Using the RE-AIM Framework in Formative Evaluation of the EAT Family Style Multilevel Intervention

Background Ecological Approach To (EAT) Family Style is a 16-week responsive feeding Early Care and Education (ECE) intervention, utilizing a multilevel improvement system of 4 implementation strategies: (a) provision of a 7-lesson, on-line professional development training for administrators and teachers (b) administrative support; (c) performance monitoring, feedback, and assistance through follow-up coaching; and (d) use of incentives. The 7 lessons cover role modeling, peer modeling, sensory exploration, self-regulation, children serve themselves, praise and rewards, and family engagement, each relying on goal setting. The evidence-based practices and implementation system was delivered to ECE administrators and teachers completing one online lesson/week followed by a coaching session with a trained coach. EAT Family Style is guided by the self-determination theory. The objective of this study was to evaluate the EAT Family Style intervention through the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework.Methods Center-based ECE administrators (n=8) and teachers (n=17) caring for preschool (3-5 years) children and coaches (n=9) who participated in the EAT Family Style intervention were recruited. Semi-structured interviews were conducted, transcribed verbatim, and coded deductively by 3 coders using RE-AIM dimensions as a priori codes and placed into themes and sub-themes using thematic analysis. Results All participants perceived that EAT Family Style improved children’s nutritional and developmental outcomes and encouraged a positive mealtime environment (Effectiveness). Coaches and administrators reported EAT Family Style aligned with their professional goals and beliefs. Coaches found professional development incentives important, whereas administrators/teachers specifically valued in-service training credit hours (Adoption). Teachers reported successful implementation of EAT Family Style practices in the classroom. Administrators and coaches supported the teachers through administrative and coaching strategies (Implementation). All participants reported they intended to continue using the intervention. Administrators and teachers discussed incorporating EAT Family Style practices into handbook/school policy (Maintenance).Conclusion(s) EAT Family Style was viewed as feasible by participants. Its 4-pronged implementation strategy has the potential to improve the uptake of evidence-informed feeding practices in ECEs.