Happy Healthy Homes Virtual Intervention Improved Rural Family Child Care Home Provider Mealtimes: Partial and Sustained Effects.

OBJECTIVE Family Child Care homes (FCCH) are home-based child care settings that often care for children in their households, operating with limited resources, and are a common choice for children from low-income families. The purpose of this study was to examine changes in FCCH provider feeding practices after a virtual intervention.

DESIGN Randomized controlled clinical trial.

SETTING Rural Oklahoma FCCHs.

PARTICIPANTS Thirty-six (intervention = 15; control = 21) FCCH providers participated at baseline.

INTERVENTION A virtual 20-minute module on implementing responsive feeding practices delivered by Extension educators.

MAIN OUTCOME MEASURES Feeding practice scores at baseline, 3, and 12 months.

ANALYSIS The Kruskal-Wallis and paired t tests were used to detect between-group and within-group differences, respectively.

RESULTS Meal service style significantly improved over time (P = 0.05), intervention providers' meal service style (2.1 points; P = 0.05), role modeling (4.0 points; P = 0.007), and mealtime quality (11.3 points; P = 0.04) improved from baseline to 12 months. Intervention providers scored significantly lower than the control group for self-regulation at 12 months (9.6 ± 0.8 vs 8.5 ± 1.4; P = 0.02).

CONCLUSIONS AND IMPLICATIONS Although the meal service style score improved over time, the scores remained low, indicating a need to improve implementation. Although self-regulation use decreased in the intervention group, it is an ambiguous and complex construct needing further exploration. Future studies must examine the implementation effectiveness of feeding practices and explore newer mealtime constructs such as sensory exploration of foods, peer modeling, and nonverbal cues to support rural FCCH providers' ability to implement optimal practices.