Nutrition Intervention Taren Swindle, Ph.D.; Leanne - PowerPoint PPT Presentation

1 Leveraging the Gap: A Mixed Methods Study Employing Deviance Methodology to Understand and Improve Fidelity to Best Practices in a Childcare Nutrition Intervention Taren Swindle, Ph.D.; Leanne Whiteside-Mansell, Ed.D.; Susan Johnson, Ph.D.; Karen Davenport, B.A .; Geoff Curran, Ph.D

This project was supported by NIH K01 DK110141-01 and the Arkansas Biosciences Institute. The project was also supported, in part, by the Agriculture and Food Research Initiative Competitive Grant no. 2011-68001-30014 from the Acknowledgements USDA National Institute of Food and Agriculture. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

The Innovation – Nutrition in Early Care • 8 Fruit and Vegetable Units • Sensory Exploration • Simple, low-cost recipes each week • Low-pressure, hands-on exposure outside mealtime • Implemented by Early Childhood Educators

WISE Implementation • Developed with stakeholders • Distributed materials • Implementation Strategies • 6-hour interactive, dynamic training • Bi-monthly newsletter with reminders Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., ... & Kirchner, J. E. (2015).

Background

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The Fidelity Spectrum Fidelity = “Degree to which an intervention was implemented as described in the original protocol or as it was intended by the program developers.” – Proctor et al., 2011 Negative Positive Deviance Deviance Gabbay RA, Friedberg MW, Miller-Day (2013); Lawton R, Taylor N, Clay-Williams R, Braithwaite, J. (2014); Marra AR, Guastelli LR, de Araújo CMP, et al. (2011); Proctor, E., Silmere, H., Raghavan, R., et al. (2011). Rose AJ, Petrakis BA, Callahan P, et al. (2012)

Gap Addressed Using an explanatory sequential mixed methods design and the i-PARIHS • Limited application of framework, the purpose of this study deviance approaches to was to: understanding use of evidence in community settings. A. Identify positive and negative deviant cases using quantitative • Need for examples of methods fidelity data from a previous to identify deviant cases and implementation WISE theoretically-grounded processes for soliciting input B. Determine barriers and facilitators from deviant cases. to fidelity through qualitative interviews with deviant cases.

Methods & Results

Design Structure Function Process Quan QUAL Expansion Connect “Primary purpose of “Using one ..to answer “Have one dataset build exploration” questions raised by the upon another…” other..” Exploratory Sequential Design Creswell JW, Klassen AC, Plano VL, & Smith KC. (2011); Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, & Landsverk, J (2011)

Quantitative Results Sample for Qualitative Positive Deviants on 3 2 7 of the 4 components Negative Deviants on 10 all components Mix Directors 17

Quantitative: Fidelity Observations Component Behaviors Fidelity Defined • Use of Mascot Mascot used during activity 1 – No mention or sight of mascot • Mascot leads chant 2 – Mentions but does not use 3 – 1-2 uses of mascot, present during chant 4 – Mascot is integral, used enthusiastically • Role modeling Eats the food with the children 1 – Does not eat/comment • Makes positive comments about target food 2 – Tried with few groups, 1 comment 3 – Tried with most groups, 2 -3 comments 4 – Tried with all groups, 4 + comments • Hands-on Completes in prescribed group size 1 – Whole group, Teacher led • exposure Involves children in lesson 2 – Half class, Few children have role 3 – Groups of 7-10, Several children have role 4 – Groups of 4 -6, All children have role • Average supportive feeding practices above 2.5 AND Positive Examples = Rush children, pressure to eat, cue unsupportive feeding practices below 1.5 based on Feeding hunger, positive comments observations of lead teachers. Practices Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., & Southam-Gerow, M. A. (2011)

Qualitative Facilitation Context Evidence Innovation What helped in that Windy was the What did other process get WISE mascot for the WISE The main goal of teachers in your curriculum. What implemented? What WISE is to help center say about worked/didn’t work would have made it children and families WISE? about using Windy? easier? eat more fruits and vegetables . In your experience, what Think about your What kind of outside worked to help I want to understand classroom in 5 years. help would have achieve this goal? what it’s like to work What would it take improved your What did not work? in your center . for you to still be implementation? doing WISE? Harvey & Kitson, 2015, 2016; Kitson, Harvey, & McCormick, 1998

Use of Mascot Barriers and Facilitators to Mascot Barriers Facilitators Local Evidence Context ECEs perceived puppet to Puppet can be used in a ECEs recognize that Number of take extra time; ECEs did variety of ways; Children each child will prefer other not feel comfortable/ did liked puppet; Puppet had a different level of programs at not use when other adults special home in the interaction with the center was were present. classroom. puppet. influential. “I wasn’t as comfortable. I mean, I did let the assistant use Windy most of the time, because she just liked doing that.”

Role Modeling Barriers and Facilitators to Role Modeling Barriers Facilitators Local Evidence Context ECEs said role modeling was ECEs believe ECEs said they can be Center support for family difficult when they did not it impacts surprised by what style dining varied. Some like the food; time was too children children will enjoy ECEs are provided a meal rushed. eating. with children. “ That’s my way of showing them that I love ‘ em . I’m protecting them. That I can eat it, it’s not gonna kill me.”

Hands On Exposure Barriers and Facilitators to Hands On Barriers Facilitators Local Evidence Context ECEs thought larger ECEs valued individual ECEs said exposures Some centers groups (not hands-on) attention; Time was are best when kept collectively decided to were easier; ECEs already available in the brief, designated an take short cuts (e.g., combined classes to schedule; ECEs area at center time, & combing classrooms reduce preparation and perceived increased when other children for lessons). Variation cleaning of supplies. child participation. have a planned activity. in policy and systems. “The kids love it, because they get to help with the recipes, and I think that’s what they like most. I have seen that with the children that are picky eaters, that if they help out with the recipes and get to make it themselves…they’re more willing to try it than if they don’t. “

Feeding Barriers and Facilitators to Mascot Barriers Facilitators Local Evidence Context ECEs prioritize manners ECEs enjoy pleasant ECEs talk more to Environment around meals (e.g., no mess); ECEs view conversation with fast eaters to give varied (cafeteria vs. encouraging as distinct from children; ECEs avoid more time to classroom setting; rigid vs. pressuring; ECEs worry hurrying children to slower eaters. flexible schedule), quality about children’s home life. prevent choking. of meals. “We have a time limit on how long we can eat…. we need to eat. Because we don’t have a lot of time, remember. She (kitchen staff) needs our plates… I’m like okay, “Remember last time [I) had to dump your plate because it was time to dump, and we were sad because we didn’t have time to eat it. “

Discussion Study of cases at the extreme ends of the fidelity spectrum may be an effective way to solicit useful information on barriers and facilitators to implementation of evidence-based interventions.

Limitations and Strengths -Few positive deviance cases - So this is more of a negative deviance study -Strong quantitative data for basis of sampling - Monthly fidelity on 32 classrooms

Future Research

THANK YOU! • Taren Swindle, UAMS • tswindle@uams.edu @taren_swindle