Table 2.

Formative Research to Inform CA-CORD Intervention

Sector and method	Selected findings
Families (parents)
Four Spanish-language focus groups (n=36) and four English-language focus groups (n=32) through CDSDP and ICPHD	Cost is a barrier to physical activity. Parents can be better role models. Doctors and other healthcare providers are the most credible source of weight and health information. Schools and early care and education centers can do more to promote healthy lifestyles.
Healthcare
One English-language focus group with healthcare providers (n=4) through CDSDP	Parents lack education and fail to acknowledge child's weight issues. Healthcare providers need more training on how to discuss child weight issues with parents.
One bilingual focus group with CHWs/promotores (n=14) through CDSDP	Parents lack education and resources to lead a healthy lifestyle. Community does not support a healthy lifestyle. Support for change needs to come from multiple sources and in multiple forms, such as policy and system changes.
One English-language focus group with WIC Providers (n=11) through CDSDP and ICPHD	Parents lack education and resources to lead a healthy lifestyle. Cultural beliefs make behavior change difficult and make it difficult to discuss weight issues with parents. Messages and other interventions need to be consistent across people and settings.
Early care and education
Three English-language focus groups with early care and education providers (n=6) through ICPHD	Obesity is the result of multiple factors, including unhealthy behaviors. The problems are many: Media influences parents; schools offer too much sugar; and restaurants try to sell foods. Important to be a role model and do what you want children to do
School
Thirteen English-language interviews with elementary school principals through IBACH	Drinking water is accessible and students can bring water bottles, but some drinking fountains not in good working order. Most school fundraisers involve selling unhealthy foods during nonschool hours.
Two English-language interviews with food service directors through IBACH	Nutrition staff tend to be the “enforcers” making everyone accountable to follow federal guidelines. “I have become the ‘no’ person.” Mixed message for school to allow unhealthy foods to be sold outside of school hours
Community
Five English- and two Spanish-language interviews with restaurant owners/managers through IBACH	No child menus available in independent restaurants, thus a potential target for change.
Seven English- and seven Spanish-language interviews with restaurant employees through IBACH	Young children do make decisions on their own in restaurants. Marketing materials need to reach children.
Twenty-one English- and five Spanish-language interviews with restaurant customers through IBACH	More likely to order a fruit and vegetable side dish versus a low-fat item. Like the idea of adult menu options, but in smaller portion sizes
Three English-language interviews with community recreation organizations through IBACH	Biggest barriers for offering physical activity programs for children are finances, equipment, and skilled staff. Biggest barriers for offering healthy eating opportunities for children are lack of or limited kitchen facilities, finances, and appropriate equipment.

CA-CORD, the Imperial County, California, Childhood Obesity Research Demonstration study; IBACH, Institute for Behavioral and Community Health; CDSDP, Clínicas de Salud del Pueblo, Inc.; ICPHD, Imperial County Public Health Department.