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Culture of Wellness in Preschools: Nutrition Education and Physical Activity (COWP NE/PA) is a direct education and PSE change intervention designed to increase fruit and vegetable intake and physical activity levels in children and their parents, as well as to reduce their risk of obesity and chronic disease. In addition to providing nutrition education and physical activity in the classrooms, COWP works with Head Start Agencies and other preschool centers to identify and change school PSEs around nutrition and physical activity by working with preschool wellness teams to impact the health of the students and their families. COWP is also designed to improve the likelihood that persons eligible for SNAP will make healthy food choices within a limited budget and choose physically active lifestyles consistent with current Dietary Guidelines for Americans and the USDA food guidance.  

Intervention Target Behavior: Healthy Eating, Physical Activity and Reducing Screen Time  

SNAP-Ed Strategies: Direct Education, PSE Change 

Intervention Reach and Adoption

COWP NE/PA targets preschool children and parents in childcare/classroom settings. Since 2017, COWP NE/PA has expanded to partner with approximately 135 preschools in 16 counties. Partner sites reach participants via direct (NE/PA classroom lessons) and indirect programming (NE family letters). By partnering with preschools who serve individuals eligible for SNAP, we can ensure the program is reaching the intended audience. The preschool setting is ideal for early childhood obesity prevention programs as many preschool-aged children spend time in center-based care where children attending full-time may consume up to two-thirds of their daily caloric intake in this environment.  

Settings: Pre-K & Childcare

Age/Population Group: Preschool, Parents/Caregivers

Race: All

Ethnicity: All 

Intervention Components
  • The NE component of the intervention has 15 lessons to choose from. At least 9 of the lessons should be implemented within a school year in order to achieve program outcomes.  
  • The PA component has PA activities using portable play equipment and music. PA activities must be incorporated into the lesson plans regularly throughout the school year to achieve intended outcomes.  

COWP staff train preschool staff in the beginning of each academic year. Post-training evaluations assess teacher confidence in curriculum implementation and identify any further training and technical assistance needs. Classroom observations and delivery tracking logs monitor fidelity. Teacher feedback forms improve program quality.  

Other components that are highly recommended are: The COWP PSE change process COWP PSE intervention as well as Parent Wellness Workshops (Please contact the original developer for access to this resource. For additional questions, please contact, both components are featured in the SNAP-Ed Toolkit. 

Intervention Materials

Listed are the intervention materials available: 

  • Toddler and Pre-K classroom-based nutrition education/physical activity curriculum (15 lessons) 
  • Family letters with recipes and health tips (English/Spanish)  
  • Culture of Wellness in Preschools: Policy, System and Environment Change Process (COWP-PSE) (Please contact the original developer for access to this resource. For additional questions, please contact 

The following items are available upon request:  

  • Toddler classroom-based nutrition education curriculum
  • Pre-K classroom-based nutrition education curriculum  
  • Evaluation tools (current and prior years) 

 The listed materials are available on the COWP website.  

Evidence Summary

Formative Tools:  

  • Focus group data: 23 focus groups were conducted with preschool teachers to identify needs, barriers and facilitators to program implementation. Meetings minutes from a day-long retreat with teachers who had used the curriculum in preschool and kindergarten classrooms informed adaptations  

 Process Tools:  

  • Teacher feedback forms administered with each NE lesson to make continuous quality improvements  
  • Teachers are surveyed annually to assess acceptability of the curriculum  
  • COWP Lesson Observation Form: COWP staff use this tool to observe lessons in the classroom, to gather feedback on fidelity to the curriculum, and to inform potential modifications throughout the year  

 QI Strategy:  

  • We utilize the Plan, Do, Study, Act (PDSA) quality improvement framework to continuously collect data, make small changes, and study these changes to improve our curriculum and ensure it serves the target audience. 

 Outcomes that occurred include:  

  • Leveraging of funds (in-kind donation of teacher time)  
  • Aligning curriculum with academic standards (Colorado Academic Standards, Teaching Strategies Gold, and Head Start/Early Learning Framework)  
  • Staff reporting an increase in healthy eating and physical activity because of the program 
  • Delivering materials to each school provided opportunities for strong relationship-building with school staff and positioned COWP for more impactful work with parent engagement and PSEs  
  • Providing ongoing training to implement curricula and increasing staff buy-in and commitment  

Lessons Learned/Recommendations:   

  • Quarterly observations of NE/PA Lesson delivery in the classrooms are needed  
  • Ongoing Technical Assistance provided for new teachers  
  • Alignment of COWP NE/PA curriculum with COWP PSE curriculum to support the sustainability of these components  
  • Identification and training of a center-specific wellness champion to help promote program delivery 

Manuscripts currently in press with peer-reviewed journals:

 Evidence Base: Research-tested 

Evaluation Indicators

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

 Readiness and Capacity - Short Term (ST)Changes - Medium Term (MT)Effectiveness and Maintenance - Long Term (LT)Population Results (R)
Individual MT1, MT3  
Environmental Settings MT5, MT6  
Sectors of Influence    

MT1: Healthy Eating 

  • MT1l, MT1m: Increased consumption of fruits and vegetables using Plate Waste methodology to measure children's consumption of fruits and vegetables before and after the COWP NE intervention.  

MT3: Physical Activity and Reduced Sedentary Behavior 

  • MT3b: Increased moderate to vigorous physical activity as demonstrated by the SOPLAY method, demonstrating a 20% increase of overall MVPA scores from 2012 - 2016. Increased child vigorous activity as demonstrated by accelerometer data.  

MT5: Nutrition Supports  

  • MT5a: Number and proportion of sites or organizations that make at least one change in writing or practice to expand access or improve appeal for healthy eating using the COWP's Evidence-Based PSE Menu (Please contact the original developer for access to this resource. For additional questions, please contact Since 2017, COWP has worked with 135 sites in 16 Counties. 

 MT6: Physical Activity and Reduced Sedentary Behavior Supports 

  • MT6a: Number and proportion of sites or organizations that make at least one change in writing or practice to expand access or improve appeal for physical activity or reduced sedentary behavior using the COWP's Evidence-Based PSE Menu (Please contact the original developer for access to this resource. For additional questions, please contact Since 2017, COWP has worked with 135 sites in 16 Counties. 
Evaluation Materials

Outcome Evaluation Tools: 

Formative Evaluation Tools:  

  • Focus Group Protocols  
  • All- Day Retreat Agenda and Meeting Minutes   

Process Evaluation Tools:  

  • NE/PA Classroom Observation Tool 
  • Teacher Feedback Forms  

PSE Change Evaluation Tools:  

  • The Culture of Wellness in Preschools: Policy, System and Environment Change Process (COWP) Evidence-Based PSE Menu/Checklist
Success Story
Additional Information

Website: The COWP NE/PA website ( includes information about the Culture of Wellness in Preschools programs and NE/PA resources. 

Contact Person(s):

Deanna LaFlamme 

Director, Rocky Mt. Prevention Research Center, Colorado School of Public Health

Phone: 303-724-4457



*Updated as of August 23, 2023

Resource Type
Age/Population Group
Evaluation Framework Indicators
Intervention Outcome Levels
SNAP-Ed Strategies
Evidence Base