With increasing rates of childhood obesity in the United States, it is important to develop effective curricula that helps children learn and practice healthy habits. Given the large percentage of children who spend time in away-from-home care, childcare centers are opportune contexts to implement such curricula. We sought insight from 35 teachers and childcare providers to identify barriers to implementing an already established healthy habits curriculum (Sprouts: Growing Healthy Habits). Of the 35 participants, 9 identified as teachers (preschool, kindergarten, first grade) while the other 26 identified as childcare providers or working in childcare (i.e., program directors). Each participant completed a semi-structured phone interview after reviewing the curriculum to examine their perspective on: (a) curriculum appeal, (b) barriers to implementing the lessons, and (c) adaptations that would be needed. Interviews were recorded then transcribed verbatim. Three researchers developed a codebook and reached reliability coding (Cohen’s kappa > .70). Themes from initial codes were then used to interpret data. The results indicate that there is great appeal for implementing a healthy habits curriculum in childcare contexts. The barriers providers thought they might face were: behavioral management, parental connections, preparation time, and lack of resources. Additional recommendations suggested a need to incorporate more diversity into lessons. Differences in responses were also noted by participant demographics and childcare/school neighborhood demographics. Despite noted barriers, most providers expressed enthusiasm for using a healthy habits curriculum. This helpful feedback provided useful adaptions to the Sprouts curriculum for children 4–6 years old.
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Anderson, S. E., & Whitaker, R. C. (2010). Household routines and obesity in US preschool-aged children. Pediatrics,125, 420–428.
Auld, G. W., Romaniello, C., Heimendinger, J., Hambidge, C., & Hambidge, M. (1999). Outcomes from a school‐based nutrition education program alternating special resource teachers and classroom teachers. Journal of School Health, 69(10), 403–408.
Bellows, L., Anderson, J., Gould, S. M., & Auld, G. (2008). Formative research and strategic development of a physical activity component to a social marketing campaign for obesity prevention in preschoolers. Journal of Community Health,33(3), 169–178. https://doi.org/10.1007/s10900-007-9079-z.
Benjamin Neelon, S. E., Østbye, T., Hales, D., Vaughn, A., & Ward, D. S. (2016). Preventing childhood obesity in early care and education settings: Lessons from two intervention studies. Child: Care, Health and Development,42(3), 351–358. https://doi.org/10.1111/cch.12329.
Brantlinger, E., Jimenez, R., Klingner, J., Pugach, M., & Richardson, V. (2005). Qualitative studies in special education. Exceptional Children,71(2), 195–207.
Chassiakos, Y. R., Radesky, J., Christakis, D., Moreno, M. A., Cross, C., Hill, D., et al. (2016). Children and adolescents and digital media. Pediatrics. https://doi.org/10.1542/peds.2016-2593.
ChildStats.gov (2019). Forum on Child and Family Statistics. Child population: Number of children (in millions) in the U.S. by Age. U.S. Census Bureau, Current Population Reports. Retrieved January 3, 2020, from https://www.childstats.gov/americaschildren/tables/pop1.asp.
Cunningham-Sabo, L. D., Balgopal, M. M., Seedig, N., & McGuin, M. (2017). School district implementation and teacher needs for quality nutrition education. Health Behavior and Policy Review,4(2), 161–172.
Danişman, Ş. (2017). The effect of parent involvement on student achievement. In E. Karadag (Ed.), The factors effecting student achievement. Cham: Springer.
Davis, J., & Bauman, K. (2013). School Enrollment in the United States: 2011. Population Characteristics. P20-571. US Census Bureau.
De Craemer, M., Lateva, M., Iotova, V., De Decker, E., Verloigne, M., De Bourdeaudhuij, I., et al. (2015). Differences in energy balance-related behaviours in European preschool children: The ToyBox-study. PLoS ONE,10(3), e0118303.
Dev, D. A., Garcia, A. S., Dzewaltowski, D. A., Sisson, S., Franzen-Castle, L., Rida, Z., et al. (2020). Provider reported implementation of nutrition-related practices in childcare centers and family childcare homes in rural and urban Nebraska. Preventive Medicine Reports,17, 101021.
Duggan, M., Lenhart, A., Lampe, C., & Ellison, N. B. (2015). Parents and social media. Pew Research Center. Retrieved September 16, 2019, from https://www.pewinternet.org/2015/07/16/parents-and-social-media/.
Freedman, M. R., & Alvarez, K. P. (2010). Early childhood feeding: Assessing knowledge, attitude, and practices of multi-ethnic child-care providers. Journal of the American Dietetic Association,110(3), 447–451.
Fiese, B. H. (2007). Routines and rituals: Opportunities for participation in family health. OTJR Occupation, Participation and Health,27(SUPPL. 1), 41–49. https://doi.org/10.1177/15394492070270s106.
Fisher, M. C., Villegas, E., Sutter, C., Musaad, S. M., Koester, B., & Fiese, B. H. (2019). Sprouts growing healthy habits: Curriculum development and pilot study. Frontiers in Public Health, 7, 65.
Fitzgibbon, M. L., Stolley, M. R., Schiffer, L., Van Horn, L., KauferChristoffel, K., & Dyer, A. (2006). Hip-hop to health Jr. for Latino preschool children. Obesity,14(9), 1616–1625.
Garcia, J. N. (2014). Teacher and parental beliefs and expectations of parental involvement and how it relates to student academic achievement (Doctoral dissertation). Texas State University, Proquest Dissertation Publishing, (UMI Number: 3681031).
Geserick, M., Vogel, M., Gausche, R., et al. (2018). Acceleration of BMI in early childhood and risk of sustained obesity. New England Journal of Medicine,379(14), 1303–1312. https://doi.org/10.1056/NEJMoa1803527.
Goodall, J. (2017). Narrowing the achievement gap: Parental engagement with children’s learning. London: Routledge.
Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2017). Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS Data Brief. No. 288.
Harrison, K., Bost, K. K., McBride, B. A., Donovan, S. M., Grigsby-Toussaint, D. S., Kim, J., et al. (2011). Toward a developmental conceptualization of contributors to overweight and obesity in childhood: The Six-Cs Model. Child Development Perspectives,5(1), 50–58. https://doi.org/10.1111/j.1750-8606.2010.00150.x.
Hesketh, K. D., & Campbell, K. J. (2010). Interventions to prevent obesity in 0–5 year olds: An updated systematic review of the literature. Obesity,18(S1), S27–S35.
Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.
Husz, I. (2018). ‘You would eat it if you were hungry’. Local perceptions and interpretations of child food poverty. Children & Society,32(3), 233–243.
Krieger, N. (1992). Overcoming the absence of socioeconomic data in medical records: Validation and application of a census-based methodology. American Journal of Public Health,82(5), 703–710. https://doi.org/10.2105/AJPH.82.5.703.
Korpershoek, H., Harms, T., de Boer, H., van Kuijk, M., & Doolaard, S. (2016). A meta-analysis of the effects of classroom management strategies and classroom management programs on students’ academic, behavioral, emotional, and motivational outcomes. Review of Educational Research,86(3), 643–680.
Larson, N., Loth, K. A., & Nanney, M. S. (2018). Staff training interests, barriers, and preferences in rural and urban child care programs in Minnesota. Journal of Nutrition Education and Behavior,51, 335–341.
Lavelle, H. V., Mackay, D. F., & Pell, J. P. (2012). Systematic review and meta-analysis of school-based interventions to reduce body mass index. Journal of Public Health,34(3), 360–369.
Maher, E. J., Li, G., Carter, L., & Johnson, D. B. (2008). Preschool child care participation and obesity at the start of kindergarten. Pediatrics,122(2), 322–330. https://doi.org/10.1542/peds.2007-2233.
Martinez, E. E., Forbes, P. W., O’Brien, S. E., & de Ferranti, S. D. (2016). Census tract based income level and lipid levels in urban pediatric primary care: A retrospective study. BMC Pediatrics,16(1), 4–9. https://doi.org/10.1186/s12887-016-0622-x.
Minniss, F. R., Wardrope, C., Johnston, D., & Kendall, E. (2013). Promoting health in early childhood environments: A health-promotion approach. Child Care in Practice,19(2), 104–117. https://doi.org/10.1080/13575279.2012.754331.
Nanney, M. S., LaRowe, T. L., Davey, C., Frost, N., Arcan, C., & O’Meara, J. (2017). Obesity prevention in early child care settings: A Bistate (Minnesota and Wisconsin) assessment of best practices, implementation difficulty, and barriers. Health Education and Behavior,44(1), 23–31.
Natale, R. A., Messiah, S. E., Asfour, L., Uhlhorn, S. B., Delamater, A., & Arheart, K. L. (2014). Role modeling as an early childhood obesity prevention strategy: Effect of parents and teachers on preschool children's healthy lifestyle habits. Journal of Developmental & Behavioral Pediatrics,35(6), 378–387. https://doi.org/10.1097/DBP.0000000000000074.
Parsons, A. A., Monteban, M., Lee, E., Bebo, P., Zubieta, A. C., Ginnetti, S., et al. (2018). Indicators of readiness and capacity for implementation of healthy eating strategies in child care settings serving low-income children. Journal of Nutrition Education and Behavior,51(4), 465–477. https://doi.org/10.1016/j.jneb.2018.09.004.
Patton, M. Q. (1990). Qualitative evaluation and research methods. Thousand Oaks, CA: SAGE Publications inc.
PEL Teaching Endorsements. (n.d.). Illinois state board of education. Retrieved July 27, 2020, from https://www.isbe.net.
Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., et al. (2018). The physical activity guidelines for Americans. JAMA,320(19), 2020–2028.
Saunders, R. P., Evans, M. H., & Joshi, P. (2005). Developing a process-evaluation plan for assessing health promotion program implementation: A how-to guide. Health Promotion Practice,6(2), 134–147.
Scaglioni, S., Arrizza, C., Vecchi, F., & Tedeschi, S. (2011). Determinants of children’s eating behavior. American Journal of Clinical Nutrition,94, S2006–2011. https://doi.org/10.3945/ajcn.110.001685.1.
Schroeder, C. T. (2006). Prophecy and porneia in shenoute’s letters: The rhetoric of sexuality in a late antique Egyptian monastery. Journal of Near Eastern Studies, 65(2), 81–97.
Schwartz, C., Scholtens, P. A. M. J., Lalanne, A., Weenen, H., & Nicklaus, S. (2011). Development of healthy eating habits early in life. Review of recent evidence and selected guidelines. Appetite,57(3), 796–807. https://doi.org/10.1016/j.appet.2011.05.316.
Sharma, S., Chuang, R. J., & Hedberg, A. M. (2011). Pilot-testing CATCH early childhood: A preschool-based healthy nutrition and physical activity program. American Journal of Health Education,42(1), 12–23.
Sisson, S. B., Smith, C. L., & Cheney, M. (2017). Big impact on small children: Child-care providers’ perceptions of their role in early childhood healthy lifestyle behaviours. Child Care in Practice,23(2), 162–180. https://doi.org/10.1080/13575279.2017.1299111.
Roux, A. V. D., Kiefe, C. I., Jacobs, D. R., Haan, M., Rph, D., Jackson, S. A., et al. (1990).  Caroline T. Schroeder—Prophecy and Porneia in Shenoute’s Letters: The Rhetoric of Sexuality in a Late Antique Egyptian Monastery, 2797(01), 24–28.
US Department of Health and Human Services. (2017). Dietary guidelines for Americans 2015–2020. New York: Skyhorse Publishing Inc.
US Department of Health and Human Services. (2018). Physical activity guidelines for Americans (2nd ed.). Washington, DC: US Department of Health and Human Services.
Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine,37(5), 360–363.
Wang, Y., Wu, Y., Wilson, R. F., Bleich, S., Cheskin, L., Weston, C. et al. (2013). Childhood obesity prevention programs: Comparative effectiveness review and meta-analysis. In Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews. Centre for Reviews and Dissemination (UK). https://www.ncbi.nlm.nih.gov/books/NBK144232/.
Ward, D. S., Welker, E., Choate, A., Henderson, K. E., Lott, M., Tovar, A., et al. (2017). Strength of obesity prevention interventions in early care and education settings: A systematic review. Preventive Medicine,95, S37–S52. https://doi.org/10.1016/j.ypmed.2016.09.033.
Watson, N. F., Badr, M. S., Belenky, G., et al. (2015). Recommended amount of sleep for a healthy adult: A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. Sleep,38, 843–844.
Funding was provided by the Christopher Family Foundation Food and Family Program and the U.S. Department of Agriculture (Grant. No. Hatch 793-328).
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Villegas, E., Sutter, C., Koester, B. et al. Barriers to Implementing a Healthy Habits Curriculum in Early Childhood Education: Perspectives from Childcare Providers and Teachers. Early Childhood Educ J (2020). https://doi.org/10.1007/s10643-020-01099-5
- Health promotion
- Early childhood