Published online September 30, 2005
PEDIATRICS Vol. 116 No. 4 October 2005, pp. e499-e505 (doi:10.1542/peds.2005-0467)
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ELECTRONIC ARTICLE

Opportunities for Health Promotion Education in Child Care

Ruchi S. Gupta, MD, MPH*,{ddagger}, Steve Shuman, BS§, Elsie M. Taveras, MD, MPH||, Martin Kulldorff, PhD|| and Jonathan A. Finkelstein, MD, MPH{ddagger},||

* Institute for Healthcare Studies and Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
{ddagger} Harvard Pediatric Health Services Research Fellowship, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts
§ ACF Region 1 Head Start Quality Initiative, Boston, Massachusetts
|| Center for Child Healthcare Studies, Department of Ambulatory Care and Prevention, Harvard Medical School, Harvard Pilgrim Healthcare, Boston, Massachusetts

Objectives. Comprehensive health promotion education is not feasible through pediatric office visits alone. Opportunities may exist for enhanced health promotion in child care settings. The objectives of this study were to understand the attitudes toward, barriers to, and strategies for incorporating health promotion activities in child care settings as well as topics that are deemed most useful from the perspectives of parents, child care directors, and health consultants. We also sought to understand the health consultants' (health professionals serving as consultants to child care centers) current and desired roles in leading health promotion activities in child care settings.

Methods. We conducted simultaneous surveys of all licensed child care center directors and their health consultants in Boston. A total of 240 parents in 16 randomly selected centers were also surveyed.

Results. A total of 97 (65%) directors in the 150 child care centers identified responded. A total of 71% (56 of 79) of consultants and 58% (138 of 240) of parents responded. Parents (89%), child care directors (88%), and health consultants (80%) believe that health promotion activities through child care centers would improve the health knowledge and behaviors of preschool children. A total of 45% of parents reported already receiving useful health information from child care staff and materials distributed in child care. Most topic areas that were suggested to parents were considered useful, with the greatest utility in the areas of behavior/discipline, child development, and emergency management. No significant barriers were identified by health professionals. Lack of funds (63%) and lack of someone to provide information (59%) were the top barriers identified by directors. An educational session on health topics by health care professionals was believed to be the best strategy to improve health promotion education for families. Among the health consultants, 83% of nurses or nurse practitioners said that they would be able to provide health education in child care compared with 53% of physicians.

Conclusion. Parents, child care center directors, and health professionals believe that enhancing health promotion education in child care could improve child health. Collaboration between pediatricians and early care and education professionals has the potential to improve the breadth and effectiveness of health promotion education. Effective strategies are necessary to optimize access to health professionals by early educators, and effectively utilize the unique skills and preferences of physicians and nurses to promote health education in child care.

Key Words: child care • child health services • health promotion • preventive services

Abbreviations: NP, nurse practitioner • ECELS, Early Childhood Education Linkage System • NTICCHC, National Training Institute for Child Care Health Consultants

Accepted May 4, 2005.