Research Article| Volume 51, ISSUE 4, P465-477, April 2019

Indicators of Readiness and Capacity for Implementation of Healthy Eating Strategies in Child Care Settings Serving Low-Income Children

Published:November 08, 2018DOI:



      Identify factors perceived to influence implementation of healthy eating policy, systems, and environmental strategies (PSEs) in child care settings serving low-income children.


      This mixed-methods study, conducted in 2015–2016, used semi-structured interviews (n = 18), focus groups (n = 23), and an expert panel.


      Public health (n = 11) and Supplemental Nutrition Assistance Program–Education practitioners (n = 9) and community residents (n = 174) from 9 counties in Ohio. Expert panelists (n = 10) had experience implementing PSEs in child care settings.

      Phenomenon of Interest

      Implementation factors influencing healthy eating PSEs in child care settings.


      Qualitative thematic analysis of 41 transcripts using a grounded theory approach. Indicators for each theme were operationalized. Consensus feedback from an expert panel weighted themes and indicators based on perceived importance for implementation.


      Identified themes relevant to implementation of PSEs included (1) organizational and practitioner capacity, (2) child care capacity, (3) networks and relationships, and (4) community resources and motivations. Nineteen indicators related to the 4 themes were identified and weighted.

      Conclusions and Implications

      Findings highlighted key factors within domains of influence and informed the operationalization of the indicators and the development of an assessment tool. The assessment tool is designed to tailor PSE implementation to the realities of different child care settings.

      Key Words

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