Hawai’i Gathers Information About Early Child Care by Using a Carbon-Copy Survey

Jennifer Ryan, School Health Coordinator

This is the first time I have seen carbon paper used in at least a decade, but it worked really well for our needs. It didn’t create too much burden on participants and will hopefully facilitate our early childhood obesity prevention efforts.
- Jennifer Ryan, School Health Coordinator

At A Glance

The Hawai’i State Department of Health (DOH) and the Healthy Hawai’i Initiative Evaluation Team (HHIET) created a carbon paper survey for 2015 Hawai’i Association for the Education of Young Children (HAEYC) Conference attendees. The quiz also included demographic variables, and top planning priorities. The survey was effective in gathering information from a hard-to-reach audience. The DOH is providing technical assistance to facilities identified as “ready to start.”

Public Health Challenge

Accessing child care providers to offer technical assistance is difficult. There are over 1,000 licensed early child care centers in Hawai’i, but the early child care system in Hawai’i includes more than just licensed providers. Because of the large number of tourism jobs, parents often need child care outside of normal workday hours, so the system also includes many family, friends, or neighbors who care for children at night or early morning. Infant and toddler centers round out the diverse system and some of these facilities are licensed, and some are not. All of the different licensing statuses and types of facilities can make it difficult to reach centers with information or ensure best practices are implemented. Additionally, the Hawai’i State Department of Health is not the licensing agency for the child care providers that do have a license.


At the 2015 HAEYC early childhood education and care provider conference, the HHIET used a carbon-copy survey with questions about evidence-based best practices. By using a carbon-copy survey, attendees, which included representatives from both licensed and license-exempt child care facilities, could return the top copy to administrators for reporting and keep the yellow carbon copy for reference when implementing changes in their facility. The quiz helps child care providers identify strengths and opportunities to improve physical activity programs and put into place nutritional best practices.

Find Out More

For more information, contact the Hawai’i State Department of Health. Additional information about the project activities and additional resources such as sample policies or checklists can be found at the Healthy Child Care Hawai’i website. http://health.hawaii.gov/cshcn/hcch/. This project was supported by the State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity, and Associated Risk Factors and Promote School Health cooperative agreement (DP13-1305).


Although the team was concerned the carbon copy approach might be outdated, it proved to be a successful strategy. Nearly 500 viable surveys were returned. Data showed which best practices were currently implemented and what facilities planned to work on next. For example, more than 90% of participants have self-serve drinking water visible and available inside and outside the facility, and more than 88% of participants never offered sugary drinks such as fruit drinks, sweet tea, or soda. However, only 65% of respondents felt they were adequately educating parents about reduced screen time. Results also indicated a child care provider’s license status didn’t necessarily reflect their ability to implement best practices. In addition, resources often influenced the changes facilities were able to implement.

What's Next

One of the main purposes of the carbon copy was to collect information while still allowing participants to retain the survey for planning purposes. Overall, survey results will allow the Hawai’i State Department of Health to create more targeted statewide initiatives and develop a list of recommendations or guidelines for child care facilities. For example, many facilities want to better educate parents about reducing screen time at home, but they have limited resources to do so. The Hawai’i State Department of Health and other partners are currently developing screen time reduction guidelines for child care centers that will include guidance for providers on how to talk to parents about reducing screen time at home.


Jennifer Ryan, School Health Coordinator
Hawai’i State Department of Health
1250 Punchbowl Street

Honolulu, GA 96813

Atlanta, GA 30348
Centers for Disease Control and Prevention

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