Peer-reviewed article
Deimplementation of inappropriate feeding practices in early care and education: a Hybrid Type 3 cluster-randomized trial.
Massey-Swindle T, Rutledge JM, Rushing T, Zhang D, Curran GM ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tests a program called WISE Words designed to reduce harmful feeding practices in early childhood education settings in Arkansas and Louisiana. Children in these settings consume many meals annually, but educators often use practices like pressuring children to eat or using food as reward, which can harm children's ability to self-regulate eating and increase obesity risk. The trial will randomly assign 88 early care and education sites to receive WISE Words immediately or after two years, measuring changes in feeding practices, child eating behaviors, and body weight.
Key points
- WISE Words includes six strategies: dynamic training using improvisation, peer learning with goal setting, external facilitation, audit and feedback, environmental reminders, and tailored materials
- Inappropriate feeding practices in early care and education settings include pressuring children to eat, rushing mealtimes, and offering food as reward
- Children consume up to 500 meals annually in early care and education environments
- The study measures both adoption of evidence-based practices and de-adoption of harmful practices at 12 and 24 months
- Study examines trust as a potential mechanism through which deimplementation strategies work
Limitations
This is a protocol paper describing a planned trial rather than results, so it cannot report whether WISE Words actually works or what outcomes were achieved. The study has not yet been completed, so no findings on effectiveness, sustainability, or mechanisms of change are available.
Abstract
Background The science of deimplementation-reducing harmful or ineffective practices-has focused almost exclusively on clinical prescribing, with no studies conducted in community or educational settings. Early care and education (ECE) settings offer a strategic venue for shaping eating behaviors, with children consuming up to 500 meals annually in these environments. However, ECE educators routinely use feeding practices that undermine self-regulation, including pressuring children to eat, rushing mealtimes, and offering food as reward. These practices contribute to food aversions, diminished self-regulation, and obesity risk. Methods We will conduct a Hybrid Type 3 cluster-randomized trial evaluating a co-designed deimplementation strategy package (WISE Words) across 88 ECE sites in Arkansas and Louisiana. Sites will be randomized 1:1 to WISE Words or usual practice, with usual practice sites receiving the intervention after two years (waitlist design). WISE Words includes six strategies: dynamic training using improvisation methods, peer learning collaboratives with goal setting, external facilitation, audit and feedback, environmental reminders, and tailored educational materials. The primary outcome is de-adoption of inappropriate feeding practices measured via direct mealtime observation (Table Talk). Secondary outcomes include adoption of evidence-based practices, acceptability, appropriateness, and sustainability at 12- and 24-months post-intervention. Child outcomes include Body Mass Index, skin carotenoid levels (Veggie Meter) willingness to try new foods (observed) and food neophobia (teacher and caregiver report). An explanatory sequential mixed methods design will test mechanisms of change derived from the Implementation Trust Building Theory of Change examining whether trust mediates strategy effects on outcomes. Discussion This trial extends deimplementation science into community settings by targeting culturally embedded behavioral practices rather than clinical prescribing behaviors. Results will inform approaches to shifting entrenched practices in ECE and similar settings while testing trust as a deimplementation mechanism. Sustainability assessments will address a notable gap, as few studies have examined whether deimplementation effects persist. Trial registration NCT07101321, July 20, 2025.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- WISE Words deimplementation strategy package comprising six components: dynamic training using improvisation methods, peer learning collaboratives with goal setting, external facilitation, audit and feedback, environmental reminders, and tailored educational materials
- Population
- Early care and education sites and educators in Arkansas and Louisiana; child outcomes measured in enrolled children
Key finding
This is a protocol paper; no outcomes have been measured yet