title: Factors Influencing the Food Purchases of Early Care and Education Providers.
abstract: BACKGROUND
  With the majority of US children enrolled in some form of early care and education, the settings for early care and education represent a valuable opportunity to positively impact young children's diets and their interactions with food. Little evidence exists on how early care and education providers make food purchasing and service decisions for this population of young children.
  
  
  OBJECTIVE
  Our aim was to explore the factors that influence early care and education providers' food purchasing and service decisions.
  
  
  METHODS
  A qualitative design consisting of individual, in-person, and semi-structured interviews with providers and on-site observations was used.
  
  
  METHODS
  Sixteen early care and education providers-selected across a variety of characteristics that might affect food selection (eg, size of site, participation in reimbursement programs, presence of staff assigned to foodservice) using maximum variation purposive sampling-based in the Puget Sound region, Washington, were interviewed from June to September 2014.
  
  
  METHODS
  Provider perspectives on food purchasing and service decisions.
  
  
  METHODS
  Inductive analysis of transcribed interviews using TAMS Analyzer software (GPL version 2, 2012) to identify themes.
  
  
  RESULTS
  Ten main influencers emerged from the data. These were grouped into four categories based on an ecological framework: macro-level environments (ie, regulations; suppliers and vendors, including stores); physical environment and settings (ie, organizational mission, budget, and structure; the facility itself); social environments (ie, professional networks; peers; the site-specific parent and child community); and individual factors at both a provider and child-level (ie, providers' skills, behaviors, motivations, attitudes, knowledge, and values; child food preferences; and, child allergies). A model was then developed to identify potential pathways of intervention and underscore the need for a comprehensive approach to improve early care and education nutrition.
  
  
  CONCLUSIONS
  This study suggests that a more system-based understanding and approach-one that accounts for an array of influencers and their interactions-is necessary to take advantage of opportunities and address barriers to improving early care and education-based nutrition.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Otten
authors.forename: Tad
authors.initials: T
authors.lastname: Hirsch
authors.forename: Catherine
authors.initials: C
authors.lastname: Lim
mesh_terms: D002017:Budgets; D002648:Child; D002656:Child Day Care Centers / Q000191:economics; D053198:Child Nutrition Sciences / Q000193:education; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D004032:Diet; D004777:Environment; D005502:Food / Q000191:economics; D005518:Food Preferences; D005522:Food Services / Q000191:economics; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D012931:Social Environment; D014861:Washington
keywords: Child care; Children; Food; Nutrition; Qualitative