Testing implementation strategies for evidence-based physical activity and nutrition education for preschoolers in SAGE - Title: Sustainability via Active Garden Education (SAGE): Scaling up evidence-based, policy-guided physical activity and nutrition education for preschoolers Sustainability via Active Garden Education (SAGE) is an evidence-based physical activity and nutrition program that has been delivered in low-income serving, early care and education (ECE; preschool) sites in Maricopa County, AZ. Gardens in ECE sites improve interest in and consumption of fruit and vegetables among young children; teach important science, social, and motor development skills; engage families and communities; and offer important outdoor learning opportunities. The overall objective of this project is to compare how three different SAGE implementation strategies impact measures of implementation (primary), sustainability (secondary), cost and child health outcomes (secondary). Strategies we will compare include (1) SAGE (garden + online curriculum + materials box) vs. SAGE plus e-support implementation package (text messages + newsletters + hotline), (2) SAGE with no in person support and training vs. SAGE with in person support and training, and (3) SAGE usual activities vs. SAGE with a ECE virtual learning collaborative to share SAGE implementation experiences and strategies with other ECE sites and community partners. We will (Aim 1) apply the Consolidated Framework for Implementation Research (CFIR) to identify inner and outer setting characteristics that hinder or facilitate SAGE implementation to tailor support strategies for local context; (Aim 2) use the Multiphase Optimization Strategy (MOST) framework to analyze SAGE implementation strategy components to determine the most efficient and effective combination of strategies across contexts; and (Aim 3) investigate the potential for sustainability, costs and cost effectiveness outcomes that may influence implementation strategies and their effect on locomotor skills and nutrition effectiveness outcomes. In Aim 1 (MOST screening), we will measure ECE site and teacher characteristics via an in person visual assessment and a teacher and director survey (inner setting). We will also complete a social network analysis of ECE personnel. With this information we will use an implementation mapping process to collaboratively develop and finalize implementation strategies. In Aim 2 (MOST refine), 32 existing SAGE ECE sites will be pair matched by degree of individual implementation and site characteristics (size, enrollment) assessed in aim 1, and assigned to one of eight implementation strategy combinations to a full factorial model. Sites will be assessed at the beginning and ending of the academic year with site audits, parent and teacher surveys, and non-invasive child fitness, physical activity, veggiemeter and eating in the absence of hunger measures. For Aim 3, (MOST refine) the potential for sustainability, costs and cost effectiveness ratio for each of the strategies will be calculated from a payer and societal perspective to determine which implementation strategy or combination of strategies may be most scalable. Results will help inform decisions about garden and curriculum implementation strategies that can be scaled for ECE sites in underserved communities.
