The Impact of Responsive Feeding Practice Training on Teacher Feeding Behaviors in Tribal Early Care and Education: The Fresh Study

Background: Establishing healthy eating habits early impacts lifelong dietary intake, which has implications for many health outcomes. With children spending time in early care and education (ECE) programs, teachers establish the daytime meal environment through their feeding practices. Objective: To determine the effect of a teacher-focused intervention to increase responsive feeding practices in two interventions, one focused exclusively on the teacher’s feeding practices and the other focused on both the teacher’s feeding practices and a nutrition classroom curriculum in ECE teachers in a Native American (NA) community in Oklahoma. Methods: Nine tribally-affiliated ECE programs were randomly assigned to an intervention: 1) a 1.5 hour teacher-focused responsive feeding practice training (TEACHER; n=4) and 2) TEACHER plus an additional 3 hour training to implement a 15-week classroom nutrition curriculum (TEACHER+CLASS; n=5). Feeding practice observations were conducted during lunch at one table in one 2-to-5-year-old classroom at each program prior to and one month after the intervention. The Mealtime Observation in Child Care (MOCC) organizes teacher behaviors into eight subsections. Descriptive statistics and Shapiro-Wilk Test for Normality were calculated. Paired t-tests were calculated to determine change in each group. Clinical trials registry: NCT03251950. Results: An average of 5.2±2.0 (total n=47) children and 1.7±0.5 (total n=14) teachers/center were observed at baseline, and 5.6±1.7 (total n=50) children and 1.7±0.7 teachers (total n=14) were observed/center post-intervention. Total MOCC scores (max possible = 10) improved for TEACHER (6.1±0.9 vs 7.5±0.3, t=4.12, p=0.026) but not for TEACHER+CLASS (6.5±0.8 vs 6.4±1.0, t=-0.11, p=0.915). No other changes were observed. Conclusions: Teacher intervention only programs demonstrated improvements in responsive feeding practices whereas the programs receiving teacher and classroom training did not.. Greater burden likely decreased capacity to make changes in multiple domains. We demonstrated the ability to implement interventions in the NA ECE. Further research with larger communities is necessary