Factores del clima organizacional

Positive findings for Shape NC and broader childhood obesity prevention

emerged from these discussions. Not only did all of the interviewed staff have some kind of wellness routine, each of them saw their workplace as having benefits for their

physical or mental health, and were able to clearly articulate benefits and health changes stemming from their workplaces. This suggests that childcare centers engaged in Shape NC are indeed having a positive impact on staff health behaviors and knowledge, regardless of whether or not they engage in formal worksite wellness programming. These positive effects could be further amplified by integrating staff wellness resources into Shape NC programming.

Blending Staff Wellness into Shape NC Content

A commitment to children’s wellbeing was a thread running through the

interviews, suggesting that educators connect their own wellness habits to their students’ wellness. How might we capitalize on this powerful motivator? If commitment to

children is a shared value among early childhood educators, highlighting staff position as “role models” may be an important component of future Shape NC training and

orientation. Shape NC staff should deliver content not only as policies and practices impacting young children, but should develop a holistic approach that invites educators to consider their role in young children’s health. Educators interviewed for this study linked an increase in their own knowledge with a drive to provide children with healthy habits. It follows then that providing teachers with ongoing opportunities to learn about, practice, and take ownership of healthy eating and exercise may help them be more actively

committed to Shape NC goals. Providers gain knowledge about health and wellness from their directors, Shape NC trainings and continuing education, from TA, and from online resources like Shape NC’s online webinar series. Messaging about provider wellness should be integrated into all of these information channels. Blending staff wellness into professional development around Shape NC content areas may be a fruitful approach, particularly for those educators who do not have a wellness routine outside of the center.

Intensifying the support educators receive for their own health and wellness may help staff better reach out to parents, an area of concern for many. At this stage, most felt comfortable sharing knowledge and practices with children, but were less likely to connect with parents. Providing staff with knowledge and skills about healthy habits, as well as strategies for engaging parents could help teachers expand their role-modeling into the community.

Lastly, alongside a holistic approach to wellness that includes staff health, there are practical and concrete considerations that may facilitate staff buy-in and motivation for health and wellness programming. As one TA remarked, making wellness easier for people may involve considerations like offering childcare for an evening health program, offering incentives, and having enthusiastic director support.

Sustaining Staff Wellness: The Role of Champions, Directors, and Technical Assistants

Directors and staff look to champions to further the work of Shape NC and staff wellness. Indeed, champions and their day-to-day efforts were discussed more than individual programs or wellness efforts, such as the “biggest loser” projects described by two sites. Champions can motivate others to join them on a walk or play a part in

changing the food habits of staff. It seems most efficacious, however, to have multiple champions in an organization, as one champion may burn out. Camaraderie and support observed at Site A highlighted how a shared commitment to wellness among staff could sustain healthy changes. Certainly, the benefit of the wearable technology they received makes this center different than the others, but sharing the role of ‘champion’ seems to be powerful in creating a workplace where health is the norm. Teachers and directors at Site E and Site C both reflected on culture in which healthy choices were affirmed and

supported, with or without a formally structured workplace wellness program.

Of course, supporting champions and tapping into teachers’ sense of self-efficacy and identity as a role model is a more nebulous prospect than initiating an ad-hoc walking program or nutrition activity. As Kent (2016) writes, sustaining a culture of health

involves active participation at all levels:

“It involves leaders practicing healthy behaviors, implementing health promoting policies and practices, creating a healthy work environment, and allocating sufficient resources for programs to be sustained over long periods. It involves managers encouraging employees to incorporate healthy activities into the workday and shaping organizational norms so that they promote health. In addition, it means actively engaging employees in the process of shaping and building wellness offerings, so that the program meets the needs of individuals and their families.”18

There are numerous strategies Shape NC might employ to support directors and teachers in creating and sustaining a culture of health. Indeed, among specific requests related to how Shape NC could help, directors indicated that guidance and technical assistance for staff wellness was welcome. Site B’s director shared that while staff wellness is critical, staff wellness programming is neither their first priority nor their expertise, and momentum may wane. To that end, she suggested that staff wellness might be incorporated into the Go NAP SACC center assessment tool. Site A’s director also

mentioned that even just sharing research, news, and facts about obesity may help

reenergize and refocus staff. New resources, ideas, or materials can help keep momentum strong. Across all sites, TA were seen as a valuable resource for Shape NC content, and could expand their guidance to include staff programming. Directors see the benefit of staff wellness, and Shape NC can support them in maintaining that commitment. Specifically, TA may be a critical driver in providing directors with resources, support, and ideas for building a culture of health in their workplace. In its third phase, Shape NC can ready its TA partners to deliver staff health and wellness content, and to help

directors see themselves as champions for health and wellness.

Finally, childcare staff may face the same economic barriers to wellness that many do: high costs of health care, higher prices for healthier foods, towns and cities that are not walkable. However, despite these barriers, the tone of the interviews and

perspective of the childcare workers was predominantly positive. As a final recommendation, the role of teacher pay and benefits should be considered. In the

literature on health of childcare workers, low wages are a pernicious factor that make the ECE workforce likelier to experience obesity and comorbidities.4,6,7 _{One director shared} that her staff was insured, and that their attention to wellness helped keep their premiums down, and one of the technical assistants shared that low-pay was a barrier to maintaining wellness in and outside of the center. To what extent could higher wages and

comprehensive benefits package support teachers in living healthy lives? The potential contribution to staff health should be considered alongside other benefits of raising the wages of childcare staff.

This sample of staff and directors share a belief in the connection between their own health habits and the health of the children they serve. This critical connection ought not be overlooked in childhood obesity programming, and indeed, understanding the degree to which provider wellness mediates the risk for childhood obesity is an area for further inquiry. As this intervention expands, the crucial role of provider wellness should be integrated into every level of Shape NC programming: from content area trainings, to technical assistance providers, to support and resources offered to center directors. The early education workforce delivers intervention, and their own health and wellness habits may mediate the degree to which they engage with Shape NC programming. To continue making meaningful progress in reducing childhood obesity, teachers and directors should be supported and encouraged to build a culture of health in their workplace for both children and adults.

References

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Prevention. http://www.cdc.gov/obesity/data/childhood.html. Updated June 19, 2015. Accessed October 9, 2016.

3. Overweight and Obesity: Adult Facts. Centers for Disease Control and Prevention. http://www.cdc.gov/obesity/data/adult.html. Updated September 1, 2016. Accessed October 10, 2016.

4. Whitaker R, Becker B, Herman A, Gooze R. The physical and mental health of head start staff: The Pennsylvania head start staff wellness survey, 2012. Preventing Chronic Disease. 2013;10(10):E181

5. Hibbs-Shipp S, Milholland M, Bellows L, Barriers and facilitators to healthy eating and activity in head start staff: An opportunity for worksite wellness. American Journal of Health Education. 2015;46(6):347.

6. Qualistar Colorado. Leadership: Leading Colorado’s early care and education workforce. 2016:1-28.

7. Allen L, Kelly B, eds. Transforming the Workforce for Children Birth through Age 8: A Unifying Foundation. Washington D.C.: The National Academies Press, 2015.

8. Gratz R, Claffey A. Adult health in child care: Health status, behaviors, and concerns of teachers, directors, and family child care providers. Early Childhood Research Quarterly.1996;11(2):243-267.

9. Baldwin D, Gaines S, Wold JL, Williams A. The health of female childcare providers: Implications for quality of care. Journal of Community Health Nursing. 2007;24(1):1-17.

10. Whitaker R, Becker B, Herman A, Gooze R. The physical and mental health of head start staff: The Pennsylvania head start staff wellness survey, 2012. Preventing Chronic Disease. 2013;10(10):E181

11. Hughes C, Gooze R, Finkelstein D, R. Barriers to obesity prevention in head start. Health Affairs. 2010;29(3):454-462.

12. Larson N, Ward D, Neelon S, Story M. What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts. Journal of the American Dietetic Association. 2011;111(9):1343-1362. 13. Goetzel RZ, Henke RM, Tabrizi M, et al. Do workplace health promotion

(wellness) programs work? Journal of Occupational & Environmental Medicine. 2014;56(9):927-934. doi: 10.1097/JOM.0000000000000276

14. Anderko L, Roffenbender JS, Goetzel RZ, et al. Promoting prevention through the affordable care act: Workplace wellness. Preventing Chronic Disease. 2012;9: E175. doi:10.5888/pcd9.120092.

15. Hersey J, Weilliams-Piehota P, Dunet D. Promising practices in promotion of healthy weight at small and medium-sized US worksites. Preventing Chronic Disease. 2008;5(4):A122.

16. CDC worksite health ScoreCard: Introduction. Centers for Disease Control and

Prevention.https://www.cdc.gov/workplacehealthpromotion/initiatives/healths corecard/introduction.html. Updated 2014. Accessed September 8, 2016, 2016.

17. Wieneke KC, Clark MM, Sifuentes LE, et al. Development and impact of a worksite wellness champions program. Am J Health Behav. 2016;40(2):215-

18. Kent K, Goetzel RZ, Roemer EC, Prasad A, Freundlich N. Promoting healthy workplaces by building cultures of health and applying strategic

communications. Journal of Occupational and Environmental Medicine. 2016

Feb 1;58(2):114-22.

19. Gosliner W, James P, Yancey A, Ritchie L, Studer N, Crawford P. Impact of a worksite wellness program on the nutrition and physical activity environment of childcare workers. American Journal of Health Promotion.

2010;24(3):186-189.

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21. Vaughn A. Shape NC annual Report 2014. Chapel Hill, NC: UNC Center for Health Promotion and Disease Prevention; January 2014.

22. Creswell, JW. Research Design: Qualitative quantitative, and mixed methods approaches. 4th Ed. Thousand Oaks, CA: SAGE Publication; 2014.

23. Creswell JW. Qualitative inquiry & research design: choosing among five approaches. 3rd ed. Los Angeles: SAGE Publications; 2013.

24. Marks J, Barnett LM, Foulkes C, Hawe P, Allender S. Using Social Network Analysis to Identify Key Child Care Center Staff for Obesity Prevention Interventions: A Pilot Study. Journal of Obesity. 2013;2013:919287. doi:10.1155/2013/919287.

Acknowledgements

This project grew out of my time spent working at Shape NC with the wonderful Jessica Burroughs, MSW/MPH and Alyssa Hill, MS. These two passionate professionals welcomed me onto their team and provided me with a supportive and collaborative learning environment, enabling me to learn so much about making change and building partnerships. I am also grateful for the support I received from Kim McCombs-Thornton, PhD, who helped me figure out how to ask the right questions. I am so appreciative to technical assistants Rachelle Hardison and Lexie Wolf who spent time orienting me to their communities. Most of all, I appreciate the dedicated childcare staff who took time out of their busy days to share with me their insights into health and wellness. Their commitment to giving kids a healthy start was palpable, and I was energized by each and every one of my conversations.

Finally, I am grateful for the support and suggestions I received from Professors Lewis Margolis and Dorothy Cilenti in the Department of Maternal and Child Health. I have been motivated, supported, and moved by my MSW/MPH cohort throughout my graduate education, as well as this paper-writing process. Lastly, the continual

encouragement I’ve gotten from my incomparable partner, Max Lazar, have kept me going all along.

Appendix A: Interview Questions about Workplace Wellness: Questions for Childcare Staff

Area of Interest Question(s)

Establishing Rapport and

Comfort •_• Name How long have you worked at the center? How long in childcare?

• Thank for agreeing to talk with me!

Personal Health • How would you describe your wellness and self-care currently? Wellness and self-care encompass the things you do to take care of yourself, physically and emotionally. • Possible use of self-assessment of health

behaviors, like the one used in Phase I, or another instrument.

Health Goals _• How would you describe your goals for your health in the short-term and long-term? Initiating Healthy Changes and

Behaviors • Reflecting back on the past few months, have you made any changes in your everyday health habits, such as drinking more water or aiming to take a walk a few times a week?

o If yes, what helped you get started and sustain those changes?

o If not, what small change might you be interested in making? What might help you to start?

Motivation _• What kind of things motivate you to take care of yourself, such as exercise, eating fruits and veggies, or not smoking? Perceptions of Workplace

Support for Healthy Habits • Do you believe your workplace contributes to your health? How so? Probes

• This can be in positive ways (prompt) or negative ways (prompt)

• Do you perceive your center as supportive of physical activity? How so?

• Do you feel like your childcare center, boss, and coworkers would support you if you were trying to eat healthier?

Experience with or Interest in

Workplace Wellness • Has your workplace ever initiated a wellness program? Probes

• If uncertain: Workplace wellness programs are usually center-wide programs that are designed to help teams improve health in some way.

• Things like a “fitness month” or a “steps challenge” might be examples, or a team- wide decision to try to drink more water and less soda.

• Some wellness programs include getting to meet with a nurse or a health educator and make health goals.

If yes:

• We know your work as a childcare provider is incredibly busy already, but did you choose to participate in the wellness program? Why or why not?

• It can be hard to sustain the energy around new habits, and sometimes they can slip away. Have you been able to stick with any new habits from your workplace wellness program?

• What were the highlights of the wellness programs? What kind of changes did you try out as a result of the workplace wellness program?

If No

• Are you interested in participating in a wellness program with your coworkers at your center?

• What might you like to learn or do? •

Barriers and Enabling Factors • In thinking about your health goals, what kind of support from your coworkers or director would help you achieve your goals or support you in making healthy changes? • It can be hard to make changes and keep

them going. What do you see as barriers to reaching your self-care goals?

Self-Efficacy _• How comfortable do you feel discussing physical activity with parents?

• Why? (regardless of answer)

• Can you tell me about a time you discussed physical activity with a parent?

• How comfortable do you feel discussing child nutrition with parents?

Follow up:

• Why? (regardless of answer) • Can you tell me about a time you

discussed nutrition with a parent? • How comfortable do you feel leading

physical activity? Follow up:

• Thinking about yesterday, if it was an “average” day at work, what kind of physical activity did you do throughout the day?

• How comfortable do you feel leading activities about nutrition, or weaving nutrition into the curriculum? Follow up

• Can you tell me about how you’ve blended nutrition or physical activity into other parts of center life? Questions for Directors

o Has your center taken part in any workplace wellness initiatives? For directors who have participated or currently participate in wellness initiatives:

§ What was the experience like for you and your team?

§ How have you built on that wellness experience and any changes you made as a team?

§ In your opinion, what does it take to build momentum for wellness among teams? What have been barriers to building momentum and obtaining buy-in?

§ What is the impact of healthy staff on children?

o We want to use this info to improve implementation of holistic wellness programming: what might help you and your team to create culture of health here?

o

For those who have not participated in any workplace wellness programming

§ What is your level of interest in initiating a wellness program among your team? What might you hope to achieve by doing this? § What is your perception of wellness and self-care at your site?

Questions for TA

• What resources are necessary to support staff in making and embedding healthy changes in the center environment?

• What successes have you observed in workplace/team wellness? Where have you observed barriers?