A RE-AIM Analysis of Better Together: A Multi-Level Program to Improve Nutrition and Physical Activity in Early Care and Education in Four States

BACKGROUND: Systemic barriers contribute to challenges in implementing sustainable improvements in early care and education (ECE) health promotion practices, including fragmented state systems, limited organizational capacity, and a lack of accessible, high-quality professional development. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this study evaluated the Better Together approach-a multi-level quasi-experimental program aimed at enhancing health promotion practices in ECE programs. METHODS: Better Together, developed by Nemours Children's Health and University of North Carolina Chapel Hill Community Health & Wellness Resource Team, used organizational- and systems-level approaches to improve ECE health promotion practices. Learning collaboratives (organizational level) addressing ECE health practices were delivered by trained consultants. State partners coordinated efforts to impact state systems change using the CDC's Spectrum of Opportunities 2.0 Framework (systems-level). Surveys and program data were collected to assess reach, effectiveness, adoption, and implementation. Descriptive statistics were used to evaluate RE-AIM outcomes. RESULTS: Four states implemented Better Together learning collaboratives, reaching 1,078 staff from 533 ECE programs. Across states, ECE program completion of initiative components ranged from 58.0 to 94.7% (adoption). Consultants implemented planned sessions (n = 26; implementation). On average, ECE programs experienced a 15.1% increase in health-promoting practices (range 11.8-17.5%; effectiveness). Partner groups generated 10 state system-level action plans to promote ECE health practices in perpetuity (maintenance). CONCLUSIONS: The RE-AIM evaluation of the Better Together program showed positive results. It reached a significant number of ECE programs, leading to increased health-promoting practices, policies, and environments, as well as initiated state-level ECE systems change to sustain support.