Cross-site process evaluation results for the early childhood education center setting: CORD study

Authors: LEDOUX, TRACEY - University Of Houston; Thompson, Deborah - Debbe; O'CONNOR, TERESIA - Children'S Nutrition Research Center (CNRC); AVERY, DANA - University Of Houston; KOCHI, CAMILA - University Of Houston; O'CONNOR, DANIEL - University Of Houston; LIN, SHIH - San Diego State University; BINGGELI-VALLARTA, AMY - Imperial County Public Health Department; BLAINE, RACHEL - California State University; SHARMA, SHREELA - University Of Texas Health Science Center; HOELSCHER, DEANNA - University Of Texas Health Science Center

Submitted to: Childhood Obesity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/13/2019
Publication Date: 5/29/2020
Citation: Ledoux, T., Thompson, D.J., O'Connor, T., Avery, D., Kochi, C., O'Connor, D.P., Lin, S.F., Binggeli-Vallarta, A., Blaine, R.E., Sharma, S., Hoelscher, D.M. 2020. Cross-site process evaluation results for the early childhood education center setting: CORD study. Childhood Obesity. https://doi.org/10.1089/chi.2019.0314.
DOI: https://doi.org/10.1089/chi.2019.0314

Interpretive Summary: Due to the continued public health concerns of childhood obesity, the Center for Disease Control and Prevention funded the Childhood Obesity Research Project (CORD) via a cooperate agreement with three different sites in the US and one evaluation center. The three participating sites, San Diego State University, Massachusetts State Department of Health, and the University of Texas Health Science Center all delivered childhood obesity demonstration projects across multiple settings, including early childhood education centers (ECEC), public schools, and primary care clinics. The evaluation center at the University of Houston led the impact, sustainability and process evaluation across the three demonstration sites. This paper describes the cross-site process evaluation in the ECEC setting across the three demonstration sites. Process evaluations such as this one, are critical to understand if the programs were implemented as intended and reached the intended target audience. Each site implemented different evidence based programs in the ECEC setting, but the process evaluation was the same for each site. It was divided into two levels: researcher-to-provider to capture the training of the ECEC providers to deliver the programs across the participating ECEC; and provider-to-family to capture what was delivered to the families and children. A total of 58 ECEC were reached across the three sites, with 390 teachers and 5174 children. About half of eligible teachers completed their training to deliver the evidence based programs designated for their classroom. The teachers' training consisted of an average of 3.9 hours. An additional 1.3-4.3 hours of technical support was delivered to the ECEC monthly. There was variation across the demonstration sites in the reach, the dose delivered, and the fidelity of program implementation of the ECEC CORD programs. While large number of young children and families were reached across the three demonstration sites, maintaining fidelity in the delivery of the programs proved to be challenging.

Technical Abstract: The Childhood Obesity Research Demonstration project aimed to deliver evidence-based obesity prevention interventions to at-risk families at three demonstration sites. The interventions were delivered in multiple settings, including early childhood education centers (ECECs), public schools, and primary care clinics. An evaluation center conducted cross-site process, impact, and sustainability evaluations. Results of the cross-site process evaluation for the ECECs will be described. Reach (proportion of the target population who participated), dose delivered (materials and interventions that were distributed), and fidelity (proportion of planned intervention components delivered) were assessed at two levels (researcher-to-provider and provider-to-family levels). Standardized data forms were completed by research team members at each demonstration site with assistance from the evaluation center. The Childhood Obesity Research Demonstration project reached 5174 children and 390 teachers in 58 ECECs. The centers delivered an average of 3.9 hours of training to teachers. A total of 1382 different types of materials were distributed to providers, and from 1.3 to 4.3 hours of technical support were delivered to centers monthly. For fidelity at the researcher-to-provider level, 49.5% (n=370) of eligible teachers completed all training sessions. Considerable variations across demonstration sites in reach, dose delivered, and fidelity across were observed. The Childhood Obesity Research Demonstration project reached large numbers of children, families, teachers, and ECECs. Maintaining intervention fidelity while reaching large numbers of at-risk individuals proved to be a challenge.