Comprehensive Assessment of Child Care Center Nutrition and Physical Activity Environments

The EPAO-SR was designed to evaluate a center’s provisions (foods/beverages served, active & sedentary opportunities, PA equipment and the outdoor environment), practices (nutrition and physical activity social environment), and policies (both nutrition and PA). The EPAO-SR contains close to 800 items. An overview of the items is found in Table 1. Based on experience in the development of the original EPAO instrument and feedback from our advisory committee, we felt that it would be necessary to obtain data from both directors and teachers to obtain the most accurate description of the child care centers’ nutrition and physical activity environments. The self-reporting version (EPAO-SR) is divided into three surveys: the Director Report (completed by the director), the Staff Daily Questionnaire and the Staff General Questionnaire (both staff questionnaires completed by teachers). Each survey contained questions that would be most appropriate for the individual (either director or teacher) to answer. The Director Report asks directors about center-wide nutrition and PA efforts, including parent education and policies for nutrition and PA. The Staff Daily Questionnaire asks classroom teachers to report on daily nutrition and PA provisions and practices on a specific day in a manner similar to a time use diary, while the Staff General Questionnaire asks teachers to report generally on their nutrition and PA practices and infrequent activities such as participation in nutrition and PA training. Most items were presented in a checklist format such that items, or sections, could be skipped if certain activities did not occur or certain types of foods were not served.Table 1

Overview of the EPAO and EPAO-SR and Field Testing Summary

Category	Sample description of items	Questionnaire	Reporter	Day completed
				1	2	3	4
Provisions 1: food and beverages served; active play and sedentary opportunities	• Types of food and beverages served	Staff today survey	Classroom teachers	X	X	X	X
	• Amount of active play time offered, indoor and outdoor	Daily observation tool	Research staff	X	X	X	X
	• Amount of TV, computer, and seated time
Provisions 2: classroom physical environment	• Classroom posters or books featuring food or PA	Staff general survey	Classroom teachers	X		X
	• Fixed and portable play equipment	Daily observation tool	Research staff	X	X	X	X
	• Amount of space for active play
Provisions 3: center’s physical environment	• Natural features, e.g., trees, open play space	Director survey	Center director	X		X
	• Presence of vending machines	Daily observation tool	Research staff	X	X	X	X
Practices: teacher engagement with children around eating & activity	• Teacher behavior around mealtimes and active play time periods	Staff today survey	Classroom teachers	X		X
	• Use of food or PA as a reward or punishment	Daily observation tool	Research staff	X	X	X	X
Policies, Training and Education: regulations, planned trainings, & formal education	• Policies regarding nutrition or PA	Director survey	Center director	X		X
	• Nutrition- or PA-related training for center staff	Document review	Research staff				X
	• Parent education around nutrition or PA, e.g., workshops, emails, pamphlets