Prospects for early childhood feeding interventions: An exploration of parent's concerns and acceptability towards social media intervention opportunities

The impact of web-based education provided to parents on the nutritional risk of preschoolers: A quasi-experimental study

The purpose of this study was to evaluate the effectiveness of web-based nutrition education for parents of preschool children in reducing nutritional risk. The study was conducted in a one-group pretest-posttest quasi-experimental design. Parents of 3-5-year-old children from 11 preschools in Istanbul participated. They underwent a web-based nutrition education program. The NutriSTEP assessment tool was used to evaluate the nutritional risk score as a pretest assessment, followed by the training program. Posttests were conducted at 1- and 3-month intervals. Before the intervention, 55.8% of the children exhibited high nutritional risk. After the intervention, this percentage decreased significantly at the 1-month and 3-month follow-ups, with 94.2% and 93.6% of the children classified as low risk, respectively. The analysis also revealed significant associations between children's eating behaviours and factors such as maternal education, family income and family structure. As a result, web-based nutrition education was effective in reducing nutritional risk among preschool children. The findings underscore the importance of using technology for nutrition interventions, especially in diverse populations. The training program's simple, short and understandable video increased participants' interest in the training and encouraged regular follow-up.

Needs for mobile and internet-based psychological intervention in patients with self-injury and suicide-related behaviors: a qualitative systematic review

BACKGROUND

In recent years, mobile psychological interventions have proven effective in reducing self-injury and suicide-related behaviors. Therefore, it is essential to continually enhance the user experience and address patients' needs to facilitate the development of mobile mental health interventions. Identifying patients with mobile mental health needs can be challenging for mental health professionals. To address this, we conducted a systematic review of qualitative research to synthesize the needs of patients engaged in self-injury and suicide-related behaviors for mobile and internet-based psychological interventions.

METHODS

This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) and the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement (ENTREQ). We explored 11 databases and synthesized the results using thematic analysis.

RESULTS

Sixteen qualitative and mixed-method studies were included. The study found that the needs of patients with self-injury and suicide-related behaviors for mobile psychological intervention included therapy, technology, culture, privacy, communication, emotional support, personalization, and self-management. Consistent with the Technology Acceptance Model (TAM), the needs of patients with self-injury and suicide-related behaviors are influenced by the perceived ease of use and perceived usefulness of the mobile intervention. However, the findings also highlight the importance and unmet needs of peer support, communication, self-management, and empowerment in using mobile psychological interventions for patients with self-injury and suicide-related behaviors.

CONCLUSIONS

Studies in this area have shown that the needs of patients with self-harm and suicide-related behaviors cover multiple stages, including basic therapeutic and technical needs and advanced emotional needs. This complexity makes it challenging to address the needs of patients engaged in self-injury and suicide-related behaviors through digital interventions. In the future, mental health professionals should be encouraged to participate in multidisciplinary collaborations to expand the use of digital interventions, enhancing remote self-management for patients and providing new strategies for the ongoing care of psychiatric patients. We registered the review protocol on PROSPERO (CRD42022324958).

Evaluating a multi-behavioural home-based intervention for reducing depressive symptoms in postnatal women : The food, move, sleep (FOMOS) for postnatal mental health randomised controlled trial protocol

BACKGROUND

Postnatal depression (PND) is a leading cause of illness and death among women following childbirth. Physical inactivity, sedentary behaviour, poor sleep, and sub-optimal diet quality are behavioural risk factors for PND. A feasible, sustainable, and scalable intervention to improve healthy behaviours and reduce PND symptoms among women at postpartum is needed. This study aims to examine the effectiveness of a multi-behavioural home-based program Food, Move, Sleep (FOMOS) for Postnatal Mental Health designed to improve PND symptoms in women at postpartum.

METHODS

This randomised clinical trial will recruit 220 Australian women (2-12 months postpartum) experiencing heightened PND symptoms (Edinburgh Postnatal Depression Scale score ≥ 10). Participants will be randomised to FOMOS or wait-list control receiving standard clinical care. FOMOS is a 6-month mobile health (mHealth) intervention targeting diet quality, physical activity, sedentary behaviour, sleep, and mental health. The intervention, informed by the Social Cognitive Theory and incorporating behaviour change techniques defined in the CALO-RE taxonomy and Cognitive Behavioural Treatment of Insomnia, provides exercise equipment, and educational/motivational material and social support via mHealth and social media. Data collection pre-intervention and at 3, 6 and 12 months will assess the primary outcome of PND symptoms and secondary outcomes (diet quality, physical activity, sitting time, sleep quality) using self-report and device measures. Process evaluation will explore acceptability, appropriateness, cost-effectiveness, feasibility, and sustainability via analytic tools, record keeping, interviews, and surveys.

DISCUSSION

If effective, FOMOS could be a feasible and potentially scalable management strategy to support improvement of health behaviours and mental health for women with PND symptoms.

TRIAL REGISTRATION

https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12622001079730p.

Reach, acceptability and impact of an online parent healthy lifestyle intervention during the COVID-19 lockdown: A pilot study

ISSUE ADDRESSED

There is growing evidence that online parent-focused child healthy lifestyle interventions can improve healthy eating practices and food environments in the home. Greater understanding of whether and how parents engage with these online interventions is needed. This study evaluated the reach, acceptability and impacts of an online parent healthy lifestyle intervention.

METHODS

A pilot study was conducted in New South Wales during the COVID-19 pandemic when stay-at-home public health orders were in place (July-August 2021). A concurrent mixed methods design was adopted. Data collection measures were: an online participant survey at baseline, post-intervention and 3-month follow-up; two online post-intervention focus groups; and web metrics at post-intervention and 3-month follow-up.

RESULTS

There were 181 intervention participants, primarily mothers with high education levels and living in advantaged areas: 43 (24%) completed surveys post-intervention; and of these, 35 (81%; 19% of participants) completed surveys at follow-up. Sixteen mothers participated in focus groups. Parents' knowledge, self efficacy, role modelling and behaviours improved, but there were no significant differences detected over time. Metrics and survey data indicated webinar recordings, particularly the topics of 'Fussy Eating' and 'Screen time and sleep', had the greatest engagement and most perceived them as useful (93% and 96%, respectively).

CONCLUSIONS

An online healthy lifestyle intervention to support parents in providing opportunities for their children to engage in healthier lifestyle behaviours was appealing and acceptable to mothers and has the potential to improve families' healthy lifestyle behaviours. Enhancing intervention reach amongst fathers and priority populations, as well as incorporating design elements to enhance engagement will be important. SO WHAT?: An online healthy lifestyle intervention reached and engaged parents, despite being faced with additional parenting challenges arising from COVID-19 stay-at-home orders.

Food Parenting Practices and Child Eating Behaviors in Australian Families: A Cross-Sectional Sibling Design

BACKGROUND

Research on feeding in early childhood has focused primarily on parent-child dyadic interactions, despite parents enacting these practices within the complex dynamic of the family system.

OBJECTIVE

Using a sibling design, this study aimed to assess how parents may adapt their food parenting practices for siblings in response to differences in their eating behaviors.

DESIGN

A cross-sectional online survey was conducted between October and December 2022.

PARTICIPANTS/SETTING

Data were collected from parents (97.5% women) in Australia with 2 children aged 2 to 5 years (n = 336 parents and n = 672 children).

MAIN OUTCOME MEASURES

Survey items were completed for each sibling, and included four subscales of the Children's Eating Behaviour Questionnaire and seven subscales of the Feeding Practices and Structure Questionnaire-28.

STATISTICAL ANALYSES PERFORMED

Multiple linear regression models examined associations between within-sibling pair differences in child eating behaviors and food parenting practices, adjusting for differences in child body mass index z score, age, gender, and early feeding method.

RESULTS

Within-sibling pair differences in eating behaviors were associated with differences in some food parenting practices. For the fussier sibling, parents reported using more control-based practices, including persuasive feeding, reward for eating, and reward for behavior, and less of the structure-based practice, family meal settings (P values < 0.001). Similar directions of associations were found for persuasive feeding, reward for eating, and family meal settings with siblings who were slower eaters or more satiety responsive (P values < 0.007); however, no significant differences in reward for behavior were observed in relation to sibling differences in these eating behaviors. For the more food responsive sibling, parents reported using more control-based practices, including reward for behavior and overt restriction (P values < 0.002).

CONCLUSIONS

Within families, parents may adapt certain practices in response to differences in their children's eating behaviors. Interventions promoting responsive feeding should be designed to acknowledge the integral role of siblings in shaping parents' feeding decisions.

Evaluation of a Media Training Workshop for Nutrition Students and Trainees in Nova Scotia

Gaps in communication training have been identified in Canadian and international academic and practicum dietetics programs. A workshop was developed to pilot supplementary media training to nutrition students/trainees studying in Nova Scotia. Students, interns, and faculty from two universities participated in the workshop. Data on perceived learning, media knowledge/skill use, and workshop feedback were collected immediately post-workshop using a mixed-form questionnaire. A modified questionnaire was administered eight months post-workshop to obtain information on utility of the perceived acquired knowledge/skills. Closed-ended responses underwent descriptive analysis, while open-ended responses underwent thematic analysis. Twenty-eight participants completed the questionnaire post-workshop, and six completed it at follow-up. All participants rated the workshop positively (7-point Likert scale) and reported learning something new (perceived). Perceived learning emphasized general media knowledge/skills and communication skills. Follow-up data suggested participants had applied perceived media knowledge/skills in message development and media and job interviews. These data suggest that nutrition students/trainees may benefit from supplementary communications and media training and provide a stimulus for ongoing curriculum review and discussion.

A thematic cluster analysis of parents' online discussions about fussy eating

Food fussiness is associated with non‐responsive parent feeding practices, such as persuasive and instrumental feeding. Although most children described as ‘fussy eaters’ are likely exhibiting developmentally typical behaviours, up to half of the parents of children 2–5 years old express concerns. Concern for fussy eating may mediate the use of non‐responsive feeding practices and so must be addressed in parent feeding interventions. Therefore, it is critical to better understand parents' concerns and how they may relate to feeding practices. This study aimed to explore how parents' feeding practices and the social cognitive factors that may drive them clustered based on parents' concern for fussy eating. Data were collected from parent discussions of fussy eating on a Reddit forum (80,366 posts). Latent Dirichlet allocation was used to identify discussions of fussy eating. Relevant posts (1542) made by users who identified as a parent of a fussy eater (n = 630) underwent qualitative coding and thematic analysis. Five clusters of parents were identified, ranging in size from 53 to 189 users. These were primarily characterised by parents' degree of concern and feeding practices: (1) High concern, nonresponsive; (2) Concerned, nonresponsive; (3) Low concern, responsive; (4) Low concern, mixed strategies; (5) Low concern, indulgent. Parents who used responsive practices tended to be less concerned for fussy eating, have greater trust in their child's ability to self‐regulate hunger, have longer‐term feeding goals, and exhibit greater ability for personal self‐regulation. Future research should further examine how these constructs may be leveraged in parent feeding interventions.

Parents using nonresponsive practices to manage fussy eating may have more concerns about fussy eating, less trust in their child's ability to self‐regulate hunger, shorter‐term feeding goals, and less developed self‐regulation skills.

As most children described as “fussy eaters” are likely exhibiting developmentally typical behaviours, interventions addressing nutrition and feeding practices in early childhood should aim to alleviate parental concern for fussy eating, for example, by helping them recognise developmentally normal eating behaviours.

Early childhood feeding interventions may also be enhanced by helping parents to develop long‐term feeding goals and improved self‐regulation skills in the context of their feeding practices.

Fussy eating in toddlers: A content analysis of parents' online support seeking

The development of healthy eating habits in childhood is essential to reducing later risk of obesity. However, many parents manage fussy eating in toddlerhood with ineffective feeding practices that limit children's dietary variety and reinforce obesogenic eating behaviours. Understanding parents' feeding concerns and support needs may assist in the development of feeding interventions designed to support parents' uptake of responsive feeding practices. A total of 130 original posts by parents of toddlers (12-36 months) were extracted from the online website Reddit's 'r/Toddlers' community discussion forum over a 12-month period. Qualitative content analysis was used to categorise the fussy eating topics that parents were most concerned about and the types of support they were seeking from online peers. The most frequently raised fussy eating concerns were refusal to eat foods offered, inadequate intake (quantity and quality), problematic mealtime behaviours and changes in eating patterns. Parents were primarily seeking practical support (69.2%) to manage emergent fussy eating behaviours. This consisted of requests for practical feeding advice and strategies or meal ideas. Nearly half of parents sought emotional support (47.7%) to normalise their child's eating behaviour and seek reassurance from people with lived experience. Informational support about feeding was sought to a lesser extent (16.2%). Fussy eating poses a barrier to children's dietary variety and establishing healthy eating habits. These results suggest parents require greater knowledge and skills on 'how to feed' children and support to manage feeding expectations. Health professionals and child feeding interventions should focus on providing parents with practical feeding strategies to manage fussy eating. Supporting parents to adopt and maintain responsive feeding practices is vital to developing healthy eating habits during toddlerhood that will continue throughout adulthood.

Changing parental feeding practices through web-based interventions: A systematic review and meta-analysis

Web-based parent interventions designed to promote children’s healthy eating patterns can enhance parents’ engagement and facilitate behavior change. However, it is still unclear how much the existing programs focus on changing parental feeding practices, and if so, which behavioral methodologies are used and how effective these interventions are in changing these parental behaviors. This systematic review and meta-analysis studied randomized controlled trials of web-based interventions targeting parents of 0-12-year-old children, aiming to promote children’s healthy diet or prevent nutrition-related problems and reporting parental feeding behaviors as one of the outcomes. We conducted an electronic search in four databases from the earliest publication date until February 2020. Of the 1271 records found, we retained twelve studies about nine programs, comprising 1766 parents that completed the baseline evaluation. We found recent interventions, mainly directed to parents of young children, with small, non-clinical samples, and mostly theory-based. The programs were heterogeneous regarding the type of intervention delivered and its duration. The most assessed parental feeding practices were Restriction, Pressure to eat, and Food availability/accessibility. The behavior change techniques Instruction on how to perform the behavior, Demonstration of the behavior, and Identification of self as role model were frequently used. Meta-analytic results indicated that most programs’ effects were small for the evaluated parental practices, except for Food availability/accessibility that benefited the intervention group only when all follow-up measurements were considered. The development of high-quality and controlled trials with larger samples is needed to determine with greater certainty the interventions’ impact on parental feeding behaviors. The more frequent inclusion of measures to evaluate parental practices to support children’s autonomy and of self-regulatory strategies as intervention components should be considered when designing programs.

Process Evaluation of an eHealth Intervention (Food4toddlers) to Improve Toddlers' Diet: Randomized Controlled Trial

BACKGROUND

Parents seek trustworthy information online to promote healthy eating for their toddlers. Such information must be perceived as relevant and easy to implement and use.

OBJECTIVE

The objectives of this study were to conduct a process evaluation of the electronic health (eHealth) intervention (Food4toddlers) targeting food environment, parental feeding practices, and toddlers' diet and to examine possible differences in these areas according to education and family composition.

METHODS

A 2-armed randomized controlled trial, including 298 parent-toddler dyads from Norway, was conducted in 2017. In total, 148 parents in the intervention group received access to an intervention website for 6 months. Data on website usage were retrieved from the learning management platform used (NEO). Participants' satisfaction with the intervention was asked for in a postintervention questionnaire. Chi-square and t tests were used to examine differences in usage and satisfaction between education and family composition groups.

RESULTS

Most participants were mothers (144/148, 97.2%), lived in two-adult households (148/148, 100%), and were born in Norway (132/148, 89.1%). Mean parental age was 31.5 years (SD 4.2). More than 87.8% (129/147) had a university education degree and 56.5% (83/147) had over 4 years of university education. Most (128/148, 86.5%) intervention participants entered the website at least once (mean days of access 7.4 [SD 7.1]). Most parents reported the website as appropriate to the child's age (71/83, 86%) and self-explanatory (79/83, 95%) and appreciated the interface (52/83, 63%) and layout (46/83, 55%). In total, 61% (51/83) stated that they learned something new from the intervention. Parents with over 4 years of university education and in 1-child households used the intervention website more than those with 4 years or less of university education (8.4 vs 5.9 days in total, P=.04) and households with more than 1 child (8.3 vs 5.8 days in total, P=.04), respectively.

CONCLUSIONS

The Food4toddlers intervention website was found to be relevant by most participants in the intervention group, although usage of the website differed according to educational level and family composition. For eHealth interventions to be effective, intervention materials such as websites must be used by the target group. Our results highlight the need to include users from different groups when developing interventions.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN92980420; http://www.isrctn.com/ISRCTN92980420.

Taking guidance from parents involved in a longitudinal birth cohort - the ROLO family advisory committee

BACKGROUND

The ROLO Study (Randomised cOntrol trial of a Low glycaemic index diet in pregnancy to prevent macrosomia) was a randomised control trial conducted between 2007 and 2011 to examine if a low glycaemic index (GI) diet could reduce the incidence of macrosomia. The ROLO Family Advisory Committee is a self-selected group of parents who are involved in the longitudinal follow-up of the ROLO Study. The committee was established in 2017 and the goal is to achieve a partnership between ROLO families and researchers, leading to improved research quality, relevance, and outcomes. This research method is termed "Public and patient involvement (PPI)" and describes how researchers collaborate and engage with the public in order to make research more relevant to them.

METHODS

The ROLO study mothers and children have been prospectively followed-up at multiple time points post-pregnancy. In October 2017, all women were invited to join the ROLO Family Advisory Committee via email or via advertisement on the ROLO Study Facebook page. Fathers and other guardians of the study children were also invited to join. Two annual meetings with the research team and parents were held in 2018 and 2019. The meetings were recorded, transcribed verbatim by researchers, and thematically analysed.

RESULTS

Parents provided opinions on the areas they felt should be explored within the ROLO study using information that was collected up to the current follow-up point. They also shared views on research interests which were of importance to them. These topics included; child mental health, fussy eating in childhood and healthy eating policies in schools. Mothers were much more concerned about factors which influenced their child's health rather than their own. Incorporating an element of PPI to this study was found to be a positive learning experience for participants and researchers.

CONCLUSION

The involvement of parents has enriched the research agenda at the UCD Perinatal Research Centre. We will continue to engage with the parents of the ROLO Study and plan to involve the children to explore their opinions at the next opportunity.

Participant Experiences of an Infant Obesity Prevention Program Delivered via Telephone Calls or Text Messages

A 3-arm randomised controlled trial implemented in 2017, recruited participants from four Local Health Districts (LHDs) in New South Wales (NSW) to test an early obesity prevention program delivered via telephone calls (telephone) or text messages (SMS). This sub-study explored participants' experience and satisfaction with the program. A multimethod design was used. Quantitative satisfaction questions were completed by participants when their child was six-months old. A purposive sample of participants with varying satisfaction levels was invited for in-depth qualitative interviews. Data were analysed using Excel (quantitative) and inductive thematic analysis (qualitative). Of the 1155 participants recruited: 947 (293 telephone; 338 SMS; 316 control) completed the six-month survey; 34 (14 telephone; 13 SMS; 7 control) were interviewed. Participants' overall program satisfaction was 100% (telephone) and 85% (SMS). Participants' qualitative responses demonstrated appreciation of: personalised stage-based information; opportunity to communicate with health professionals (telephone); linked Healthy Beginnings booklets and SMS mostly as nudges (SMS). There is a clear need for stage-based information, and supplemented modes of delivery i.e., text messages along with telephone calls; with text messages solely seen as nudges or reminders. However, individual preferences vary according to information needs at any given time, time constraints on new mothers and hence, multiple modes of information provision are recommended in order to reach a wider population and for better engagement. Choice and flexibility in mode of delivery has the potential to provide equitable access to information, empowering women with infants to practice recommended health behaviours for infant obesity prevention.

Picky eating in an obesity intervention for preschool-aged children - what role does it play, and does the measurement instrument matter?

INTRODUCTION

Research on picky eating in childhood obesity treatment is limited and inconsistent, with various instruments and questions used. This study examines the role of picky eating in a randomized controlled obesity intervention for preschoolers using subscales from two instruments: The Child Eating Behavior Questionnaire (CEBQ) and the Lifestyle Behavior Checklist (LBC).

METHOD

The study includes 130 children (mean age 5.2 years (SD 0.7), 54% girls, mean Body Mass Index (BMI) z-score 2.9 (SD 0.6)) and their parents (nearly 60% of non-Swedish background, 40% with university degree). Families were randomized to a parent-group treatment focusing on evidence-based parenting practices or to standard treatment focusing on lifestyle changes. The children's heights and weights (BMI z-score) were measured at baseline, and at 3, 6 and 12 months post baseline. At these time-points, picky eating was reported by parents using the CEBQ (Food Fussiness scale, 6 items) and 5 items from the LBC. Child food intake was reported with a Food Frequency Questionnaire (FFQ). Pearson correlation was used to study associations between baseline picky eating and baseline BMI z-scores and food intake. Mixed effects models were used to study associations between the two measurements of picky eating and changes in picky eating, to assess the effects of changes in picky eating on BMI z-scores, and to evaluate baseline picky eating as a predictor of changes in BMI z-scores.

RESULTS

Neither the standard treatment nor the parent-group treatment reduced the degree of picky eating (measured with CEBQ or LBC). Baseline picky eating measured with the CEBQ was associated with a lower BMI z-score and lower intake of vegetables. Children with a higher degree of picky eating at baseline (measured with the CEBQ) displayed a lower degree of weight loss. When degree of picky eating was examined, for 25% of the children, the CEBQ and the LBC yielded diverging results.

CONCLUSIONS

Baseline picky eating may weaken the effectiveness of obesity treatment, and assessments should be conducted before treatment to adjust the treatment approach. Different measurements of picky eating may lead to different results. The CEBQ seems more robust than the LBC in measuring picky eating.

TRIAL REGISTRATION

Clinicaltrials.gov , NCT01792531. Registered 15 February 2013 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT01792531.