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Training, and particularly coaching, may have contributed to these positive changes in child care practices. Items that did not change from baseline to follow-up tended to fall into one of these categories: 1) Items where participants reported high levels at baseline leaving little room for change, 2) Items where participants reported high levels of “Not Applicable to My Site” at both baseline and follow-up, and 3) Items related to breastfeeding. Cultural values and norms may play a role in whether or not change is realized in some of these areas. For example, there are many factors including cultural norms, values, and perceived ‘hassles’ that could prevent child care sites from progressing to provide access and services for breastfeeding mothers. In addition, to dispel stereotype and misinformation about topics such as allowing children to decide what foods to eat may require long-term interventions across multiple domains.
Potential areas to continue to target are: 1) providing parents with guidelines for when food is brought from home. As demonstrated in Figure 1, less than 45% of providers are doing this at baseline and follow-up. While this low percent is in part due to the high percentage that indicated this item did not apply to their program, this was an area that showed no significant change in providers “Doing” from baseline to follow-up. 2) Children serve themselves from serving dishes at mealtime. There was a significant positive change in this area from baseline to follow-up. However, the percent of providers reporting “Doing” this is still relatively low at 72%. Furthermore, when looking closely at just the participants who reported “not doing” this at baseline, only 59.8% changes to “Doing” at follow-up. All other areas in which positive change was made ranged from a total of 75% to 100% of participants “Doing” at follow-up. 3) Special occasions and holidays are celebration with healthy foods or with non-food treats is another area which may merit further attention. While there was a significant difference in percent of providers “Doing” this at follow-up compared to baseline, the percent of providers doing this at follow up is still less than 80%.
An examination of differences between site type indicated that there were significant differences in providers reporting “Doing” on items at baseline and at follow-up. For a proportion of items showing differences, the difference was only evident at follow-up. However, for other items the differences existed at both baseline and at follow-up. Across all items, more center-based staff than family child care providers reported engaging in the practices. Detailed analyses are included in Appendix C. Differences between site types were as follows:
At baseline only, Fisher’s Exact tests revealed that more center-based staff than family child cares providers were doing the following:
 Parents receive written nutrition policies upon enrollment. Center-based participants were 4.43 times more likely than family child care providers to report “Doing” this.
Improving Health in Child Care Settings: 2016 22

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