Healthy Start: Family Childcare Providers and Parents

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.

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

Exclusion criteria

• Not meeting above criteria.

Children:

Inclusion criteria

• Children 18-54 months-old who receive care in a participating FCCH
• Care must be for at least 15 hours per week
• Agree to be measured (All other evaluation is observation that does not require assent).

Exclusion criteria

• Not meeting above criteria.