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    Item 27. Flavored or sweetened milk was served:
     1 time per day or more
  2-3 times per week
   1 time per week or less
    Does not apply to my site
  To determine whether providers made positive or negative changes in the food they served from baseline to follow-up, change scores were analyzed. First a numeric value corresponding to each ordinal category was assigned with the healthiest behavior assigned higher numbers. For example, a response of “Never” to Item 27 would have been coded as a 3. The highest possible score for each item was a three and the lowest possible score was a zero. All participants who achieved a three at baseline were removed from the analysis on an item-by- item basis as they had no room to improve. Also, only participants who completed both a baseline and follow-up survey were included. A change in the desired direction was categorized as “Positive Change” in Table 6; if the participant provided the exact same response at baseline and follow-up they were categorized as “No Change;” if a participant provided a response in their follow-up which was less desirable than what they selected during the baseline, they were categorized as “Negative Change.”
As seen in Table 6, 21% to 62% of providers who had room for growth experienced positive change. The area that showed the greatest amount of positive change was in serving flavored or sweetened milk, which showed the least amount of positive change last year. Specifically, 62.3% of participants showed positive change, serving less flavored or sweetened milk at follow-up. This compares to a 12.9% positive change last year (serving less frequently) from baseline to follow-up. Positive changes were also seen in the other areas (36.0% of participants showed positive change in the serving of fruit, 34.6% of participants showed positive change in the serving of whole grain foods, 32.9% in the serving of vegetables, 26.8% made a positive change in serving of processed meats, 24.9% made positive change in the serving of 100% juice, and 21.6% made positive change in serving unflavored milk or non-dairy alternative to children age 2 and older). Nevertheless, 11% to 18% of participants reported negative change from baseline to follow-up. Why the negative changes are so high is not clear. Is it due to faulty estimations of how often or how much is served, or was there true negative change? This area may merit further exploration.
Improving Health in Child Care Settings: 2016 25

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