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Overall, providers who participated in Choose Health LA Child Care training and coaching reported high levels of knowledge, are engaging in practices to create a healthy child care environment, showed positive change in policies and practices targeted by CHLA CC, and are prepared to make changes. Specifically, there were significant increases in the percent of providers who engaged in positive nutrition policies and practices, positive changes were made in food served, and there were significant increases in providers engaged in positive physical activity policies and practices from before participating in CHLA CC to after participating in CHLA CC.
It was expected that participants who received a greater intensity of the program (i.e. coaching in addition to training) would show greater positive change in aspects targeted by CHLA CC than participants who only attended the training. This expectation was not supported by findings in this survey. However, factors which could explain this finding were identified: 1) At baseline, there were differences between participants who received coaching and those who did not, as demonstrated in post-hoc analyses such that providers who received coaching reported more challenges in creating healthy practices and routines and creating written rules or guidelines about healthy practices than providers who did not receive coaching. However, that group difference did not persist at follow-up, indicating a possible gap closure between groups and reduction in challenges experienced by CHLA CC coaching participants during follow-up. 2) Participants who received coaching received at most 2 coaching sessions lasting approximately one hour. Longer and more frequent sessions may be necessary to affect change above and beyond that made by training alone. Finally, 3) The coaching sessions participants received through CHLA CC were very specific and focused on one goal while the Policies and Practices survey measures change in multiple areas.
Based on findings from this survey, four main areas of need were identified:
• Breastfeeding knowledge and policies. Compared to other areas of healthy policies and practices assessed with this survey, participants’ implementation, knowledge, and efficacy or readiness to change in regards to breastfeeding practices and policies was low, suggesting this area may merit further attention. Breastfeeding exists in a value system that may be difficult to change. Myths about the difficulty of dealing with breastfeeding and breast milk or lack of understanding of its importance may be challenging to overcome. Furthermore, qualitative analyses of program data indicate that mothers move their children to formula before enrolling children in child care. Therefore, being able to support parents who have already made the shift from breast feeding to formula may present an additional challenge. Other possibilities to
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