Creating healthy eating and active environments in early learning settings: protocol of the CHEERS eHealth intervention study

Background: Early childhood educators through their daily interactions with children, play a central role in shaping young children's health behaviors. Given their influential role, early childhood educators are often targeted in interventions aiming at enhancing their nutrition and physical activity practices.

Methods: This paper presents the design of the CHEERS eHealth program to improve nutrition and physical activity practices within Early Childhood Education and Care (ECEC) centers. The study has a longitudinal quasi-experimental design with recruitment of ECECs across Alberta Canada. ECEC intervention group educators complete 12 weekly online nutrition and physical activity modules and participate in weekly communities of practice sessions to discuss practical applications within their centers. Outcome assessments are scheduled at baseline (T1), mid-point at 5 months (T2), and end of program after 10 months (T3). Outcome measures include the Creating Healthy Eating and Active Environments survey (CHEERS), Mindful Eating Questionnaire (MEQ), Canadian Behavior, Attitude and Nutrition Knowledge Survey (C-BANKS 2.0), Physical Literacy Knowledge, Attitude, Self-Efficacy, and Behavior (PLKASB-ECE), the Environment and Policy Assessment and Observation (EPAO) derived variables, and an objective measure of children's physical activity using ActiGraph GT3X accelerometers. Linear mixed model analyses will be used to evaluate the effectiveness of the intervention. Qualitative assessments comprise exit interviews and open-response questions embedded within the educational modules.

Results: Preliminary baseline data from the 2019 cohort indicate no statistically significant differences between the intervention and control groups for the primary outcome variables, except age. Educators' personal nutrition-related knowledge, attitude and behaviors were positively associated with their self-assessments of the nutrition environment and practices in ECECs. A significant correlation was observed between educators' self-reported physical activity practices and observed activity practices. The CHEERS survey Food Served subscale showed a positive correlation with the objective measures of EPAO-Foods Provided and Nutrition Policy subdomains.

Discussion: We propose that this eHealth intervention would be an effective scaling up approach to enhancing the nutrition and physical activity environments of ECECs by fostering improved nutrition and physical activity-related knowledge, attitudes, and adherence to best practices which will potentially lead to improved outcomes for children in their care.