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Child Obes. 2013 Feb;9(1):43-50. doi: 10.1089/chi.2012.0057. Epub 2013 Jan 17.

The impact of a statewide training to increase child care providers' knowledge of nutrition and physical activity rules in Delaware.

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Capacity and Knowledge Development Department, Nemours Health & Prevention Services, Newark, DE, USA.



Childhood obesity has been recognized as a national problem of epidemic proportions. Child care represents an ideal venue in which to address this problem, as many young children spend a significant amount of time and consume the majority of their meals in this setting. Recognizing this opportunity, Delaware recently enacted reforms to statewide licensing regulations designed to improve the quality of the nutrition-, physical activity-, and screen viewing-related environments in child care settings.


To facilitate the translation of these regulations into practices, a series of broad-scale trainings was held throughout the state. Attendance was required for all Child & Adult Care Food Program (CACFP)-participating facilities, although child care providers from non-CACFP facilities also attended. Pre- and posttraining surveys were used to assess changes in providers' knowledge of the regulations and satisfaction with the training.


In total 1094 presurveys and 1076 postsurveys were received. Participants were highly satisfied with the training format and content, including the instructors, materials, and schedule. Data analysis demonstrates improved knowledge of all 26 regulation components from presurvey to postsurvey. Family child care providers, providers with more years of experience, CACFP-participating facilities, and facilities with food service personnel scored significantly higher than their center staff, less experienced and non-CACFP counterparts, as well as those without food service personnel.


Broad-scale, in-person training can effectively increase child care providers' knowledge of the regulations and is well received by this audience. Other states and jurisdictions seeking to improve nutrition, physical activity, and screen-viewing practices in child care settings should consider this model of quality improvement.

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