INFLUENCERS OF FIDELITY IN IMPLEMENTATION OF GO NAPSACC AT SELECTED EARLY CHILDHOOD EDUCATION CENTERS IN KENTUCKY

Several lifestyle interventions have been explored to ameliorate obesity and most associated non-communicable diseases in children attending early childhood education settings (ECE). Go Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) program has been implemented nationally to improve dietary intake and physical activities among children in ECE settings. However, a large proportion of ECE centers do not complete the five-step process that leads to change. This project, thus, aims to identify contextual factors that facilitate and/or impede the fidelity in implementation of Go NAPSACC. This thesis is a comparative case study using secondary data to compare, and contrast reported barriers and facilitators amongst eight ECE centers that demonstrated low- or high-fidelity implementing Go NAPSACC. To identify the sample, a fidelity score was created from 11 milestones in the Go NAPSACC process. Survey and interview responses were organized by constructs of the Consolidated Framework for Implementation Research. Demographic characteristics and survey responses were summarized by computing descriptive statistics. A rapid qualitative hybrid deductive and inductive approach was used to analyze interview data. Qualitative and quantitative data were analyzed concurrently and subsequently integratedand organized in matrices according to low- and high-fidelity group. The COVID-19 pandemic had an overarching influence on ECE centers’ ability to implement Go NAPSACC as intended and may have amplified the influence of organizational factors on the ability to implement Go NAPSACC. Social network and communication processes, the relative priority of Go NAPSACC, access to information about Go NAPSACC, and available resources (inner setting constructs) were notably different between centers categorized as high- and low-fidelity of implementation of Go NAPSACC. There were distinct differences in feelings of (in)adequacy of support received from Go NAPSACC Consultants (process construct) among high- and low-fidelity centers. It is therefore imperative that strategic organizational structural improvement and support, and appropriate policies reviews be targeted at ECEs to increase fidelity to Go NAPSACC implementation.