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American Journal of Health Education

ISSN: 1932-5037 (Print) 2168-3751 (Online) Journal homepage: https://tandfonline.com/loi/ujhe20

Partnership Roles in Early-Learning Providers’Healthy Eating and Physical Activity Programs: AQualitative Study

Angela M. Coppola, Allison L. Voils, Janet Gafkjen & David J. Hancock

To cite this article: Angela M. Coppola, Allison L. Voils, Janet Gafkjen & David J. Hancock(2019) Partnership Roles in Early-Learning Providers’ Healthy Eating and Physical ActivityPrograms: A Qualitative Study, American Journal of Health Education, 50:3, 190-199, DOI:10.1080/19325037.2019.1590262

To link to this article: https://doi.org/10.1080/19325037.2019.1590262

Published online: 22 Apr 2019.

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Partnership Roles in Early-Learning Providers’ Healthy Eating and PhysicalActivity Programs: A Qualitative StudyAngela M. Coppola a, Allison L. Voilsa, Janet Gafkjenb, and David J. Hancocka

aIndiana University Kokomo; bPartnership for a Healthy Hamilton County

ABSTRACTBackground: The Centers for Disease Control and Prevention (CDC) provide recommendations forchildren’s physical activity (PA) and nutrition practices. Community partnerships in school-basedprograms are recommended by the CDC to support children’s opportunities to regularly engagein these practices. Purpose: Informing the role of Health Educators and community partners, theresearch purpose was to explore how to support early-learning providers’ healthy eating and PAprograms. Methods: Drawing upon interpretive description methodology, 13 Indiana early-learning providers participated in one-on-one interviews. Participants shared experiences of,and recommendations for, building school health partnerships and programs. Three areas forsupporting programs were identified and recontextualized into guiding questions for practice.Results: Health Educators and community partners can support providers by developing oracquiring resources, such as examples of classroom PA delivery. They can contribute by providingprogram planning services, like co-developing PA programs with teachers and meal planning withstaff. By creating networking opportunities, community partners can initiate online or in-personknowledge-sharing and mentor–mentee programs. Discussion: These findings inform how HealthEducators and community partners can be involved in school-based health promotion by provid-ing insight into partnership roles. Translation to Health Education Practice: The practicalquestions can be used to guide the development of collaborations.

ARTICLE HISTORYReceived 4 December 2018Accepted 28 January 2019

Background

The associations between children’s physical activity (PA)and health outcomes, such as cognitive development,1

physical health,2 and social and emotional well-being,3

have been reported. Furthermore, fruit and vegetable con-sumption is associated with reduced risk for chronic dis-eases, such as cardiovascular disease.4 Because of theseassociations, the Centers for Disease Control andPrevention (CDC) created guidelines for children’s engage-ment in PA5 and consumption of fruits and vegetables.6

Specifically, children should engage in a minimum of 60minutes of moderate-to-vigorous PA every day and con-sume at least 5 servings of fruits and vegetables daily.

Despite the well-documented benefits of children’shealthy eating and PA behaviors and the national recom-mendations, a majority of children in the United Statesare not achieving these recommendations.7–9 In Indianaspecifically, most children are not achieving the recom-mended amounts of PA or fruit and vegetable intake.1,10

Only approximately 25% of Indiana children achieve therecommended amount of PA, and approximately 40% of

Indiana children report consuming fruits and vegetablesless than once per day.10

Programs in early-learning2 settings have been imple-mented to address these behaviors. PA programs in early-learning settings can moderately affect PA levels, withsignificant positive effects on PA levels evident in activ-ities led by teachers, conducted outdoors, and/or that areunstructured.11 There is also evidence that these pro-grams improve motor skills.11 Comprehensive healthyeating or nutrition programs (ie, programs that includeexposure to healthy foods and nutrition education) inearly-learning settings can influence physical health andincrease fruit and vegetable intake.12

The important role of early-learning programs in pro-moting children’s health is evident, and the CDC haspublished 2 frameworks within the Healthy Schoolsinitiative13 that guide the development of health-basedprograms. The Whole School, Whole Community,Whole Child (WSCC) model14 and the ComprehensiveSchool Physical Activity Program approach15 involve sev-eral components that are integral to effective school-basedhealth and activity promotion, such as PA promotion

CONTACT Angela M. Coppola, angela.coppola1@gmail.com Division of Allied Health Sciences, Indiana University Kokomo, 2300 S. WashingtonStreet, Kokomo, IN, 46902Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/ujhe.

AMERICAN JOURNAL OF HEALTH EDUCATION2019, VOL. 50, NO. 3, 190–199https://doi.org/10.1080/19325037.2019.1590262

© 2019 SHAPE America

throughout the day and inclusion of Health Educationand services. Across both frameworks, community invol-vement and engagement remain key components ofschool-based health programs.14,15

To address community involvement and engagement,school communities are encouraged to partner with stateand local organizations.13 Community partnerships,including university partnerships, have been describedas an effective vehicle to implement and evaluate nutritionand PA programs in early-learning settings.16 Recently,Hunt and colleagues17 offered insight into how to fostercommunity involvement, recommending that invitingcommunity partners with health expertise and resourcesto the program partnership can help with the develop-ment and implementation of program goals. Ultimately,partnerships are key, yet there is not much guidance forproviders, Health Educators, or community partners todo so. Evidence exists, however, that defining partnerroles from the beginning of health-based programs isimportant.18 Thus, an exploration of how to supportearly-learning providers’ programs would contribute toresearchers’ and community partners’ (including HealthEducators or Certified Health Education Specialists[CHES]) understandings of potential roles in programsand might facilitate collaborations in different early-learning settings. Because of the research and practicebenefits of identifying opportunities to partner with early-learning providers, the purpose of this study was to qua-litatively explore how to support early-learning providers’healthy eating and PA programs.

Methods

Community-based participatory research

Community-based participatory research (CBPR)19,20 isa collaborative method that involves the inclusion ofresearch practices to understand a community issueand enhance the well-being of a community. Buildingrelationships and community partnerships, and build-ing upon existing community resources are key princi-ples of CBPR.20 Israel and colleagues outline severalphases to CBPR projects that can be contextualized.20

The current article involves the development andimplementation of the first 2 phases. Forming andmaintaining partnerships by identifying potentialpartners and mutual interests is the initial compo-nent of a CBPR project, and the second phaseincludes identifying relevant needs of the communitymembers (ie, in this context, early-learningproviders).20 For the initial partnership formation,the first and third authors met at a community con-sultation event hosted by the first author and identi-fied a mutual interest in building partnerships tosupport healthy eating and PA programs in early-learning settings. However, we were unsure how toprovide support or what our role could be.

The current study therefore represents the second phasein which we identified relevant needs of early-learningproviders’ healthy eating and PA programs. Figure 1 is anoverview of the research process and future phases, withthe first 2 phases shown in bold and discussed in this

Phase 1: Initial Partnership Formation for larger CBPR

Project

Phase 2: Study Early-Learning Providers' Relevant

Needs and Identify Partnership Roles

Phase 3: Co-Develop Training Program with Local Resource

and Service Providers, and Early-Learning Providers

Phase 4: Program Implementation and Data

Collection

Phase 5: Program Process and Outcome Evaluation/ Knowledge Transfer

Figure 1. Overview of the research process and future phases.

PARTNERSHIP ROLES IN EARLY-LEARNING PROVIDERS’ HEALTHY EATING AND PHYSICAL ACTIVITY PROGRAMS 191

article. We also identified additional key project partici-pants who are early-learning providers, or who are partnerswho support early-learning providers. The results of thisphase helped us and the community partners identify rolesfor supporting healthy eating and PA programs in early-learning provider settings based on expertise and interests,and provider needs.

Participants

Early-learning providers (ie, provided early-learning cur-riculum and childcare to children 0–12 years old) wereinterviewed in this study. We were particularly interestedin talking to providers from different contexts. Forinstance, those who provide services through registeredministries, licensed centers, and licensed homes wereinterviewed about their experiences of current andplanned healthy eating and PA programs and partner-ships, as well as their needs and resources for these pro-grams. In some of the licensed centers andministries, staffmembers such as kitchen staff, directors, and teachersprovided a comprehensive understanding of both healthyeating and PA programs, as well as partnership resourcesand needs. The participant in a home-based setting wasthe sole provider of health programs in her setting.

Instruments

A semistructured interview guide was designed based onthe research purpose. The interview began with an intro-duction to the study, interviewer, and participant. Theinterview guide had 3 main sections with open-endedquestions. The first section included questions about theparticipants’ early-learning communities and communitypartners (eg, Who is involved in the center/home pro-grams and/or initiatives?). The participants then sharedtheir experiences of current and planned healthy eatingand PA programs and/or initiatives in the second section(eg, What are you doing and/or planning to do to facil-itate healthy eating and PA practices for the children?What are the facilitators and barriers of the initiatives?).In the third section, participants discussed their recom-mendations for building partnerships and programs inthis context (eg, What would help you or what would yourecommend to enhance facilitators and address barriers ofhealthy eating and PA programs?).

Data collection

Thirteen Indiana early-learning providers participatedin one-on-one in-person interviews. Participants werepurposively sampled through email. Written consentwas obtained before the interview began. A state-wide

nonprofit sent the recruitment email to early-learningproviders in their network. The participants receiveda $10 Visa gift card for their participation and wereincluded in a $50 raffle at the end of data collection toacknowledge the contribution of their time and knowl-edge to the project. Interviews were digitally recordedand transcribed by a transcription service and studentresearch assistants, and reviewed by the first author.

Data analysis

The methods in the study were guided by interpretivedescription.21 This methodology encourages traditionalforms of generating data, such as thematic analysis, butalso encourages a process of recontextualizing researchfindings into practice. Thorne21 recommends Morse’s22 4phases of cognitive processes of analyzing data to captureparticipants’ experiences and the researchers’ interpreta-tions to inform practice.

Morse22 describes the first cognitive process as compre-hending the data. In this phase, we (the first and secondauthors) read and reread transcriptions, began codinginterview transcriptions and taking notes of general mes-sages conveyed during interviews, and reflected on why themessages were shared. The synthesizing process involvescreating patterns within the data. Using the codes, thefirst and second authors explored commonalities betweencoded data to create common features between partici-pants’ experiences. When theorizing, the first author con-sidered common frameworks and research related topartnership development and school health partnershipsto ensure that the findings had empirical relevance. Forexample, theWSCCmodel14 shares how community invol-vement is key to health-based program development inschool settings that is in line with the findings and partici-pants’ experiences. The 3 aforementioned processes madeup the conceptualizing phase. Three themes (see Results)were conceptualized to describe how community partnerscan support healthy eating and PA programs.

When recontextualizing, the first author held a 1-hourmeeting with the third author (coalition director) andrepresentatives from a state-wide service provider to early-learning communities (ie, our project partners) to discussthe findings and ask for feedback about the relevance andapplicability of findings. Recontextualized questions forcommunity partners were confirmed and/or developedbased on the resulting 3 themes to facilitate the applicationof the findings. Specifically, the project partners suggestedadding considerations for collaborating with existing pro-vider networks (see existing networks in Table 1) to therecontextualized questions, and the themes were used togenerate the questions about community partner roles (seepartner roles in Table 1).

192 A. M. COPPOLA ET AL.

Results

There are 3 resulting themes that describe how communitypartners can support programs. The recontextualized ques-tions for practice based on the study findings and projectpartners’ feedback about exploring existing networks arepresented in Table 1.

Developing or acquiring resources

Community partners could develop or acquire resources bycompiling program resources or evidence-based practiceresources related to budgeting and meal planning or theycould explore potential funding opportunities. Communitypartners might also contextualize evidence-based practiceresources, such as fundamental motor skill developmentresources, for a particular early-learning setting. Theseweremostly described as relatively shorter time commitments.When discussing facilitators of implementing activity-based programs, participant 1 shared, “I would love it ifsomebody actually put together like 12 activity bins forus… and then we could just say, ‘Okay, I’ll buy those.’ Or

somebody like a contractor who just kind of did it for youand then just left, so I wouldn’t have to hire them would beawesome.” Furthermore, participant 5 shared how her staffcould use resources for games and activities but they hadtrouble finding the time to acquire resources on their own,also indicating the benefits of community partners whodevelop or acquire resources:

I had this huge portfolio full of games and activities we cando with the children. And I referred to that all the timewhen I was in the classroom. So, I had those resources atmy fingertips. And the staff have access to a lot of informa-tion. I tell the staff here all the time, “You have no ideawhat it was like to teach before Pinterest.” [laughter] It wasa lot harder back in the day. We had to go to the libraryand check out books and read through books and booksand books to find the activities that we wanted to do withthe kids. … They have access to this information. But it’swhether or not they’re actually getting it… taking the timeto find the information on their own.

Developing and acquiring resources involved relativelyshorter time commitments in which community part-ners could acquire resources to support healthy eating

Table 1. Recontextualized questions for practice.To help providers and community partners create partnerships for healthy eating and PA programs, the following guiding questions based on the resulting3 themes could be considered and discussed. The current project partners who work with early-learning providers suggested that community partnersexplore opportunities to collaborate with existing networks before considering the subsequent questions about partner roles.

Existing networks● What networks (eg, online, listservs, or groups) currently exist?

● Who are the state or local organizations who are partnering with providers? And what initiatives/services are being offered (related to the partner rolesbelow)?

● Is there an opportunity to collaborate with or learn (be trained) from these organizations or their community partners to achieve the same goal?

Partner rolesDeveloping or acquiring resources● How can we support programs by acquiring:

● Funding (eg, provide or acquire funding opportunities)?

● Planning resources (eg, budgeting and meal planning resources)?

● Implementation resources (eg, provide or acquire class PA and healthy eating education and activities and equipment for programs)?

● Other resources not listed?

Providing program planning services● How can we support program planning for the longer term and more frequently by:

● Providing services that support program delivery (eg, gardening-related services, meal planning, capacity building for program implementation andbudgeting)?

● Implementing programs and activities (eg, providing interns or trained volunteers to work with staff to deliver programs)?

● Writing grants for funding?

● Other services not listed?

Creating networking opportunities● How can we support connections between and for centers by:

● Sharing online or in-person networking and professional development opportunities?

● Developing and/or providing online or in-person networking and professional development opportunities?

● Connecting mentors and mentees?

● Other networking opportunities?

PARTNERSHIP ROLES IN EARLY-LEARNING PROVIDERS’ HEALTHY EATING AND PHYSICAL ACTIVITY PROGRAMS 193

opportunities for children. Participant 3 discussed facil-itators for healthy cooking and shared that she wouldlove recipe ideas for a variety of child-friendly healthysnacks, “For me, I think I would benefit from recipeideas. Just more ideas, having more of a selection tochoose from … when it comes to those kid-friendlyhealthy snacks, I’m having problems. I feel like I’m justserving the same things all the time, and I don’t likethat. I want to have a variety.” Overall, the participantsdescribed funding (eg, provide or acquire fundingopportunities), planning resources (eg, budgeting andmeal planning resources), and implementationresources (eg, provide or acquire PA and healthy eatingor gardening education and activities, equipment forprograms in the context of this theme). Thus, therecontextualized questions (see Table 1) promptedcommunity partners to think about these potentialresources.

Providing program planning services

Trained or supervised community partners could pro-vide healthy eating and activity program services bycontextualizing and implementing existing practicesand programs (eg, evidence-based PA programs) orby developing and implementing service-based partner-ships (eg, rototilling for gardens) with providers. Thisincluded relatively longer-term and more frequent timecommitments and a specific service to facilitate healthyeating or PA programs. When discussing facilitators ofprograms in her early-learning context, participant 11shared an opportunity in which she had an intern comein to do yoga with children twice a week for anextended period of time: “Three years ago, we had [anintern] that came in. I had written a grant, so I hadextra funding, and she did yoga with our kids twicea week. And that not only was exercise, but it helpedwith behavior management.”

These services were also relevant to healthy eatingprograms. Participant 10 shared that she neededa registered dietitian to help with meal planning, stat-ing, “We haven’t really changed [the menu] in the lastseveral years because once [chef] went on to anotherposition, we hired someone … but not someone thatwas really trained on the nutritional side to give us theright nutritional component. So we really needa dietitian or someone that can help us do that mealplanning and that menu planning.” Meal planning–related services not only included menu planning; par-ticipants also discussed storage and kitchen spaces aspotential barriers to healthy meal planning and garden-ing as facilitators to healthy meal planning and foodeducation. For example, when participant 9 was

discussing parents’ support of health programs, shesaid, “Parents have asked for more fresh fruits, but it’skind of hard when you have limited space to house allthe fruits and vegetables. We try to get as much as wecan … but then you have the freezer and the refrig-erator space also that you had to take in consideration,”indicating that community partners might plan mealsand kitchen spaces as a service. Participant 9 went on todiscuss how gardening was a facilitator of healthy eat-ing programs and that community members could anddo provide services to help:

We have a teacher whose husband comes in and rototillstheir little garden areas for them and then I go out andbuy the seeds or the plants for them and then the kidsand the teachers go out and they plant them. … IfI could work with somebody and possibly build someraised garden areas for the classrooms so that they couldhave those garden areas. And then it’d be easier tomaintain each year.

Program planning services were recontextualized intoquestions that prompted community partners to con-sider longer-term and more frequent support, such asimplementing programs and activities with interns ortrained individuals, and working with providers to planprogram curriculums or budgets.

Creating networking opportunities

The participants also discussed the need for connectionsand networking opportunities with potential communitypartners or mentors. They also shared that they couldbenefit from knowledge about resources and regulations.Creating networking opportunities could include facil-itating connections between centers and evidence-basedknowledge, resources, and mentors, as well as creatingonline or in-person events for partnership and profes-sional development. Participant 7 shared her perceptionsof the important role of networking and support: “Ithink people need to have that networking and thatsupport because childcare changes every day. Youknow, there’s a new regulation every day that childcarestend to get knocked down sometimes because there’s somany rules and regulations.”

Participants shared that having opportunities tolearn through networking and knowledge sharingwould be beneficial. When discussing her additionalthoughts on how to build partnerships and programsin this context, participant 10 shared that a mentor–mentee program would be useful:

[The center] has a mentoring program. And even justknowing the people that would be interested, I feel likewe could mentor in certain areas, but that we would bethe mentee in other areas. I feel like we could help in

194 A. M. COPPOLA ET AL.

breastfeeding and maybe activity and outdoor play andthings like that. But we would really love to meet peoplethat have—feel like they’ve nailed down the nutritioncomponent. You know, “Hey, what’s the secret to yoursuccess? How do you rotate your menus? How do you dothis? How do you meet the state requirements and stillhave a palatable menu for children? And what do youdo and how do you do it?”

Participants enjoyed professional development and net-working but felt that opportunities should be conveni-ent. Participant 13 thought that it would be nice to havea group that could meet in her area. “It would be nice ifthere was a group [here] that would meet that werechildcare or early childhood development people.Whether it’s directors or just people interested in devel-opmentally appropriate practices or something, just tobe resources for each other. I’ve not been a director forthat long and honestly haven’t sought out a whole lotbecause we’ve been busy doing other things.”Participants also described that another convenientway to share, develop, or provide professional develop-ment and networking was through an online forum.For instance, participant 11 said when discussing con-tinued education for staff, “You can just go online andlearn … which is convenient.” The recontextualizedquestions prompted community partners to considerhow to support connections between and for providersby sharing, developing, or providing online or in-person networking and professional developmentopportunities, and connecting mentors and mentees.

Discussion

This study explored how to support early-learning pro-viders’ healthy eating and PA programs for children toinform partnership development between communitypartners, including Health Educators and CHES, andearly-learning providers. The findings provide insightinto the potential roles of these community partners,identifying examples of what is needed to support pro-grams (eg, PA resources, services, and networking) andhow community partners can provide support (eg,acquire classroom activities, implement classroomactivities, or provide professional development oppor-tunities for fostering fundamental motor skills).Extending upon the evidence that community partner-ships and involvement are key to the development ofthese programs,14,15 the findings and recontextualizedquestions may help community partners identify theirrole in and commitment to these programs to set thefoundation for partnership development. Early-learningproviders and service providers in early-learning set-tings might use the findings and recontextualized

questions to identify community partners as well.Taken together, the findings provide community part-ners with a greater understanding of and direction forhow to support healthy eating and PA programs inearly-learning settings.

Though multiple sources indicate that partnershipsand community involvement are key to school-basedor early-learning health programs,15,16,23 there is notmuch guidance for or documentation of how commu-nity partners can support early-learning providers’healthy eating and PA programs. The study outcomesaddress this gap by identifying partner roles (ie, devel-oping and acquiring resources, providing program plan-ning services, and creating networking opportunities) aswell as the recontextualized guiding questions for prac-tice. These can be used to help community partnerssituate themselves in existing partnerships or developnew partnerships. The theme descriptions include theresource or service that is recommended or needed anddescribe the time and dedication involved in those roles.Specifically, in the recontextualized questions, commu-nity partners are prompted to consider how they cancontribute and prompted to consider their level of com-mitment (eg, time and dedication) to programs. This isimportant because it might prevent community partnersfrom overcommitting and enhance transparencybetween early-learning providers and community part-ners about what is needed by the provider and how thecommunity partner will address that need. Extendingupon Hunt and colleagues,17 the current findings alsoindicate that community partners with health expertiseare important but that community partners could addi-tionally offer other services and resources, such as build-ing gardens or online professional development orknowledge sharing, that would be useful to early-learning providers. This indicates that school and early-learning communities might consider community part-nerships with health services as well as other servicesthat address the needs or recommendations for theirhealthy eating and PA programs.

The multiple perspectives involved in data genera-tion contributed to relevance of the findings.Specifically, the insight provided by service providersin early-learning settings (ie, project partners) offersadditional considerations for collaborating with orbuilding upon existing networks of providers to com-bine resources or services. One of the tenets of partner-ship building in CBPR is building upon existingresources.20 Specific to school health programs, Kolbeand colleagues24 reported that partnerships in this set-ting that built infrastructures to effectively combineresources are essential for implementing the WSCCframework or school health programs. Thus, it is not

PARTNERSHIP ROLES IN EARLY-LEARNING PROVIDERS’ HEALTHY EATING AND PHYSICAL ACTIVITY PROGRAMS 195

surprising that this was suggested by our project part-ners; however, it was important to ensure that it wasincluded in the recontextualized questions becausesome community partners may not initially think tocontact existing networks that might identify early-learning providers who could benefit from theirresources or services. Furthermore, early-learning pro-viders and those who are serving these providers coulduse the findings and questions to solicit the resourcesor services of potential community partners, serving astools for both providers and community partners.

Early-learning communities and community part-ners should also consider supporting opportunities formentor–mentee programs and knowledge sharingbetween early-learning providers. Co-learning ormutual capacity building involves partners who bothshare knowledge with and learn from each other,20 andthe benefits of co-learning and knowledge sharinginclude partnership and program sustainability.25

Strategically connecting schools or early-learning pro-viders based on their resources and needs can bea mutually beneficial way for them to provide andreceive support and build collaborations that areimportant for school-based health programs.23

Strengths, limitations, and future directions

The participants represented different early-learningsettings but had similar experiences, indicating thatregardless of the setting, community partners can playsimilar roles in programs. This project included multi-ple perspectives to take a coordinated approach toexploring how to support early-learning providers’healthy eating and PA programs for children. State-and county-wide service providers (ie, project partners)partnered with academics to research and developthemes and recontextualize findings into a resource.However, we were missing perspectives from someearly-learning providers (ie, those who are not regis-tered or licensed). Thus, it is important to note that thefindings might not be applicable to all early-learningsettings. Furthermore, this research was conducted withearly-learning providers in Indiana and might not beapplicable to other states or countries. However, thequestions might be transferable or broad enough to beuseful in other locations or school contexts with similarprogram planning needs.26

The findings and recontextualized questions can beused by partners, early-learning providers, or service pro-viders to build partnerships for healthy eating and PAprograms in early-learning settings. That said, it might bebeneficial to study or reflect upon the development ofpartnerships. For instance, Rasberry and colleagues27

found that strong community collaborations, specificallyauthentic andmutually beneficial relationships, were usefulfor building school health programs. Once a partnership isestablished, providers and community partners can discusspartnership and program outcomes, how each will benefit,what will be needed to ensure that they achieve partnershipand program outcomes, and how each in the partnershipwill support the other in implementing their role.Community partners can also reflect on the developmentof and recommendations for an early-learning healthyeating and PA program to inform partnership develop-ment. The next section provides an example of the use ofobservation and reflection when applying our studyfindings.

Applying the findings: Providing program planningservices and identifying the next CBPR phase

The second author provided program planning servicesto a local early-learning center. During her internship,she created and implemented a healthy eating educa-tion and PA program with 3- to 5-year-old childrenand the center director over a 3-month period. Thefollowing is her reflection of the process and outcomesof the program and her recommendations for internsworking as community partners to support early-learning providers’ healthy eating and PA programsfor children.

During my time at the school, I focused on expandingthe current unit on nutrition and incorporating PA educa-tion into daily activities. I created games that we [thechildren and I] could play each day and reflected on whathad been taught. For example, there was a scavenger huntgame that required the children to go around the room andfind different food items. Once each food was found, thechildren placed different foods into the 5 basic food groups.After this activity, I noticed significant improvement intheir ability to classify the different foods they came incontact with. To ensure the relevancy of the program,I reviewed literature from the CDC28 that revealed thecorrelation between PA, nutrition, and academics. Thecenter director read through the research28 that supportedthe activities, assisted in developing the parent and studenteducation, and discussed how to improve the PA andnutrition unit with me.

I observed greatest improvements in the children’sknowledge when they were able to take the lesson learnedin class and apply it in an activity. I could tell that theprogram was successful after casual conversations withthe children during snack time, where many informedme that they had strawberries, bananas, and otherhealthy breakfast items for their meal. I also introducednew ways to keep them active during the school day. We

196 A. M. COPPOLA ET AL.

would have obstacle races, play Simon Says, and playsimilar games that correlated with daily lessons. Basedon these observations, my recommendations to studentinterns are to include both education and applicationcomponents in activities and to ensure that physical andnutritional activities included in lesson plans are fun andengaging.

The next step of the larger CBPR project (seeFigure 1, phase 3) will be to build a partnership withstate and local health resource providers who directlyserve early-learning providers. This group will connectus to those early-learning providers who have indicatedthat they would benefit from staff and child engage-ment in physical activity promotion programs in anearly-learning setting. After early-learning staff trainingand informational sessions with health sciences stu-dents and professors, we will co-create and study phy-sical activity programs with children in their context toensure mutual partner benefits and program relevance.

Translation to Health Education Practice

To support early-learning providers’ healthy eating andPA programs for children, community partners, includ-ing Health Educators and CHES, might

● Use the findings and recontextualized questions toidentify their roles in and commitment toprograms.

● Consider exploring existing networks of serviceproviders who are working with early-learningproviders to support healthy eating and PA pro-grams. Existing provider networks might helppartners identify early-learning providers whocould benefit from their resources or services.

● Develop and acquire resources, such as physicalactivities and recipe ideas, which may involveless time and fewer resource commitments.

● Provide program planning services, such asimplementing a PA education program or plan-ning and budgeting healthy menus, which mayinvolve more time and greater resourcecommitments.

● Create networking opportunities, such asmentor–mentee programs and online or in-person net-working and professional developmentopportunities.

Early-learning providers and service providers in early-learning settings can use the findings and recontextualizedquestions to identify community partners and might con-sider community partners based on program needs, whichmay include partners outside of the health field.

Community partners, including academic researchers andHealth Educators, should continue exploring and sharingthe roles of community partners in developing and imple-menting early-learning providers’ healthy eating and PAprograms. For example, Health Educators or CHES havethe responsibilities to plan, implement, and evaluateHealthEducation and promotion programs.29 Based on the studyfindings and practical implications, Health Educators andCHES can design, implement, and evaluate programs orinterventions that include community partners by usingthe resource to build partnerships and study the develop-ment and implementation of partner roles in early-learningproviders’ healthy eating and PA programs. For instance,Health Educators and CHES can develop networking andmentorship opportunities and study the effectiveness ofthese opportunities and the influence that network and/ormentorship building has on early-learning providers’knowledge, skills, and attitudes toward these programs.Health Educators and CHES might also use the resourceto connect partners who provide relevant program plan-ning services to early-learning providers and study thedevelopment and implementation of partners’ roles in thedelivery and effectiveness of programs.

Notes

1. These statistics were collected from adolescents ingrades 9 through 12 but a systematic review of long-itudinal changes in PA indicate that efforts to promoteand/or maintain PA should begin well beforeadolescence,30 and there is also evidence that child-hood diet is a determinant of adolescent diet.31

2. The early-learning context is inclusive of childcare andearly-learning centers or providers in any setting (eg,ministries, homes, centers, schools) in which they pro-vide services.

Acknowledgments

The authors thank the participants and project partners forsharing their knowledge and insights about early-learninghealthy eating and physical programs.

Human Subjects Approval Statement

The Indiana University Institutional Review Board approved thisstudy (Protocol ID: 23 041 990; Protocol #: 1 609 341 230).

Disclosure statement

No potential conflict of interest was reported by theauthors.

PARTNERSHIP ROLES IN EARLY-LEARNING PROVIDERS’ HEALTHY EATING AND PHYSICAL ACTIVITY PROGRAMS 197

Funding

The project was funded by the Indiana University KokomoGrant in Aid Program.

ORCID

Angela M. Coppola http://orcid.org/0000-0002-3001-2569

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