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. 2019 Feb;22(2):223-234.
doi: 10.1017/S1368980018002665. Epub 2018 Oct 31.

Modifying the Environment and Policy Assessment and Observation (EPAO) to better capture feeding practices of family childcare home providers

Alison Tovar  1 , Amber E Vaughn  2 , Jennifer Orlet Fisher  3 , Sara E Benjamin Neelon  4 , Regan Burney  5 , Kathleen Webster  6 , Tao Liu  7 , Truls Ostbye  8 , Dianne S Ward  9
Affiliations

Modifying the Environment and Policy Assessment and Observation (EPAO) to better capture feeding practices of family childcare home providers

Alison Tovar et al. Public Health Nutr. 2019 Feb.

Abstract

Objective: To describe the modification and validation of an existing instrument, the Environment and Policy Assessment and Observation (EPAO), to better capture provider feeding practices.

Design: Modifications to the EPAO were made, validity assessed through expert review, pilot tested and then used to collect follow-up data during a two-day home visit from an ongoing cluster-randomized trial. Exploratory factor analysis investigated the underlying factor structure of the feeding practices. To test predictive validity of the factors, multilevel mixed models examined associations between factors and child's diet quality as captured by the Healthy Eating Index-2010 (HEI-2010) score (measured via the Dietary Observation in Childcare Protocol).

Setting: Family childcare homes (FCCH) in Rhode Island and North Carolina, USA.ParticipantsThe modified EPAO was pilot tested with fifty-three FCCH and then used to collect data in 133 FCCH.

Results: The final three-factor solution ('coercive control and indulgent feeding practices', 'autonomy support practices', 'negative role modelling') captured 43 % of total variance. In multilevel mixed models adjusted for covariates, 'autonomy support practices' was positively associated with children's diet quality. A 1-unit increase in the use of 'autonomy support practices' was associated with a 9·4-unit increase in child HEI-2010 score (P=0·001).

Conclusions: Similar to the parenting literature, constructs which describe coercive controlling practices and those which describe autonomy-supportive practices emerged. Given that diets of pre-schoolers in the USA remain suboptimal, teaching childcare providers about supportive feeding practices may help improve children's diet quality.

Keywords: Childcare provider; Feeding practices; Observational tool.

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Figures

Fig. 1
Fig. 1
Existing content map of feeding with existing and additional EPAO items: formula image, measured by EPAO; formula image, additions made by EPAO Supplemental Assessment of Feeding Practices (EPAO, Environment and Policy Assessment and Observation)
See this image and copyright information in PMC

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