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any written rules or guidelines about healthy practices” or “I did not face any challenges to creating written rules or guidelines about healthy practices” did not have any other checked items included in the percentages reported in Table 12.
The percent of providers reporting each challenge were similar at baseline and follow-up. At follow-up, 46.6% of participants reported at least one challenge and 37.0% indicated they did not face any challenges creating written rules or guidelines about healthy practices. The areas of greatest challenge in creating written rules or guidelines at both baseline and follow-up, with approximately 20% or more citing these challenges, were the following:
 Lack of support from parents
 Not enough time to write rules or guidelines
 Not enough training to make changes
Similar to the prior question about challenges in creating healthy routines and practices, the most frequently cited challenge was lack of support from parents with 21.6% of participants citing this challenge at follow-up.
Table 12. Percent of Participants Reporting Challenges in Creating Written Rules or Guidelines about Healthy Practices
Challenges Faced Creating Written Guidelines Baseline (n=600)
Follow-Up (n=602)
Lack of support from management staff 10.7% 12.8%
Lack of support from other child care staff 6.7% 8.0%
Lack of support from parents 19.7% 21.6%
Not enough training to make changes 18.7% 16.8%
Not enough time to write rules or guidelines 18.7% 17.9%
Other 2.7% 2.3%
I did not face any challenges to creating written rules or 32.8% 37.0% guidelines about healthy practices.
Does not apply: I did not create any written rules or guidelines 19.3% 16.4% about healthy practices.
Individual questions did not show a statistically significant change from baseline to follow-up. However, there were group differences in the mean number of challenges providers reported. Specifically, center-based staff reported more challenges (M = 0.855, SD = 1.260) than family child care providers (M = 0.474, SD = 0.840), t (317.95) = 4.089, p < .001 at follow-up as demonstrated by an independent samples t-test.
Improving Health in Child Care Settings: 2016 38