title: The keys to healthy family child care homes intervention: study design and rationale.
abstract: BACKGROUND
  Obesity is a major public health problem for which early preventive interventions are needed. Large numbers of young children are enrolled in some form of child care program, making these facilities influential environments in children's development. Family child care homes (FCCH) are a specific type of child care in which children are cared for within the provider's own residence. FCCHs serve approximately 1.5 million children in the U.S.; however, research to date has overlooked FCCH providers and their potential to positively influence children's health-related behaviors.
  
  
  METHODS
  Keys to Healthy Family Child Care Homes (Keys) is a cluster-randomized controlled trial testing the efficacy of an intervention designed to help providers become healthy role models, provide quality food- and physical activity-supportive FCCH environments, and implement effective business practices. The intervention is delivered through workshops, home visits, tailored coaching calls, and educational toolkits. Primary outcomes are child physical activity measured via accelerometry data and dietary intake data collected using direct observation at the FCCH. Secondary outcomes include child body mass index, provider weight-related behaviors, and observed obesogenic environmental characteristics.
  
  
  CONCLUSIONS
  Keys is an innovative approach to promoting healthy eating and physical activity in young children. The intervention operates in a novel setting, targets children during a key developmental period, and addresses both provider and child behaviors to synergistically promote health.
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, 2200 W. Main St., Suite 600, Room 621, DUMC Box 104006, Durham, NC 27705, USA.
authors.forename: Truls
authors.initials: T
authors.lastname: Østbye
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, 2200 W. Main St., Suite 600, Room 621, DUMC Box 104006, Durham, NC 27705, USA. Electronic address: courtney.mann@dm.duke.edu.
authors.forename: Courtney M
authors.initials: CM
authors.lastname: Mann
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA.
authors.forename: Amber E
authors.initials: AE
authors.lastname: Vaughn
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, 2200 W. Main St., Suite 600, Room 621, DUMC Box 104006, Durham, NC 27705, USA.
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Namenek Brouwer
authors.affiliation: Department of Community and Family Medicine, Duke University Medical Center, 2200 W. Main St., Suite 600, Room 621, DUMC Box 104006, Durham, NC 27705, USA.
authors.forename: Sara E
authors.initials: SE
authors.lastname: Benjamin Neelon
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Hales
authors.affiliation: Department of Biostatistics, University of North Carolina at Chapel Hill, 137 E Franklin St Ste 203, Campus Box 8030, Chapel Hill, NC 27514, USA.
authors.forename: Shrikant I
authors.initials: SI
authors.lastname: Bangdiwala
authors.affiliation: Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, 1700 Martin L. King Jr. Blvd., CB 7426, Chapel Hill, NC, 27599-7426, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2207 McGavran-Greenberg Hall, CB 7461, Chapel Hill, NC 27599-7461, USA.
authors.forename: Dianne S
authors.initials: DS
authors.lastname: Ward
mesh_terms: D061725:Accelerometry; D002654:Child Care / Q000458:organization & administration*; D002675:Child, Preschool; D004032:Diet; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D008297:Male; D008405:Massage; D012107:Research Design; D057185:Sedentary Behavior; D020377:Self Efficacy; D016037:Single-Blind Method; D012959:Socioeconomic Factors; D014481:United States
keywords: Children; Family child care homes; Obesity; Overweight; Randomized controlled trial