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A Menu to Evaluate Factors Influencing Implementation of Obesity Prevention Early Care and Education Regulations

Sawicki, Erin, MPH; Barker, Dianne C., MHS; Gutman, Marjorie A., PhD; Caughlan, Ian, BA; Yochelson, Marissa, BA; Grob, George, MA

Journal of Public Health Management and Practice: May/June 2019 - Volume 25 - Issue 3 - p E11–E18
doi: 10.1097/PHH.0000000000000796
Research Reports: Research Full Report

Context: In recent years, several states have adopted new regulations concerning nutrition, physical activity, and screen time in early care and education (ECE) settings to help prevent childhood obesity.

Objective: To disseminate a menu of factors that facilitate and/or impede implementation of obesity prevention regulations in ECE settings.

Design: To create the menu, we condensed and categorized factors identified in the literature and through field work by placing them within domains. We applied the menu by conducting semistructured interviews during a pilot test assessing implementation of ECE regulations in Colorado.

Setting and Participants: We first interviewed state and local government agency leaders responsible for policy oversight, and state employees and contractors who acted as intermediaries to direct implementers. We then interviewed directors at ECE centers in the Denver, Colorado, area. We selected 21 ECE centers for a site visit on the basis of feasibility, percentage of low-income families, and diversity in race and ethnicity at each center. Seven centers participated.

Main Outcome Measures: Minor and major facilitators and impediments to implementation of childhood obesity prevention regulations in ECE settings.

Results: The resulting menu includes 7 domains and 39 factors influential for implementation of ECE regulations. Of these 39 factors, interviewees identified 7 facilitating factors (4 major and 3 minor) and 2 impeding factors (both major). Major facilitating factors were buy-in from parents/caregivers, training and communication provided by governing authority and their contractors, and low level of change required by the regulations themselves. Major impeding factors were timing of implementation and balancing the demands of the regulations against other priorities.

Conclusions: The menu developed by our research team, combined with existing frameworks in dissemination and implementation research, can be used by researchers, practitioners, and policy makers to anticipate factors that facilitate and/or impede implementation of ECE policies to prevent childhood obesity.

Barker Bi-Coastal Health Consultants, Inc, Calabasas, California (Mss Sawicki, Barker, and Yochelson and Mr Caughlan); Gutman Research Associates, Princeton, New Jersey (Dr Gutman); and Center for Public Program Evaluation, Purcellville, Virginia (Mr Grob).

Correspondence: Erin Sawicki, MPH, Barker Bi-Coastal Health Consultants, Inc, PO Box 8723, Calabasas, CA 91372 (

The authors thank Sasha Albert, MSc, for her help in developing the initial manuscript.

Support for this research was provided by the Robert Wood Johnson Foundation (grant no. 73770). The views expressed here do not necessarily reflect the views of the Foundation.

The authors declare no conflicts of interest.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.