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DOI 10.1007/s10995-011-0874-x
BRIEF REPORTS
Abstract To compare the obesity related training, prac- that influenced both types of care providers’ food service
tices, and perceptions of home child care providers and menus. Both care provider types perceived they have less
center care providers. A self-administered survey was influence on children’s food preferences, eating habits, and
collected from child care providers who attended local weight status compared to the home environment. How-
child care training workshops in east central Illinois from ever, home care providers perceived a smaller discrepancy
March 2009 to August 2010. Study results were based on between the influences of child care and home environ-
responses from 88 home care providers and 94 center ments compared to center care providers. Compared to
providers. The survey questions addressed child care pro- center providers, home care providers were more likely to
viders’ training in the prior year, their obesity prevention have had training, be involved with health promotion
practices including written policies, their perceptions of activities, and rate their influence higher on children’s
influences on children’s health, and factors determining health behaviors. Findings underscore the need for obesity
food menu selection. Paired t tests and Chi-square tests prevention efforts in both types of child care settings.
were used to compare the difference by child care type.
81.9% of home care providers and 58.6% of center care Keywords Child care providers Center care providers
providers received nutrition training, while 66.7 and 43.0% Family home care providers Nutrition Physical activity
of these providers received physical activity training, Obesity
respectively. Nutrition content, guidelines or state regula-
tions, and food availability were the most important factors
Introduction
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behaviors and outcomes among young children. It is well with no specific theme. At the beginning of the workshop, a
established that high-quality child care translates to better research assistant explained the voluntary nature of the
child outcomes such as vocabulary development and study and distributed consent forms and surveys. Partici-
school readiness [7, 8]. The education and training levels of pation in the study was not a part of the workshop, and
child care providers have consistently been found to be once the introduction was given, the research assistant left
strong indicators of high quality child care [9–11]. Beyond the classroom. Child care providers who choose to partic-
influencing cognitive outcomes, past assessments of chil- ipate deposited their surveys in a collection box. These
dren’s physical activity, dietary intake, and feeding pat- were collected at the end of the workshop. The survey took
terns in child care have indicated that child care providers between 10 and 15 min to complete.
and environments also can influence health behaviors [12– A total of 232 child care providers completed the survey
18]. However, Benjamin and colleagues have reported that (response rate = 60%). For the purpose of this study, we
many state regulations on family care homes and child care included child care providers in this convenience sample
centers do not meet recommended child care standards in who reported their facility type to be either center or family
the areas of nutrition and physical activity [19–21]. Recent home care (n = 182), among which 88 providers were
studies have suggested that the use of child care may be a from 82 family child care homes while 94 were from 31
risk factor for unfavorable feeding practices and an child care centers. The University of Illinois institutional
increased risk of obesity during early childhood [22–24]. review board approved the research protocol.
Recognizing the importance of child care as a context to
promote the development of healthy behaviors, there is a
Measures
growing need for child care providers to receive profes-
sional development training in obesity prevention. The
This survey was developed as a needs assessment tool to
effectiveness of professional development is vastly
examine the training, practices, and perceptions related to
improved when built on a firm understanding of existing
obesity prevention among child care providers. The ques-
perceptions and practices. Little information is available
tions about training, practices and policies were modified
about child care providers’ training, practices and percep-
from the California Survey of Child Care Providers of
tions related to nutrition and physical activity, especially
2–5 Year Old Children [28]. After compiling the survey,
among family home care providers. Some past research has
the survey was revised incorporating feedback solicited
documented lower levels of formal education and distinct
from child care providers and child care training staff.
professional development pathways for home care pro-
viders compared to center providers [25–27], however,
there is no evidence on whether this difference also applies Training
to health- and obesity-related topics. To address the gap in
past research and provide a foundation for future education Providers were asked to indicate whether they attended
and professional development efforts, this study aims to professional development trainings related to obesity-
examine training, practices, and perceptions related to prevention, nutrition, and physical activity in early care and
obesity prevention among child care providers and com- education settings in the prior year (yes or no).
pare the potential differences between center and home
care providers. Practices
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Table 1 Obesity prevention training and practices in the past year by child care providers
Activities Child care center providers Family child care home providers P value1
n Freq % n Freq %
having policies than center care providers; however, there the influence of child care on children’s physical activity as
was no statistically significant difference between them even similar to that of the home environment.
except for the breastfeeding policy (57.1% for center pro- Providers indicated the importance they give to selected
viders and 26.7% for home providers, P = 0.0503). factors when planning a food menu for children (Table 4).
For both provider types, the three most important factors
Perception were nutrition content, the CACFP guidelines or state
regulations, and availability of foods. There were no dif-
Child care providers responded to questions about the ferences by provider type in rating important factors for
influence of both child care and home environments on food service menus.
children’s health behaviors and weight status (Table 3).
Care providers in both settings perceived the home envi-
ronment to have more influence on children’s health Discussion
behaviors and weight status compared to the child care
environment. However, home care providers ranked their With growing numbers of children spending large portions
influence higher than center care providers on every health of their day in non-parental care, child care providers have
behavior and weight status. Therefore the perceived gap an increasing need for training and best practice and policy
between the influence of home and child care were smaller guidelines to support high quality child care. There is a
among home care provides and home care providers rated lack of information from the perspectives of child care
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Table 3 Child care Provider’s perceptions on the influence of child care environment and home environment on child’s health behaviors and
weight status
Child care environment Home environment Difference (Home—child care)
Mean SD Mean SD Mean SD P1
providers to inform the development of training models training as an opportunity to network as well as learn [31].
and best practice and policy guidelines related to obesity- Family care providers are also, by and large, the chief
prevention in child care settings. This study is an explor- entrepreneur in their own small business. The need to learn
atory study to compare the training, practices and percep- about state regulations and incentivized star-rating systems
tions, related to obesity-prevention of family home care may also draw family care providers.
and center care providers. This increased participation in training may be related to
Several differences between family home care providers another disparity. Overall, home care providers reported
and center providers emerged. Notably, more family home more health promotion activities than did center care pro-
care providers relative to center care providers reported viders. These included teaching children about physical
attending trainings related to obesity-prevention, nutrition, activity and offering obesity prevention information to
and physical activity in the prior year. Compared to those parents. Because they are attending more trainings on
in centers, family care providers have fewer daily oppor- related topics, family care providers may be more likely to
tunities to connect with a professional community for integrate obesity promotion activities into their daily
support in their work of caring for children [29, 30]. practice. Home care providers ranked themselves as having
Opportunities for training may represent a chance to con- higher influence on children’s health behaviors and weight
nect, garner support, and socialize. A recent training needs status than center care providers. In terms of children’s
assessment among family care providers in the same ser- physical activity, home care providers perceived they
vice delivery area confirmed that family providers value have a similar level of influence as children’s home
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environments. Past research has documented a lower providers report teaching children about health-relevant
caregiver-to-child ratio in home based care [32] so it is topics. This would include training about proper imple-
possible that home care providers may see themselves as mentation of nutrition and physical activity with the chil-
having more individual contact with and connection to dren in their care.
children and their parents. With typically fewer children, The final theme to emerge was to encourage and sup-
family child care providers in some studies have exhibited port care providers to develop and implement concrete
more attentive and encouraging behaviors than center care and written obesity-preventing policies and guidelines in
providers [33]. The connection between providers and the their child care settings. The results of this study indicated
parents of children in their care may be especially salient in that written policies are often missing in child care set-
home care settings where relationships are a foregrounded tings. Among those providing care to infants, less than
feature [26]. There is some evidence that parents who use two-thirds of center care providers reported having a
family home care appreciate the more intimate relation- policy on breastfeeding compared to just over a quarter of
ships that can be afforded in the home-based setting. home care providers. More than one-quarter of providers
Layzer & Goodson reported that parents who prefer family in both settings did not have a written policy restricting
home care believed that family home care provides a the availability of unhealthy food and beverages for the
homelike setting and allows more individual attention to children in their care. Without establishing such standards
their children compared to center care [34]. The current in both settings, consistency in health promotion practices
findings pave the way for further exploring and capitalizing is unlikely. This study screened for the presence or
on the experiences of home care providers to help improve absence of written policies and did not examine the con-
the health-promotion efficacy of their colleagues in center tent or source of those reported to exist. Training and
settings. support efforts should promote the development of written
This study identifies specific professional development policies that are aligned with the new set of child care
themes that cannot be overlooked in obesity prevention as a standards for obesity prevention that address nutrition,
venue to improve the quality in child care settings. These physical activity, and screen time released by the Amer-
themes can be directly implemented into education, train- ican Public Health Association, in partnership with the
ing, and professional development for practitioners in the American Academy of Pediatrics and the National
field. The first theme involves helping providers to see Resource Center for Health and Safety in Child Care and
child care as an important context for health promotion and Early Education [38].
obesity prevention. In most cases, providers saw the home The unique characteristics of family child care homes
environment as a more important influence on children’s (e.g., small number of children, close contact with parents,
health behaviors and weight status than the child care home-like setting, and flexibility of arrangements) could
environment. Providers should be empowered to under- provide an effective health promotion delivery system for
stand their own potential role as health promoters, both young children and families. Centers have their own
directly to children and to their parents. Many providers, strengths including existing infrastructure and access to
especially those employed in centers, did not commonly relatively larger numbers of children and families at each
offer nutrition, physical activity, or obesity prevention site. However, currently, many providers do not have
information to the parents of children in their care. A adequate preparation and training to meet their full
number of studies have suggested that the relationship potential in the realm of health promotion and obesity
between child care providers and parents is related to prevention.
children’s adjustment to care and the quality of care pro- Historically, the care of young children has been thought
vided [35, 36]. Child care providers are positioned to serve to provide more ‘nurturing’ than ‘education,’ and thus
as experts in early childhood development and can provide many providers may have not had access to specialized
families with trusted information and support [37]. Train- trainings and comprehensive regulation in health-related
ing efforts should be aimed at helping providers see topics focused on education and promotion. The child care
themselves as partners with parents in setting the stage for environment, regardless of its explicit educational content,
children’s healthy physical as well as cognitive and is a context where children are likely receiving socializa-
socioemotional development. tion related to health behaviors. A growing body of
The second theme is to assist care providers in accessing research suggests that the social conditions and health
and valuing health promotion training as a regular part of behaviors present in childhood have long-lasting impacts
their continuing education and professional development, on later health behaviors and health status [39–42]. For this
especially for center providers who reported significantly reason, a life course perspective is important in planning
less of this kind of training in the previous year. This is all for the training, education, and policies that enable best
the more important given that a notable majority of practice in early child care programs.
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This study has some limitations. The study respondents require creative thinking and new partnerships among par-
are a convenience sample that attended local training ents, health care professionals, and those who educate and
workshops, and thus they are not a representative sample of care for young children. We found that there were differ-
all child care providers in east central Illinois. Those who ences in training, practices and perceptions in obesity pre-
attend training workshops may be more likely to seek vention between family home and center care providers.
information, education and resources in order to improve The most basic implication for practice is that professional
their care practices. They may have different response development offerings related to obesity prevention should
characteristics and tendencies than those who do not par- be developed to target the particular characteristics and
ticipate in training programs. The generalizablity of these patterns of these two provider types. Further studies are
findings is thus limited. Furthermore, child care providers warranted to understand the role of child care providers in
may be aware of the current national attention to childhood obesity prevention and to clarify the barriers and facilitators
obesity and this may have influenced them to respond in of obesity prevention in family and center-based care
more positive ways. However, we do not expect any sys- settings.
tematic difference between family home and center care
providers in this area, and the anonymous and voluntary Acknowledgments The authors wish to thank Ms. Lou Anne
Burton at CCRS for her guidance and assistance during the survey at
nature of the survey may reduce potential response bias due local child care training workshops. The authors also wish to thank
to social desirability. Self-report survey methodology Dr. Hyun Shin Park at University of Sung Kyun Kwan for his guid-
assesses subjective perceptions that are important for ance and thoughtful comments on survey development and analysis
understanding patterns in social and intrapersonal phe- and lastly Ms. Jasmine Abdullh at the University of Illinois at Urbana-
Champaign for her assistance on survey collection and data
nomena. Future work should expand the analyses to procedure.
include other sources of data, for example, observations
and archival reviews. Conflict of interest None of the authors has any conflict of interest
Finally, a comparison of family home and center care on this manuscript to report.
providers must be done carefully. While most family care
providers are the owners of their child care business, this
is not the case for most center care providers. Sensitivity
analyses found that most responses remained consistently References
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