Table 5 Facilitators of healthy eating and physical activity in preschool-aged children in two rural communities

Family level:

Efforts by parents to promote healthy eating in children

Role-modeling by some parents

“I have learned that what you do for children will follow. Like they will follow whatever you do because they think is right. Your mom, like you know, they think that what (you do) is golden.” (Parent)

Efforts to provide healthy foods by some parents

“So, we value trying new foods and serving healthy foods as much as possible. Sugar-free, low-carb, high in protein and healthy fats. And I would say that we eat from a variety of cultures and prepare foods from a variety of cultures.” (Childcare provider)

Organization level:

Ongoing health promotion efforts in the community

Health promotion efforts at childcare programs

“I do try to encourage more whole foods because it's so much better for you. And the kids try it, they'll try at the daycare. They're encouraged when I encourage them to try something new or they see me eating it or then well she eats it, [so I’ll eat it.]” (Childcare provider)

“Plus, we have the cafeteria that provides a meal. Right now, they're offering free lunch, free breakfast, and also, something that they call dinner bags for all of our kids right now. That is something great… They try to send a fruit and a vegetable daily, along with a protein and a dairy item.” (Childcare provider)

Health promotion efforts through other community organizations

“We’ve also had a recent partnership … where we provided nutrition support classes. All of these programs, again, it's not just about throwing food at people but it's about making sure that people have things like sharp knives so they can process, they can actually cut fresh produce. Making sure they have cutting boards; making sure they know how to store onions versus potatoes so that they last longer.” (Stakeholder)

Community level:

Existing community assets and resources

Existing resources in the community that can support healthy eating and physical activity

“The park is owned by the city; it is utilized a lot... . So, there are festivals held there. Just about any kind of community event is held there. This is pre-COVID of course. There is also the Farmers’ Market held every Saturday from May until September… it is definitely our biggest area for fitness/physical activity.” (Stakeholder)

“[County] has an excellent Farmers’ Market, so I try to promote those as much as I can. Because there are good prices. You can go and get fresh fruits and vegetables at not a bad price at the Farmers’ Market. Promoting those things that, I think, in everybody’s mind, if you eat healthy it’s going to be super expensive because you have to go organic in order to eat healthy, but that’s not necessarily true.” (Stakeholder)

“The hospital definitely promotes healthy living and physical activity. Like I said before, we are connected with the park, and we try to strengthen the park as much as we can. We offer grant support; we help facilitate the grant that they just received this year.” (Stakeholder)