Culture of Wellness in Preschools: Nutrition Education and Physical Activity (COWP NE/PA)

COWP NE/PA targets preschool children and parents in childcare/classroom settings. Since 2017, COWP NE/PA has expanded to partner with approximately 135 preschools in 16 counties. Partner sites reach participants via direct (NE/PA classroom lessons) and indirect programming (NE family letters). By partnering with preschools who serve individuals eligible for SNAP, we can ensure the program is reaching the intended audience. The preschool setting is ideal for early childhood obesity prevention programs as many preschool-aged children spend time in center-based care where children attending full-time may consume up to two-thirds of their daily caloric intake in this environment.   Settings:  Pre-K & Childcare Age/Population Group:  Preschool, Parents/Caregivers Race: All Ethnicity:  All

The NE component of the intervention has 15 lessons to choose from. At least 9 of the lessons should be implemented within a school year in order to achieve program outcomes.  The PA component has PA activities using portable play equipment and music. PA activities must be incorporated into the lesson plans regularly throughout the school year to achieve intended outcomes.   COWP staff train preschool staff in the beginning of each academic year. Post-training evaluations assess teacher confidence in curriculum implementation and identify any further training and technical assistance needs. Classroom observations and delivery tracking logs monitor fidelity. Teacher feedback forms improve program quality.   Other components that are highly recommended are: The COWP PSE change process COWP PSE intervention as well as  Parent Wellness Workshops ,  both components are featured in the SNAP-Ed Toolkit.

Listed are the intervention materials available:  Toddler and Pre-K classroom-based nutrition education/physical activity curriculum (15 lessons) Family letters with recipes and health tips Culture of Wellness in Preschools: Policy, System and Environment Change Process  (COWP-PSE). The following items are available upon request:   Toddler classroom-based nutrition education curriculum Pre-K classroom-based nutrition education curriculum  Evaluation tools (current and prior years)   The listed materials are available on the  COWP website .

Formative Tools:   Focus group data: 23 focus groups were conducted with preschool teachers to identify needs, barriers and facilitators to program implementation. Meetings minutes from a day-long retreat with teachers who had used the curriculum in preschool and kindergarten classrooms informed adaptations    Process Tools:   Teacher feedback forms administered with each NE lesson to make continuous quality improvements  Teachers are surveyed annually to assess acceptability of the curriculum  COWP Lesson Observation Form: COWP staff use this tool to observe lessons in the classroom, to gather feedback on fidelity to the curriculum, and to inform potential modifications throughout the year    QI Strategy:   We utilize the Plan, Do, Study, Act (PDSA) quality improvement framework to continuously collect data, make small changes, and study these changes to improve our curriculum and ensure it serves the target audience.   Outcomes that occurred include:   Leveraging of funds (in-kind donation of teacher time)  Aligning curriculum with academic standards (Colorado Academic Standards, Teaching Strategies Gold, and Head Start/Early Learning Framework)  Staff reporting an increase in healthy eating and physical activity because of the program Delivering materials to each school provided opportunities for strong relationship-building with school staff and positioned COWP for more impactful work with parent engagement and PSEs  Providing ongoing training to implement curricula and increasing staff buy-in and commitment   Lessons Learned/Recommendations:    Quarterly observations of NE/PA Lesson delivery in the classrooms are needed  Ongoing Technical Assistance provided for new teachers  Alignment of COWP NE/PA curriculum with COWP PSE curriculum to support the sustainability of these components  Identification and training of a center-specific wellness champion to help promote program delivery  Manuscripts currently in press with peer-reviewed journals: Impact of a nutrition education programme on preschool children's willingness to consume fruits and vegetables Implementation of Policy, System and Environment Changes in Early Childhood Education Settings \ Development of a Dissemination and Implementation Framework for an Early Childhood Obesity Prevention Program An exploration of constructs related to dissemination and implementation of an early childhood systems-level intervention       Evidence Base:  Research-tested

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.   Readiness and Capacity - Short Term (ST) Changes - Medium Term (MT) Effectiveness and Maintenance - Long Term (LT) Population Results (R) Individual   MT1 , MT3     Environmental Settings   MT5 , MT6     Sectors of Influence         MT1: Healthy Eating   MT1l, MT1m : Increased consumption of fruits and vegetables using Plate Waste methodology to measure children's consumption of fruits and vegetables before and after the COWP NE intervention.   MT3: Physical Activity and Reduced Sedentary Behavior   MT3b:  Increased moderate to vigorous physical activity as demonstrated by the SOPLAY method, demonstrating a 20% increase of overall MVPA scores from 2012 - 2016. Increased child vigorous activity as demonstrated by accelerometer data.   MT5: Nutrition Supports    MT5a: Number and proportion of sites or organizations that make at least one change in writing or practice to expand access or improve appeal for healthy eating using the COWP's Evidence-Based PSE Menu. Since 2017, COWP has worked with 135 sites in 16 Counties.    MT6: Physical Activity and Reduced Sedentary Behavior Supports   MT6a: Number and proportion of sites or organizations that make at least one change in writing or practice to expand access or improve appeal for physical activity or reduced sedentary behavior using the COWP's Evidence-Based PSE Menu. Since 2017, COWP has worked with 135 sites in 16 Counties.

Outcome Evaluation Tools:  SOPLAY Methods: https://activelivingresearch.org/sites/activelivingresearch.org/files/SOPLAY_Protocols.pdf SOPLAY & Accelerometer results    Plate Waste Protocol/Results   Formative Evaluation Tools:   Focus Group Protocols  All- Day Retreat Agenda and Meeting Minutes      Process Evaluation Tools:   NE/PA Classroom Observation Tool Teacher Feedback Forms     PSE Change Evaluation Tools:   The Culture of Wellness in Preschools: Policy, System and Environment Change Process (COWP) Evidence-Based PSE Menu/Checklist

Website:  The COWP NE/PA website ( www.cowpprogram.com ) includes information about the Culture of Wellness in Preschools programs and NE/PA resources.  Contact Person(s): Deanna LaFlamme  Director, Rocky Mt. Prevention Research Center, Colorado School of Public Health Phone: 303-724-4457 Email: deanna.laflamme@cuanschutz.edu     *Updated as of August 23, 2023