediums, appropriate duration/frequency of messages, and presented from a voice of authority. Conclusion and Implication While parents expressed desires to be healthy, the home food environment presented substantial challenges. Multi-media supports such as workshops, flyers, and text messaging may be useful to facilitate the sharing of information to minimize the tensions between intentionality and reaching desired goals to be healthy. Some parents thought that information received through text messaging could be easily shared and would act as a voice of authority to support child behavior change.