Factors Influencing the Food Purchases of Early Care and Education Providers

Published:January 27, 2017DOI:



      With the majority of US children enrolled in some form of early care and education, the settings for early care and education represent a valuable opportunity to positively impact young children’s diets and their interactions with food. Little evidence exists on how early care and education providers make food purchasing and service decisions for this population of young children.


      Our aim was to explore the factors that influence early care and education providers’ food purchasing and service decisions.


      A qualitative design consisting of individual, in-person, and semi-structured interviews with providers and on-site observations was used.


      Sixteen early care and education providers—selected across a variety of characteristics that might affect food selection (eg, size of site, participation in reimbursement programs, presence of staff assigned to foodservice) using maximum variation purposive sampling—based in the Puget Sound region, Washington, were interviewed from June to September 2014.

      Main outcome measure

      Provider perspectives on food purchasing and service decisions.

      Statistical analyses performed

      Inductive analysis of transcribed interviews using TAMS Analyzer software (GPL version 2, 2012) to identify themes.


      Ten main influencers emerged from the data. These were grouped into four categories based on an ecological framework: macro-level environments (ie, regulations; suppliers and vendors, including stores); physical environment and settings (ie, organizational mission, budget, and structure; the facility itself); social environments (ie, professional networks; peers; the site-specific parent and child community); and individual factors at both a provider and child-level (ie, providers’ skills, behaviors, motivations, attitudes, knowledge, and values; child food preferences; and, child allergies). A model was then developed to identify potential pathways of intervention and underscore the need for a comprehensive approach to improve early care and education nutrition.


      This study suggests that a more system-based understanding and approach—one that accounts for an array of influencers and their interactions—is necessary to take advantage of opportunities and address barriers to improving early care and education-based nutrition.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Birch L.
        Devleopment of food preferences.
        Annu Rev Nutr. 1999; 19: 41-62
        • Neelon S.B.
        • Briley M.E.
        American Dietetic Association. Position of the American Dietetic Association: Benchmarks for nutrition in child care.
        J Am Diet Assoc. 2011; 111: 607-615
      1. Laughlin L; US Census Bureau, Department of Commerce. Who's minding the kids? Child care arrangements: Spring 2011. Published April 2013. Accessed October 24, 2016.

        • Kaphingst K.M.
        • Story M.
        Child care as an untapped setting for obesity prevention: State child care licensing regulations related to nutrition, physical activity, and media use for preschool-aged children in the United States.
        Prev Chronic Dis. 2009; 6: A11
        • Moore H.
        • Nelson P.
        • Marshall J.
        • et al.
        Laying foundations for health: Food provision for under 5s in day care.
        Appetite. 2005; 44: 207-213
        • Larson N.
        • Ward D.S.
        • Neelon S.B.
        • Story M.
        What role can child-care settings play in obesity prevention? A review of the evidence and call for research efforts.
        J Am Diet Assoc. 2011; 111: 1343-1362
        • Ball S.C.
        • Benjamin S.E.
        • Ward D.S.
        Dietary intakes in North Carolina child-care centers: Are children meeting current recommendations?.
        J Am Diet Assoc. 2008; 108: 718-721
      2. Hamilton W, Burstein N, Crepinsek MK; USDA Economic Research Service, USDA Food Assistance & Nutrition Research Program. Reimbursement tiering in the CACFP: Summary report to Congress on the Family Child Care Homes Legislative Changes Study. Published March 2002. Accessed October 24, 2016.

      3. Payne E, Igoe B. Washington State survey of nutrition and physical activity practices and policies in child care report. University of Washington Center for Public Health Nutrition. Updated December 2014. Accessed October 24, 2016.

        • Lynch M.
        • Batal M.
        Factors influencing childcare providers' food and mealtime decisions: An ecological approach.
        Child Care Pract. 2011; 17: 185-203
        • Miles M.B.
        • Huberman A.M.
        • Saldaña J.
        Qualitative Data Analysis: A Methods Sourcebook.
        3rd ed. Sage Publications, Washington, DC2014
        • Harris J.E.
        • Gleason P.M.
        • Sheean P.M.
        • Boushey C.
        • Beto J.A.
        • Bruemmer B.
        An introduction to qualitative research for food and nutrition professionals.
        J Am Diet Assoc. 2009; 109: 80-90
      4. TAMS: Text Analysis Markup System: An Open Source Qualitative Analysis System [computer program]. GPL Version 2. Matthew Weinstein; 2012. Accessed October 8, 2016.

        • Story M.
        • Kaphingst K.M.
        • Robinson-O'Brien R.
        • Glanz K.
        Creating healthy food and eating environments: Policy and environmental approaches.
        Annu Rev Public Health. 2008; 29: 253-272
      5. US Department of Agriculture, Food and Nutrition Service. Crediting handbook for the Child and Adult Care Food Program. FNS-425. Effective January 2014. Accessed October 24, 2016.

        • Robles B.
        • Wood M.
        • Kimmons J.
        • Kuo T.
        Comparison of nutrition standards and other recommended procurement practices for improving institutional food offerings in Los Angeles County, 2010-2012.
        Adv Nutr. 2013; 4: 191-202
        • Lindsay P.
        • Lindsay C.H.
        Teachers in preschools and child-care centers−Overlooked and undervalued.
        Child Youth Care Q. 1987; 16: 91-105
        • Fees B.
        • Trost S.
        • Bopp M.
        • Dzewaltowski D.A.
        Physical activity programming in family child care homes: Providers' perceptions of practices and barriers.
        J Nutr Educ Behav. 2009; 41: 268-273
        • Fleischacker S.
        • Cason K.
        • Achterberg C.
        “Always a vegetable at dinner”: A fruit and vegetable qualitative study with primary care providers of preschoolers enrolled in an inner-city, Head Start childcare center.
        J Hunger Environment Nutr. 2007; 1: 55-68


      J. J. Otten is an assistant professor, Nutritional Sciences Program, Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle.


      T. Hirsch is an associate professor, Division of Design, University of Washington School of Art, Art History, and Design, Seattle.


      C. Lim is a research associate, Group Health Research Institute, Group Health Cooperative, Seattle, WA; at the time of the study, she was a graduate student, Division of Design, University of Washington School of Art, Art History and Design, Seattle.