Deimplementation of Inappropriate Feeding Practices in Early Care andEducation Settings

Project Summary More than 12 million children in the U.S. consume up to two-thirds of their dietary intake in early care and education (ECE) settings.1,2 Yet, educators in ECE often use dietary and feeding practices that are not evidence-based.3 Given that childhood dietary habits often persist into adulthood,4–6 failure to use evidence- based practices (EBPs) related to healthy nutrition and feeding patterns can have negative implications for development of weight trajectories and dietary patterns across the lifespan. The overall objective for this application is to determine the effectiveness and associated mechanisms of a package of deimplementation strategies to reduce the use of inappropriate feeding practices in ECE. Demonstrating the effectiveness of strategies for reducing inappropriate feeding practices in ECE and determining how the strategies work and for whom will provide new opportunities for building a strong foundation in the ECE setting for lifelong healthy eating habits. We will conduct a cluster-randomized Hybrid Type III trial with 88 ECE sites serving children ages 3 and 5. The trial will achieve two specific aims: Aim 1: Determine the effectiveness of a package of deimplementation strategies for reducing the use of inappropriate feeding practices in ECE. Our hypothesis is that, compared to usual practice, the deimplementation strategies will be effective at reducing the total number of observed inappropriate feeding practices per meal, our primary deimplementation outcome (N= 88 sites, 528 educators).3 We will also identify effects on secondary effectiveness outcome measures including child body mass index, willingness to try novel foods, fear of new foods (i.e., neophobia), and dietary intake (N=1320 children). Aim 2: Identify mechanisms of deimplementation using a mixed methods approach. Our hypothesis is that factors specified by the Implementation Trust Building Theory of Change22 will mediate the effect of strategies on deimplementation outcomes. Using an explanatory, sequential design, we will collect qualitative data with purposively selected educators (N = 32) to identify emergent mediators and moderators. The project will determine the effectiveness of a blended in-person and virtual approach to deimplementation with scalable tailoring elements. In addition, we expect to have determined key mechanisms of our deimplementation strategies, providing practice-relevant information on how and why strategies work to change behavior in the real world and informing future replication and scale-up. These results are expected to have a positive impact on the weight and dietary behaviors of young children through the targeted removal of inappropriate feeding practices in ECE.