Wellness Child Care Assessment Tool (WellCCAT): A measure to assess the quality of written nutrition and physical activity policies in child care centers

Introduction: Nearly 60% of children ages 3-6 years are enrolled in child care centers. Policies governing child care practices have the potential to ensure that children are exposed to healthy foods, physical activity, and limited sedentary time. Currently, little is known about the quality of written nutrition and physical activity policies at individual child care centers.

Methods: Based on a review of existing nutrition, physical activity, and child care standards specific to preschool-aged children, an instrument was developed to measure the strength and comprehensiveness of written nutrition, physical activity, and wellness policies in child care centers. Psychometric properties were evaluated based on ratings of 94 independent policies from Connecticut child care centers participating in the Child and Adult Care Food Program (CACFP) in 2008.

Results: Interrater reliability was excellent: ICC 0.98 for total comprehensiveness score, ICC 0.94 for total strength score, and ICC 0.84 to 0.97 for subscales. Subscales were adequately internally reliable (Cronbach's α = 0.58 to 0.83). Comprehensiveness and strength scores were higher for Head Start centers than non-Head Start centers across most domains and higher for National Association for the Education of Young Children-accredited centers than non-accredited centers across some domains.

Discussion: Written program-level policies can improve practices and offer a means through which administrators and families can evaluate program performance. The WellCCAT provides a standardized method to assess and compare the quality of written wellness policies in and across child care centers and will be useful for studying predictors or consequences of child care policy.