Barriers and Facilitators of Parent Engagement With Health Promotion in Child Care: A Mixed-Methods Evaluation

Abstract

Background Early care and education providers cite lack of parent engagement as a central barrier to promoting healthy behaviors among young children. However, little research exists about factors influencing parent engagement with promoting healthy eating and activity behaviors in the this setting. Aims This study aimed to address this gap by examining low and high parent engagement with the Healthy Me, Healthy We campaign to identify barriers and facilitators of parent engagement with the intervention. Method This comparative case study used an explanatory sequential mixed-methods approach. We created center-level parent engagement scores using process evaluation data from the effectiveness trial of Healthy Me, Healthy We. Recruitment focused on centers with the five lowest and five highest scores. Twenty-eight adults (7 directors, 9 teachers, 12 parents) from seven centers (3 low engagement, 4 high engagement) completed semistructured interviews and the Family and Provider/Teacher Relationship Quality measure. Analytic approaches included descriptive statistical analyses for surveys and a framework-informed thematic analysis for interviews. Results Prominent contrasts between low- and high-engagement groups involved center culture for parent engagement and health promotion, practices for fostering networks and communication within centers, and communication between centers and parents. Personal attributes of providers (e.g., attitudes) also differentially influenced practices for engaging parents. Discussion and Conclusion Organizational characteristics and individual practices can facilitate or impede parent engagement with health promotion efforts. Assessing organizational context, gaining input from all stakeholders, and conducting capacity-building interventions may be critical for laying the foundation for positive relationships that support parent engagement in implementation of health promotion programs and beyond.

Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial

“…A potential explanation for this reduction may be the competing information relating to COVID-19 distributed to parents during the intervention period (eg, communication regarding center safety protocols and changes to child attendance fees), resulting in support for parents to provide foods consistent with sector dietary guidelines being of lesser priority at this time. Research suggests a lack of skills, knowledge, and confidence in communicating with parents regarding healthy eating [58,59,65] may also negatively impact the implementation of this practice. Using strategies, such as ongoing professional development, coaching, and training, have been suggested in recent studies to address such barriers and support ECEC staff to engage in positive and effective communication with parents [65].…”

“…Research suggests a lack of skills, knowledge, and confidence in communicating with parents regarding healthy eating [58,59,65] may also negatively impact the implementation of this practice. Using strategies, such as ongoing professional development, coaching, and training, have been suggested in recent studies to address such barriers and support ECEC staff to engage in positive and effective communication with parents [65]. As centers were encouraged to distribute the healthy eating resources to parents via usual communication methods (eg, parent communication apps, email, and written information), further consideration of the most effective method to facilitate staff communication with parents regarding healthy eating and nutrition may be required.…”

A qualitative comparison of parent and childcare provider perceptions of communication and family engagement in children's healthy eating and physical activity

“…Previous research though has primarily explored either the parents' or childcare providers' perceptions and focused only on healthy eating or physical activity (Dev et al, 2017; Johnson et al, 2013; Tandon et al, 2017). However, discrepancies in promotional practices are often uncovered between these two caregivers (Hennink‐Kaminski et al, 2018; Luecking et al, 2020; Tandon et al, 2017). For example, parents in one study more often believed their child could get sick when playing outside in the cold compared with providers (Tandon et al, 2017).…”

Efficacy of an Enhanced Implementation Strategy to Increase Parent Engagement with a Health Promotion Program in Childcare

“…Results also highlight the complexities of providing adequate implementation support for multiple levels of interventions which occur in community-based settings like ECE centers and the importance of designing interventions with implementation in mind [ 44 ]. Although strategies were selected to address previously identified barriers [ 23 ], it is worth considering whether the strategies were in fact the best match for ECE providers to employ with parents. Future planning and implementation efforts should involve all stakeholders in the strategic selection, specification, tailoring of implementation strategies [ 48 , 49 ].…”

“…To develop the enhanced implementation approach, we conducted a mixed methods comparative case study among seven centers from Wave 1 of the overarching trial that demonstrated low and high parent involvement with HMHW [ 23 ]. Two frameworks informed the development of semi-structured interview guides and the initial coding frameworks.…”