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Cooking With Whole Grains: A Skills-Based Training for Child Care Providers
GEM No. Cooking With Whole Grains: A Skills-Based Training for Child Care Providers Mary Schroeder, MPH, RD, LD; Anne Dybsetter, MS; Laura Perdue, MPH, RD; Hyunjun Kim, MA; Misty Blue, BA; G. Ali Hurtado, PhD INTRODUCTION Considering that nearly two thirds of all preschool children in the US are in some form of child care,1 child care settings present a significant opportunity to improve the food environments of young children. Unfortunately, not all child care providers have the knowledge or skills to prepare healthy foods.2 Cooking With Whole Grains in Child Care (CWG) is a hands-on skill development training designed to increase the knowledge and skills of child care providers to serve wholegrain foods. Training objectives are for providers to (1) assess current use of whole grains, (2) identify whole grains using food labels, (3) prepare whole-grain foods in ways that are acceptable to children, (4) develop a plan to increase the number and variety of whole grains served and (5) use resources to increase child and family acceptance of whole grains.
PROGRAM DEVELOPMENT Cooking With Whole Grains in Child Care for child care providers is based on the model of a successful wholegrains training for school food service staff that was developed by a team of University Extension educators and faculty.3 The school food service training was based on the Attention, Relevance, Confidence, and Satisfaction (ARCS) model,4 which uses the
concepts of attention, relevance, confidence, and satisfaction to motivate learners. The school training was divided into 3 components: (1) whole-grain basics, (2) cooking with whole grains, and (3) introducing whole grains to children. Using the ARCS model and the same 3 components, Extension educators adapted the whole-grains training for child care providers. Cooking With Whole Grains in Child Care is a 3-hour training, which allows ample time for skill development through active learning. Providers are able to identify whole grains using food labels and learn tips for buying, storing, and preparing whole-grain foods. Working in small groups, they prepare simple, tasty whole-grain recipes. A taste test follows (Figure), along with discussion about encouraging children to try new foods. Providers also learn strategies to engage parents and gain ideas for incorporating whole grains into playtime and story time. Finally, providers assess current use of whole grains and develop a plan to increase the frequency and variety of whole grains served. To meet the needs of providers who are not native English speakers, the CWG team worked with Hmong, Somali, and Latino Extension staff to adapt CWG to include traditional foods and offer the course in 3 languages. Participant materials and parent handouts were also translated.
University of Minnesota Extension, Marshall, MN Conflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found online with this article on www.jneb.org. Address for correspondence: Mary Schroeder, MPH, RD, LD, University of Minnesota Extension, 1424 East College Dr, Ste 100, Marshall, MN 56258; Phone: (507) 828-2547; Fax: (507) 337-2002; E-mail: [email protected] J Nutr Educ Behav. 2016;-:1-2 Ó2016 Society for Nutrition Education and Behavior. Published by Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.jneb.2015.12.011
Journal of Nutrition Education and Behavior Volume -, Number -, 2016
PROGRAM IMPLEMENTATION Cooking With Whole Grains in Child Care was taught 12 times (10 times in English, once in Hmong, and once in Somali) during summer, 2014, with 158 child care providers voluntarily attending the free training. In January, 2015, an additional 38 providers attended the Latino CWG. University of Minnesota Institutional Review Board protocol was followed.
PROGRAM EVALUATION The 2014 CWG trainings were evaluated using pre-, post-, and 3-month follow-up surveys that had been tested for construct validity. Evaluation measurements assessed knowledge, behavioral confidence, and satisfaction. Six multiple choice questions measured participants' knowledge of whole grains, including correctly identifying wholegrain foods. Nine questions measured behavioral confidence, asking participants to rate agreement with statements such as ‘‘I can make whole grain food choices for children with resources I already have.’’ In addition, 4 satisfaction questions were included only in post-survey; both behavior and satisfaction were assessed using a 4-point Likert-type scale. Preand post-surveys were completed by 120 participants (76%). For the 3-month follow-up surveys, the response rate was too low to be included in the analysis (28.5%). The researchers used paired-sample t test to determine whether significant differences occurred between pre- and post-survey scores. The difference between pre- and post-survey knowledge scores was statistically significant for 5 of 6 questions (P < .05). One knowledge question, ‘‘A good way to introduce whole-grain foods is .’’ did not show statistical significance because
1
2 Schroeder et al
Journal of Nutrition Education and Behavior Volume -, Number -, 2016 make it easier for providers to attend, CWG is now offered online through the state's child care professional development system. Engaging online activities are used to build skills and confidence.
Future Plans
most participants selected the correct answer at baseline. Behavioral confidence scores increased after the intervention, with 6 of 9 questions showing a statistical difference between pre- and postsurvey (P < .05). The 3 questions that did not show statistical difference discussed (1) introducing whole grains to children, (2) serving family style, and (3) ability to communicate with parents about whole grains, which were emphasized less in the training than the ability to select and prepare whole-grain foods. A table of results for knowledge and behavioral confidence questions is included in Supplementary Data. Satisfaction results showed that over 90% of respondents agreed or strongly agreed that they were satisfied with the training's content, activities, and trainers.
A 3-month follow-up will be added to the online training to assess behavior change. Data are also being collected to compare the effectiveness of the online training with the in-person training. A CWG trainer guide for the in-person training will be made available online for other child care trainers. This suite of resources will be especially relevant if the 2015 Proposed Rule for the Child and Adult Care Food Program5 recommendation is approved for providers to serve at least 1 whole grain–rich food per day. Additional skills-based trainings for other topics of interest to child care providers could be developed based on this model. Because of ongoing changes in nutrition recommendations for child care settings, skills-based trainings for child care providers are timely and relevant. Cooking With Whole Grains in Child Care was developed to address the need to increase whole-grain foods in child care. Cooking With Whole Grains in Child Care can be used to increase the knowledge and confidence of providers to serve more whole grains.
LESSONS LEARNED
NOTES
A challenge of CWG was only 67% of those who preregistered attended. To
A Determination Form was completed for the institutional review board.
Figure. Somali child care providers sampling the whole-grain foods they prepared.
Because this project was evaluating a training program and did not collect personal information, it did not require institutional review by the University of Minnesota Institutional Review Board. This study received financial support from the Cargill Foundation.
SUPPLEMENTARY DATA Supplementary data related to this article can be found at http://dx.doi. org/10.1016/j.jneb.2015.12.011.
REFERENCES 1. Laughlin L. Who’s Minding the Kids? Child Care Arrangements: Spring 2011. Washington, DC: US Census Bureau; 2013. 2. Nanney M, O’Meara, J. Examining healthy food and activity practices in Minnesota child care: a brief report, 2012. http://www.healthdisparities.umn. edu/prod/groups/med/@pub/@med/@ hdresearch/documents/content/med_con tent_425108.pdf. Accessed December 7, 2015. 3. Roth-Yousey L, Barno T, Caskey M, Asche K, Reicks M. Whole-grain continuing education for school foodservice personnel: keeping kids from falling short. J Nutr Educ Behav. 2009;41: 429-435. 4. Keller J. Development and use of the ARCS Model of instructional design. Journal of Instructional Development. 1987;3:2-10. 5. Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger Free Kids Act of 2010. Washington, DC: Federal Register; 2015.
Journal of Nutrition Education and Behavior Volume -, Number -, 2016
CONFLICT OF INTEREST The authors have not stated any conflicts of interest.
Schroeder et al 2.e1
PROGRAM DEVELOPMENT Cooking With Whole Grains in Child Care for child care providers is based on the model of a successful wholegrains training for school food service staff that was developed by a team of University Extension educators and faculty.3 The school food service training was based on the Attention, Relevance, Confidence, and Satisfaction (ARCS) model,4 which uses the
concepts of attention, relevance, confidence, and satisfaction to motivate learners. The school training was divided into 3 components: (1) whole-grain basics, (2) cooking with whole grains, and (3) introducing whole grains to children. Using the ARCS model and the same 3 components, Extension educators adapted the whole-grains training for child care providers. Cooking With Whole Grains in Child Care is a 3-hour training, which allows ample time for skill development through active learning. Providers are able to identify whole grains using food labels and learn tips for buying, storing, and preparing whole-grain foods. Working in small groups, they prepare simple, tasty whole-grain recipes. A taste test follows (Figure), along with discussion about encouraging children to try new foods. Providers also learn strategies to engage parents and gain ideas for incorporating whole grains into playtime and story time. Finally, providers assess current use of whole grains and develop a plan to increase the frequency and variety of whole grains served. To meet the needs of providers who are not native English speakers, the CWG team worked with Hmong, Somali, and Latino Extension staff to adapt CWG to include traditional foods and offer the course in 3 languages. Participant materials and parent handouts were also translated.
University of Minnesota Extension, Marshall, MN Conflict of Interest Disclosure: The authors’ conflict of interest disclosures can be found online with this article on www.jneb.org. Address for correspondence: Mary Schroeder, MPH, RD, LD, University of Minnesota Extension, 1424 East College Dr, Ste 100, Marshall, MN 56258; Phone: (507) 828-2547; Fax: (507) 337-2002; E-mail: [email protected] J Nutr Educ Behav. 2016;-:1-2 Ó2016 Society for Nutrition Education and Behavior. Published by Elsevier, Inc. All rights reserved. http://dx.doi.org/10.1016/j.jneb.2015.12.011
Journal of Nutrition Education and Behavior Volume -, Number -, 2016
PROGRAM IMPLEMENTATION Cooking With Whole Grains in Child Care was taught 12 times (10 times in English, once in Hmong, and once in Somali) during summer, 2014, with 158 child care providers voluntarily attending the free training. In January, 2015, an additional 38 providers attended the Latino CWG. University of Minnesota Institutional Review Board protocol was followed.
PROGRAM EVALUATION The 2014 CWG trainings were evaluated using pre-, post-, and 3-month follow-up surveys that had been tested for construct validity. Evaluation measurements assessed knowledge, behavioral confidence, and satisfaction. Six multiple choice questions measured participants' knowledge of whole grains, including correctly identifying wholegrain foods. Nine questions measured behavioral confidence, asking participants to rate agreement with statements such as ‘‘I can make whole grain food choices for children with resources I already have.’’ In addition, 4 satisfaction questions were included only in post-survey; both behavior and satisfaction were assessed using a 4-point Likert-type scale. Preand post-surveys were completed by 120 participants (76%). For the 3-month follow-up surveys, the response rate was too low to be included in the analysis (28.5%). The researchers used paired-sample t test to determine whether significant differences occurred between pre- and post-survey scores. The difference between pre- and post-survey knowledge scores was statistically significant for 5 of 6 questions (P < .05). One knowledge question, ‘‘A good way to introduce whole-grain foods is .’’ did not show statistical significance because
1
2 Schroeder et al
Journal of Nutrition Education and Behavior Volume -, Number -, 2016 make it easier for providers to attend, CWG is now offered online through the state's child care professional development system. Engaging online activities are used to build skills and confidence.
Future Plans
most participants selected the correct answer at baseline. Behavioral confidence scores increased after the intervention, with 6 of 9 questions showing a statistical difference between pre- and postsurvey (P < .05). The 3 questions that did not show statistical difference discussed (1) introducing whole grains to children, (2) serving family style, and (3) ability to communicate with parents about whole grains, which were emphasized less in the training than the ability to select and prepare whole-grain foods. A table of results for knowledge and behavioral confidence questions is included in Supplementary Data. Satisfaction results showed that over 90% of respondents agreed or strongly agreed that they were satisfied with the training's content, activities, and trainers.
A 3-month follow-up will be added to the online training to assess behavior change. Data are also being collected to compare the effectiveness of the online training with the in-person training. A CWG trainer guide for the in-person training will be made available online for other child care trainers. This suite of resources will be especially relevant if the 2015 Proposed Rule for the Child and Adult Care Food Program5 recommendation is approved for providers to serve at least 1 whole grain–rich food per day. Additional skills-based trainings for other topics of interest to child care providers could be developed based on this model. Because of ongoing changes in nutrition recommendations for child care settings, skills-based trainings for child care providers are timely and relevant. Cooking With Whole Grains in Child Care was developed to address the need to increase whole-grain foods in child care. Cooking With Whole Grains in Child Care can be used to increase the knowledge and confidence of providers to serve more whole grains.
LESSONS LEARNED
NOTES
A challenge of CWG was only 67% of those who preregistered attended. To
A Determination Form was completed for the institutional review board.
Figure. Somali child care providers sampling the whole-grain foods they prepared.
Because this project was evaluating a training program and did not collect personal information, it did not require institutional review by the University of Minnesota Institutional Review Board. This study received financial support from the Cargill Foundation.
SUPPLEMENTARY DATA Supplementary data related to this article can be found at http://dx.doi. org/10.1016/j.jneb.2015.12.011.
REFERENCES 1. Laughlin L. Who’s Minding the Kids? Child Care Arrangements: Spring 2011. Washington, DC: US Census Bureau; 2013. 2. Nanney M, O’Meara, J. Examining healthy food and activity practices in Minnesota child care: a brief report, 2012. http://www.healthdisparities.umn. edu/prod/groups/med/@pub/@med/@ hdresearch/documents/content/med_con tent_425108.pdf. Accessed December 7, 2015. 3. Roth-Yousey L, Barno T, Caskey M, Asche K, Reicks M. Whole-grain continuing education for school foodservice personnel: keeping kids from falling short. J Nutr Educ Behav. 2009;41: 429-435. 4. Keller J. Development and use of the ARCS Model of instructional design. Journal of Instructional Development. 1987;3:2-10. 5. Child and Adult Care Food Program: Meal Pattern Revisions Related to the Healthy, Hunger Free Kids Act of 2010. Washington, DC: Federal Register; 2015.
Journal of Nutrition Education and Behavior Volume -, Number -, 2016
CONFLICT OF INTEREST The authors have not stated any conflicts of interest.
Schroeder et al 2.e1