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Nutrition and Physical Activity Self-Assessment for Child-Care (NAP SACC)

Evidence Summary

Underlying Theory:   The NAP SACC intervention uses constructs of the Social Cognitive Theory including: expectancies, observational learning, self-efficacy, behavioral capability, environment, situation, reinforcement, and reciprocal determinism.

Strategy(ies) Used:   The NAP SACC intervention includes strategies for both healthy eating and physical activity that have been adapted to child care settings, including:

Research Findings and Evaluation Outcomes:

The NAP SACC intervention was developed and evaluated first in the field as a practice-based intervention and subsequently studied in a larger randomized controlled trial involving 30 consultants assigned to 84 child care centers.  Centers were randomly assigned to receive the intervention or serve as controls. Among the 82 centers remaining in the study, 56 were randomly assigned to receive the intervention. Forty-one intervention centers (73%) completed most (>75%) or all of the intervention components. The program outcomes discussed below are based on this subset of intervention sites as compared to controls.  

Intervention Effect (overall environment and policy assessment):  Child care centers completing most or all of the intervention components improved their nutrition and physical activity policies and practices more than control facilities. Changes in the total child care nutrition environment scores (16% increase) were statistically  significant (p

Individual Item Scores in Nutrition and Physical Activity:  Because the NAP SACC intervention allows some flexibility in the areas centers could target for change and because the observation instrument is scored using averages of sub-areas to obtain the Nutrition and Physical Activity scores, an additional assessment of an intervention effect was measured using all of the individual 75-items from the observation instrument. Nutrition effects were assessed with 51 items and physical activity with 24 items. The mean change in nutrition scores was a 4.3 point improvement in the intervention centers compared to -0.5 change in the controls; for physical activity, scores increased by 3.6 in the intervention centers compared to a -0.2 change in the controls. Both nutrition and physical activity improvements were statistically significant.