Thirteen care providers were recruited for interviews. Participants included site leaders (n=5, 38%); full-time staff (n=8, 62%); and part-time staff (n=5, 38%). The majority of the participants were female (n=11, 85%). While diverse, it should be noted that participants were purposefully sampled for the phenomenon of interest. Thus, it is appropriate, and advantageous to examine their responses collectively. Interviews were conducted at each ASC site, lasting between 35-90 minutes.
Data analysis resulted in five major themes related to care providers’ role and experience promoting HE and PA through the SOLMo intervention: (1) enhanced awareness, (2) improved program planning, (3) strong relationships, (4) collaborative approach, and (5) role tension. Overall, interviews with ASC providers and site observations indicated their understanding and support for the use of a comprehensive approach (i.e., CSH) to ensure the well-being and health of children in the ASC setting. We have provided quotes within the text to support our findings. Additional quotes can be found in Table 1.
Interviews revealed the impact SOLMo had on care providers’ ability to promote HE and PA opportunities. Enhanced awareness was reported through participants’ involvement in SOLMo, including meetings with the SOLMo team and supporting child-level data collection. Two subthemes emerged including (1) re-prioritizing HE and PA, and (2) research as an implementation tool. Both subthemes are described below.
Re-Prioritizing HE and PA
By participating in SOLMo, care providers perceived an enhanced awareness of the importance of providing HE and PA opportunities for children in their care. Care providers described how meetings with the SOLMo team acted as a frequent reminder to prioritize healthy behaviours and encouraged care providers to be “more aware” of healthy eating and physical activity in the ASC. One provider described being: “More conscious about what we were having for snack...And physical activity, too.” Participants reported a general understanding regarding the importance of encouraging healthy behaviours as care providers; however, participants stated these priorities were often previously overlooked during program time due to the hectic nature of the ASC environment.
There was also an increased awareness by site leaders in the importance of the care providers’ ability to influence and promote HE and PA for children, which was recognized by other care providers as significant. Many felt that through the SOLMo intervention, site leaders re-prioritized the need to encourage HE and PA for children, creating awareness for their team as a whole. Enhanced awareness was demonstrated by site leaders through team meetings and conversations amongst staff members, which made it easier for other ASC providers to also prioritize HE and PA.
Research as an Implementation Tool
ASC providers perceived that the child-level SOLMo data collection (e.g., pedometers, snack observations) enhanced their awareness of SOLMo, including their awareness for promoting HE and PA at their site. Multiple research activities acted as frequent reminders for the project goals (i.e., provide a healthy snack and to increase moderate-to-vigorous PA) and therefore enhanced awareness. For example, pedometers worn by children for data collection served as a reminder for care providers to encourage PA opportunities and often facilitated a conversation with the children regarding what they were for and why they were wearing them. One participant described the benefit of the pedometer as a motivation to participate in physical activity. As they stated: “I thought that the pedometers were great…we did use it [pedometers] like…‘Well, you want to get more steps, right?’ So and then kids would be more likely to want to participate.” Additionally, not all care providers working within SOLMo sites were full-time. As such, part-time staff reported challenges in communication of new programs or initiatives. Research activities such as child-level baseline data collection (e.g., pedometers, snack observation) served as a means to signal to all staff that the SOLMo intervention was taking place.
Improved Program Planning
While programs differed between ASC sites, care providers agreed that there was a need to provide quality programs and shared a common goal of ensuring the well-being of children as a priority. Two subthemes of (1) knowledge and (2) resources emerged. An improvement in program planning processes to support HE and PA through the knowledge gained and resources provided by SOLMo was reported by participants. Efforts required to plan activities that were of interest to children, combined with the chaotic environment, made planning for HE and PA opportunities difficult at times. Subthemes are described in detail below.
Participants spoke of an increase in knowledge gained in the areas of HE and PA from participating in SOLMo and discussed how this knowledge allowed them to intentionally plan activities which regularly included HE and PA opportunities. Care providers mentioned program planning as a significant component of their role. The program planning process for each site varied (i.e., some daily, weekly, or monthly), however, program planning was important as it provided a loose structure for each site’s daily operations. A participant described how even though their organization encourages PA, she learned of MVPA recommendations for children due to being a part of SOLMo: “I would say what has changed is just my perspective. I did know that it’s important, but I didn’t think every day had to incorporate at least 60 minutes of exercising or of [moderate-to-vigorous] physical activity.”
Care providers recognized the physical environment impacted their ability to promote healthy lifestyle behaviours. Participants indicated opportunities to promote HE and PA were challenging given their limited access to resources, and reported how SOLMo resources (i.e., ideas, supplies) allowed them to make changes to the environment to improve HE and PA opportunities. This was particularly relevant when providing PA opportunities within small spaces, as one participant illustrated: “that [daily physical activity] bin in particular allows us to do things in a smaller space, which is really useful.”
Care providers identified themselves as being effective health promoters. Care providers perceived they had a significant ability to impact children’s health behaviours (i.e., HE and PA) through the strong relationships they had with children, which were established over time. The importance of building a relationship with each child was reported as a main priority for care providers; participants spoke of how the relationship with each child needed to be established before promoting health. Trust and established relationships with the children were discussed as crucial components of their role. By creating a positive social environment, open communication, and conversations between the care provider and children, promoting HE and PA was made easier. Two subthemes emerged within the context of ‘Strong Relationships’: (1) unique role as ASC providers and (2) role modeling, as described in detail below.
Unique Role as ASC Providers
Care providers perceived their strong relationship with children was established through their unique role as ASC providers. Care providers interact daily with children, and sometimes these interactions occur over long a period of time, lasting years for some children. This continued interaction in a less structured environment, combined with an emphasis on establishing connection, fostered an important bond between the care provider and children.
Once a relationship was formed with a child and trust was established, care providers perceived this bond as advantageous in their ability to influence children’s health behaviours. While hectic at times, the less structured nature of ASC programs allowed for meaningful connections between care providers and children. Forming relationships, building trust, and creating mutual respect with children supported care providers in their ability to promote HE and PA because “once that respect is established and that relationship is built…it makes a difference …they’re super respectful and wanting to be here. And so I feel like what I [the care provider] say to them matters.” The relationship care providers developed with children was reported as unique to their role as ASC providers, and enhanced their ability to influence and promote health behaviours.
Many care providers recognized the importance of their indirect influence through role modeling of HE and PA. Participants commented on the responsibility of care providers to exhibit health behaviours and the importance of ‘practicing what you preach’ by role modeling healthy behaviours to encourage and positively influence children’s behaviours. Participants recognized their ability to influence children through their own thoughts and actions, and could bring energy and excitement to activities. The need to be conscious of their behaviours exhibited during program time was described by one participant: “We are really big influencers on them... we’re role models.” Participants described modeling healthy behaviours by participating in the activities with the children (e.g., playing games, sitting with children and eating the healthy snacks prepared) as well as being conscientious about not bringing in unhealthy food choices. Activities were not mandatory in the ASC setting due to the nature of child-led programming, and role modeling by care providers was reported to improve children’s participation, especially those children who were less likely to participate. While some challenges in participating in activities were voiced due to the need to oversee the entire program or other activities, care providers agreed that their engagement improved participation levels.
Care providers discussed the importance of a collaborative approach in their ability to successfully promote HE and PA within the ASC setting, including the significance of connections formed within their community. Partnerships with schools were described as impactful; however, participants indicated challenges were often encountered when establishing these relationships. Once a partnership was established, participants reported a reliance on schools. Many sites had limited resources, thus care providers indicated a collaborative approach was required to improve HE and PA opportunities. Two subthemes were revealed: (1) school partnerships and (2) community support, and are described below.
Three of the four SOLMo sites were within walking distance to schools, one within the school itself. For some sites, the relationship with the school and school staff was significant and positive and supported HE and PA opportunities. This included opportunities to access school resources (e.g., equipment, space) during program hours. Unfortunately, this ‘fundamental’ support between the school and ASC site was not observed by all, and was recognized as atypical by most. Throughout the SOLMo intervention, conversations with care providers revealed challenges in establishing these relationships.
In comparison to ASC sites, schools are generally better equipped with resources. Participants agreed that support from school improved care providers’ ability to promote HE and PA. Participants from sites with established partnerships spoke of their reliance on the school for resources including access to school gymnasium, sports equipment, outdoor play space, kitchen space, and food donations which often came as leftovers from school events. While not all sites had strong relationships with the local school, ASC providers perceived access to shared school resources would improve their ability to promote HE and PA.
Care providers also spoke of the connections made with the community as necessary in promoting HE and PA. This was especially true in the context of the financial constraints faced for sites offering a service-fee free program. Due to budgetary challenges, community support for food donations was essential, as described by one participant: “…we have limited resources as far as our budget’s set out for the year. And we do rely on the food bank. And that dictates basically what it is we can offer.” Community partnerships were also invaluable in improving PA opportunities for ASC sites. Access to resources in the community was described as significant in the care provider’s ability to plan PA opportunities without adding additional costs. Connecting with other sites within the ASC community was viewed as an opportunity to improve HE and PA opportunities through idea sharing. Support from families was also regarded as beneficial. Conversations initiated with parents on HE and PA encouraged parental involvement and support for SOLMo. Community volunteers were also viewed as essential, especially during times of high staff turnover, supporting care providers by leading and facilitating activities during program time. The ‘extra bodies’ assisted care providers in improving HE and PA promotion by engaging with children to encourage participation.
The role of an ASC provider is unique. They provide overall care and support the educational needs for children. Throughout the SOLMo intervention, the responsibilities of the care provider as being both a child minder and educator was observed, and challenges of this dual role were revealed. These challenges extended to how care providers were able to support HE and PA opportunities for children. While care providers embraced their dual role, they experienced an internal tension, describing this tension related to the dynamic day-to-day operations, less structured nature of the ASC setting, and the perceived lack of support within their community. Care providers recognized their ability to influence children’s health behaviours and aimed to plan programs that incorporated HE and PA opportunities. However, observations and discussions with participants exposed the reality of the care provider’s role, which predominantly prioritized safety (i.e., managing and ensuring safety of children), and left little time to facilitate planned health promoting activities during ASC hours. Additionally, handling behavioural issues among the children was reported as a frequent deterrence.
Participants spoke of the role tension experienced within the school community. Care providers shared their perceptions of feeling undervalued by members of the school, notably teachers. Comparisons between the role of ASC providers and teachers emerged at various points throughout the SOLMo intervention. A perceived hierarchy within the school community was described, with some participants perceiving their role as inferior to other staff members within the school. A lack of respect was perceived compared to teachers in the school setting. Participants perceived their unique role, the dual role of both a child minder and educator, was unrecognized by most.
The perceived low regard for the ASC provider role came from the school community, families, and the general public. This perceived lack of a sense of community or belonging, and value and professionalism in their role affected the quality of care provided by care providers. The negative perception was challenging for care providers to feel confident and competent in their role, impacting their ability to provide quality care for children, including their ability to promote health. The lack of understanding for their role was described by one participant in the following: “…the perception that we’re just child care workers sometimes lays on people pretty hard…sometimes that actually weighs on staff. ‘Well why am I doing it? The family just views me as a babysitter.”
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