Go NAPSACC

UNC Center for Health Promotion & Disease Prevention

Overview

NAPSACC/Go NAPSACC is a direct education and PSE change intervention designed to enhance nutrition and physical activity practices in early care and education programs by improving the:

  • supports for breastfeeding, healthy meals, farm to ECE, and oral health;
  • amount and quality of indoor and outdoor physical activity;
  • provider–child interactions around food and physical activity;
  • educational opportunities for children, parents, and providers; and
  • program policies related to breastfeeding, nutrition, oral health, indoor and outdoor physical activity, and screen time.

Target Behavior: Breastfeeding, Healthy Eating, Physical Activity

Intervention Type: Direct Education, PSE Change

Intervention Reach and Adoption

Go NAPSACC targets child care policy, practice and environmental influences on nutrition and physical activity behaviors in young children. The original NAPSACC program was designed for Child Care Health Consultants to use with the centers they serve and focused on best practices for promoting healthy eating and physical activity habits in children ages 3–5.  The online Go NAPSACC tools can be used directly by ECE programs, with varying amounts and types of support from technical assistance consultants, thus lending more flexibility to the model. The seven updated Go NAPSACC self-assessments and online tools cater to both centers and family child care homes and provide guidance for promoting healthy habits in children ages birth to five. Over the history of the program, the self-assessments and/or entire change process have been used by groups in at least 30 states and internationally.

Setting: Child care

Target Audience: Preschool (<5 years old)

Race/Ethnicity: All

Intervention Components

5 Steps of Go NAPSACC


The 5 Steps of Go NAPSACC

1. Assess: Take a Self-Assessment and see how your program can improve.

2. Plan: Use our Action Planning tool to set yourself up for success!

3. Take Action: Use our Tips and Materials to put your plan into action!

4. Learn More: Take a Training and learn new skills to help kids be healthy.

5. Keep It Up: Celebrate your progress and plan your next move.

Follow these steps to success in child nutrition, breastfeeding and infant feeding, farm to ECE, oral health, infant and child physical activity, outdoor play and learning, and screen time.

Technical assistance consultants can offer great guidance every step of the way.


 

Intervention Materials

The original NAPSACC materials, including a handbook for technical assistance professionals implementing the program, the original self-assessment instrument, action planning materials, and resources for staff and family education, are available for free download at http://centertrt.org/?p=intervention&id=1091&section=1. Updated self-assessments can be found at https://gonapsacc.org/resources/nap-sacc-materials.

Go NAPSACC is an updated, interactive version of the original program, including online self-assessments, interactive goal-setting and action planning support, and an online library of helpful documents and videos. Go NAPSACC is available to ECE programs in regions or states in which a state agency or other organization has contracted with the UNC Center for Health Promotion and Disease Prevention for access to the site. Along with site access for ECE programs, partnering agencies/organizations receive reports of self-assessment score and action planning goal data for ECE programs who participate under their contract. Please contact Go NAPSACC at gonapsacc@unc.edu for more information about pricing and features.

Intervention Costs

Annual membership price for contracts is $25,000.

Evidence Summary

The NAPSACC intervention was developed and evaluated first in the field as a practice-based intervention and subsequently studied in a larger randomized controlled trial involving 30 consultants assigned to 84 child care centers (Ward, 2008). Centers were randomly assigned to receive the intervention or serve as controls. Among the 82 centers remaining in the study, 56 were randomly assigned to receive the intervention. Forty-one intervention centers (73%) completed most (>75%) or all of the intervention components. The program outcomes discussed below are based on this subset of intervention sites as compared to controls. 

Intervention Effect (overall environment and policy assessment):  Child care centers completing most or all of the intervention components improved their nutrition and physical activity policies and practices more than control facilities. Changes in the total child care nutrition environment scores (16% increase) were statistically significant. 

Individual Item Scores in Nutrition and Physical Activity: Because the NAPSACC intervention allows some flexibility in the areas centers could target for change and because the observation instrument is scored using averages of sub-areas to obtain the Nutrition and Physical Activity scores, an additional assessment of an intervention effect was measured using all of the individual 75-items from the observation instrument. Nutrition effects were assessed with 51 items and physical activity with 24 items. The mean change in nutrition scores was a 4.3 point improvement in the intervention centers compared to -0.5 change in the controls; for physical activity, scores increased by 3.6 in the intervention centers compared to a -0.2 change in the controls. Both nutrition and physical activity improvements were statistically significant. 

The impact of the original NAPSACC model has also been shown through studies by Drummond (2009) and Alkon (2014). 

Between 2014 and 2015, a small randomized control trial was conducted to evaluate the impact of Go NAPSACC, specifically in the area of Child Nutrition. Over a period or four months, thirty-one center directors in rural North Carolina used the online tools with low-intensity support (average of 1 hour/month/provider) from trained local technical assistance consultants. Centers that participated in Go NAPSACC saw a 7.5% increase in their overall nutrition environment scores, which approached statistical significance when compared to control centers. 

Healthy Eating Research has labeled NAPSACC as showing the best evidence for reducing childhood obesity risk in children under age 5 (Kenney, 2019). A recent CHOICES (Childhood Obesity Intervention Cost-Effectiveness Study) analysis found the integration of NAPSACC into Arkansas Better Beginnings Quality Rating Improvement System to be an investment in child health, that could result in the training of over 1,300 child care directors and staff and lead to healthier ECE environments for 116,000 children over the next decade (Adams, 2021). 

  • Kenney E, Cradock A, Resch S, Giles C, Gortmaker S. The Cost-Effectiveness of Interventions for Reducing Obesity among Young Children through Healthy Eating, Physical Activity, and Screen Time. Durham, NC: Healthy Eating Research; 2019. Available at: http://healthyeatingresearch.org.
  • Adams B, Sutphin B, Betancourt K, Balamurugan A, Kim H, Bolton A, Barrett J, Reiner J, Cradock AL. Arkansas: Creating Healthier Child Care Environments: Nutrition and Physical Activity Self-Assessment for Child Care (NAP SACC) in the Quality Rating Improvement System (QRIS) {Issue Brief}. Arkansas Department of Health, Little Rock, AR, and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; May 2021. For more information, please visit www.choicesproject.org

Classification: Research-tested

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

Readiness and Capacity – Short Term (ST) Changes – Medium Term (MT) Effectiveness and Maintenance – Long Term (LT) Population Results (R)
Individual ST1, ST3, ST4 MT1, MT3, MT4 LT1, LT3, LT4
Environmental Settings ST5 MT5, MT6 LT5, LT6, LT10
Sectors of Influence MT9

Evaluation Materials

The self-assessment is completed a second time (after 6 months to a year) to see where improvements have or have not been made.  At this time Action Plans can be revised to include new goals and objectives and technical assistance can continue.

Additional Information

Website: The Go NAPSACC website (https://gonapsacc.org/) includes information on the program, downloadable self-assessments for childcare centers and family child care homes, and access to the online tools for participating ECE programs.

Contact Person:
Falon Tilley Smith, PhD

Managing Director of Research Dissemination

UNC Center for Health Promotion and Disease Prevention

Phone: 919-843-3863

Email: ftilley@unc.edu
gonapsacc@unc.edu