Self-reported and observed feeding practices of Rhode Island Head Start teachers: Knowing what not to do
Introduction
Childhood obesity is a serious public health issue. Early prevention efforts targeting preschool-age children is of particular importance given that taste preference and eating behaviors develop early in life (Birch and Fisher, 1998, Davison and Birch, 2001, Grimm et al., 2014, Skinner et al., 2002), and often persist into adulthood (Kelder, Perry, Klepp, & Lytle, 1994). Mothers have been considered the primary caregivers during this critical period (McBride and Mills, 1993, Nicklas et al., 2001), and their feeding practices during meals have been shown to influence a child's dietary intake (Hoerr et al., 2009, Papaioannou et al., 2013, Park et al., 2015, Vereecken et al., 2010) and weight status (Cardel et al., 2012, Hughes et al., 2008, Lumeng et al., 2012). However, an increase in the annual enrollment of full day child care programs from 34 percent in 1990 to 49 percent in 2014 (Natonal Center for Education Statistics, 2016) suggests a need to examine the feeding practices of child care teachers (Dev et al., 2013, Larson et al., 2011). In order to do this, appropriate measurement tools that capture feeding practices of teachers are needed.
Measuring feeding practices of teachers is a nascent area and of the few studies that have done this, most have used self-report measures, which can be easy to use and have less participant burden (Dev et al., 2013, Dev et al., 2014, Hendy and Raudenbush, 2000, Hendy, 2002, Larson et al., 2011). Major limitations of using self-report measures (e.g., surveys, questionnaires, focus groups, interviews), however, include response bias, such as social desirability, as well as problems with memory, judgments and generalizations (Hughes et al., 2013, Lanigan, 2012, Lumeng et al., 2008, Mita et al., 2013, Sharma et al., 2013). Rather than capturing actual feeding practices that occur, self-report measures may instead be tapping into a teacher's perception of what feeding practices they think they are using during meals (Hughes et al., 2007). Few studies have used observation to capture teacher feeding practices, which may provide valuable information beyond self-reported data.
Given that most of the feeding practice literature has been conducted with parents, this research helps inform the measurement of teacher feeding practices. For example, several studies with mothers and their children are novel in that they have directly observed the caregiver-child feeding relationship in naturalistic environments (Bergmeier et al., 2015, Gardner, 2000, Hughes et al., 2013, Edelson et al., 2016, Fries et al., 2017, Johnson et al., 2017, Pesch et al., 2016). In particular, observations are effective in providing insight to the verbal and nonverbal contexts that occur during feeding (Hughes et al., 2013). Of the studies completed with parents, most focus only on measuring the feeding environment in one setting at one given time, rather than examining whether feeding practices are stable across environments with other influential caregivers such as child care teachers (Hughes et al., 2013).
Combined, mixed-method approaches utilizing both self-report and observation provide the opportunity to draw on the strengths of each methodology, enabling a more rigorous study to draw stronger inferences than either method alone (Bergmeier et al., 2015, Hughes et al., 2013, Zoellner and Harris, 2017). For example, mixed-method approaches have been utilized to evaluate mother-child mealtime behaviors (Haycraft and Blissett, 2008, Sacco et al., 2007). However, a systematic review by Bergmeier, Skouteris, and Hetherington (2015) found no significant relationships between self-reported and observed maternal feeding practices (Bergmeier, Skouteris, & Hetherington, 2015). This review also found the most widely used measure of self-reported parent feeding practices, the Child Feeding Questionnaire, was not always significantly associated with observational measures of parent feeding practices (Bergmeier et al., 2015, Lewis and Worobey, 2011). Although one would not expect the two measures to be identical, one would expect that the observational coding system would capture similar constructs as the traditional and validated self-report instrument chosen for their study (Hughes et al., 2013, Bergmeier et al., 2015, Vaughn et al., 2013). In contrast to the home environment, teacher feeding practices in a child care setting have shown moderate congruency between observed and self-reported assessments of feeding practices (Hughes et al., 2007). Given the more structured feeding environment of a child care center compared to a home, other external factors that influence feeding behaviors may come into play. For example, child care environments that enforce nutrition policies and programs may influence the feeding practices of teachers during meal times (Dev et al., 2014, Hughes et al., 2007).
Given the mixed results of the caregiver-child feeding practice literature and the limited research with child care teachers in particular, it is important to further evaluate the agreement between self-reported and observed measures with child care teachers. Thus, the purpose of this study was to compare self-reported and observed feeding practices in a group of Rhode Island (RI) Head Start teachers. Given the more structured environment of Head Start centers, we hypothesized that self-reported and observed feeding practices among child care teachers would be higher in agreement, compared to a home environment.
Section snippets
Materials and methods
Data utilized for this paper are from a larger study that examined the relationship between teacher nutrition knowledge, attitudes, diet and mealtime behaviors in Head Start classrooms (Halloran, 2016). Head Start is a United States federally funded, comprehensive child development program that serves low-income children from ages 3 to 5. Federal regulations require most Head Start centers to participate in other federal programs, such as the Child Adult Care Food Program (CACFP) (Food and
Teacher demographics and characteristics
From September of 2014 to May of 2015, 85 teachers provided consent and were observed during one mealtime in their classroom. On average, teachers were in charge of feeding 10 students (9.57 ± 4.81) at their table during mealtime observations (results not shown). Of the 85 teachers who participated in this study, most were female (n = 83; 97.6%) and identified as non-Hispanic/Latino (88.2%) with a mean age of 40.3 ± 11.7 years (Table 2). Almost all teachers enrolled in college, with nearly half
Discussion
The purpose of this study was to compare self-reported and observed feeding practices among a sample of RI Head Start teachers. We found a high level of agreement between controlling self-reported and observed feeding practices, while healthful feeding practices had much lower levels of agreement.
The high level of agreement among the controlling feeding practices might be explained in part by the presence of strong Head Start mealtime policies (e.g., use of food as a reward, avoidance of food
Conclusions
We found that the agreement between observed and reported behaviors was generally high for controlling feeding practices, but low for healthful feeding practices. Having clear policies within child care settings that discourage certain feeding practices may help teachers know and practice what they should and should not be doing in the classroom. Future policies may need to emphasize opportunities for engaging in more healthful feeding practices as opposed to focusing on the more controlling
Competing interests
The authors declare that they have no competing interests.
Role of the funding source
This project was supported, in part, by the USDA National Institute of Food and Agriculture, Hatch capacity grants, project #RI00H-90, administered by the Rhode Island Agricultural Experiment Station and an early career diversity grant for Alison Tovar, 3R01HL108390-03S1 from the National Institutes of Health, Bethesda MD.
Authors’ contributions
MF participated in data collection, and was primarily responsible for reviewing the literature and all written drafts of the manuscript. AT, KG, and KH oversaw all study components (study design, IRB approval, collection of reliability data). MF conducted analyses. MF, AT, KG, KH and GG participated in data review and interpretation of analyses. MF and AT led manuscript development, with contributions, edits and review by KG, KH, DW and GG. All authors read and approved the final manuscript.
Acknowledgements
The authors would like to thank the directors and teachers who participated in this study.
References (62)
- et al.
Reported and observed controlling feeding practices predict child eating behavior after 12 months
The Journal of Nutrition
(2015) - et al.
Systematic research review of observational approaches used to evaluate mother-child mealtime interactions during preschool years
American Journal of Clinical Nutrition
(2015) - et al.
Responsive feeding is embedded in a theoretical framework of responsive parenting
Journal of Nutrition
(2011) - et al.
Maternal and paternal controlling feeding practices with male and female children
Appetite
(2006) - et al.
The childcare environment and children's physical activity
American Journal of Preventive Medicine
(2008) - et al.
Parental feeding practices and socioeconomic status are associated with child adiposity in a multi-ethnic sample of children
Appetite
(2012) - et al.
Academy of Nutrition and Dietetics benchmarks for nutrition in child care 2011: Are child-care providers across contexts meeting recommendations?
Journal of the Academy of Nutrition and Dietetics
(2013) - et al.
Predictors of Head Start and child-care providers' healthful and controlling feeding practices with children aged 2 to 5 years
Journal of the Academy of Nutrition and Dietetics
(2014) - et al.
Prompts to eat novel and familiar fruits and vegetables in families with 1–3 year-old children: Relationships with food acceptance and intake
Appetite
(2016) - et al.
Responsive feeding: Implications for policy and program implementation
Journal of Nutrition
(2011)
Parent-child mealtime interactions associated with toddlers' refusals of novel and familiar foods
Physiology & Behavior
Systematic errors in middle-aged women's estimates of energy intake: Comparing three self-report measures to total energy expenditure from doubly labeled water
Annals of Epidemiology
Effectiveness of trained peer models to encourage food acceptance in preschool children
Appetite
Effectiveness of teacher modeling to encourage food acceptance in preschool children
Appetite
Feeding practices and child weight: Is the association bidirectional in preschool children?
American Journal of Clinical Nutrition
The relationship between practices and child care providers' beliefs related to child feeding and obesity prevention
Journal of Nutrition Education and Behavior
What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts
Journal of the American Dietetic Association
Mothers and toddlers lunch together. The relation between observed and reported behavior
Appetite
Head Start teachers' perceptions of children's eating behavior and weight status in the context of food scarcity
Journal of Nutrition Education and Behavior
Observed assertive and intrusive maternal feeding behaviors increase child adiposity
American Journal of Clinical Nutrition
Child-feeding strategies are associated with maternal concern about children becoming overweight, but not children's weight status
Journal of the American Dietetic Association
A comparison of mother and father involvement with their preschool age children
Early Childhood Research Quarterly
A qualitative investigation of teachers' information, motivation, and behavioral skills for increasing fruit and vegetable consumption in preschoolers
Journal of Nutrition Education and Behavior
Position of the Academy of Nutrition and Dietetics: Nutrition guidance for healthy children ages 2 to 11 years
Journal of the Academy of Nutrition and Dietetics
Feeding style differences in food parenting practices associated with fruit and vegetable intake in children from low-income families
Journal of Nutrition Education and Behavior
Mothers' child-feeding practices are associated with children's sugar-sweetened beverage intake
Journal of Nutrition
Assessment of infant feeding styles among low-income African-American mothers: Comparing reported and observed behaviors
Appetite
Nutrition-related knowledge, attitudes, and dietary behaviors among Head start teachers in Texas: A cross-sectional study
Journal of the Academy of Nutrition and Dietetics
Children's food preferences: A longitudinal analysis
Journal of the American Dietetic Association
Providers' response to child eating behaviors: A direct observation study
Appetite
Associations of parenting styles, parental feeding practices and child characteristics with young children's fruit and vegetable consumption
Appetite
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2018, Journal of Nutrition Education and BehaviorCitation Excerpt :Associations between the observation and mealtime self-report were examined using Pearson correlations. The full report of these findings are the focus of a separate study; however, main findings are briefly included here in the Results.49 All analyses were performed using SPSS software (version 21.0, IBM Corp., Armonk, NY, 2012).