De-implementation of detrimental feeding practices: a pilot protocol
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(2020) 6:181
STUDY PROTOCOL
Open Access
De-implementation of detrimental feeding practices: a pilot protocol Taren Swindle1* , Julie M. Rutledge2, Susan L. Johnson3, James P. Selig4 and Geoff M. Curran5
Abstract Background: Early childhood educators (ECEs) often use detrimental feeding practices and are slow to implement positive feeding practices. Nevertheless, few studies have aimed to understand and change ECEs’ feeding practices. This gap needs to be addressed because implementation (i.e., adding new, evidence-based practices) and deimplementation (i.e., stopping low-value or harmful practices) are distinct processes that require unique strategies. Methods: We will develop a de-implementation strategy for detrimental feeding practices using evidence-based quality improvement (EBQI) sessions to engage stakeholders and draw on the Niven process model for deimplementation. Then, we will investigate the effects of the de-implementation strategy in a proof-of-principle study. The de-implementation strategy will be evaluated in 2 partnering childcare agencies using a pre-post, withinsite design. For our primary outcome, we will interview educators throughout the school year to assess the feasibility and acceptability of the intervention and survey them with standard measures for assessing feasibility and acceptability. For secondary outcomes, we will investigate its effects on the use of detrimental and evidence-based feeding practices by teachers and impacts on child BMI and diet. Discussion: The current study will establish the feasibility and acceptability of our de-implementation approach and will provide preliminary data toward 3 predicted secondary outcomes: (1) decreased detrimental feeding practices by ECEs, (2) increased adoption of and fidelity to nutrition promotion practices, and (3) improved child dietary outcomes. These results are expected to contribute to the uptake and sustainability of mealtime interventions to improve the diets of young children. Results will also apply to the field of implementation science by informing processes for developing de-implementation approaches in a community setting. Keywords: De-implementation, Childcare, Feeding practices, Nutrition, Implementation science
Background Diet quality predicts a child’s physical, mental, and academic well-being [1–3], yet the diets of many children in the USA are of low nutrient density [4, 5]. One important setting for addressing children’s dietary quality is childcare given that 11 million children under age 5 are in childcare settings in the USA [6] and may consume over two-thirds of their daily diets in this setting [7]. Research supports that childcare influences children’s diets more broadly * Correspondence: [email protected] 1 Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St, #530, Little Rock, AR 72205-7199, USA Full list of author information is available at the end of the article
with spillover effects into the home [8, 9]. Further, dietary habits established i
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