(P16-021-25) Association of Early-Care Education Teachers’ Self-Reflection Frequency to Fidelity of Nutrition-Related Evidence-Based Practices in a Preschool Nutrition Curriculum

Objectives: Evidence-based practices (EBPs) are often adopted slowly in public health, with some best practices taking decades to become routine. A common challenge for nutrition programs is low fidelity (i.e., the adoption of EBPs as intended). Hence, in Implementation Science, fidelity is an important outcome of successful EBP uptake, and fidelity-increasing strategies are studied. While self-reflection frequency positively associates with EBP adoption in healthcare education, this relationship has not been observed in community health settings to support nutrition interventions.

Methods: Data from a larger trial examining the effectiveness of an adaptive implementation strategy was analyzed to investigate whether early care and education (ECE) teacher self-reflection frequency influences fidelity to a preschool nutrition program, [Together, We Inspire Smart Eating (WISE)]. Ninety-one preschool teachers from 48 sites participated, with baseline demographic data collected on gender, race, age, education, and teaching experience. Monthly surveys prompted teachers to reflect on their use of four target EBPs of WISE (role modeling, small groups, mascot use, and positive feeding practices). Teacher fidelity to WISE EBPs was measured through direct observation at two time points by trained observers. Higher fidelity scores indicated more consistent use of the nutrition EBPs. A multiple regression analysis was conducted to examine the relationship between self-reflection frequency and endpoint fidelity score, controlling for covariates race, teaching experience, and baseline fidelity.

Results: The regression model significantly predicted endpoint fidelity scores, F(4,64) =7.22, p< .001, and accounted for 27% of the variance (R² =.27). Self-reflection frequency was positively correlated with endpoint fidelity scores, r(77) =.31, p=.006, and was a significant predictor of endpoint fidelity scores (β =.35, t =3.31, p=.002). As teacher self-reflection frequency increased, observed nutrition EBP fidelity scores rose.

Conclusions: These study findings suggest self-reflection frequency as a strategy to increase fidelity to nutrition EBPs in an ECE setting. Integration of self-reflection frequency in nutrition interventions may increase long-term adoption of EBPs in daily practice, leading to improved public health outcomes.

Funding Sources: NIH