HHFKA CACFP State Agencies

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Attachment F_HHFKA Section 221 CACFP Master FG Discussion Guide 7 26 13

HHFKA CACFP State Agencies

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TELEPHONE FOCUS GROUPS ON NUTRITION, PHYSICAL ACTIVITY AND ELECTRONIC MEDIA USE IN CHILD CARE SETTINGS1


I. INTRODUCTION 10 minutes


  • Moderator introduction:

    • My name is [INSERT] and I’m with KRC Research. Thank you so much for agreeing to participate in our small group discussion.

    • KRC is an independent research firm. We are conducting interviews on behalf of the U.S. Department of Agriculture Food and Nutrition Service.

    • You have all been selected to participate in this discussion based on a survey on similar topics a few months ago. Today’s conversation is a follow-up to that survey and will take approximately 90 minutes. As a reminder, your answers are anonymous and neither you nor your organization will be identified in the final report for this study.

  • To get started, let me explain how our discussion will work today. EXPLAIN THE FOLLOWING:

    • Discussion is audio-taped to create an accurate transcript

    • There will be no identifying information in the transcript or final report

    • Speak one at a time; be respectful/mindful when others are speaking

    • No wrong answers—we want to hear what you personally think

  • Participant introductions:

    • First name

    • Where you live

    • Length of time with current organization



II. HEALTHY HABITS IN YOUNG CHILDREN 10 minutes

Moderator’s goals: To better understand the importance placed on promoting healthy habits in young children

  1. Today’s discussion is focused on promoting certain habits in children. To start, I would like to get your perspective on promoting healthy habits in infants and young children. When I say, “healthy habits,” what comes to mind that is age appropriate for children as young as infants and toddlers?

    1. How important, if at all, is it to promote healthy habits in children this young?

      1. IF IMPORTANT: What is important about it? What’s the impact?

      2. IF NOT/LESS IMPORTANT: What makes this not as important for younger children? At what age does this start to become important?

  2. How, if at all, has the attention given to promoting healthy habits in young children changed over the last few years?

    1. PROBE: How would you describe changes that have taken place – are they positive, negative or neutral? And what makes you describe them as positive/negative/neutral?

    2. What factors have influenced changes you have seen?

  3. What is the role of child care providers in promoting healthy habits among children?

    1. What, if anything, distinguishes child care settings from a child’s home when it comes to promoting healthy habits?

    2. How, if at all, has the role of child care providers in promoting healthy habits changed over the past few years?

      1. How would you describe these changes?

      2. How, if at all, have they affected your work?



III. NUTRITION 40 minutes

Moderator’s goals: To better understand attitudes about nutrition guidelines and recommendations for children ages 0 to 5, including developing a clearer picture of how these guidelines and recommendations can be adopted/operationalized in child care settings

  1. We’ve talked generally about healthy habits in children. For the rest of today’s discussion, I want to focus on specific topics, starting with nutrition. What are some nutrition guidelines or recommendations for infants and young children?

      1. IF NOT MENTIONED: Let’s break it down by ages starting with infants (0 – 12 months). What are some specific nutrition guidelines and recommendations for children in this age range? Children ages 1 & 2? Children ages 3, 4 and 5?

        1. Stepping back, how useful is it to have guidelines and recommendations that are specific to children of certain ages?

        2. What about nutrition guidelines and recommendations is useful? What is the value of having nutrition guidelines and recommendations for children ages 0 to 5?

        3. What is the short-term impact of following nutrition guidelines and recommendations for children ages 0 to 5?

        4. What about the long-term impact? What, if any, long-term benefits are there to these nutrition guidelines and recommendations?

  2. IF NOT MENTIONED: Are you familiar with the Dietary Guidelines for Americans? What about the Institute of Medicine’s guidelines for CACFP?

    1. PROBE: How did you learn about the Dietary Guidelines and/or IOM’s guidelines and recommendations?

    2. Have you received any information about nutrition guidelines and recommendations for children recently?

        1. IF YES: What have you received and from where?

  3. How can child care providers help promote better nutrition habits for children?

    1. Is this something child care providers should be doing? What makes you think that?

    2. What could make it easier for them to promote better nutrition habits?

    3. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] How does your agency/organization help child care providers implement guidelines?

    4. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] What, if anything, are you currently doing to help child care providers promote better nutrition habits for children?

  4. [CHILD CARE PROVIDERS ONLY] Where is the food that is served in your care typically prepared – on site? By a central provider? Somewhere else?

    1. How, if at all, does the source of food preparation affect your efforts to promote better nutrition habits in the children you care for?

    2. What, if anything, related to where food is prepared would make it easier for you to provide more nutritious meals and snacks for the children under your care?

  5. Thinking now about what children drink while under your care/in a child care setting, what drinks are typically served throughout the day? DEVELOP LIST. Which ones are served most frequently?

    1. How often are children served milk? And, what types of milk are typically provided?

    2. What about water? Is water available throughout the day? At meals and snacks?

    3. [CHILD CARE PROVIDERS ONLY] What types of beverages do children typically ask for while under your care?

    4. [CHILD CARE PROVIDERS ONLY] What are the biggest barriers to getting children to drink healthy beverages? Tell me more about that. How do you overcome that barrier?

    5. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] How frequently do you advise or provide information to child care providers about recommended beverages for children under their care?

  6. [CHILD CARE PROVIDERS ONLY] Now, I want to move to food served during meals and snacks, starting with menu planning each week. Is menu planning something your center/day care home regularly does? Tell me how this usually works.

    1. IF YES: How often – daily? Weekly? Monthly?

    2. IF NO: How are meals and snacks planned?

    3. What factors influence any formal or informal menu planning?

        1. PROBE: To what degree do you usually follow age-specific nutrition guidelines and recommendations when you are planning? Tell me more about that.

        2. What, if anything, would help ensure that nutrition guidelines are reflected in meal planning?

    4. I also want to hear more about food preparation at your center or home. Do you prepare food every day or less frequently than that?

        1. Does the person or people preparing food follow recipes most of the time? Do they regularly measure ingredients?

        2. How mindful are you or those preparing food of the quality and nutritional value of ingredients used in food preparation?

        3. Thinking about the meals and snacks you served yesterday, how closely did they follow nutrition guidelines and recommendations as you understand them?

        4. PROBE: What foods, if any, do you try to limit the use of during food preparation?

        5. Let’s talk about specific ingredients, starting with salt. When salt is added during food preparation, how frequently is the amount of salt that is added measured or limited?

        6. What about fat, such as butter or oil? How frequently is the amount of fat that is added measured or limited?

        7. What about sugar? How frequently is the amount of sugar that is added measured or limited?

        8. What would help you make sure that the use of some of the ingredients we just discussed was limited during food preparation?

        9. How often are you or the person responsible for purchasing and preparing food using and looking at nutrition labels? Overall, how helpful are nutrition labels when purchasing, preparing or serving food to children in your care?

  7. [PROVIDERS ONLY] In a typical day, what’s going on at your center or home when you serve a meal or snack? What does that look like?

    1. When you are serving a meal or snack, what makes it easier to encourage the children in your care to eat more nutritious foods?

    2. What about mealtime or snack time makes this more difficult?

  8. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] Do you counsel child care providers about menu planning? What about counseling them about reading nutrition labels?

    1. IF YES TO EITHER: How do you provide counsel?

        1. How closely do your recommendations follow the Dietary Guidelines for Americans and/or IOM’s guidelines and recommendations?

      1. How frequently do you monitor or talk to child care providers in your area about age-specific nutrition guidelines and recommendations as they relate to menu planning/actual meals and snacks served to children under their care?

        1. [SPONSORING ORGANIZATIONS ONLY] Thinking about the child care providers you work with directly, how would you rate the healthfulness of meals and snacks they serve? How closely did they follow nutrition guidelines and recommendations as you understand them?

      2. From your experience and perspective, what factors most influence the healthfulness (or lack thereof) of meals and snacks served in child care settings?

        1. What sense, if any, do you have about whether or not child care providers are modeling healthy eating habits?

  9. What would help you/child care providers make changes to the meals and snacks you serve so that they more closely followed nutrition guidelines and recommendations?

    1. [SELECT 3-4 HIGH RANKING FOODS FROM SURVEY, INCLUDING 1-2 WITH HIGH NUTRITIONAL VALUE AND 1-2 WITH LOW NUTRITIONAL VALUE] What about [INSERT FOOD]? On the recent survey, this was among the most commonly served foods. What about this is so popular?

    2. [SELECT 2 LOW RANKING FOODS WITH HIGH NUTRITIONAL VALUE] What about [INSERT FOOD]? According to the survey, child care providers are less likely to serve this. What are some reasons that this is not included more frequently as a part of meals and snacks in child care settings?

        1. What are some other reasons that foods like [INSERT FROM ABOVE] are not served more frequently?

        2. What would allow child care providers to serve foods like [INSERT FROM ABOVE] more often?

  10. In the recent survey, the following were among the top barriers to greater adoption of nutrition guidelines and recommendations [INSERT 3-4 BARRIERS FOR EACH AUDIENCE FROM SURVEY]. Please tell me your own experience with each of these and how this specifically presents challenges?

    1. FOR EACH: What specifically could help you overcome this barrier?

    2. What additional barriers or challenges do you face that have not already been discussed?

  11. Let’s spend a few minutes talking about what might be useful and helpful to providers, like information or training related to learning more about nutrition guidelines. What kind of training are you interested in? What would be most helpful to you?

    1. What about training to overcome some of the barriers we discussed earlier? How helpful would this type of training be?

    2. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] What will make it easier for you to promote nutrition guidelines at centers and homes? What training do you need?

    3. What other topics would you be interested in receiving information or training on?

    4. In the survey, the following were among the top preferences [INSERT FROM SURVEY]. Would these work for you? What’s your preferred format for training?

    5. What format would you like to receive information or training in – is paper best? Online resources? Videos? Something else? What format will make the training more useful or easier to implement?

IV. PHYSICAL ACTIVITY 30 minutes

Moderator’s goals: To better understand attitudes about physical activity guidelines and recommendations for children ages 0 to 5, including developing a clearer picture of how these guidelines and recommendations can be adopted/operationalized in child care settings

  1. Let’s turn now to physical activity. What are some physical activity guidelines or recommendations for infants and young children?

      1. IF NOT MENTIONED: Let’s break it down by ages. What are some specific physical activity guidelines and recommendations for children 0 – 12 months old? Children ages 1 and 2? Children ages 3, 4 and 5?

        1. PROBE: For each of these age ranges, what do you think is the right amount of time for physical activity during a typical day?

        2. Stepping back, how useful is it to have physical activity guidelines and recommendations that are specific to children of certain ages?

        3. And what about these physical activity guidelines and recommendations is useful/not useful?

        4. What, if anything, is the short-term impact of following physical activity guidelines and recommendations for children ages 0 to 5?

        5. What about the long-term impact? What, if any, long-term benefits are there to these physical activity guidelines and recommendations?

        6. Do you see nutrition and physical activity guidelines and recommendations going hand-in-hand or are they separate?

  2. What, if any, information have you received recently about physical activity guidelines and recommendations for infants and young children?

    1. What did it include? How helpful was the information you received?

  3. How can child care providers help promote physical activity in infants and young children?

    1. Is this something child care providers should be doing? Why or why not?

    2. What, if anything, would make promoting physical activity easier for you?

    3. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] How can your agency/organization help child care providers with this effort?

    4. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] What, if anything, are you currently doing to help child care providers promote better physical activity habits for children?

    5. What are the biggest barriers to following physical activity guidelines? In what ways are each of these a barrier?

  4. [CHILD CARE PROVIDERS ONLY] What opportunities are there for physical activity at your center/day care home during a typical day?

      1. What kinds of physical activity do you typically offer at your center/day care home? For example, tell me about what yesterday looked like. If it is helpful, please break this out by different age groups?

    1. PROBE FOR THREE AGE GROUPS (0 – 12 months; 1-2 years; 3, 4&5): How much time is structured play with an adult supervisor? How much time is free play?

        1. What, if anything, goes into your thinking about whether to have structured or free play?

        2. What are some examples of structured play for [INSERT AGE GROUP]?

        3. What are some examples of free play for [INSERT AGE GROUP]?

        4. How much training or experience does the staff at your center/day care home have related to age-appropriate physical activity?

    2. What are some examples of the most popular types of physical activity?

    3. Overall, how enthusiastic are children under your care about physical activity?

    1. What makes some children more excited?

    2. Thinking about the children you care for and what they enjoy doing over the course of a typical day, how does time for physical activity compare to time for other activities? Would you say it is more popular? Less popular?

    3. What prevents children from engaging in physical activity/being interested in it and how serious of a problem/challenge is this?

    4. PROBE: Roughly what percentage of children you care for are less interested or disinterested in physical activity?

  1. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] Do you counsel child care providers to encourage them to make ample time for physical activity during the day?

    1. IF YES: In what ways do you offer counsel?

        1. Are your recommendations age-specific?

      1. [SPONSORING ORGANIZATIONS ONLY] Thinking about the child care providers you work with directly, how would you rate the amount of time for physical activity during a typical day?

      2. From your experience and perspective, what factors most influence the amount of time provided for physical activity during a typical day at a child care center or day care home?

        1. Is it your sense that there is a difference in these factors between child care centers and day care homes? Why or why not?

        2. What sense, if any, do you have about whether or not child care providers are modeling healthy physical activity habits?

  2. What would help you/child care providers make changes during a typical day to allow more time for physical activity?

    1. [SELECT 3-4 ITEMS FROM SURVEY] What about [INSERT ITEM]? On the recent survey, this was among the things most frequently selected. Why do you think this is so important?

  3. In the recent survey, the following were among the top barriers to greater adoption of physical activity guidelines and recommendations [INSERT 3-4 BARRIERS FOR EACH AUDIENCE FROM SURVEY]. Please tell me your own experience with each of these and how this specifically presents challenges?

    1. FOR EACH: What specifically could help you overcome this barrier?

    2. What, if anything, makes this even more of a challenge for you?

    3. What additional barriers or challenges do you face that have not already been discussed?

  4. I want to spend a few minutes talking about the information and training that would be of most use to you when it comes to physical activity. Let’s start with information and training related to learning more about physical activity guidelines. What kind of training are you interested in? What would you find most helpful?

    1. What about training to overcome some of the barriers we discussed earlier? How helpful would this type of training be?

    2. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] What will make it easier for you to promote physical activity guidelines at centers and homes? What training do you need?

    3. What other topics would you be interested in receiving information or training on?

    4. In the survey, the following were among the top preferences [INSERT FROM SURVEY]. Would these work for you? What’s your preferred format for training?

    5. What format would you like to receive information or training in – is paper best? Online resources? Videos? Something else? What format will make the training more useful or easier to implement?


ELECTRONIC MEDIA USE 30 minutes

Moderator’s goals: To better understand attitudes about electronic media use guidelines and recommendations for children ages 0 to 5, including developing a clearer picture of how these guidelines and recommendations can be adopted/operationalized in child care settings

  1. Let’s turn now to electronic media use. By electronic media use, I’m referring to TV, computers, computer games, educational videos, and so forth. What are some of the most important electronic media use guidelines or recommendations for infants and young children?

      1. IF NOT MENTIONED: Let’s break it down by ages. What are some specific electronic media use guidelines and recommendations for children younger than 2? Children ages 2 and older?

        1. PROBE: For each of these age ranges, what do you think is the right amount of time for electronic media use during a typical day?

        2. Stepping back, how important is it to have electronic media use guidelines and recommendations that are specific to children of certain ages?

        3. And why are these electronic media use guidelines and recommendations important? What is the value of having electronic media use guidelines and recommendations for children ages 0 to 5?

        4. What is the short-term impact of following electronic media use guidelines and recommendations for children ages 0 to 5?

        5. What about the long-term impact? What, if any, long-term benefits are there to these electronic media use guidelines and recommendations?

        6. Do you see physical activity and electronic media use guidelines and recommendations going hand-in-hand or are they separate?

  1. In what instances, if any, is it appropriate for children to use electronic media?

        1. How, if at all, can electronic media be considered educational?

          1. What percentage of electronic media would you say is educational (of all electronic media that an infant or young child might be exposed to in a typical day)?

        2. [CHILD CARE PROVIDERS ONLY] How do others that you work with view electronic media – do they see it as educational?

          1. What about the parents of the children you care for?

  2. What, if any, information have you received recently about electronic media use guidelines and recommendations for infants and young children?

    1. What did it include? How helpful was this information?

  3. How can child care providers help discourage and/or limit electronic media use in infants and young children?

    1. Is this something child care providers should be doing? Why or why not?

    2. What would make it easier for child care providers to discourage or limit using electronic media?

    3. What are the barriers to limiting the use of excessive TV and computer use? How do you overcome those barriers?

    4. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] How can your agency/organization help child care providers with this effort?

    5. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] What, if anything, are you currently doing to help child care providers limit electronic media use for children under their care?

  4. [CHILD CARE PROVIDERS ONLY] What electronic media use opportunities do you offer at your center/day care home during a typical day?

      1. What electronic media use was used at your center/day care home yesterday and for how long? If it is helpful, please break this out by different age groups.

    1. PROBE FOR TWO AGE GROUPS (–Under 2; 2 and older): In a typical day, how much time do children spend using electronic media? If it is helpful, please break this out by different age groups.

          1. What are some examples of electronic media use that is supervised by an adult for [INSERT AGE GROUP]?

          2. What are some examples of unsupervised electronic media use [INSERT AGE GROUP]?

          3. How much training or experience does the staff at your center/day care home have related to age-appropriate electronic media use?

    2. What are some examples of the most popular types of electronic media used by children at your center/in your day care home?

    3. Overall, how difficult is it to control electronic media use at your center/day care home?

          1. What makes this difficult?

          2. PROBE: What would help overcome some of these difficulties?

  5. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] Do you counsel child care providers to limit electronic media use during a typical day?

    1. IF YES: What kind of counsel do you give—in what form do you give it?

    2. Are your recommendations age-specific?

    3. [SPONSORING ORGANIZATIONS ONLY] Thinking about the child care providers you work with directly, how much time, on average, do children have to use electronic media in a typical day?

    4. From your experience and perspective, what factors most influence the amount of time children are using electronic media during a typical day at a child care center or day care home?

    5. Is it your sense that there is a difference in these factors between child care centers and day care homes? Why or why not?

    6. What sense, if any, do you have about whether or not child care providers are modeling good electronic media use habits?

  6. What would help you/child care providers make changes during a typical day to limit or eliminate electronic media use all together?

    1. [SELECT 3-4 ITEMS FROM SURVEY] What about [INSERT ITEM]? On the recent survey, this was among the things most frequently selected. Why do you think this is so important?

  7. In the recent survey, the following were among the top barriers to greater adoption of electronic media use guidelines and recommendations [INSERT 3-4 BARRIERS FOR EACH AUDIENCE FROM SURVEY]. Please tell me your own experience with each of these and how this specifically presents challenges?

    1. FOR EACH: What specifically could help you overcome this barrier?

    2. What additional barriers or challenges do you face that have not already been discussed?

  8. I want to spend a few minutes talking about the information and training that would be of most use to you when it comes to electronic media use. Let’s start with information and training related to learning more about electronic media use guidelines. What kind of training are you interested in? What would be most helpful to you?

    1. What about training to overcome some of the barriers we discussed earlier? How helpful would this type of training be?

    2. [STATE AND TRIBAL AGENCY STAFF AND SPONSORING ORGANIZATIONS ONLY] What will make it easier for you to promote nutrition guidelines at centers and homes? What training do you need?

    3. What other topics would you be interested in receiving information or training on?

    4. In the survey, the following were among the top preferences [INSERT FROM SURVEY]. Would these work for you? What’s your preferred format for training?

    5. What format would you like to receive information or training in – is paper best? Online resources? Videos? Something else? What format will make the training more useful or easier to implement?


WRAP-UP 5 minutes

Moderator’s goals: To collect any final thoughts on nutrition, physical activity and electronic media use, including asking if there are any areas that have not been covered that participants would like to discuss

  1. We’ve talked about three different topics today – nutrition, physical activity and electronic media use – and different guidelines and recommendations for each. In your opinion, thinking about children ages 0 to 5, is any one of these topics more important?

  1. IF YES: What about that is so important?

  2. IF NO: Why are they equally important?

  3. Which of the three areas, if any, pose the biggest challenges for you/child care providers? Why?

  1. Is there anything you would like to add about how USDA/FNS can assist you in your work to follow guidelines related to nutrition, physical activity, and media use? What?

Thank you for your participation.

1 Note: This discussion guide includes more questions than will be covered in each 90-minute focus group. Sections I and II will be included for all focus groups. However, the subset of additional questions selected for each focus group will depend on the Phase 1 findings, and the final discussion guide for each audience will be shorter than this draft.

USDA/FNS

1.23.2021

Formative Research: Phase 2

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