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Table 1 Implementation models for Basic Go NAPSACC and Enhanced Go NAPSACC with their respective activities/strategies presented in sequence

From: The impact of basic vs. enhanced Go NAPSACC on child care centers’ healthy eating and physical activity practices: protocol for a type 3 hybrid effectiveness-implementation cluster-randomized trial

Basic implementationEnhanced implementation
Use local technical assistance, specifically Child Care Aware coaches, to assist center directors with implementation of Go NAPSACC.Use local technical assistance, specifically Child Care Aware coaches, to assist center directors with implementation of Go NAPSACC.
QIF Phase 1–Assessment and Adaptation Identification of implementation team
• Coaches will meet with center directors (individually) either in-person or by phone to identify potential staff (at least one administrator and two other staff) who can become champions for Go NAPSACC.
• Center directors will extend invites; coaches will monitor progress via quick check-ins by phone or email.
• Time required is estimated at 1 h.
• Intended to enhance Go NAPSACC adoption and implementation by increasing available resources (i.e., staff) to help with implementation, promoting a learning climate where staff input is essential, and expanding networks and communication by having more staff involved in developing the vision and sharing information.
 Readiness Check:
• Coaches will meet with each of their implementation teams to introduce the Readiness Check and create a plan for center-wide administration. The Readiness Check will assess the center’s readiness and identify potential barriers and facilitators. The Readiness Check is based off of the CFIR (REF) and assesses characteristics of the inner setting (e.g., communication networks, culture, implementation climate, readiness for implementation) and the staff involved (e.g., knowledge, beliefs, skills, and self-efficacy around child health promotion).
• The implementation team will distribute paper copies of the Readiness Check to all center administrators and staff, to be completed anonymously (using either sealed envelopes or a drop box).
• Coaches will compile results and present them back to each implementation team in an in-person meeting. Coaches will use results to facilitate a discussion about prioritizing capacity building needs.
  Example: Initial results from the Readiness Check may indicate potential challenges related to communication, priority given to child nutrition and physical activity (part of implementation climate), and staff knowledge and skills. After discussing results, the implementation team may decide to prioritize communication as good communication will also be essential for addressing the other challenges.
• Time required to plan and distribute the Readiness Check is estimated at 1 h. Time required to discuss results is estimated at 1–2 h.
• Intended to enhance Go NAPSACC adoption and implementation by promoting a learning climate where staff input is valued, acknowledging current limitations in readiness and capacity, and offering tailored supportive resources to address those limitations.
Registration:
 • Coaches will use their Consultant Tools to send email invites to center directors to register for their Go NAPSACC account.
 • Time required is 5 min.
 • Intended to support Go NAPSACC adoption by engaging center directors and providing them access to the Provider Tools.
QIF Phase 2 – Capacity Building and Planning
Registration:
• Coaches will use their Consultant Tools to send email invites to all members of their implementation teams to register for their Go NAPSACC account. Members from the same implementation team will have linked accounts, allowing all members of the team to see information about their center and its progress on the 5-step improvement process.
• Time required to register is about 5 min.
• Linked accounts intended to enhance Go NAPSACC implementation by solidifying the available resources (i.e., staff) to help with implementation and facilitating communication between team members.
Orientation:
 • Coaches will conduct educational outreach visits with center directors in either a one-on-one or small group meetings to introduce Go NAPSACC.
 • Standardized orientation slides (provided to all coaches) will cover the importance of healthy eating and physical activity in the development of the whole child, Go NAPSACC’s 5-step improvement process and its effectiveness, training on the Provider Tools, and the timeline for the next 12 months (encouraging two cycles through the improvement process). Time will also be provided for hands-on practice with Provider Tools.
 • Time required is about 1 h.
 • Intended to support Go NAPSACC adoption and implementation by highlighting the compatibility of Go NAPSACC with other center priorities (e.g., children’s cognitive development and social and emotional health); building awareness of Go NAPSACC’s strength, adaptability, low complexity, and design quality; developing self-efficacy on the use of Provider Tools; and offering a basic plan for implementing Go NAPSACC.
Orientation:
• Coaches will conduct educational outreach visits with implementation teams one-on-one during in-person meetings to introduce Go NAPSACC.
• Standardized enhanced orientation slides and talking points will be provided to coaches to guide the orientation and ensure that all critical topics are covered. The content will be similar to the orientation used for “Basic Go NAPSACC,” but it will incorporate tailored content based on prioritized capacity building needs. This tailored content will provide guidance on how to build capacity using natural opportunities during Go NAPSACC implementation.
   Example: Prioritized capacity building need based on Readiness Check results = Communication. During orientation, the coach will emphasize that good communication allows for a two-way exchange of ideas. The coach will ask the team to identify what channels are currently used for communication with staff and parents and how it could be improved. Finally, the coach will guide the team in planning a communication strategy for announcing the center’s participation in Go NAPSACC, ensuring that it facilitates two-way communication, targets both staff and parents, and makes use of effective communication channels.
• The orientation will also provide time at the end for implementation teams to develop a formal implementation blueprint with key milestones and division of duties over the next 10–12 months of Go NAPSACC implementation. To solidify their formal commitment, team members will sign the final plan.
• Time required is 1–1.5 h.
• Intended to enhance implementation of Go NAPSACC, use of evidence-based practices, and effectiveness on children’s health behaviors by beginning to address known challenges in the implementation context and thereby increasing readiness and capacity.
Monthly check-ins:
 • Center directors will use the provided timeline to guide their work through the Go NAPSACC program.
 • Coaches will check in with center directors monthly either in-person, by phone, or by email to remind directors about Go NAPSACC timelines and to offer facilitation. In-person visits will be strongly encouraged during check-ins that coincide with action planning. Standard agendas and prompts will guide these check-ins and allow the coach to assess progress on the current Go NAPSACC step (assess, plan, take action, learn more, keep it up) and address challenges encountered.
 • Check-ins will require about 10–30 min each; in-person check-ins may require up to 1 h.
 • Intended to support implementation of Go NAPSACC, use of evidence-based practices, and effectiveness on children’s health behaviors by prompting the center director about their execution of the program and providing resources (e.g., coach support) in support of changes.
QIF Phase 3 – Launch Go NAPSACC Implementation
Monthly check-ins:
• Implementation teams will use the plan created during their orientation to guide their work through the Go NAPSACC program.
• Coaches will check in with each team monthly (in-person, by phone, or by email) to remind them about Go NAPSACC timelines and to offer facilitation. Similar to “Basic Go NAPSACC,” in-person visits will be strongly encouraged during check-ins that coincide with Go NAPSACC action planning. In addition to the standard agendas and prompts about Go NAPSACC steps (assess, plan, take action, learn more, keep it up), coaches will have access to tailored support guidance that describes how to incorporate advice for prioritized capacity building needs throughout the improvement process.
   Example: Prioritized capacity building need = Communication. During the assessment check-in, the coach will prompt the team to share results of the initial self-assessment and elicit feedback from staff and parents about potential goals. During the planning check-in, the coach will inquire about staff and parent feedback received and advises on how to incorporate that into goal selection and action planning. The coach will also highlight critical steps in the action plan where there are natural opportunities to promote communication and how to find helpful resources in the tips and materials library to use for that communication. During take action check-ins, the coach will follow-up about these critical steps, offer guidance about any communication challenges encountered, and reminds the team about upcoming communication opportunities. During the keep it up check-in, the coach will encourage the team to reflect on the communication strategies used, how they impacted the effectiveness of their communications, and how the same strategies could be applied to help with communication about other issues (outside of Go NAPSACC).
• Tailored check-ins are estimated to require 20–30 min each; in-person check-ins may require up to 1 h.
• Intended to enhance implementation of Go NAPSACC, use of evidence-based practices, and effectiveness on children’s health behaviors by addressing known challenges in the implementation context and thereby increasing readiness and capacity.
 QIF Phase 4 – Apply Lessons Learned
Cross-center meetings:
• Coaches will facilitate cross-center implementation team meetings every 3 to 4 months. Coaches will have the option of hosting either in-person meetings or video conference calls. These meetings will bring together the implementation teams from different centers and use standard discussion guides to encourage reflection on their efforts, sharing of lessons learned, and peer support and encouragement.
• These meetings will require about 1 h each.
• Intended to enhance use of evidence-based practices as well as effectiveness on children’s health behaviors by building self-efficacy of implementation team members.