Matern Child Health J (2012) 16:1559–1566
DOI 10.1007/s10995-011-0874-x
BRIEF REPORTS
Is There a Difference Between Center and Home Care Providers’
Training, Perceptions, and Practices Related to Obesity
Prevention?
Juhee Kim • Jae Eun Shim • Angela R. Wiley •
Keunsei Kim • Brent A. McBride
Published online: 30 August 2011
 Springer Science+Business Media, LLC 2011
Abstract To compare the obesity related training, prac-
tices, and perceptions of home child care providers and
center care providers. A self-administered survey was
collected from child care providers who attended local
child care training workshops in east central Illinois from
March 2009 to August 2010. Study results were based on
responses from 88 home care providers and 94 center
providers. The survey questions addressed child care pro-
viders’ training in the prior year, their obesity prevention
practices including written policies, their perceptions of
influences on children’s health, and factors determining
food menu selection. Paired t tests and Chi-square tests
were used to compare the difference by child care type.
81.9% of home care providers and 58.6% of center care
providers received nutrition training, while 66.7 and 43.0%
of these providers received physical activity training,
respectively. Nutrition content, guidelines or state regula-
tions, and food availability were the most important factors
J. Kim (&)
J. E. Shim
Department of Kinesiology and Community Health, University
of Illinois at Urbana Champaign, 1206 South Fourth St.,
213 Huff Hall, 61820 Champaign, IL, USA
e-mail: juheekim@illinois.edu
J. E. Shim
Research Institute of Human Ecology, Seoul National
University, Seoul, South Korea
A. R. Wiley
B. A. McBride
Department of Human and Community Development,
University of Illinois at Urbana Champaign, Urbana, IL, USA
K. Kim
Graduate School of Governance, Sung Kyun Kwan University,
Seoul, Korea
that influenced both types of care providers’ food service
menus. Both care provider types perceived they have less
influence on children’s food preferences, eating habits, and
weight status compared to the home environment. How-
ever, home care providers perceived a smaller discrepancy
between the influences of child care and home environ-
ments compared to center care providers. Compared to
center providers, home care providers were more likely to
have had training, be involved with health promotion
activities, and rate their influence higher on children’s
health behaviors. Findings underscore the need for obesity
prevention efforts in both types of child care settings.
Keywords Child care providers
Center care providers

Family home care providers
Nutrition
Physical activity

Obesity
Introduction
Childhood obesity is a rapidly growing problem in the US
today. According to the National Health and Nutrition
Examination Survey, the prevalence of obese preschool
children has doubled from 5 to 10% since the 1970s [1–3].
During the same period, the number of US child care
facilities has increased fourfold from 1977 to 2004 [4].
Nearly three-quarters of children ages 3–6 use some form
of non-parental child care, and about half of these children
use home-based child care [5]. While the number of family
child care homes is more than double the number of child
care centers in the US [6], research is scarce about family
child care homes.
Because many children spend considerable time in out-
of-home care, child care providers represent an important
potential influence on the early development of health
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behaviors and outcomes among young children. It is well
established that high-quality child care translates to better
child outcomes such as vocabulary development and
school readiness [7, 8]. The education and training levels of
child care providers have consistently been found to be
strong indicators of high quality child care [9–11]. Beyond
influencing cognitive outcomes, past assessments of chil-
dren’s physical activity, dietary intake, and feeding pat-
terns in child care have indicated that child care providers
and environments also can influence health behaviors [12–
18]. However, Benjamin and colleagues have reported that
many state regulations on family care homes and child care
centers do not meet recommended child care standards in
the areas of nutrition and physical activity [19–21]. Recent
studies have suggested that the use of child care may be a
risk factor for unfavorable feeding practices and an
increased risk of obesity during early childhood [22–24].
Recognizing the importance of child care as a context to
promote the development of healthy behaviors, there is a
growing need for child care providers to receive profes-
sional development training in obesity prevention. The
effectiveness of professional development is vastly
improved when built on a firm understanding of existing
perceptions and practices. Little information is available
about child care providers’ training, practices and percep-
tions related to nutrition and physical activity, especially
among family home care providers. Some past research has
documented lower levels of formal education and distinct
professional development pathways for home care pro-
viders compared to center providers [25–27], however,
there is no evidence on whether this difference also applies
to health- and obesity-related topics. To address the gap in
past research and provide a foundation for future education
and professional development efforts, this study aims to
examine training, practices, and perceptions related to
obesity prevention among child care providers and com-
pare the potential differences between center and home
care providers.
Methods
The CRAYON (Caretaker Research Advance Youth
Obesity Knowledge) and Child Care Resource Services
(CCRS) at the University of Illinois conducted a needs
assessment survey measuring the current training, percep-
tions, and practices of child care providers in relation to
obesity prevention. As part of a convenience sample, both
family home and center care providers were invited to
complete a voluntary and anonymous survey when they
participated in child care training workshops in east central
Illinois from March 2009 to August 2010. These work-
shops for local licensed providers were varied in content
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Matern Child Health J (2012) 16:1559–1566
with no specific theme. At the beginning of the workshop, a
research assistant explained the voluntary nature of the
study and distributed consent forms and surveys. Partici-
pation in the study was not a part of the workshop, and
once the introduction was given, the research assistant left
the classroom. Child care providers who choose to partic-
ipate deposited their surveys in a collection box. These
were collected at the end of the workshop. The survey took
between 10 and 15 min to complete.
A total of 232 child care providers completed the survey
(response rate = 60%). For the purpose of this study, we
included child care providers in this convenience sample
who reported their facility type to be either center or family
home care (n = 182), among which 88 providers were
from 82 family child care homes while 94 were from 31
child care centers. The University of Illinois institutional
review board approved the research protocol.
Measures
This survey was developed as a needs assessment tool to
examine the training, practices, and perceptions related to
obesity prevention among child care providers. The ques-
tions about training, practices and policies were modified
from the California Survey of Child Care Providers of
2–5 Year Old Children [28]. After compiling the survey,
the survey was revised incorporating feedback solicited
from child care providers and child care training staff.
Training
Providers were asked to indicate whether they attended
professional development trainings related to obesity-
prevention, nutrition, and physical activity in early care and
education settings in the prior year (yes or no).
Practices
Respondents were asked to indicate whether or not they
had practiced obesity-relevant practices in their child care
setting in the prior year (yes or no). They were asked if
they had engaged in teaching the children in their care or in
offering information to parents. Providers were asked
whether or not they have written policies addressing the
following specific topics: breastfeeding; foods to be avoi-
ded (i.e., common food allergens); promotion of healthy
foods and beverages (such as whole grains and fruits);
restriction on unhealthy foods and beverages (such as soda
and candy); physical activity (regulating and promoting
outdoor and indoor activities); media use (TV/video
watching and video games). The response categories were
yes, no, and don’t know.
Matern Child Health J (2012) 16:1559–1566
Perceptions
We measured child care providers’ perceptions of the level
of influence on children’s health behaviors and weight
status by asking ‘‘How much influence do you think child
care providers have on the child?’’ and ‘‘How much
influence do you think home environment has on the
child?’’. Participants responded using a 5-point scale
(ranging from none to a lot). Providers were asked the
extent to which they perceive selected factors to be
important influences on food menus in their child care
(cost, convenience, availability, nutritional content, chil-
dren’s’ preferences, parents’ request, the Child and Adult
Care Food Program (CACFP) guidelines or state regula-
tions. Participants responded using a 5-point scale (ranging
from very unimportant to very important).
Statistical Analysis
We created two datasets each using a different unit of
analysis: child care facility type and child care provider. To
test the differences by the child care type, we selected one
child care provider’s response for each child care facility.
If more than one child care provider responded from the
same child care facility, we selected the one who described
themselves as a director or owner. If there was no director
or owner found at the same facility, we randomly selected
one provider from each facility. Descriptive statistics were
used to summarize the responses by child care type. Paired
t tests were used to compare the mean difference between
child care types in continuous variables, and Chi-square
tests were used for all binary measures.
To test whether child care providers’ responses were
influenced by sharing the same child care facility, we
conducted sensitivity analyses on the outcomes of child
care providers’ response by running the same models using
the care facility dataset. These analyses confirmed that
most observed differences in practices and perceptions
between two providers were not changed because of
potential group effects. Overall, the differences between
home and center care providers became smaller but
remained significant except that home care providers’
perceived influence on children’s eating behaviors between
child care environment and family became not significant
when using the care facility dataset.
To test the potential effect of ownership or responsibility
of care facility, we also ran the same models using the owner/
director dataset that included only the center directors and
family owners. Most differences observed between home
and center care providers remained significant with smaller
discrepancies. We found the observed discrepancies
between two care providers disappeared in training on
nutrition, teaching nutrition, and offering information on
1561
physical activity. Also, there was no difference in perceived
influence on children’s physical activity between home and
center care providers. Because of the small number of center
care directors (n = 18), statistical inference at the level of
P = 0.05 may be too stringent. Regardless of the statistical
significance, it is consistent that more positive responses
from family home care providers than center care providers
were noted using the owner/director dataset. Therefore, we
present the results of practices and perceptions by the level of
child care providers in Tables 1 and 3. All statistical anal-
yses were done using SAS statistical software (version 9.1,
Statistical Analysis Systems, Cary, NC).
Results
The participants included nearly equal numbers of family
care home and center care providers. Most (95.3%) home
care providers were owners, and 31.2% of center providers
were owners or center directors. A lower proportion of
home care providers (22.7%) had more than a high school
degree compared to 77.1% of center care providers. The
mean number of children was 65.5 (SD 39.8) for centers
and 6.6 (SD 3.7) for family care homes. The average
number of staff was 19.5 (SD 16.9) for centers and 1.3 (SD
0.5) for family care homes.
Training
Home care providers were more likely to attended training
workshops during the past year (Table 1). Fifty-seven
percent of home care providers received obesity prevention
training compared to 30.2% of center care providers
(P value = 0.0005). About 82% of home care providers
and 58.6% of center care providers received nutrition
training (P value = 0.0009) while 66.7% of home care
providers and 43% of center care providers received
physical activity training (P value = 0.0024).
Practice
Table 1 also presents the specific percentage of obesity-
prevention activities that care providers had practiced or
were involved with during the last year. While a relatively
high proportion of child care providers taught children
about nutrition and physical activity, a much lower pro-
portion offered similar information to parents. Respondents
were also asked about written policies or guidelines per-
taining to children’s nutrition and physical activity in their
home business or at their center (Table 2). More than
seventy percent of child care providers of both types had
written policy restrictions on unhealthy food and beverage
options for children. Fewer home care providers reported
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Table 1 Obesity prevention training and practices in the past year by child care providers
Activities Child care center providers Family child care home providers P value1
n Freq % n Freq %

Training self or staff

Nutrition 87 51 58.6 83 68 81.9 0.0009
Physical activity 86 37 43.0 78 52 66.7 0.0024
Obesity prevention 86 26 30.2 81 46 56.8 0.0005
Teaching children
Nutrition 90 76 84.4 86 84 97.7 0.0023
Physical activity 92 73 79.4 86 85 98.8 \0.0001
Offering information to parents
Nutrition 82 43 52.4 84 53 63.1 0.1645
Physical activity 80 32 40.0 82 47 57.3 0.0275
Obesity prevention 76 16 21.1 80 37 46.3 0.0009
This analysis was performed at the level of child care provider
1
Chi-square test

having policies than center care providers; however, there
was no statistically significant difference between them
except for the breastfeeding policy (57.1% for center pro-
viders and 26.7% for home providers, P = 0.0503).
Perception
Child care providers responded to questions about the
influence of both child care and home environments on
children’s health behaviors and weight status (Table 3).
Care providers in both settings perceived the home envi-
ronment to have more influence on children’s health
behaviors and weight status compared to the child care
environment. However, home care providers ranked their
influence higher than center care providers on every health
behavior and weight status. Therefore the perceived gap
between the influence of home and child care were smaller
among home care provides and home care providers rated
the influence of child care on children’s physical activity as
even similar to that of the home environment.
Providers indicated the importance they give to selected
factors when planning a food menu for children (Table 4).
For both provider types, the three most important factors
were nutrition content, the CACFP guidelines or state
regulations, and availability of foods. There were no dif-
ferences by provider type in rating important factors for
food service menus.
Discussion
With growing numbers of children spending large portions
of their day in non-parental care, child care providers have
an increasing need for training and best practice and policy
guidelines to support high quality child care. There is a
lack of information from the perspectives of child care

Table 2 Policies on obesity prevention by child care facility type

Policies Child care centers Family child care homes P value1
n Freq % n Freq %

Breastfeeding 14 8 57.1 30 8 26.7 0.0503

Foods to be avoided such as common food allergens 21 18 85.7 65 43 66.2 0.0861
Promotion of healthy food and beverage 22 15 68.2 65 50 76.9 0.4149
Restriction on unhealthy food and beverage 22 16 72.7 64 47 73.4 0.9482
Physical activity 23 20 87.0 67 51 76.1 0.2718
Media use 22 16 72.7 66 41 62.1 0.3671
The analysis was performed at the level of child care facility (25 child care centers and 68 family child care homes). Breastfeeding policy was
evaluated among 46 facilities which provided infant care
1
Chi-square test

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Table 3 Child care Provider’s perceptions on the influence of child care environment and home environment on child’s health behaviors and
weight status
Child care environment Home environment Difference (Home—child care)
Mean SD Mean SD Mean SD P1

Child care center providers, n = 91

Food preferences 3.4 1.3 4.7 0.6 1.32 1.3 \0.0001
Eating habits 3.8 1.1 4.8 0.5 1.02 1.2 \0.0001
Physical activity 4.3 0.9 4.8 0.5 0.53 1.0 \0.0001
Weight status 3.2 1.1 4.6 0.7 1.42 1.2 \0.0001
Family child care home providers, n = 87
Food preferences 4.4 0.9 4.6 0.7 0.3 1.0 0.0139
Eating habits 4.4 0.8 4.6 0.7 0.2 0.9 0.0408
Physical activity 4.6 0.7 4.6 0.7 0.1 0.8 0.3201
Weight status 3.9 1.0 4.4 0.9 0.6 1.2 \0.0001
This analysis was performed at the level of child care provider. The response level ranges from none (1) to a lot (5)
1 2, 3
Paired t test, Mean differences are significantly lower than child care home providers (2P \ 0.0001, 3P = 0.0022)

Table 4 Important factors on food menu selection by child care type

Factors Child care centers Family child care homes P value1
n Freq % n Freq %

Cost 28 18 64.3 80 56 70.0 0.5753

Convenience 29 19 65.5 80 55 68.8 0.7494
Availability 28 21 75.0 79 69 87.3 0.1248
Nutrition content 29 23 79.3 80 73 91.3 0.0892
Kids’ preferences 29 19 65.5 81 59 72.8 0.4563
Parent’s request 29 18 62.3 81 56 69.1 0.4864
CACFP Guidelines or state regulations 29 22 75.9 80 71 88.8 0.0929
The analysis was performed at the level of child care facility
1
Chi-square test

providers to inform the development of training models
and best practice and policy guidelines related to obesity-
prevention in child care settings. This study is an explor-
atory study to compare the training, practices and percep-
tions, related to obesity-prevention of family home care
and center care providers.
Several differences between family home care providers
and center providers emerged. Notably, more family home
care providers relative to center care providers reported
attending trainings related to obesity-prevention, nutrition,
and physical activity in the prior year. Compared to those
in centers, family care providers have fewer daily oppor-
tunities to connect with a professional community for
support in their work of caring for children [29, 30].
Opportunities for training may represent a chance to con-
nect, garner support, and socialize. A recent training needs
assessment among family care providers in the same ser-
vice delivery area confirmed that family providers value
training as an opportunity to network as well as learn [31].
Family care providers are also, by and large, the chief
entrepreneur in their own small business. The need to learn
about state regulations and incentivized star-rating systems
may also draw family care providers.
This increased participation in training may be related to
another disparity. Overall, home care providers reported
more health promotion activities than did center care pro-
viders. These included teaching children about physical
activity and offering obesity prevention information to
parents. Because they are attending more trainings on
related topics, family care providers may be more likely to
integrate obesity promotion activities into their daily
practice. Home care providers ranked themselves as having
higher influence on children’s health behaviors and weight
status than center care providers. In terms of children’s
physical activity, home care providers perceived they
have a similar level of influence as children’s home

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environments. Past research has documented a lower
caregiver-to-child ratio in home based care [32] so it is
possible that home care providers may see themselves as
having more individual contact with and connection to
children and their parents. With typically fewer children,
family child care providers in some studies have exhibited
more attentive and encouraging behaviors than center care
providers [33]. The connection between providers and the
parents of children in their care may be especially salient in
home care settings where relationships are a foregrounded
feature [26]. There is some evidence that parents who use
family home care appreciate the more intimate relation-
ships that can be afforded in the home-based setting.
Layzer & Goodson reported that parents who prefer family
home care believed that family home care provides a
homelike setting and allows more individual attention to
their children compared to center care [34]. The current
findings pave the way for further exploring and capitalizing
on the experiences of home care providers to help improve
the health-promotion efficacy of their colleagues in center
settings.
This study identifies specific professional development
themes that cannot be overlooked in obesity prevention as a
venue to improve the quality in child care settings. These
themes can be directly implemented into education, train-
ing, and professional development for practitioners in the
field. The first theme involves helping providers to see
child care as an important context for health promotion and
obesity prevention. In most cases, providers saw the home
environment as a more important influence on children’s
health behaviors and weight status than the child care
environment. Providers should be empowered to under-
stand their own potential role as health promoters, both
directly to children and to their parents. Many providers,
especially those employed in centers, did not commonly
offer nutrition, physical activity, or obesity prevention
information to the parents of children in their care. A
number of studies have suggested that the relationship
between child care providers and parents is related to
children’s adjustment to care and the quality of care pro-
vided [35, 36]. Child care providers are positioned to serve
as experts in early childhood development and can provide
families with trusted information and support [37]. Train-
ing efforts should be aimed at helping providers see
themselves as partners with parents in setting the stage for
children’s healthy physical as well as cognitive and
socioemotional development.
The second theme is to assist care providers in accessing
and valuing health promotion training as a regular part of
their continuing education and professional development,
especially for center providers who reported significantly
less of this kind of training in the previous year. This is all
the more important given that a notable majority of
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Matern Child Health J (2012) 16:1559–1566
providers report teaching children about health-relevant
topics. This would include training about proper imple-
mentation of nutrition and physical activity with the chil-
dren in their care.
The final theme to emerge was to encourage and sup-
port care providers to develop and implement concrete
and written obesity-preventing policies and guidelines in
their child care settings. The results of this study indicated
that written policies are often missing in child care set-
tings. Among those providing care to infants, less than
two-thirds of center care providers reported having a
policy on breastfeeding compared to just over a quarter of
home care providers. More than one-quarter of providers
in both settings did not have a written policy restricting
the availability of unhealthy food and beverages for the
children in their care. Without establishing such standards
in both settings, consistency in health promotion practices
is unlikely. This study screened for the presence or
absence of written policies and did not examine the con-
tent or source of those reported to exist. Training and
support efforts should promote the development of written
policies that are aligned with the new set of child care
standards for obesity prevention that address nutrition,
physical activity, and screen time released by the Amer-
ican Public Health Association, in partnership with the
American Academy of Pediatrics and the National
Resource Center for Health and Safety in Child Care and
Early Education [38].
The unique characteristics of family child care homes
(e.g., small number of children, close contact with parents,
home-like setting, and flexibility of arrangements) could
provide an effective health promotion delivery system for
young children and families. Centers have their own
strengths including existing infrastructure and access to
relatively larger numbers of children and families at each
site. However, currently, many providers do not have
adequate preparation and training to meet their full
potential in the realm of health promotion and obesity
prevention.
Historically, the care of young children has been thought
to provide more ‘nurturing’ than ‘education,’ and thus
many providers may have not had access to specialized
trainings and comprehensive regulation in health-related
topics focused on education and promotion. The child care
environment, regardless of its explicit educational content,
is a context where children are likely receiving socializa-
tion related to health behaviors. A growing body of
research suggests that the social conditions and health
behaviors present in childhood have long-lasting impacts
on later health behaviors and health status [39–42]. For this
reason, a life course perspective is important in planning
for the training, education, and policies that enable best
practice in early child care programs.
Matern Child Health J (2012) 16:1559–1566
This study has some limitations. The study respondents
are a convenience sample that attended local training
workshops, and thus they are not a representative sample of
all child care providers in east central Illinois. Those who
attend training workshops may be more likely to seek
information, education and resources in order to improve
their care practices. They may have different response
characteristics and tendencies than those who do not par-
ticipate in training programs. The generalizablity of these
findings is thus limited. Furthermore, child care providers
may be aware of the current national attention to childhood
obesity and this may have influenced them to respond in
more positive ways. However, we do not expect any sys-
tematic difference between family home and center care
providers in this area, and the anonymous and voluntary
nature of the survey may reduce potential response bias due
to social desirability. Self-report survey methodology
assesses subjective perceptions that are important for
understanding patterns in social and intrapersonal phe-
nomena. Future work should expand the analyses to
include other sources of data, for example, observations
and archival reviews.
Finally, a comparison of family home and center care
providers must be done carefully. While most family care
providers are the owners of their child care business, this
is not the case for most center care providers. Sensitivity
analyses found that most responses remained consistently
different between the two provider types with the smaller
magnitude of differences and statistical significance.
Because of the small sample size, the potential effects of
ownership between family and center care providers could
not be fully addressed in this study. Further, the purpose
of this study is to understand the needs of care facility and
providers, not restricting to owners or directors of child
care facilities. In addition, differences in care provider’s
demographics and professional backgrounds may have
contributed to differences in the reported perceptions and
practices of family home and center care providers.
Despite these limitations, the current research presents an
important contribution to the literature on public health
promotion targeting child care settings to tackle childhood
obesity.
Conclusions
The findings of this study suggest that child care providers
regardless of child care type have the potential to promote
healthy behaviors and help prevent obesity for young chil-
dren. As obesogenic environments become more common,
the role of child care providers in promoting childhood
wellness will become increasingly important. The current
pediatric obesity epidemic is a public health crisis that will
1565
require creative thinking and new partnerships among par-
ents, health care professionals, and those who educate and
care for young children. We found that there were differ-
ences in training, practices and perceptions in obesity pre-
vention between family home and center care providers.
The most basic implication for practice is that professional
development offerings related to obesity prevention should
be developed to target the particular characteristics and
patterns of these two provider types. Further studies are
warranted to understand the role of child care providers in
obesity prevention and to clarify the barriers and facilitators
of obesity prevention in family and center-based care
settings.
Acknowledgments The authors wish to thank Ms. Lou Anne
Burton at CCRS for her guidance and assistance during the survey at
local child care training workshops. The authors also wish to thank
Dr. Hyun Shin Park at University of Sung Kyun Kwan for his guid-
ance and thoughtful comments on survey development and analysis
and lastly Ms. Jasmine Abdullh at the University of Illinois at Urbana-
Champaign for her assistance on survey collection and data
procedure.
Conflict of interest None of the authors has any conflict of interest
on this manuscript to report.
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