Cross-Sectional associations between inner setting determinants of self-efficacy and intent to deliver a healthy eating and activity curriculum embedded in a community setting.

BACKGROUND

Healthy Eating and Active Living Taught at Home (HEALTH) embeds healthy eating and activity content within Parents as Teachers (PAT), a national home visiting program. HEALTH is evidence based to prevent weight gain among mothers of young children. This secondary analysis aims to understand the factors associated with intention and self-efficacy to deliver HEALTH among parent educators (home vising providers).

METHODS

This is a cross-sectional, secondary analysis of data from a trial evaluating the effectiveness of HEALTH when delivered by parent educators as part of usual practice. Parent educators completed surveys following training in the HEALTH intervention; demographic characteristics (including self-reported body mass index) were collected in a baseline survey (pre-training). Surveys were based on two implementation science frameworks: Consolidated Framework for Implementation Research (CFIR, implementation context) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM, implementation outcomes). Associations between intent to deliver HEALTH (intent) and self-efficacy (SE) to deliver HEALTH, implementation context constructs and demographic characteristics were explored using Pearson correlations (continuous variables) and t-tests (binary variable). Relationships were considered significant if the p-value was < 0.05.

RESULTS

Among the 149 parent educators who completed the survey, just over half identified as white/non-Hispanic (53%), while just over a third identified as Hispanic. Participants reported having worked at their site for a mean of 4.7 years (standard deviation, SD = 5.85), and the mean body mass index was 30.43 kg/m (SD = 7.35). There was a significant correlation between intent and SE, r = 0.46 (< 0.0001). Most demographic characteristics (e.g., body mass index, age) were not significantly correlated with either variable, however, intent and SE were both significantly lower among white non-Hispanic parent educators than among those identifying as another race/ethnicity. Several other implementation context constructs such as evidence strength and quality, mission alignment, appeal, openness, and relative advantage were positively correlated with both intent and SE; complexity was negatively correlated.

CONCLUSIONS

When implementing healthy eating and activity content within community settings, it is important to consider what factors may be related to provider intent and provider self-efficacy to deliver the content. Specifically, mission alignment, complexity, evidence strength and quality, and relative advantage may be important.

TRIAL REGISTRATION

NCT03758638 ( https://clinicaltrials.gov/study/NCT03758638 ), registered Nov 29, 2018.