Measuring Barriers to Change in Child Care Settings

Most of the methodologies that Ritchie identified for use in measuring barriers to change in child care settings were built upon the Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) questionnaire (Benjamin et al., 2007).2 Although NAP SACC itself did not contain any barrier questions, researchers have adapted the questionnaire for use in measuring barriers. For example, in ongoing work, Dianne Ward and colleagues added self-efficacy questions aimed at understanding individual behavior change within the context of organization behavior change (e.g., How confident do you feel about improving the quality of food that you serve? How confident do you feel about making menu changes?) (Personal communication, D. Stanton Ward, University of North Carolina at Chapel Hill, January 2012). The Yale Rudd Center also used a NAP SACC–like questionnaire in its Child Care Nutrition & Physical Activity Assessment survey (Henderson et al., 2011). The survey included a checklist of barriers to promoting a healthy environment (e.g., lack of support, sale of unhealthy foods at fundraisers, serving unhealthy foods at social events, insufficient funds, inadequate food preparation or storage facilities, limitations of food service providers or vendors, lack of policies, and lack of training for food service staff).

As yet another example of a NAP SACC–like tool being used to assess barriers to change in child care, the Survey of Healthy Activity and Eating Practices in Environments in Head Start (SHAPES) includes a question on challenges to providing healthier foods in child care (Whitaker et al., 2009). Ritchie noted that the questions are more theoretical than those on the Yale Rudd Center’s Child Care Nutrition & Physical Activity Assessment survey. Rather than asking the provider about current challenges, the tool asks the provider about anticipated challenges if they were to serve healthier foods. The tool acknowledges some of the same challenges as the Yale Rudd Center survey (e.g., funds, control over food service provider, and knowledge) but also includes some additional challenges (e.g., time, child preferences, and parent support).

Finally, the Statewide Assessment of California tool administered by Ritchie and colleagues (2012) also included some barrier questions. Based on results of the survey, major challenges to providing healthier foods among both CACFP and non-CACFP providers were no CACFP reimbursement (4 percent), parents not wanting healthier foods (7 percent), not enough information (8 percent), not enough room for food preparation or


2NAP SACC is an intervention designed to improve the nutrition and physical activity environment, policies, and practices of child care centers through self-assessment and technical assistance. For more information, visit

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