title: Barriers and supports to implementing a nutrition and physical activity intervention in child care: directors' perspectives.
abstract: OBJECTIVE
  To explore the experiences of child care centers implementing a nutrition and physical activity (PA) program and identify supports and barriers as reported by center directors.
  
  
  METHODS
  Semi-structured interviews with 20 child care center directors following program implementation.
  
  
  METHODS
  Twenty-two child care centers serving low-income children in Georgia.
  
  
  METHODS
  Twenty child care center directors who led program implementation at their respective centers.
  
  
  METHODS
  The program focused on introducing wellness policies to centers and on providing training and technical assistance to support implementation.
  
  
  METHODS
  Center directors' perceptions, attitudes, and reflections on the process of implementing changes to nutrition and PA practices.
  
  
  METHODS
  Qualitative analysis of interview transcripts was conducted using NVivo 9 software. Researchers employed 2 levels of coding; 4 predominant themes emerged.
  
  
  RESULTS
  Directors' insights included the importance of hands-on activities and printable materials to engage children in nutrition and PA education and healthy behaviors; challenges and supports to engaging parents in child wellness; recognition that children readily accept nutrition and PA changes; and the need for program implementation efforts to prioritize the provision of support for directors and staff in modifying nutrition and PA practices.
  
  
  CONCLUSIONS
  Directors consider nutrition and PA policy changes to be beneficial to the child care environment. This study highlights important considerations for efforts to promote healthy weight environments in the early care setting.
authors.affiliation: School of Public Health, Georgia State University, Atlanta, GA. Electronic address: rlyn1@gsu.edu.
authors.forename: Rodney
authors.initials: R
authors.lastname: Lyn
authors.affiliation: School of Public Health, Georgia State University, Atlanta, GA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Evers
authors.affiliation: School of Public Health, Georgia State University, Atlanta, GA.
authors.forename: Justin
authors.initials: J
authors.lastname: Davis
authors.affiliation: School of Public Health, Georgia State University, Atlanta, GA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Maalouf
authors.affiliation: Nutrition Services Division, Bright From the Start: Georgia Department of Early Care and Learning, Atlanta, GA.
authors.forename: Monica
authors.initials: M
authors.lastname: Griffin
mesh_terms: D000328:Adult; D001294:Attitude to Health; D002656:Child Day Care Centers; D002675:Child, Preschool; D005845:Georgia; D006266:Health Education / Q000379:methods / Q000458:organization & administration; D006291:Health Policy; D006801:Humans; D009752:Nutritional Status; D010290:Parents / Q000523:psychology*; D010806:Physical Education and Training; D011203:Poverty
keywords: child care; nutrition; physical activity; policies; wellness