A cluster-randomized trial protocol tests whether a structured intervention package can eliminate harmful feeding practices in early care settings, where children consume roughly 500 meals per year. This is the first rigorous study applying deimplementation science outside clinical settings.
This is a trial protocol rather than completed findings, but it represents a significant methodological shift in implementation science. Researchers are launching an 88-site cluster-randomized trial across Arkansas and Louisiana to test whether harmful feeding practices in early care and education (ECE) settings can be systematically reduced through a structured intervention called WISE Words.
The problem being addressed is concrete. ECE educators routinely use feeding practices that contradict what research shows supports healthy eating: pressuring children to finish plates, rushing meals, and using food as behavioral reward. These practices are documented contributors to food aversions, diminished internal hunger cues, and elevated obesity risk in childhood. With children consuming approximately 500 meals annually in ECE environments, these settings represent a high-leverage point for shaping long-term eating behaviors and metabolic health.
WISE Words bundles six implementation strategies: dynamic training using improvisation-based methods (rather than standard lecture), peer learning collaboratives with structured goal setting, external facilitation, regular audit and feedback on observed behaviors, environmental reminders in classrooms, and tailored educational materials. Half of the 88 sites receive the full intervention immediately, while the other half serve as controls with waitlist access after two years. This design allows researchers to measure both immediate effects and whether change persists.
The trial is tracking multiple outcome layers. Primary outcomes focus on the deimplementation target: actual reduction in observed inappropriate feeding practices during mealtimes, measured through a structured observation tool called Table Talk. Secondary outcomes measure whether sites simultaneously adopt evidence-based alternatives, and whether educators find the intervention acceptable, appropriate, and sustainable to continue beyond the study period. Child-level outcomes include BMI, dietary diversity indicators (skin carotenoid levels via the Veggie Meter device), observed willingness to try new foods, and teacher-reported food neophobia. Critically, the trial examines mechanisms of change through an explanatory mixed-methods design grounded in Implementation Trust Building Theory, testing whether increased trust in the intervention mediates its effects on practice change.
If you work in early care education, this trial signals that harmful mealtime practices are now being systematically studied and targeted for change. The evidence is accumulating that pressuring children to eat, controlling portions, and using food as behavior management undermine self-regulation around eating. This protocol suggests the field is moving toward structured, testable methods to shift these embedded practices rather than relying on awareness alone.
For parents, the practical implication is that the quality of mealtime practices at your child's daycare or preschool likely matters for long-term eating behaviors and metabolic health. The practices being targeted in this trial are common enough that many caregivers encounter them. If you're evaluating or communicating with early care settings, understanding that practices like "finish your plate" or using snacks as behavioral incentives have become recognized targets for improvement is relevant context.
The trial's focus on sustainability and long-term persistence is also noteworthy. Many implementation studies measure change immediately after an intervention, then disappear. This protocol specifically examines whether reduced inappropriate practices and adoption of better alternatives persist at 12 and 24 months post-intervention, addressing a documented gap in the literature.
| Parameter | Details |
|---|---|
| Study type | Cluster-randomized controlled trial (protocol) |
| Sample | 88 early care and education sites across Arkansas and Louisiana |
| Design | 1:1 randomization; waitlist control design with 2-year delayed access |
| Intervention | WISE Words: 6-strategy implementation package (dynamic training, peer collaboratives, external facilitation, audit/feedback, environmental reminders, tailored materials) |
| Primary outcomes | De-adoption of inappropriate feeding practices (direct observation via Table Talk) |
| Secondary outcomes | Adoption of evidence-based practices; acceptability, appropriateness, and sustainability; child BMI, skin carotenoid levels, food neophobia |
| Theoretical framework | Implementation Trust Building Theory of Change |
| Study status | Protocol; enrollment anticipated 2025 (NCT07101321) |
| Significance | First rigorous deimplementation trial conducted in community/educational settings rather than clinical prescribing contexts |
Stein DJ, et al. Deimplementation of inappropriate feeding practices in early care and education: a Hybrid Type 3 cluster-randomized trial. *Implementation Science*. 2025. PubMed.
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