The purpose of this study is to find out whether a program called "Healthy Children, Healthy Communities" can help young children in rural areas eat healthier and improve their health. The study focuses on children ages 3 to 5 who attend family childcare homes in rural communities.
The main goal is to see if the program can:
Help children eat healthier foods, like more fruits and vegetables.
Support childcare providers in using positive mealtime practices that encourage healthy eating.
The study will involve about 120 licensed family childcare providers in rural areas who participate in the Child and Adult Care Food Program (CACFP), along with about 240 children they care for.
Childcare providers will be randomly placed into one of two groups:
EAT Family Style Group (Intervention Group):
Complete 7 online training modules over 16 weeks about healthy mealtime practices.
Join 7 individual coaching sessions on Zoom.
Record short videos of their mealtimes to get personalized feedback from a coach.
Work with a coach to set goals and make plans to improve mealtimes.
Receive printed materials and conversation cards to use during meals.
Some providers may join Zoom interviews to share their experiences.
Better Kid Care Group (Comparison Group):
Complete 10 online modules about general childcare topics like child development, oral health, play, and managing a childcare home.
For both groups, the research team will:
Ask providers to fill out online surveys about how mealtimes work in their childcare homes.
Visit the childcare homes to observe and record children's mealtimes on two days at each data collection point.
Measure the height and weight of participating children.
Use a painless skin scanner (Veggie Meter) to check how many fruits and vegetables children have been eating.
Ask providers to complete surveys about the children's eating habits.
The study focuses on rural, low-income communities, where children are at higher risk of having poor diets and obesity compared to children in urban areas. Information will be collected at the start of the study, after 16 weeks, and again after 24 weeks to see if there are lasting changes.
Licensed family child care home-based early child care and education settings
Located in RURAL Nebraska or Kansas
Participate in the Child and Adult Care Food Program (CACFP)
Care for at least 2 preschool-aged children (3-5 years old) without feeding disorders or developmental delays
FCCH provider closes the business
FCCH provider stops serving meals to children
FCCH provider discontinues participation in CACFP and no longer adheres to CACFP meal pattern requirements
FCCH provider loses all eligible study children due to children leaving care, developing developmental delays or feeding disorders, or other reasons making them ineligible
Parallel
EAT Family Style
BehavioralRural family childcare home providers receive 7 online modules on responsive feeding practices over 16 weeks, plus 7 individual coaching sessions via Zoom with Extension agents. Providers record mealtime videos for personalized feedback, engage in goal-setting and action planning, and receive printed materials and conversation cards.
Better Kid Care
BehavioralRural family childcare home providers receive 10 online modules about general childcare topics unrelated to nutrition, including child development, block play, oral health, supervising children, and managing a family childcare home through the Better Kid Care platform.
Change in children's observed combined fruit and vegetable consumption [16 weeks]
Children's fruit and vegetable consumption (servings/day) will be assessed by trained research staff observing two consecutive days of meals and snacks in family child care homes (FCCHs), following the Dietary Observation in Child Care (DOCC) protocol, which allows one observer to record intake for up to three children with minimal disruption. Data will be entered into the Nutrition Data System for Research (NDSR) to convert observed foods into nutrient and food group values. Fruit and vegetable intake will be compared to Dietary Guidelines for Americans to determine each child's two-day average intake.
Change in children's observed combined fruit and vegetable consumption [24 weeks]
Children's fruit and vegetable consumption (servings/day) will be assessed by trained research staff observing two consecutive days of meals and snacks in family child care homes (FCCHs), following the Dietary Observation in Child Care (DOCC) protocol, which allows one observer to record intake for up to three children with minimal disruption. Data will be entered into the Nutrition Data System for Research (NDSR) to convert observed foods into nutrient and food group values. Fruit and vegetable intake will be compared to Dietary Guidelines for Americans to determine each child's two-day average intake.
Change in children's observed diet quality, measured by the Healthy Eating Index-2020 (HEI-2020) (16 weeks)
Children's dietary intake will be assessed by trained research staff observing two days of meals and snacks in family child care homes (FCCHs), following the Dietary Observation in Child Care (DOCC) protocol, which allows one observer to record intake for up to three children with minimal disruption. Data will be entered into the Nutrition Data System for Research (NDSR) to convert observed foods into nutrient and food group values. Diet quality will be measured with the Healthy Eating Index-2020 (HEI-2020), ranging from 0-100, where higher scores reflect better diet quality. Average HEI-2020 scores will be calculated per child, standardized per 1,000 kcal, and aggregated at the FCCH level.
Change in children's observed diet quality, measured by the Healthy Eating Index-2020 (HEI-2020) (24 weeks)
Children's dietary intake will be assessed by trained research staff observing two days of meals and snacks in family child care homes (FCCHs), following the Dietary Observation in Child Care (DOCC) protocol, which allows one observer to record intake for up to three children with minimal disruption. Data will be entered into the Nutrition Data System for Research (NDSR) to convert observed foods into nutrient and food group values. Diet quality will be measured with the Healthy Eating Index-2020 (HEI-2020), ranging from 0-100, where higher scores reflect better diet quality. Average HEI-2020 scores will be calculated per child, standardized per 1,000 kcal, and aggregated at the FCCH level.
Change in the observed mealtime emotional climate
Mealtime emotional climate refers to the quality of interpersonal interactions between the provider and children during mealtime. We will record lunchtime videos during baseline, post and follow-up to assess MEC coded by the Mealtime Emotional Climate in Child Care Observational Scales , which includes two higher-level constructs: positive and negative MEC.
Change in family childcare home providers observed responsive feeding practices (16 weeks)
Providers' observed responsive feeding practices. The research team will record lunchtime videos before and after the intervention and follow-up; these videos will be coded using the Mealtime Observation in Child Care Checklist. These responsive feeding practices are focused on improving mealtime structure and providing developmentally appropriate support for children's autonomy.
Change in children's skin carotenoids (16 weeks)
The Veggie Meter device (Longevity Link Corp., Utah)will provide an objective, non-invasive, and quick measure reflecting fruit and vegetable intake at all three study timepoints. The device uses reflection spectroscopy to detect carotenoid levels in human skin, has been validated against dietary intake in diverse groups of adults and children and also assess changes over time.
Change in children's skin carotenoids (24 weeks)
The Veggie Meter device (Longevity Link Corp., Utah)will provide an objective, non-invasive, and quick measure reflecting fruit and vegetable intake at all three study timepoints. The device uses reflection spectroscopy to detect carotenoid levels in human skin, has been validated against dietary intake in diverse groups of adults and children and also assess changes over time.
Change in children's measured BMI z-score (16 weeks)
Children's standing height (in meters) will be measured using a portable stadiometer, and weight (in kg) will be measured using a calibrated digital scale in the FCCH setting, following a standard protocol. Height-weight measurements will be aggregated to arrive at BMI z-score (e.g., weight and height will be combined to report BMI in kg/m\^2 and then calculate the BMI z-score).
Change in children's measured BMI z-score (24 weeks)
Children's standing height (in meters) will be measured using a portable stadiometer, and weight (in kg) will be measured using a calibrated digital scale in the FCCH setting, following a standard protocol. Height-weight measurements will be aggregated to arrive at BMI z-score (e.g., weight and height will be combined to report BMI in kg/m\^2 and then calculate the BMI z-score).
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