Implementation Challenges With the Child and Adult Care Food Program in Family Childcare Homes: A Qualitative Study.

BACKGROUND: The Child and Adult Care Food Program (CACFP) reimburses childcare programs for serving nutritious foods to young children and has potential as a strategy to improve young children's dietary quality. However, it is underutilized. OBJECTIVES: Using the Consolidated Framework for Implementation Research (CFIR), identify the systemic challenges family childcare home (FCH) providers face when implementing CACFP. METHODS: In this descriptive qualitative study, we conducted interviews with 33 English- or Spanish-speaking FCH providers operating in Massachusetts, including current, former, and never participants in CACFP. We elicited their perspectives on barriers and facilitators to implementing CACFP using a semistructured interview protocol with open-ended questions informed by CFIR. Interviews were transcribed and analyzed using a pragmatic thematic analysis approach. RESULTS: Four main themes were identified from the interviews: 1) frustration and fatigue across multiple implementation activities; 2) perception that CACFP's implementation requirements do not consider FCH providers' unique needs; 3) providers' commitment to reducing families' burdens; and 4) providers' discontinuing or avoiding participation when they perceive the burdens of participation to outweigh benefits. CONCLUSIONS: The range of activities required for FCH providers to implement CACFP results in their taking on roles and responsibilities that are outside of their main professional role, creating fatigue and conflict. More implementation support, in the form of food service infrastructure or increased flexibility for program operations, could help FCH providers participate in CACFP.