Study concepts (related TPB concepts) and article’s definition
Results on TPB-related concepts
Association between TPB concepts and child care practices
Covariates in analyses (potential demographic moderators)
Brann [16], Journal of Pediatric Health Care/2010/Onondaga County, central NY/Cross-sectional survey
FCCH providers Provider aRace: 84% white, 11% black, 2% hispanic, 0.8% native American Age: 45% 20–40, 50% 41–60, 5% greater than 60 years Education level: 30% college graduate or above, 66% HS graduate or some college, 4% some HS Avg. BMI: 27 ± 7.7 Children Avg. age: 4.5 years ± 1.5 Avg. household Income: 42% < 40K, 52% 40–80K, 6% > 80K
Perceptions of childhood overweight (subjective norm): perception of what is considered overweight by identifying drawings of boys and girls ranging from very thin to very heavy that lie in a gradient from thin to heavy Perceived responsibility in child feeding (perceived behavioral control)
Perception of childhood overweight (subjective norm) Most providers chose a figure representing an above average-sized boy and girl as a cut off point for overweight Perceived responsibility in child feeding (perceived behavioral control) High level of responsibility for feeding and monitoring
Perception of childhood overweight (subjective norm) Providers who selected smaller silhouettes for girls as a measure for overweight reported using more food restriction on girls ().
Level of Education Providers with a higher level of education were correlated with less pressuring of children to eat more food () Concerned about child weight Relationship exist between concern about weight and restriction of unhealthy foods () Providers who selected smaller silhouettes for girls were more likely to have more concern about the child’s weight ()
Kim et al. [32], Maternal and Child Health Journal/2012/East Central Illinois/Cross-sectional analysis
FCCH providers; 94 center-based providers
Perceptions (perceived behavioral control) providers’ perceptions of the level of influence on children’s healthy behaviors and weight status
Providers’ perceptions of the level of influence on children’s healthy behaviors and weight status (perceived behavioral control) Both the family and center-based providers felt that the home environment had more influence on healthy eating/PA habits and weight status of the children (paired t tests, all significant p values) FCCHs > centers ranked influence on health behaviors and weight status with the exception of PA. FCCH providers felt that home and center-based facilities shared similar influence on physical activity of the children.
Level of training results >55% of FCCH providers = obesity prevention training within the past year, which is a marked difference 30% of center-based providers (). Highly trained FCCH providers more likely to receive nutrition and PA training ( respectively) Highly trained FCCH providers more likely to disseminate healthy nutrition and PA information to children (PA and obesity prevention information to parents (all significant values)
Lindsay et al. [18], Journal of Obesity/2015/MA/Focus groups
Latino FCCH providers; 4 focus groups Provider Ethnicity 100% Latino Education level −1/3 HS graduate or GED, 40% some college Years of experience 93% up to 25 years of child care experience
Provider’s perceptions, attitudes and practices related to nutrition and physical activity (attitudes) perceptions of the CACFP and EEC (attitudes) attitudes related to communication with parents (subjective norm) perception of child weight status of kids in care of providers (subjective norm) beliefs about physical activity and sedentary behaviors (perceived behavioral control) provider control on what and how much children eat (perceived behavioral control) perceived barriers to PA and healthy eating (perceived behavioral control) provider’s belief related to their role (perceived behavioral control) perceived barriers to provision of healthy foods (Behavioral Intent) Strategies to incorporate nutritious foods
Attitudes towards CACFP and EEC (attitudes) CACFP policies helpful and made a difference in the health of children. Attitudes related to communication with parents (attitudes) communication with parents important and critical in understanding child’s well-being at home did not feel comfortable discussing children’s weight status with parents. Perceptions of child weight status (subjective norm) Few providers reported having some children at risk for overweight or obesity Most reported that they did not have major concerns about weight status of children currently under their care. Beliefs about PA and sedentary behavior (subjective norm) Most believed the importance for children to engage in PA throughout the day. However, the amount of time providers believed children should engage in PA varied (from 30 minutes to 2 hours) Foods served and portion sizes (perceived behavioral control) perceive parents to be a barrier to healthy eating in FCCH Beliefs related to child feeding (perceived behavioral control) Perceived role is to nurture and educate children Most feel confident in the abilities to serve healthy foods Perception on need to control feeding (perceived behavioral control) Felt need to control what and how much children eat Perceived barriers to PA (perceived behavioral control) Most believed lack of space and cold whether to be major obstacles for PA opportunities Perceived barriers to provision of healthy foods (perceived behavioral control) Perceived high cost of fresh fruits and vegetables does not enable them to purchase and provide these foods. Perceived that the CACFP does not pay enough for purchase of fresh fruits and vegetables Strategies to incorporate nutrition foods (behavioral intent) Encouraging new foods Meal planning Participating in workshops
Attitudes related to communication with parents and communicating weight concerns to parents (attitudes) Providers who reported being uncomfortable and reluctant to discusschild’s weight felt that parents can be very sensitive to other people’s perceptions of their children, and because of that they preferred not to talk about it with parents. Foods served and portion sizes (subjective norm) Providers report serving foods aligned with recommendations from USDA Many providers base portion sizes on age of child Perceptions of child weight status and determining portion sizes (subjective norm) Few providers reported having some children at risk for overweight or obesity and that this influenced their feeding practices, especially in determining portion sizes
Providers’ place of birth Providers who had formative years outside of US, in warmer climates, perceived winter as a barrier to PA more than US-born providers
Rosenthal et al. [24], Journal of Nutrition Education and Behavior/2013/CT/in-depth interviews
FCCH providers Provider Race/ethnicity 29% African American, 53% white, 24% Latina Mean age 43 yrs (31–54) Mean yrs working in child care 13 (5–32) Household income less than 50K (47%), 50–75K (29%), 75–100K (18%), more than 100K (6%)
Attitudes towards parents (attitudes) Perceived role in obesity prevention (perceived behavioral control) Strategies used to implement best practices in nutrition and PA (behavioral intent)
Attitudes towards parents (attitudes) expressed both empathy and frustration with parents. Perceived role in obesity Prevention (perceived behavioral control) perceived they had a personal responsibility in obesity prevention. Discussed the importance of their role in sharing healthy foods with parents. acknowledged the supportive role of food guidelines, unannounced inspections from the government sponsored food program, and the peer group.
Strategies used to implement best practices in nutrition and PA (behavioral intent) described how, at the first meeting with parents, they try to be clear with parents about food guidelines. Some have written rules about food guidelines and all described having a conversation with families about food guidelines. described using their own knowledge of child development to improve nutritional intake and incorporating dramatic play to facilitate times of high PA described how they incorporate another aspect of child development, socialization, to improve a child's nutrition. described how they use dramatic play to facilitate PA described sharing with parents both the actual food and the techniques they use to encourage children to eat nutritiously did not pressure kids to eat but were still concerned so helped the child to eat
Tovar et al. [28], Childhood Obesity/2015/RI/Focus groups
FCCH providers; 4 focus groups Provider Race/ethnicity 100% female, Hispanic (predominantly Dominican, 77%), and Spanish speaking Level of education 50% = some college+ Mean age 50 years
Perceptions on use of TV (subjective norm) Perceptions and beliefs regarding which factors influence children’s PA, screen time and dietary behaviors (perceived behavioral control) Perceived strategies to improve the nutrition and PA environment of FCCHs (behavioral intention)
Provider perceptions on screen time behaviors (subjective norm) Screen time should be limited and rules should be in place to stop parents from leaving children at FCCH with electronic devices Perceived watching educational programs such as Dora the Explorer learning and not screen time Use of TV for food prep Others felt that watching TV did not benefit child Provider’s perceptions on how preschool-aged children can be physically active (perceived behavioral control) Perceived that children have many opportunities to engage in PA in the home Perceived that children are more active when outside Perceived that there are opportunities indoor but needs to be scheduled into the provider’s day Influences on what and how providers feed or offer PA opportunities for preschool-aged children (perceived behavioral control) Perceived responsibility to provide children with nutritious foods Perceived need to abide by program regulations, though some deem regulations as contributing to added stress Culture influenced foods served Poor parental behavior influences the childcare environment Providers perceive parents’ poor beliefs regarding PA to be a major barrier to PA in the FCCH. Providers perceive children’s varying preferences to be a barrier to group PA Fear of children getting hurt in home limits PA in home Winter weather Provider perceived 50F to be too cold to take children outside Perceived strategies to improve the nutrition and PA environment of FCCHs (behavioral intent) More problem-based solutions oriented trainings, programs and resources Increased reimbursement for purchase of fruits and vegetables Improve communication with parents regarding proper nutrition and PA practices
Training and feeding practices Often disconnect between providers belief on the importance of healthy foods and what they actually serve Perceived the CACFP program to help enhance knowledge on nutrition foods, yet some still do not follow nutrition guidelines of the food program due to cultural feeding practices Providers relied on child’s age and physical stature to determine portion size instead of relying on age-appropriate guidelines for portion sizes Due to training, providers appreciated the importance of not force feeding and being a role model during feeding mealtimes
Vinci et al. [33], Journal of Obesity/2016/FL/Focus groups
FCCHs (75.9% of sample of child care providers)
Subjective beliefs of what is needed to ensure PA in homes (perceived behavioral control)
Subjective beliefs of what is needed to ensure PA in homes (perceived behavioral control) additional specific factors that were not raised by center staff including the need for activities that can be adapted for a wide range of ages. Home providers cautioned against providing PA that required extensive space or equipment, since space is limited in FCCHs.
Van Stan et al. [31], Childhood Obesity/2013/DE/survey
FCCHs; 5% center owner; 84% CACFP
Knowledge of nutrition and PA rules
FCCHs>Center staff Knowledge of DE’s nutrition and PA rules (14.7 versus 18 out of 26, )
aMissing data for five providers; FCCH = Family Child Care Homes; EEC = Early Education and Care; BMI = body mass index; PA = physical activity; MVPA = moderate to vigorous physical activity; TPA = total physical activity; U = Mann–Whitney test.
