# Cross-Sectional associations between inner setting determinants of self-efficacy and intent to deliver a healthy eating and activity curriculum embedded in a community setting

## TL;DR

This study explores how factors like mission alignment and complexity affect parent educators' intent and confidence to deliver a healthy eating and activity curriculum in home visits.

## Contribution

The study identifies specific implementation context factors associated with provider intent and self-efficacy in delivering a health curriculum in community settings.

## Key findings

- Intent and self-efficacy to deliver HEALTH were significantly correlated (r = 0.46).
- White non-Hispanic educators reported lower intent and self-efficacy compared to other racial/ethnic groups.
- Implementation factors like mission alignment and evidence strength were positively linked to intent and self-efficacy.

## Abstract

Healthy Eating and Active Living Taught at Home (HEALTH) embeds healthy eating and activity content within Parents as Teachers (PAT), a national home visiting program. HEALTH is evidence based to prevent weight gain among mothers of young children. This secondary analysis aims to understand the factors associated with intention and self-efficacy to deliver HEALTH among parent educators (home vising providers).

This is a cross-sectional, secondary analysis of data from a trial evaluating the effectiveness of HEALTH when delivered by parent educators as part of usual practice. Parent educators completed surveys following training in the HEALTH intervention; demographic characteristics (including self-reported body mass index) were collected in a baseline survey (pre-training). Surveys were based on two implementation science frameworks: Consolidated Framework for Implementation Research (CFIR, implementation context) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM, implementation outcomes). Associations between intent to deliver HEALTH (intent) and self-efficacy (SE) to deliver HEALTH, implementation context constructs and demographic characteristics were explored using Pearson correlations (continuous variables) and t-tests (binary variable). Relationships were considered significant if the p-value was < 0.05.

Among the 149 parent educators who completed the survey, just over half identified as white/non-Hispanic (53%), while just over a third identified as Hispanic. Participants reported having worked at their site for a mean of 4.7 years (standard deviation, SD = 5.85), and the mean body mass index was 30.43 kg/m2 (SD = 7.35). There was a significant correlation between intent and SE, r = 0.46 (< 0.0001). Most demographic characteristics (e.g., body mass index, age) were not significantly correlated with either variable, however, intent and SE were both significantly lower among white non-Hispanic parent educators than among those identifying as another race/ethnicity. Several other implementation context constructs such as evidence strength and quality, mission alignment, appeal, openness, and relative advantage were positively correlated with both intent and SE; complexity was negatively correlated.

When implementing healthy eating and activity content within community settings, it is important to consider what factors may be related to provider intent and provider self-efficacy to deliver the content. Specifically, mission alignment, complexity, evidence strength and quality, and relative advantage may be important.

: NCT03758638 (https://clinicaltrials.gov/study/NCT03758638), registered Nov 29, 2018.