Emerging research suggests a comprehensive approach is needed to address the multiple environmental factors influencing children’s health behaviours. As such, taking a CSH approach in the ASC setting is warranted. While it was anticipated that the ASC provider plays a crucial role in providing HE and PA opportunities in the ASC setting, limited research was available regarding their role specifically. The goal of this research was to explore the role of the care provider and their perceived ability to promote HE and PA opportunities within ASC sites participating in the SOLMo intervention. Five themes resulted from this study, revealing care providers’ perceptions and experiences of the SOLMo intervention. Generally, a positive experience was reported by participants.
Participants reported an improved awareness of HE and PA as a result of the intervention. An enhanced awareness was also seen in the after-school intervention reported by Dobson et al. (unpublished). The authors concluded that care providers showed increases in knowledge and confidence levels in offering HE and PA opportunities. Through focus groups, ASC providers participating in the intervention reported “feeling empowered and excited” in their role as ASC providers as a result of the intervention (Dobson et al., unpublished, p. 14,). The enhanced awareness in the present study was reported through the re-prioritization of HE and PA, with site leaders as key individuals leading the change within sites. The significant role of the site leader in implementing health interventions for children has also been reported by other studies (29, 30). Beets et al. (31) found changes made to improve PA opportunities at ASC sites were primarily driven by the ASC leader, despite a lack of formal or routine changes to site programs observed at post-intervention. Similarly, as the leader of a school, principals are viewed as essential to successfully implementing school-based interventions (30).
Although ASC sites are non-curriculum based, program planning is an important component. Participants reported improvements to program planning as a result of the SOLMo intervention. While care providers acknowledged a general understanding of HE and PA recommendations, an increase in their knowledge was reported. Care providers receive little education on HE and PA during their formal training, and thus SOLMo served as a means to provide professional development in health behaviours. This has been similarly reported in other studies with this population (32). Studies on HE and PA interventions implemented in schools and after-school child care centres suggest teachers, care providers, or the persons implementing the program need ongoing training and support in order to feel confident and competent in their ability to implement changes (33–35). A common challenge ASC programs experience is low attendance and participation (36). As a strategy, care providers use child-led programming to improve participation and thus aimed to change activities frequently to tailor to childrens’ interests. Limited access to equipment and a limited budget made planning for PA or HE programs challenging for SOLMo care providers and is a challenge ASC programs regularly face (18, 37). Additional resources helped to improve healthy opportunities for SOLMo sites, and has also been similarly reported in other after-school interventions (37, 38). Huberty et al. (38) found an increase in MVPA participation for both boys and girls with the presence of equipment (e.g., balls, jump-ropes, hula-hoop). The increase in variety of activities, with the addition of resources from an intervention, helps to increase interest and participation in PA among children in the ASC setting (20, 38).
Care providers’ influence on children’s HE and PA behaviours as a result of the strong relationships they had formed with the children was revealed. The unique bond ASC providers share with children built trust and encouraged open communication. This unique bond was similarly identified by Leos-Urbel (36) who described how the interactions between care providers and children were associated with higher reading scores and academic success within an ASC setting. In addition to strong relationships, role modeling was also viewed as imperative in the present study. Role modeling of positive health behaviours, such as participating and actively engaging with children during activities, was recognized as a significant component of the care provider role within the ASC setting. The effects of role modelling to influence children’s health behaviours have been reported in other ASC settings (38), and were also found in other contexts, such as teachers within a school (39–42), and mentors within the community (43, 44). Additionally, He and colleagues (40) demonstrated the need for teachers to have healthy attitudes and be positive role models because of the considerable time they spend with children. Similar to the findings of the present study, Zarrett et al. (37) reported on the impact of care provider’s facilitation style; the importance of care providers actively engaging with children to improve PA participation through verbal encouragement and participation in the activity.
The ability to collaborate with the school and community was perceived as essential. Care providers viewed partnerships with the school and community as crucial in their ability to access resources they would not have otherwise had. The collaborative approach required is consistent with findings in the literature, including after-school (45, 46), community (47), and school settings (43). The conflicts with the school community identified by ASC providers in this study were unexpected. Participants revealed the challenges care providers experienced in their efforts to work collaboratively with schools. To our knowledge, the relational conflicts ASC providers experience with schools or partnerships within the community has not been investigated. This may be due to the limited research on the care providers’ role in promoting HE and PA within the ASC setting.
Role tension was commonly experienced by care providers in this study. Their unique role as both care provider and educator in the ASC setting was embraced by participants, however, challenging at times. There are multiple responsibilities faced by ASC providers which have been similarly described as work-related stress by child care workers in daycare centres (48). The challenges of the ASC providers’ dual role of providing overall care and educating school-age children combined with the hectic nature of the ASC environment was perceived to create this role tension. Furthermore, the perceived lack of support, in particular the relationship with the school, was a trigger for the tension experienced. A perceived lack of respect by the community was also mentioned. The misconception of their role as ‘babysitter’ by parents or the general public was found to be discouraging. Participants indicated this misconception affected their ability to feel a sense of pride in their role and to provide quality programming and care.
Strengths and Limitations
Strengths of this research include the consistent and prolonged engagement with participants. Field visits by the primary researcher over the two-year period of the SOLMo project provided background knowledge regarding the after-school setting and allowed for the development of strong relationships with participants (23, 26). Additionally, there was a diverse range of participants in: age, child care experience, full-time, part-time staff, and included site leaders in addition to front-line staff. While this intervention took a CSH approach, it is known that comprehensive approaches require time to implement (49). Furthermore, the primary researcher was also the project coordinator for the SOLMo intervention, which had the potential to create a social desirability bias. The topic of this research, however, was not sensitive, and the researcher was mindful in establishing a relationship with participants to gain trust prior to conducting interviews to encourage participants to speak freely. To enhance the quality and transparency of all aspects of the research, we applied the 21-item Standards for Reporting Qualitative Research checklist (50), see supplemental material.