Design and Evaluation of the MaineHealth Food Is Medicine Pilot Program in Rural Franklin County, Maine

Methods: Data from a larger trial examining the effectiveness of an adaptive implementation strategy was analyzed to investigate whether early care and education (ECE) teacher selfreflection frequency influences fidelity to a preschool nutrition program, [Together, We Inspire Smart Eating (WISE)].Ninetyone preschool teachers from 48 sites participated, with baseline demographic data collected on gender, race, age, education, and teaching experience.Monthly surveys prompted teachers to reflect on their use of four target EBPs of WISE (role modeling, small groups, mascot use, and positive feeding practices).Teacher fidelity to WISE EBPs was measured through direct observation at two time points by trained observers.Higher fidelity scores indicated more consistent use of the nutrition EBPs.A multiple regression analysis was conducted to examine the relationship between self-reflection frequency and endpoint fidelity score, controlling for covariates race, teaching experience, and baseline fidelity.Results: The regression model significantly predicted endpoint fidelity scores, F(4,64) 7.22, p< .001,and accounted for 27% of the variance (R 2 .27).Self-reflection frequency was positively correlated with endpoint fidelity scores, r(77) .31, p.006, and was a significant predictor of endpoint fidelity scores ( .35, t 3.31, p.002).As teacher self-reflection frequency increased, observed nutrition EBP fidelity scores rose.Conclusions: These study findings suggest self-reflection frequency as a strategy to increase fidelity to nutrition EBPs in an ECE setting.Integration of self-reflection frequency in nutrition interventions may increase long-term adoption of EBPs in daily practice, leading to improved public health outcomes.