NAP SACC

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Evidence Summary

Underlying Theory: The NAP SACC intervention uses constructs of the Social Cognitive Theory including: expectancies, observational learning, self-efficacy, behavioral capability, environment, situation, reinforcement, and reciprocal determinism.

Strategies Used: The NAP SACC intervention includes strategies for both healthy eating and physical activity that have been adapted to child care settings, including:

• Social Support for both healthy eating and physical activity using child care providers as teachers and role models
• Increasing the availability of healthy foods through menu changes
• Increased time for physical activity through active play while in child care
• Increasing access to places for physical activity through changes in indoor and/or outdoor play space.

Research Findings and Evaluation Outcomes: The NAP SACC intervention was developed and evaluated first in the field as a practice-based intervention and subsequently studied in a larger randomized controlled trial involving 30 consultants assigned to 84 centers. Child care centers were randomly assigned to receive the intervention or serve as controls. Among the 82 centers remaining in the study, 56 were randomly assigned to receive the intervention. Forty-one intervention centers (73%) completed most (>75%) or all of the intervention components. The program outcomes listed below are based on this subset of intervention sites compared to controls.

Intervention Effect (overall environment and policy assessment)^*: Child care centers completing most or all of the intervention components improved their nutrition and physical activity policies and practices more than control facilities. Changes (16% increase) in the total child care nutrition environment scores were statistically significant (p>.01). Changes in physical activity were not, but showed positive improvement.

^*When all centers are included in the analysis of the intervention effect, the 11% improvement in nutrition environment and policies, was only marginally statistically significant (p=.06). Physical activity changes were modest and non-significant when compared to controls.

Individual Item Scores in Nutrition and Physical Activity: Because the NAP SACC intervention allows some flexibility in the areas targeted for change by centers and because the observation instrument is scored using averages of sub-areas to obtain the Nutrition and Physical Activity scores, an additional assessment of an intervention effect was measured using all of the individual 75-items from the observation instrument. Nutrition effects are assessed with 51 items and physical activity with 24 items. The mean change in nutrition scores was a 4.3 point improvement in the intervention centers compared to -0.5 change in the controls; for physical activity, scores increased by 3.6 in the intervention centers compared to a -0.2 change in the controls. Both nutrition and physical activity improvements were statistically significant.