Research Findings. Application of mixed methods in a dissemination and implementation framework can give researchers a better understanding of the reach and delivery of early childhood obesity prevention programs in preschool settings, as well as potential facilitators and barriers related to implementation and sustainability. This study utilized a simultaneous, exploratory, mixed-methods design to investigate individual-, organizational-, and intervention-level factors that were related to the implementation and sustainability of policy, system, and environment (PSE) changes as part of a larger obesity prevention program in a randomly selected sample of preschool centers (n = 20). Individual-level factors, and specifically the attitudes and skills of preschool providers, were identified in both the qualitative and quantitative data as important factors related to the sustainability of PSE changes (r = .56, p < .01). Staff and leadership engagement and adaptability of the program were also identified as important factors related to the implementation and sustainability of PSE changes. Practice or Policy. These findings highlight the complexity of implementation success and suggest PSE obesity prevention interventions in preschool centers require the consideration of numerous, multilevel factors to ensure programming is impactful and sustained over time.
BarryC. A. (1998). Choosing qualitative data analysis software: Atlas/ti and Nudist compared. Sociological Research Online, 3(3), 16–28. https://doi.org/10.5153/sro.178
2.
BartholomewL.ParcelG.KokG. (1998). Intervention mapping: A process for developing theory- and evidence-based health education programs. Health Education & Behavior, 25(5), 545–563. https://doi.org/10.1177/109019819802500502
3.
BauerM. S.DamschroderL.HagedornH.SmithJ.KilbourneA. M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(1), Article 32. https://doi.org/10.1186/S40359-015-0089-9
4.
BelanskyE. S.CutforthN.ChavezR. A.WatersE.Bartlett-HorchK. (2011). An Adapted Version of Intervention Mapping (AIM) is a tool for conducting community-based participatory research. Health Promotion Practice, 12(3), 440–455. https://doi.org/10.1177/1524839909334620
5.
BerglingE.FarewellC.PumaJ. (2020). Development of a dissemination and implementation framework for an early childhood obesity prevention program. Journal of Nutrition Education and Behavior, 52(12), 1160–1165. https://doi.org/10.1016/j.jneb.2020.08.012
6.
BissetS.DanielM.PotvinL. (2009). Exploring the intervention–context interface. American Journal of Evaluation, 30(4), 554–571. https://doi.org/10.1177/1098214009349792
7.
BissetS.PotvinL.DanielM. (2013). The adaptive nature of implementation practice: Case study of a school-based nutrition education intervention. Evaluation and Program Planning, 39(August), 10–18. https://doi.org/10.1016/j.evalprogplan.2012.12.004
8.
BlackM. M.Pérez-EscamillaR.Fernandez RaoS. (2015). Integrating nutrition and child development interventions: Scientific basis, evidence of impact, and implementation considerations. Advances in Nutrition, 6(6), 852–859. https://doi.org/10.3945/an.115.010348
9.
BrownC. H.CurranG.PalinkasL. A.AaronsG. A.WellsK. B.JonesL.CollinsL. M.DuanN.MittmanB. S.WallaceA.TabakR. G.DucharmeL.ChambersD. A.NetaG.WileyT.LandsverkJ.CheungK.CrudenG. (2017). An overview of research and evaluation designs for dissemination and implementation. Annual Review of Public Health, 38(1), 1–22. https://doi.org/10.1146/annurev-publhealth-031816-044215
DamschroderL. J.AronD. C.KeithR. E.KirshS. R.AlexanderJ. A.LoweryJ. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), Article 50. https://doi.org/10.1186/1748-5908-4-50
12.
de MeijJ. S. B.van der WalM. F.van MechelenW.ChinapawM. J. M. (2013). A mixed methods process evaluation of the implementation of JUMP-in, a multilevel school-based intervention aimed at physical activity promotion. Health Promotion Practice, 14(5), 777–790. https://doi.org/10.1177/1524839912465750
13.
de Silva-SanigorskiA. M.BellA. C.KremerP.NicholsM.CrellinM.SmithM.SharpS.de GrootF.CarpenterL.BoakR.RobertsonN.SwinburnB. A. (2010). Reducing obesity in early childhood: Results from Romp & Chomp, an Australian community-wide intervention program. American Journal of Clinical Nutrition, 91(4), 831–840. https://doi.org/10.3945/ajcn.2009.28826
14.
de Silva-SanigorskiA. M.BellA. C.KremerP.ParkJ.DemajoL.SmithM.SharpS.NicholsM.CarpenterL.BoakR.SwinburnB. (2012). Process and impact evaluation of the Romp & Chomp obesity prevention intervention in early childhood settings: Lessons learned from implementation in preschools and long day care settings. Childhood Obesity, 8(3), 205–215. https://doi.org/10.1089/chi.2011.0118
15.
DreisingerM. L.BolandE. M.FillerC. D.BakerE. A.HesselA. S.BrownsonR. C. (2012). Contextual factors influencing readiness for dissemination of obesity prevention programs and policies. Health Education Research, 27(2), 292–306. https://doi.org/10.1093/her/cyr063
16.
FarewellC. VPumaJ.BerglingE.WebbJ.QuinlanJ.ShahP.MaiurroE. (2020). An exploration of constructs related to dissemination and implementation of an early childhood systems-level intervention. Health Education Research, 35(6), 574-583. https://doi.org/10.1093/her/cyaa038
17.
FarewellC. V.PumaJ. E.PowersJ.BelanskyE. S. (2018). Assess, identify, make it happen (AIM) for preschools: A tool to decrease early childhood obesity. Health Promotion Practice, 19(6), 935–945. https://doi.org/10.1177/1524839917746677
18.
FormanS. G.OlinS. S.HoagwoodK. E.CroweM.SakaN. (2009). Evidence-based interventions in schools: Developers’ views of implementation barriers and facilitators. School Mental Health, 1, Article 26. https://doi.org/10.1007/s12310-008-9002-5
19.
GreaneyM. L.HardwickC. K.Spadano-GasbarroJ. L.MezgebuS.HoranC. M.SchlotterbeckS.AustinS. B.PetersonK. E. (2014). Implementing a multicomponent school-based obesity prevention intervention: A qualitative study. Journal of Nutrition Education and Behavior, 46(6), 576–582. https://doi.org/10.1016/j.jneb.2014.04.293
HanS. S.WeissB. (2005). Sustainability of teacher implementation of school-based mental health programs. Journal of Abnormal Child Psychology, 33(6), 665–679. https://doi.org/10.1007/s10802-005-7646-2
22.
HarrisP. A.TaylorR.ThielkeR.PayneJ.GonzalezN.CondeJ. G. (2009). Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377–381. https://doi.org/10.1016/j.jbi.2008.08.010
23.
HodderR. K.O’BrienK. M.TzelepisF.WyseR. J.WolfendenL. (2020). Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database of Systematic Reviews, 5(5), CD008552. https://doi.org/10.1002/14651858.CD008552.pub7
24.
HungL.-S.TidwellD. K.HallM. E.LeeM. L.BrileyC. A.HuntB. P. (2015). A meta-analysis of school-based obesity prevention programs demonstrates limited efficacy of decreasing childhood obesity. Nutrition Research, 35(3), 229–240. https://doi.org/10.1016/J.NUTRES.2015.01.002
LaniganJ. D. (2011). Family child care providers’ perspectives regarding effective professional development and their role in the child care system: A qualitative study. Early Childhood Education Journal, 38(6), 399–409. https://doi.org/10.1007/s10643-010-0420-2
27.
LebronC. N.OforiA.SardinasK.LuacesM.NataleR.MessiahS. E. (2020). Barriers and facilitators to obesity prevention dissemination and implementation efforts in the childcare centre setting from the provider perspective. Child: Care, Health and Development, 46(3), 352–359. https://doi.org/10.1111/cch.12752
28.
LeemanJ.BirkenS. A.PowellB. J.RohwederC.SheaC. M. (2017). Beyond “implementation strategies”: Classifying the full range of strategies used in implementation science and practice. Implementation Science, 12(1), Article 125. https://doi.org/10.1186/s13012-017-0657-x
LuceroJ.WallersteinN.DuranB.AlegriaM.Greene-MotonE.IsraelB.KastelicS.MagaratiM.OetzelJ.PearsonC.SchulzA.VillegasM.White HatE. R. (2018). Development of a mixed methods investigation of process and outcomes of community-based participatory research. Journal of Mixed Methods Research, 12(1), 55–74. https://doi.org/10.1177/1558689816633309
31.
LynR.EversS.DavisJ.MaaloufJ.GriffinM. (2014). Barriers and supports to implementing a nutrition and physical activity intervention in child care: Directors’ perspectives. Journal of Nutrition Education and Behavior, 46(3), 171–180. https://doi.org/10.1016/j.jneb.2013.11.003
32.
Martínez-MesaJ.González-ChicaD. A.DuquiaR. P.BonamigoR. R.BastosJ. L. (2016). Sampling: How to select participants in my research study?Anais Brasileiros de Dermatologia, 91(3), 326–330. https://doi.org/10.1590/abd1806-4841.20165254
33.
MelnickE. M.ThomasK.FarewellC.QuinlanJ.LaflammeD.BrogdenD.ScarbroS.PumaJ. E. (2020). Impact of a nutrition education programme on preschool children’s willingness to consume fruits and vegetables. Public Health Nutrition, 23(10), 1846–1853. https://doi.org/10.1017/S1368980019005032
PalinkasL. A.AaronsG. A.HorwitzS.ChamberlainP.HurlburtM.LandsverkJ. (2011). Mixed Method Designs in Implementation Research. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 44–53. https://doi.org/10.1007/s10488-010-0314-z
37.
PowersJ. N.FarewellC. V.MaiurroE.PumaJ. (2020). The impact of a workplace wellness program on provider health in early childhood education settings. Workplace Health & Safety, 68(2), 65–72. https://doi.org/10.1177/2165079919882732
38.
RapportF.Clay-WilliamsR.ChurrucaK.ShihP.HogdenA.BraithwaiteJ. (2018). The struggle of translating science into action: Foundational concepts of implementation science. Journal of Evaluation in Clinical Practice, 24(1), 117–126. https://doi.org/10.1111/jep.12741
39.
RedfordJ.DesrochersD.HoyerK. M.RalphJ. (2017). Stats in brief: The years before school: Children’s nonparental care arrangements from 2001 to 2012.
40.
RogersE. M. (2003). Diffusion of innovations. Free Press.
41.
Southam-GerowM. A.DorseyS. (2014). Qualitative and mixed methods research in dissemination and implementation science: Introduction to the special issue. Journal of Clinical Child and Adolescent Psychology, 43(6), 845–850. https://doi.org/10.1080/15374416.2014.930690
42.
TeddlieC.TashakkoriA. (2009). Foundations of mixed methods research: Integrating quantitative and qualitative approaches in the social and behavioral sciences. Sage.
43.
WatersE.de Silva-SanigorskiA.BurfordB. J.BrownT.CampbellK. J.GaoY.ArmstrongR.ProsserL.SummerbellC. D. (2011). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 12, Article CD001871. https://doi.org/10.1002/14651858.CD001871.pub3
44.
WolfendenL.FinchM.NathanN.WeaverN.WiggersJ.YoongS. L.JonesJ.DoddsP.WyseR.SutherlandR.GillhamK. (2015). Factors associated with early childhood education and care service implementation of healthy eating and physical activity policies and practices in Australia: A cross-sectional study. Translational Behavioral Medicine, 5(3), 327–334. https://doi.org/10.1007/s13142-015-0319-y
45.
WolfendenL.NathanN. K.SutherlandR.YoongS. L.HodderR. K.WyseR. J.DelaneyT.GradyA.FieldingA.TzelepisF.Clinton-McHargT.ParmenterB.ButlerP.WiggersJ.BaumanA.MilatA.BoothD.WilliamsC. M. (2017). Strategies for enhancing the implementation of school-based policies or practices targeting risk factors for chronic disease. Cochrane Database of Systematic Reviews, 11(11), CD011677. https://doi.org/10.1002/14651858.CD011677.pub2
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