The self-assessment instrument [see Additional file 1 ] was developed for the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) intervention. The NAP SACC intervention was designed to allow child care facilities to self-assess their nutrition and physical activity environments, select areas for improvement, and make environmental changes with the help of a local health consultant (NAP SACC Consultant). Trained NAP SACC Consultants provided technical assistance and support for environmental improvements at child care facilities.
To develop the NAP SACC self-assessment instrument, we conducted a thorough review of nutrition and physical activity standards and recommendations for children ages 2 to 5 years and child care. In addition, we searched the scientific literature for nutrition and physical activity recommendations for young children. In-depth results of this review can be found elsewhere [34 ]. Based on these reviews, we developed key nutrition and physical activity areas of focus. Key NAP SACC nutrition areas of focus included: Fruits and Vegetables; Fried Foods and High Fat Meats; Beverages; Menus and Variety; Meals and Snacks; Foods Outside of Regular Meals and Snacks; Supporting Healthy Eating; Nutrition Education for Children, Parents and Staff; and Nutrition Policy. Key NAP SACC physical activity areas of focus included: Active Play and Inactive Time; TV Use and TV Viewing; Play Environment; Supporting Physical Activity; Physical Activity Education for Children, Parents, and Staff; and Physical Activity Policy. The self-assessment instrument included 38 nutrition and 18 physical activity questions that had a demonstrated relationship to childhood overweight, or were likely contributors to an unhealthy environment. Each question had four possible response options ranging from minimum standard to best practice. The NAP SACC self-assessment instrument and accompanying intervention were developed based on aspects of Social Cognitive Theory (SCT), which describes individual behaviors as stemming from environmental influences, and identifies several crucial factors that influence behavior change including observational learning, self-efficacy, environment, reinforcement, and reciprocal determinism [35 ]. In addition to SCT, the socio-ecological framework helps to describe the relationship between an individual and the environment [36 (link)]. Additional information on the NAP SACC intervention and further description of the nutrition and physical activity areas of focus for the self-assessment instrument are described elsewhere [34 ,37 (link)].
To develop the NAP SACC self-assessment instrument, we conducted a thorough review of nutrition and physical activity standards and recommendations for children ages 2 to 5 years and child care. In addition, we searched the scientific literature for nutrition and physical activity recommendations for young children. In-depth results of this review can be found elsewhere [34 ]. Based on these reviews, we developed key nutrition and physical activity areas of focus. Key NAP SACC nutrition areas of focus included: Fruits and Vegetables; Fried Foods and High Fat Meats; Beverages; Menus and Variety; Meals and Snacks; Foods Outside of Regular Meals and Snacks; Supporting Healthy Eating; Nutrition Education for Children, Parents and Staff; and Nutrition Policy. Key NAP SACC physical activity areas of focus included: Active Play and Inactive Time; TV Use and TV Viewing; Play Environment; Supporting Physical Activity; Physical Activity Education for Children, Parents, and Staff; and Physical Activity Policy. The self-assessment instrument included 38 nutrition and 18 physical activity questions that had a demonstrated relationship to childhood overweight, or were likely contributors to an unhealthy environment. Each question had four possible response options ranging from minimum standard to best practice. The NAP SACC self-assessment instrument and accompanying intervention were developed based on aspects of Social Cognitive Theory (SCT), which describes individual behaviors as stemming from environmental influences, and identifies several crucial factors that influence behavior change including observational learning, self-efficacy, environment, reinforcement, and reciprocal determinism [35 ]. In addition to SCT, the socio-ecological framework helps to describe the relationship between an individual and the environment [36 (link)]. Additional information on the NAP SACC intervention and further description of the nutrition and physical activity areas of focus for the self-assessment instrument are described elsewhere [34 ,37 (link)].
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