De-Implementation of Detrimental Feeding Practices in Childcare: Mixed Methods Evaluation of Community Partner Selected Strategies.

This pilot evaluated strategies to decrease detrimental feeding practices in early care and education, which are hypothesized to compete with evidence-based feeding and obesity prevention practices. This study made two key comparisons: (1) a between-site comparison of sites receiving (a) no implementation or de-implementation strategies (i.e., Basic Support; B), (b) implementation strategies only (i.e., Enhanced Support; E), and (c) implementation and de-implementation strategies (i.e., De-implementation + Enhanced Support; D + E) and (2) a within-site pre-post comparison among sites with D + E. At nutrition lessons, the D + E group had more Positive Comments (Hedege's = 0.60) and higher Role Model fidelity (Hedege's = 1.34) compared to the E group. At meals, assistant teachers in the D + E group had higher Positive Comments than in the B group ( = 0.72). For within-group comparisons, the D + E group decreased Negative Comments ((19) = 2.842, = 0.01), increased Positive Comments ((20) = 2.314, = 0.031), and improved use of the program mascot at nutrition lessons ((21) = 3.899, = 0.001). At meals, lead teachers' Negative Comments decreased ((22) = 2.73, = 0.01). Qualitative data identified strengths and opportunities for iteration. Despite a COVID interruption, mid-point comparisons and qualitative feedback suggest promise of the de-implementation strategy package.