Department of Dietetics and Human Nutrition, College of Agriculture, Food and Environment, University of Kentucky, Lexington, KY 40506, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC 27710, USA.
Int J Environ Res Public Health. 2021 Dec 23;19(1):106. doi: 10.3390/ijerph19010106.
Previous efforts to involve parents in implementation of childcare-based health promotion interventions have yielded limited success, suggesting a need for different implementation strategies. This study evaluated the efficacy of an enhanced implementation strategy to increase parent engagement with , . This quasi-experimental study included childcare centers from the second of two waves of a cluster-randomized trial. The standard approach (giving parents intervention materials, prompting participation at home, inviting participation with classroom events) was delivered in 2016-2017 (29 centers, 116 providers, and 199 parents). The enhanced approach (standard plus seeking feedback, identifying and addressing barriers to parent participation) was delivered in 2017-2018 (13 centers, 57 providers, and 114 parents). Parent engagement was evaluated at two levels. For the center-level, structured interview questions with providers throughout the intervention were systematically scored. For the parent-level, parents completed surveys following the intervention. Differences in parent engagement were evaluated using linear regression (center-level) and mixed effects (parent-level) models. Statistical significance was set at 0.025 for two primary outcomes. There was no difference in parent engagement between approaches at the center-level, = -1.45 (95% confidence interval, -4.76 to 1.87), = 0.38l. However, the enhanced approach had higher parent-level scores, = 3.60, (95% confidence interval, 1.49 to 5.75), < 0.001. In the enhanced approach group, providers consistently reported greater satisfaction with the intervention than parents ( < 0.001), yet their fidelity of implementing the enhanced approach was low (less than 20%). Results show promise that parent engagement with childcare-based health promotion innovations can positively respond to appropriately designed and executed implementation strategies, but strategies need to be feasible and acceptable for all stakeholders.
先前让家长参与实施以儿童保育为基础的健康促进干预措施的努力收效甚微，这表明需要采取不同的实施策略。本研究评估了增强实施策略以增加家长参与度的效果，该策略用于推广 和 。这项准实验研究纳入了来自一项两波群组随机试验第二波的儿童保育中心。标准方法（向家长提供干预材料、在家中鼓励参与、邀请家长参与课堂活动）于 2016-2017 年实施（29 个中心、116 名提供者和 199 名家长）。增强方法（标准方法加征求反馈、识别和解决家长参与障碍）于 2017-2018 年实施（13 个中心、57 名提供者和 114 名家长）。在两个层面评估家长参与度。对于中心层面，对整个干预期间的提供者进行了结构化访谈，并对问题进行了系统评分。对于家长层面，家长在干预结束后完成了调查。使用线性回归（中心层面）和混合效应（家长层面）模型评估家长参与度的差异。两个主要结局的统计学意义设为 0.025。两种方法在中心层面的家长参与度没有差异， = -1.45（95%置信区间，-4.76 至 1.87）， = 0.38l。然而，增强方法的家长层面得分更高， = 3.60（95%置信区间，1.49 至 5.75），<0.001。在增强方法组中，提供者一致报告对干预措施的满意度高于家长（<0.001），但他们执行增强方法的忠实度较低（不到 20%）。结果表明，家长对以儿童保育为基础的健康促进创新的参与度可以积极响应适当设计和执行的实施策略，但策略需要对所有利益相关者可行且可接受。
