title: Planning for health promotion in low-income preschool child care settings: focus groups of parents and child care providers.
abstract: OBJECTIVE
  To identify potentially successful strategies, barriers, and facilitators for health promotion in preschool child care settings.
  
  
  METHODS
  We conducted 6 focus groups including each of the following: parents of children attending child care centers and home-based family child care (2 in English, 1 in Spanish) and directors of child care centers and family child care providers (2 in English, 1 in Spanish). Systematic thematic analysis was conducted to generate themes to address study questions.
  
  
  RESULTS
  A total of 24 parents and 45 child care providers, serving predominantly urban, low-income children in Boston, participated. Parents and child care providers agreed that in-person group discussions would be the most effective strategy for providing health education information to parents. Several barriers that could affect implementation emerged. First, some providers expressed frustration toward parents' attitudes about child safety and health. Second, there was diversity of opinion among providers on whether conducting health promotion activities was consistent with their training and role. In addition, literacy, language, and cultural barriers were identified as potential barriers to health promotion in child care.
  
  
  CONCLUSIONS
  In order to be successful, health promotion strategies in child care settings will need to overcome tensions between providers and parents, allow professional growth of child care providers to serve in a health promotion role, and better integrate external health resources and personnel. Group sessions and peer learning opportunities that are culturally and linguistically sensitive are potentially successful strategies for implementation of health promotion interventions for many parents.
authors.affiliation: Center for Child Health Care Studies, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care and the Division of General Pediatrics, Children's Hospital, Boston, MA 02215, USA. Elsie_Taveras@hphc.org
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
authors.forename: Nancy
authors.initials: N
authors.lastname: LaPelle
authors.forename: Ruchi S
authors.initials: RS
authors.lastname: Gupta
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D000328:Adult; D001294:Attitude to Health; D001900:Boston; D017028:Caregivers / Q000523:psychology; D002654:Child Care; D002656:Child Day Care Centers / Q000458:organization & administration*; D002675:Child, Preschool; D003256:Community Participation; D017144:Focus Groups; D006266:Health Education / Q000458:organization & administration*; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D016487:Parenting; D010290:Parents / Q000523:psychology; D010934:Planning Techniques; D011203:Poverty; D040242:Risk Reduction Behavior; D014505:Urban Population