The study aims to identify family child care home (FCCH) setting- and environment-level predictors related to providers' perceived difficulty in implementing the Child and Adult Care Food Program (CACFP) recommendations for serving vegetables to children. This was a cross-sectional study, which used a validated paper-based survey with a multi-method data analysis approach. Participants were licenced FCCH providers (N = 943) in Nebraska, who were predominantly White (94%), non-Hispanic (97%), CACFP-participants (89%), and in urban areas (64%). Reflective latent variable modelling was conducted in to explore associations between dependent variable and predictors. Dependent variable was providers' perceived difficulty to implement CACFP recommendations for serving vegetables. Predictors were providers' mealtime practices, perceived barriers to serve healthy foods, CACFP participation, geographic location, food access, food insecurity, and child poverty. Qualitative comments (n=122) from the survey were analysed using direct content analysis approach. Providers' perceived lack of time to prepare foods and perceived children's taste preferences increased their perceived difficulty; and CACFP-participation decreased their perceived difficulty to implement CACFP recommendations for serving vegetables. Qualitative comments highlighted that providers felt discouraged to serve vegetables knowing that vegetables would likely be wasted because of children's preferences. More tailored professional development is required to address FCCH providers' perceived difficulty and build providers' skills on preparing time saving, CACFP-reimbursable and appealing vegetable recipes, and on strategies to promote vegetable consumption in children.
