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.;
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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
Acknowledgements
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 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.
Educators
training
reminders
Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M., ... & Kirchner, J. E. (2015).
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)
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
deviance approaches to understanding use of evidence in community settings.
to identify deviant cases and theoretically-grounded processes for soliciting input from deviant cases. Using an explanatory sequential mixed methods design and the i-PARIHS framework, the purpose of this study was to: A. Identify positive and negative deviant cases using quantitative fidelity data from a previous implementation WISE B. Determine barriers and facilitators to fidelity through qualitative interviews with deviant cases.
Structure Function Process Quan QUAL “Primary purpose of exploration” Expansion “Using one ..to answer questions raised by the
Connect “Have one dataset build upon another…”
Creswell JW, Klassen AC, Plano VL, & Smith KC. (2011); Palinkas LA, Aarons GA, Horwitz S, Chamberlain P, Hurlburt M, & Landsverk, J (2011)
Exploratory Sequential Design
Quantitative Results Sample for Qualitative
2 10 17 7 Positive Deviants on 3
Negative Deviants on all components Mix Directors
Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., & Southam-Gerow, M. A. (2011)
Component Behaviors Fidelity Defined
Use of Mascot
1 – No mention or sight of mascot 2 – Mentions but does not use 3 – 1-2 uses of mascot, present during chant 4 – Mascot is integral, used enthusiastically Role modeling
1 – Does not eat/comment 2 – Tried with few groups, 1 comment 3 – Tried with most groups, 2 -3 comments 4 – Tried with all groups, 4 + comments Hands-on exposure
1 – Whole group, Teacher led 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 Positive Feeding Practices
unsupportive feeding practices below 1.5 based on
Examples = Rush children, pressure to eat, cue hunger, positive comments
Facilitation
What helped in that process get WISE implemented? What would have made it easier? What kind of outside help would have improved your implementation?
Context
What did other teachers in your center say about WISE? I want to understand what it’s like to work in your center.
Evidence
The main goal of WISE is to help children and families eat more fruits and
experience, what worked to help achieve this goal? What did not work?
Innovation
Windy was the mascot for the WISE
worked/didn’t work about using Windy? Think about your classroom in 5 years. What would it take for you to still be doing WISE?
Harvey & Kitson, 2015, 2016; Kitson, Harvey, & McCormick, 1998
Barriers and Facilitators to Mascot
Barriers Facilitators Local Evidence Context ECEs perceived puppet to take extra time; ECEs did not feel comfortable/ did not use when other adults were present. Puppet can be used in a variety of ways; Children liked puppet; Puppet had a special home in the classroom. ECEs recognize that each child will prefer different level of interaction with the puppet. Number of
programs at center was 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.”
Barriers and Facilitators to Role Modeling
Barriers Facilitators Local Evidence Context ECEs said role modeling was difficult when they did not like the food; time was too rushed. ECEs believe it impacts children ECEs said they can be surprised by what children will enjoy eating. Center support for family style dining varied. Some ECEs are provided a meal 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.”
Barriers and Facilitators to Hands On
Barriers Facilitators Local Evidence Context ECEs thought larger groups (not hands-on) were easier; ECEs combined classes to reduce preparation and cleaning of supplies. ECEs valued individual attention; Time was already available in the schedule; ECEs perceived increased child participation. ECEs said exposures are best when kept brief, designated an area at center time, & when other children have a planned activity. Some centers collectively decided to take short cuts (e.g., combing classrooms for lessons). Variation 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. “
Barriers and Facilitators to Mascot
Barriers Facilitators Local Evidence Context ECEs prioritize manners (e.g., no mess); ECEs view encouraging as distinct from pressuring; ECEs worry about children’s home life. ECEs enjoy pleasant conversation with children; ECEs avoid hurrying children to prevent choking. ECEs talk more to fast eaters to give more time to slower eaters. Environment around meals varied (cafeteria vs. classroom setting; rigid vs. flexible schedule), quality
“We have a time limit on how long we can eat…. we need to eat. Because we don’t have a lot of time,
plate because it was time to dump, and we were sad because we didn’t have time to eat it. “
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.
@taren_swindle