Alison Tovar1, Amber E Vaughn2, Jennifer Orlet Fisher3, Sara E Benjamin Neelon4, Regan Burney5, Kathleen Webster6, Tao Liu7, Truls Ostbye8, Dianne S Ward9. 1. 1Department of Nutrition and Food Sciences,University of Rhode Island,Kingston,RI02881,USA. 2. 2Children's Healthy Weight Research Group,UNC Center for Health Promotion & Disease Prevention,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA. 3. 3Department of Social and Behavioral Sciences,Center for Obesity Research and Education,College of Public Health,Temple University,Philadelphia,PA,USA. 4. 4Johns Hopkins Bloomberg School of Public Health,Baltimore,MD,USA. 5. 5Center for Health Promotion and Disease Prevention,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA. 6. 6Department of Psychology,University of Rhode Island,Kingston,RI,USA. 7. 7Department of Biostatistics,Center for Statistical Sciences,Brown University,Providence,RI,USA. 8. 8Community and Family Medicine,Nursing and Global Health,Duke University Medical Center,Durham,NC,USA. 9. 9Department of Nutrition,UNC Center for Health Promotion & Disease Prevention,University of North Carolina at Chapel Hill,Chapel Hill,NC,USA.
Abstract
OBJECTIVE: To describe the modification and validation of an existing instrument, the Environment and Policy Assessment and Observation (EPAO), to better capture provider feeding practices. DESIGN: Modifications to the EPAO were made, validity assessed through expert review, pilot tested and then used to collect follow-up data during a two-day home visit from an ongoing cluster-randomized trial. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. To test predictive validity of the factors, multilevel mixed models examined associations between factors and child's diet quality as captured by the Healthy Eating Index-2010 (HEI-2010) score (measured via the Dietary Observation in Childcare Protocol). SETTING:Family childcare homes (FCCH) in Rhode Island and North Carolina, USA.ParticipantsThe modified EPAO was pilot tested with fifty-three FCCH and then used to collect data in 133 FCCH. RESULTS: The final three-factor solution ('coercive control and indulgent feeding practices', 'autonomy support practices', 'negative role modelling') captured 43 % of total variance. In multilevel mixed models adjusted for covariates, 'autonomy support practices' was positively associated with children's diet quality. A 1-unit increase in the use of 'autonomy support practices' was associated with a 9·4-unit increase in child HEI-2010 score (P=0·001). CONCLUSIONS: Similar to the parenting literature, constructs which describe coercive controlling practices and those which describe autonomy-supportive practices emerged. Given that diets of pre-schoolers in the USA remain suboptimal, teaching childcare providers about supportive feeding practices may help improve children's diet quality.
RCT Entities:
OBJECTIVE: To describe the modification and validation of an existing instrument, the Environment and Policy Assessment and Observation (EPAO), to better capture provider feeding practices. DESIGN: Modifications to the EPAO were made, validity assessed through expert review, pilot tested and then used to collect follow-up data during a two-day home visit from an ongoing cluster-randomized trial. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. To test predictive validity of the factors, multilevel mixed models examined associations between factors and child's diet quality as captured by the Healthy Eating Index-2010 (HEI-2010) score (measured via the Dietary Observation in Childcare Protocol). SETTING: Family childcare homes (FCCH) in Rhode Island and North Carolina, USA.ParticipantsThe modified EPAO was pilot tested with fifty-three FCCH and then used to collect data in 133 FCCH. RESULTS: The final three-factor solution ('coercive control and indulgent feeding practices', 'autonomy support practices', 'negative role modelling') captured 43 % of total variance. In multilevel mixed models adjusted for covariates, 'autonomy support practices' was positively associated with children's diet quality. A 1-unit increase in the use of 'autonomy support practices' was associated with a 9·4-unit increase in child HEI-2010 score (P=0·001). CONCLUSIONS: Similar to the parenting literature, constructs which describe coercive controlling practices and those which describe autonomy-supportive practices emerged. Given that diets of pre-schoolers in the USA remain suboptimal, teaching childcare providers about supportive feeding practices may help improve children's diet quality.
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