Potential Public Health Impact
Color Me Healthy has a low to moderate potential for public health impact. The behavioral effect appears promising; however, further evaluation is needed to confirm these findings in more and diverse populations. At this point, it is unclear that CMH, as a standalone program, would result in a change in fruit and vegetable intake if the foods are not more accessible within the child care setting. However, CMH is unique, given the ease of adoption and proven potential for dissemination. In addition, the impact of the intervention could be further strengthened if the curriculum is used as part of a multi-component and comprehensive child care initiative, which includes policy and environmental changes to support the intended behaviors.
Reach: With approximately three-quarters of US children spending time in child care settings, this program has potential for efficiently reaching a large number of children. In addition, early dissemination of Color Me Healthy was funded by Supplemental Nutrition Assistance Program – Education (SNAP-Ed) and implemented in low-income, under-resourced child care centers, e.g., Expanded Food and Nutrition Education Programs (EFNEP), Head Start Centers, and Child and Adult Care Food Programs (CACFP).
Effectiveness: Data from the randomized controlled trial suggest that, compared to a control group, children participating in the Color Me Healthy program are more likely to increase consumption of fruit and vegetable snacks when presented with fruit and vegetable snacks while in child care centers, at 1 week and 3 months after the program was completed. However, it is unknown if and how children’s home food consumption may have changed after completion of CMH.
Adoption: Color Me Healthy is designed to be used in family daycare centers, Head Start classrooms and child care centers. In North Carolina, practice-based data (Dunn et al., 2006) show there was good adoption of the program by child care providers, with an adoption rate of 85% (870 out of 1023) based upon 8- week evaluation following training. In addition, New Jersey, Pennsylvania, Indiana, Kentucky, South Dakota, South Carolina and Tennessee have statewide adoption plans. The following states have adopted CMH regionally: Wyoming, Maryland, and New York. Training has been provided in 17 states and more than 12,000 CMH Kits have been purchased by organizations in 48 states.
Implementation: This intervention was designed for dissemination – training, program curriculum and materials, implementation guidance and technical support for implementation are available. The program is easy to implement at a relatively low cost and there is high acceptability of the curriculum. CMH has been implemented in low-resource settings.
Practice-based data that were available for this review (Dunn et al., 2006) show that of the child care providers who attended Color Me Healthy trainings in North Carolina, 97% thought that the materials were Excellent or Very Good. Nearly all of the child care providers (99%) were Confident or Very Confident in their ability to use the CMH materials after the training. The majority of the providers (91%) planned to increase the time spent teaching nutrition and physical activity in the classroom, with 29% and 68% indicating intent to incorporate CMH lessons into their curriculum 1 to 2 times per week and 1 to 2 times per month, respectively. It seems reasonable to expect that the intervention could be implemented as intended (with fidelity) in similar settings with similar infrastructure.
Maintenance: Color Me Healthy has been in the field for 8 years. While data for long-term maintenance of the program at the childcare center level were not available at the time of this review, it is reasonable to expect that the program could be sustained over time, given the relatively low cost of implementation and high acceptability of the CMH curriculum. Furthermore, maintenance at the individual-level is promising, as an increase in fruit and vegetable snack consumption was observed in children, at three months after completion of the curriculum. Future research should include examination of longer term maintenance of fruit and vegetable consumption in both the home and childcare settings.