Results of Caring and Reaching for Health (CARE): A Cluster-Randomized Controlled Trial Assessing a Worksite Wellness Intervention for Child Care Staff

Abstract Background: Child care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers’ physical activity (primary outcome), other health behaviors, and their workplace health environment. Methods: Eligible child care centers, defined as being in operation for at least two years and employing at least four staff, were enrolled into CARE’s cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers’ physical activity was assessed with accelerometers, worn for seven days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes. Results: Participants included 553 child care workers representing 56 centers (HL=250 staff/28 centers, HF=303 staff/28 centers). At six months, moderate-to-vigorous physical activity declined slightly in both arms (-1.3 minutes/day, 95% CI: -3.0, 0.3 in HL; -1.9 minutes/day, 95% CI: -3.3, -0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons. Conclusions: While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these important workers.

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Results of Caring and Reaching for Health (CARE): A Cluster-Randomized Controlled Trial Assessing a Worksite Wellness Intervention for Child Care Staff

10.21203/rs.2.18643/v3 ◽

2020 ◽

Author(s):

Laura A Linnan ◽

Amber E Vaughn ◽

Falon Smith ◽

Philip Westgate ◽

Derek Hales ◽

...

Keyword(s):

Physical Activity ◽

Child Care ◽

Health Behaviors ◽

Care Staff ◽

Worksite Wellness ◽

Healthy Lifestyles ◽

Child Care Workers ◽

Workplace Health ◽

Care Workers ◽

Cluster Randomized

Abstract Background: Child care workers are among the lowest paid US workers and experience a wide array of health concerns. The physical and mental demands of their job and the lack of employer-provided health-insurance increase health risks. The Caring and Reaching for Health (CARE) study evaluated a 6-month Healthy Lifestyles intervention targeting child care workers’ physical activity (primary outcome), other health behaviors, and their workplace health environment. Methods: Eligible child care centers, defined as being in operation for at least two years and employing at least four staff, were enrolled into CARE’s cluster-randomized trial. Centers and their child care staff were randomly assigned to either the Healthy Lifestyles (HL) intervention arm or the Healthy Finances (HF) attention control arm using a block randomization approach. Intervention components were delivered through in-person workshops, center-level displays, informational magazines, director coaching, electronic messaging, and an interactive website. Outcome measures were collected during center visits at baseline and immediately post-intervention by trained data collectors blinded to center arm assignment. Workers’ physical activity was assessed with accelerometers, worn for seven days. Secondary outcome measures included biometric assessments of health and fitness, web-based surveys about health behaviors, and an environmental audit of workplace supports for health. Multi-level linear mixed models assessed worker- and center-level changes in these outcomes. Results: Participants included 553 child care workers representing 56 centers (HL=250 staff/28 centers, HF=303 staff/28 centers). At six months, moderate-to-vigorous physical activity declined slightly in both arms (-1.3 minutes/day, 95% CI: -3.0, 0.3 in HL; -1.9 minutes/day, 95% CI: -3.3, -0.5 in HF), but there was no significant group by time interaction. Several secondary outcomes for other health behaviors and workplace health environment showed improvements in favor of the intervention arm, yet differences did not remain statistically significant after adjustment for multiple comparisons. Conclusions: While the Healthy Lifestyles intervention did not improve health behaviors or the workplace health environment, results confirmed the pressing need to focus on the health of child care workers. Future interventions should focus on prevalent health issues (e.g., weight, stress), include both high-tech and high-touch intervention strategies, and address work conditions or other social determinants of health (e.g. wages) as a means of improving the health of these essential workers. Trial Registration: Care2BWell: Worksite Wellness for Child Care (NCT02381938)

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Results of caring and reaching for health (CARE): a cluster-randomized controlled trial assessing a worksite wellness intervention for child care staff

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-020-00968-x ◽

2020 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Laura A. Linnan ◽

Amber E. Vaughn ◽

Falon T. Smith ◽

Philip Westgate ◽

Derek Hales ◽

...

Keyword(s):

Health Care ◽

Randomized Controlled Trial ◽

Child Care ◽

Controlled Trial ◽

Cluster Randomized Controlled Trial ◽

Care Staff ◽

Worksite Wellness ◽

Randomized Controlled ◽

Wellness Intervention ◽

Cluster Randomized

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Implementation of a workplace physical activity intervention in child care: process evaluation results from the Care2BWell trial

Translational Behavioral Medicine ◽

10.1093/tbm/ibab034 ◽

2021 ◽

Author(s):

Cody D Neshteruk ◽

Erik Willis ◽

Falon Smith ◽

Amber E Vaughn ◽

Anna H Grummon ◽

...

Keyword(s):

Physical Activity ◽

Social Support ◽

Health Promotion ◽

Child Care ◽

Process Evaluation ◽

Physical Activity Intervention ◽

Care Process ◽

Child Care Workers ◽

Self Monitoring ◽

Care Workers

Abstract Care2BWell was designed to evaluate the efficacy of Healthy Lifestyles (HL), a worksite health promotion intervention to increase child care workers’ physical activity. The purpose of this study was to use process evaluation to describe the implementation of HL and determine if different levels of implementation are associated with changes in workers’ physical activity. Data were collected from 250 workers randomized to HL, a 6 month, multilevel intervention that included an educational workshop followed by three 8 week campaigns that included self-monitoring and feedback, raffle incentive, social support, and center director coaching. Process evaluation data collection included direct observation, self-reported evaluation surveys, website analytics and user test account data, tracking databases and semi-structured interviews. Implementation scores were calculated for each intervention component and compared at the center and individual levels. Nearly a third of workers never self-monitored and few (16%) met self-monitoring goals. Only 39% of centers engaged with the social support component as intended. Raffle and social support components were perceived as the least useful. Implementation varied widely by center (25%–76%) and individual workers (0%–94%). No within- or between-group differences for high compared to low implementation groups for change in physical activity were evident. Interview themes included limited sustainability, competing priorities, importance of social support, and desire for a more intensive, personalized intervention. Wide variation in implementation may explain limited effects on intervention outcomes. Future worksite interventions designed for child care workers can use these findings to optimize health promotion in this setting.

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Development of a Workplace Intervention for Child Care Staff: Caring and Reaching for Health’s (CARE) Healthy Lifestyles Intervention

Health Promotion Practice ◽

10.1177/1524839918786214 ◽

2018 ◽

Vol 21 (2) ◽

pp. 277-287 ◽

Cited By ~ 1

Author(s):

Gabriela Arandia ◽

Amber E. Vaughn ◽

Lori A. Bateman ◽

Dianne S. Ward ◽

Laura A. Linnan

Keyword(s):

Child Care ◽

Controlled Trial ◽

Lessons Learned ◽

Care Staff ◽

Workplace Intervention ◽

Healthy Lifestyles ◽

Child Care Workers ◽

Self Monitoring ◽

Increased Risk ◽

Multilevel Theory

Child care staff are among the lowest wage workers, a group at increased risk for a wide array of chronic diseases. To date, the health of child care staff has been largely ignored, and there have been very few interventions designed for child care staff. This article describes the development of the Caring and Reaching for Health (CARE) Healthy Lifestyles intervention, a workplace intervention aimed at improving physical activity and health behaviors among child care staff. Theory and evidence-based behavior change techniques informed the development of intervention components with targets at multiple social ecological levels. Final intervention components included an educational workshop held at a kick-off event, followed by three 8-week campaigns. Intervention components within each campaign included (1) an informational magazine, (2) goal setting and weekly behavior self-monitoring, (3) weekly tailored feedback, (4) e-mail/text prompts, (5) center-level displays that encouraged team-based goals and activities, and (6) coaching for center directors. This multilevel, theory-driven intervention is currently being evaluated as part of a larger randomized controlled trial. Process evaluation efforts will assess the extent to which child care staff participated in, engaged with, and were satisfied with the intervention. Lessons learned will guide future intervention research engaging child care workers.

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Not just a job: A study of the needs of residential child care workers in Melbourne, Australia

Children Australia ◽

10.1017/s1035077200003801 ◽

1994 ◽

Vol 19 (1) ◽

pp. 27-32 ◽

Cited By ~ 2

Author(s):

John Murphy

Keyword(s):

Child Care ◽

Working Conditions ◽

Care Staff ◽

Quality Of Services ◽

Child Care Workers ◽

Factors Affecting ◽

Residential Child Care ◽

Care Workers ◽

Children In Care

While it is universally accepted that residential child care workers have a key role to play in the quality of services for children in care, the working conditions of many staff are poor and do not reflect the importance of their work. Very little research has been undertaken which focuses on the needs of residential child care staff. The following study examined the factors affecting the job satisfaction of residential child care workers in Melbourne, Australia.

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