Acceptability and accessibility of child nutrition interventions: fathers' perspectives from survey and interview studies

Fathers Nutrition Knowledge and Child Feeding Practices Associated with Childhood Overweight and Obesity: A Scoping Review of Literature From 2000 to 2023

Objective. Childhood overweight/obesity is a serious global public health issue, demanding parental involvement to reverse trends. Despite fathers' crucial parenting roles, research on fathers and childhood overweight/obesity is limited. This scoping review examines the literature on fathers' nutrition knowledge and feeding practices with childhood overweight/obesity. Methods. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and Arksey and O'Malley (2005) framework, multiple databases were searched. Eligible father-child related studies focused on fathers' nutrition knowledge, feeding practices, and childhood overweight/obesity. Results. Of 26 eligible articles, 52% originated from the United States, and 44% focused on father-child dyads. Most studies were cross-sectional (64%) and survey-based (68%). Further, 11.5% assessed fathers' nutrition knowledge, and child feeding practices (53.4%). Conclusion. Literature on fathers' nutrition knowledge and feeding practices concerning childhood overweight/obesity is limited. Scaling-up fathers' inclusion in childhood nutrition research is encouraged for the design of holistic interventions.

Federal Food Assistance Accessibility and Acceptability Among Indigenous Peoples in the United States: A Scoping Review

The purpose of this scoping review was to determine the extent to which accessibility and acceptability of federal food assistance programs in the United States have been evaluated among indigenous peoples and to summarize what is currently known. Twelve publications were found that examine aspects of accessibility or acceptability by indigenous peoples of 1 or more federal food assistance programs, including the supplemental nutrition assistance program (SNAP) and/or the Food Distribution Program on Indian Reservations (n = 8), the Special Supplemental Nutrition Program for Women, infants, and children (WIC) (n = 3), and the national school lunch program (n = 1). No publications were found to include the commodity supplemental food program or the child and adult care food program. Publications ranged in time from 1990-2023, and all reported on findings from rural populations, whereas 3 also included urban settings. Program accessibility varied by program type and geographic location. Road conditions, transportation access, telephone and internet connectivity, and an overall number of food stores were identified as key access barriers to SNAP and WIC benefit redemption in rural areas. Program acceptability was attributed to factors such as being tribally administered, providing culturally sensitive services, and offering foods of cultural significance. For these reasons, Food Distribution Program on Indian Reservations and WIC were more frequently described as acceptable compared to SNAP and national school lunch programs. However, SNAP was occasionally described as more acceptable than other assistance programs because it allows participants autonomy to decide which foods to purchase and when. Overall, little attention has been paid to the accessibility and acceptability of federal food assistance programs among indigenous peoples in the United States. More research is needed to understand and improve the participation experiences and health trajectories of these priority populations.

Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops

BACKGROUND

Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers' experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers.

OBJECTIVE

This study aims to explore fathers' experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers.

METHODS

Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops.

RESULTS

A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation-Behavior model. The interview data illuminated factors influencing fathers' initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers' diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men's caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child's age and targeted at fathers using comprehensive promotion strategies.

CONCLUSIONS

Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice.

"You just have to spread it thin": Perceptions and feeding experiences of Australian fathers of young children living with disadvantage

The role of fathers in feeding is an emerging field within child feeding literature. Fathers have unique contributions to make to family mealtimes and child eating behaviours. However, qualitative research on fathers' experiences is limited, especially in the context of disadvantage. This study explored fathers' perceptions of their roles and feeding practices and their lived experience of disadvantage through a symbolic interactionism lens. Twenty-five Australian fathers of children aged six months to five years who experienced socioeconomic disadvantage participated in semi-structured interviews. Five themes were constructed from reflexive thematic analysis: (i) responsibilities for foodwork are based on strengths, opportunities, and values, (ii) negotiating fatherhood identity from a place of tension to acceptance, (iii) struggling with financial and mental strain, and food insecurity, (iv) managing adversity whist prioritising feeding children, and (v) paternal feeding practices are driven by values, adversity, and emotions. The division of foodwork was contingent on family capability and employment, maternal gatekeeping, paternal attitudes and values, and intergenerational, cultural and gender norms around earning and childrearing. Economic, environmental, and emotional stressors triggered changes to fathers' feeding practices, often contradicting their ideals (e.g., providing alternative meals, using rewards and electronic devices, unstructured settings). Fathers described income and food-based strategies to protect children's food intake, which may involve caregivers forgoing meals. These findings provide insight into fathers' feeding experiences through recognising personal, interpersonal, and systemic enablers and barriers. Promoting optimal feeding practices should include targeted feeding support and broader structural interventions to address inequality. Fathers' experiences as they navigate child mealtime interactions within a context of adversity can be used to inform child feeding interventions to improve child health and development.

The contribution of Australian fathers in getting food on the table among families with young children

OBJECTIVE

To explore how fathers with young children contributed to healthy home food provisioning and the factors enabling or inhibiting their involvement in family food tasks.

DESIGN

Cross-sectional study using purpose-designed online survey. The survey assessed the level of responsibilities and practices in family food tasks, food agency (Cooking and Food Provisioning Action Scale), and use of resources to support involvement in family food tasks. Data collection took place over 3 weeks in November-December 2020 when various COVID-19-related restrictions were in place. Descriptive and regression analyses were used to assess psychosocial factors influencing responsibilities in family food tasks and food agency.

SETTING

Online survey.

PARTICIPANTS

Included in the analysis were 435 Australian fathers with children aged under 5 years.

RESULTS

Between 75 and 77 % of fathers in this study reported having at least half of the responsibilities in meal planning, shopping, and cooking. Health was frequently considered when deciding what to eat, but few used nutrition or food labels when shopping, tried new recipes or modified recipes to make them healthier. Involvement in family food tasks was promoted by a higher food agency, but time spent in employment was a significant barrier to reported food agency and greater involvement in food tasks. There was a high interest in resources to support healthy home food provisioning.

CONCLUSIONS

The findings suggest the need to consider father-specific strategies to overcome time barriers and opportunities to enhance their capabilities for healthy home food provisioning.

Spicing up food interactions: Development of a healthy food education activity targeting fathers and their young children

BACKGROUND

Childhood obesity rates have been rapidly increasing worldwide. Several actions to reduce this trend have addressed maternal feeding practices. However, research reports an unwillingness to taste healthful foods expressed by children and fathers, which represents a major obstacle to a healthy diet in the family household. The present study aims to propose and qualitatively evaluate an intervention to increase fathers' involvement with their families' healthy eating through exposure to new/disliked healthy foods.

METHODS

Fifteen Danish families took part in a 4-week online intervention involving picture book reading, a sensory experience session and the cooking of four recipes with four targeted vegetables (celeriac, Brussels sprouts, spinach and kale) and two spices (turmeric and ginger). Interviews were conducted with the families and the content was analysed through a blended or abductive approach.

RESULTS

Participating in the activities motivated children and fathers to try new vegetables and spices, and increased fathers' sense of self-efficacy toward cooking, tasting new foods and healthy feeding. For the family, the intervention acted as a trigger to consume a higher variety of vegetables and spices and prompted feelings of "food joy". The outcomes observed are of importance considering the relatively low cost and the remote approach of the intervention.

CONCLUSIONS

The results highlight the fact that fathers play an important role in the home food environment. We conclude that fathers should be included to a higher extent in food and nutrition strategies aimed at promoting healthy weight development in their children.

Bringing down barriers to children's healthy eating: a critical review of opportunities, within a complex food system

This narrative review revises the scientific evidence of recent years on healthy eating in children and adolescents, making sense of promising avenues of action, from a food system perspective. A conceptual framework is provided to better understand how eating habits of children and adolescents are shaped to identify key multisectoral approaches that should be implemented to promote healthier diets. The following influencing factors are discussed: individual factors (physiological and psychological factors, food preferences and food literacy competencies), factors within the personal and socio-cultural food environments, external food environments, and the supply chain. In each section, the main barriers to healthy eating are briefly discussed focussing on how to overcome them. Finally, a discussion with recommendations of actions is provided, anchored in scientific knowledge, and transferable to the general public, industry, and policymakers. We highlight that multidisciplinary approaches are not enough, a systems approach, with a truly holistic view, is needed. Apart from introducing systemic changes, a variety of interventions can be implemented at different levels to foster healthier diets in children through fostering healthier and more sustainable food environments, facilitating pleasurable sensory experiences, increasing their food literacy, and enhancing their agency by empowering them to make better food related decisions. Acknowledging children as unique individuals is required, through interpersonal interactions, as well as their role in their environments. Actions should aim to enable children and adolescents as active participants within sustainable food systems, to support healthier dietary behaviours that can be sustained throughout life, impacting health at a societal level.

Where is the father? Challenges and solutions to the inclusion of fathers in child feeding and nutrition research

Despite an increasing acknowledgement of fathers' involvement in and impact on children's lives, fathers remain underrepresented in child feeding and childhood obesity prevention research, interventions, and actions. Built on our own experiences with conducting research with fathers and recent evidence on this topic, this Research in Practice article has three aims. It will first substantiate the importance of including and studying fathers in the field of child feeding and childhood obesity prevention based on recent study results. Secondly, the article will present and discuss barriers to fathers' inclusion and participation (why isn't it happening?), among other issues, by drawing on sociological and gender ideological insights. Finally, it will provide recommendations and suggestions related to recruitment, focus and methods that can facilitate fathers' involvement in future research, interventions, and practice. Taken together, this article aims to provide tools for giving fathers a voice in the field of child nutrition and by doing so, to decrease maternal-only "burden" of care. We hope our experiences and theoretical reflections will inspire and support researchers and practitioners to be as successful as possible in the realm of family care.

Perceived Role of Asian Indian Fathers in Florida During Mealtimes: Factors to Consider for Their Involvement in Childhood Obesity Prevention

Research has shown that fathers play an important role in children's mealtimes and dietary habits; yet, little is known about the factors that affect how fathers perceive this role, especially among Asian Indians. This study aimed to examine how Asian Indian fathers perceive their role during child mealtimes and the factors that are associated with fathers' mealtime perceptions. Eighty Asian Indian fathers of 6- to 11-year-old children completed an online survey including measures of demographics, acculturation, gender roles, nutrition knowledge, parental self-efficacy, perceived child weight, and the role of father at mealtime (ROFM). Data were analyzed using descriptive statistics and linear regression. Participants perceived a moderately high level of responsibility during child mealtimes. Regression analysis showed that fathers who had higher income, perceived child weight as being higher, and had higher self-efficacy in feeding children healthy food had higher ROFM. Higher father nutrition knowledge was correlated with lower perceived ROFM, indicating a lack of confidence in utilizing their nutrition knowledge during child mealtimes. The results indicate potential targets to improve Asian Indian fathers' involvement during child mealtimes. These results could be utilized to enhance their engagement in child mealtime healthy eating practices and for childhood obesity prevention.

Struggling with overweight or obesity in children - fathers' perceptions and experiences of contributing factors, role and responsibility

PURPOSE

The family environment is crucial in the prevention and treatment of childhood obesity; however, there is a lack of knowledge concerning paternal perceptions and experiences in childhood weight management. The aim of this study was to explore (i) perceptions of contributing factors to childhood overweight and obesity among fathers of children with overweight or obesity and (ii) the fathers' experiences of their parental role caring for a child with overweight or obesity.

METHOD

A qualitative content analysis was conducted of data from semi-structured in-depth interviews with eight Norwegian fathers of ten children and adolescents with overweight or obesity.

RESULTS

The analysis identified one overall theme; Feeling uncertain and struggling to understand their own responsibility for the child's overweight or obesity, which consists of two themes; 1)Trying hard to figure out the child's obesity as a complex interaction of factors and 2)Family functioning-negotiating roles and responsibility in parenthood.

CONCLUSION

Fathers must be met with understanding about their uncertainty and their struggle to understand their individual responsibility for their child's weight excess. It can be necessary to address the significance of family functioning, collaboration, responsibility within the familiy in addition to structural responsibility in clinical dialogues and counselling in order to help with weight management.

Associations of mothers' and fathers' structure-related food parenting practices and child food approach eating behaviors during the COVID pandemic

BACKGROUND

During the COVID-19 pandemic, many mothers and fathers have spent more time at home with their children, warranting consideration of parenting practices around food during the pandemic as influences on obesogenic eating behaviors among children. Structure-related feeding practices, particularly around snacking, may be particularly challenging yet influential in the pandemic setting. Parent sex and levels of feeding-related co-operation among parents (co-feeding) are understudied potential influences on parent-child feeding relationships.

METHODS

We investigated relationships between structure-related parent feeding and child food approach behaviors during the COVID-19 pandemic, while considering potential moderating influences of parent sex and co-feeding levels. An online survey was completed by 318 parents (206 mothers and 112 fathers) of 2-12-year-olds who were living in states with statewide or regional lockdowns in May/June 2020 within the US. Mothers and fathers were drawn from different families, with each survey corresponding to a unique parent-child dyad. Parental stress/mental health, co-feeding (Feeding Coparenting Scale), structure-related food and snack parenting (Feeding Practices and Structure Questionnaire and Parenting around SNAcking Questionnaire), and child eating behaviors (Child Eating Behaviour Questionnaire) were assessed. Relationships of parents' structure-related food and snack parenting practices with their child's emotional overeating and food responsiveness behaviors were examined using structural equation modelling. Further, we investigated whether these relations were moderated by parent sex or level of co-feeding.

RESULTS

Parent sex differences were seen in parental stress, mental health, and co-feeding, but not in structure-related food and snack parenting or child food approach eating behaviors. Structure-related food parenting was negatively associated with emotional overeating. However, structure-related snack parenting was positively associated with emotional overeating and food responsiveness. While regression paths varied between mothers vs. fathers, as well as by co-feeding levels, neither parent sex nor co-feeding levels significantly moderated relationships between parent feeding and child eating variables.

CONCLUSIONS

Future studies of food and snack parenting and co-operation in relation to feeding among mothers and fathers within a familial unit may be critical to identify intervention strategies that draw on all family resources to better navigate future disruptive events such as the COVID-19 pandemic.

Parenting and childhood obesity: Validation of a new questionnaire and evaluation of treatment effects during the preschool years

Objectives

Parenting is an integral component of obesity treatment in early childhood. However, the link between specific parenting practices and treatment effectiveness remains unclear. This paper introduces and validates a new parenting questionnaire and evaluates mothers’ and fathers’ parenting practices in relation to child weight status during a 12-month childhood obesity treatment trial.

Methods

First, a merged school/clinical sample (n = 558, 82% mothers) was used for the factorial and construct validation of the new parenting questionnaire. Second, changes in parenting were evaluated using clinical data from the More and Less Study, a randomized controlled trial (RCT) with 174 children (mean age = 5 years, mean Body Mass Index Standard Deviation Score (BMI SDS) = 3.0) comparing a parent support program (with and without booster sessions) and standard treatment. Data were collected at four time points over 12 months. We used linear mixed models and mediation models to investigate associations between changes in parenting practices and treatment effects.

Findings

The validation of the questionnaire (9 items; responses on a 5-point Likert scale) revealed two dimensions of parenting (Cronbach’s alpha ≥0.7): setting limits to the child and regulating one’s own emotions when interacting with the child, both of which correlated with feeding practices and parental self-efficacy. We administered the questionnaire to the RCT participants. Fathers in standard treatment increased their emotional regulation compared to fathers in the parenting program (p = 0.03). Mothers increased their limit-setting regardless of treatment allocation (p = 0.01). No treatment effect was found on child weight status through changes in parenting practices.

Conclusion

Taken together, the findings demonstrate that the new questionnaire assessing parenting practices proved valid in a 12-month childhood obesity trial. During treatment, paternal and maternal parenting practices followed different trajectories, though they did not mediate treatment effects on child weight status. Future research should address the pathways whereby maternal and paternal parenting practices affect treatment outcomes, such as child eating behaviors and weight status.

An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT

Background

Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.

Objectives

To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.

Design

The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.

Setting

Norfolk/Suffolk counties, UK.

Participants

Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.

Interventions

The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.

Main outcome measures

Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.

Data sources review

Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).

Review methods

Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.

Inclusion criteria

Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.

Results

The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.

Limitations

Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.

Conclusions

This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.

Future work

Further refinements to intervention delivery and recruitment methods should be investigated.

Study registration

Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.

Funding

This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.

Engaging family members in maternal, infant and young child nutrition activities in low- and middle-income countries: A systematic scoping review

The influence of fathers, grandmothers and other family members on maternal, infant and young child nutrition practices has been well documented for decades, yet many social and behavioural interventions continue to reach only mothers. While recent guidelines recommend involving fathers, grandmothers and other family members in maternal and child nutrition, we lack a comprehensive review of interventions that have engaged them. This scoping review aimed to address this gap by describing social and behavioural interventions to engage family members in maternal and child nutrition in low- and middle-income countries. We systematically searched PubMed, Scopus, Web of Science, Global Health and CINAHL for peer-reviewed studies meeting inclusion criteria. We screened 6,570 abstracts, evaluated 179 full-text articles, and included 87 articles from 63 studies. Studies reported a broad range of approaches to engage fathers, grandmothers and other family members to support maternal nutrition (n = 6); breastfeeding (n = 32); complementary feeding (n = 6) and multiple maternal and child nutrition practices (n = 19). Interventions were facility and community based; included individual and group-based interpersonal communication, community mobilization, mass media and mHealth; and reached mothers and family members together or separately. Most interventions were located within the health sector; rare exceptions included nutrition-sensitive agriculture, social protection, early child development and community development interventions. Few interventions addressed gender norms, decision-making, and family dynamics or described formative research or theories informing intervention design. These diverse studies can shed light on innovative programme approaches to increase family support for maternal and child nutrition.

Are food parenting practices gendered? Impact of mothers' and fathers' practices on their child's eating behaviors

Past research has mainly focused on the links between child eating behaviors and maternal food practices. The impact of fathers and of concordant/discordant food parenting practices within families has received much less attention. To fill this gap, both parents of 105 French children aged 2.01-6.51 years (54 boys, M_age = 3.88 years, SD = 1.40) filled in a survey with items from validated questionnaires. Results showed that fathers and mothers perceived their child's eating behaviors in similar ways (Pearson correlations between 0.34 and 0.78; M = 0.60), despite mothers taking significantly more meals with their child than fathers. Fathers reported using significantly more pressure to eat and food as reward, but reported lower levels of "family meal setting" than mothers. Moderate to high correlations were observed between mothers' and fathers' feeding practices and styles. Regression analyses showed that both maternal and paternal practices and styles were predictors for child eating behaviors. One interaction effect was observed: in households where both parents used higher levels of pressure to eat, the child showed a significantly lower food enjoyment than expected if the effects were additive. Our findings underline the importance of studying the individual role of each parent in child feeding research and that both parents within families should avoid using coercive practices. This could finally stimulate new interventions and recommendations addressed to both parents.

The Effect of Learning Module Program on Mothers’ Ability to Adapt to New Foods, Feeding Styles, and Self-efficacy to Their Children with Avoidant Restrictive Food Intake Disorder

BACKGROUND: The education to improve a mother’s knowledge is deemed to be important because it may improve children’s nutritional status. AIM: The aim of this study was to examine the effects of learning module program on the mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with avoidant restrictive food intake disorder (ARFID). METHODS: Quasi-experimental design was used to evaluate the effectiveness of learning module program. Fifteen mothers of experimental group were given four meetings within 4 weeks. Each meeting ran about 50 min. Fifteen mothers of control group were conducted home visit and received twice education about the health principals of feeding children. Both experimental group and control group had pre-test and post-test. The data were analyzed using Chi-square test, Fisher’s exact test, and Mann–Whitney U-test. RESULTS: The participants of the experimental group have shown bigger surge of new foods adaptation (t = –2.973, p < 0.003), feeding style (t = –4.646, p < 0.001), self-efficacy (t = –3.652, p = 0.001) than the control group has. CONCLUSION: The findings indicated that the learning module program was deemed to be effective to improve mothers’ ability to adapt to new foods, feeding styles, and self-efficacy to their children with ARFID.

Comparison of Early Feeding Practices in Mother-Father Dyads and Possible Generalization of an Efficacious Maternal Intervention to Fathers' Feeding Practices: A Secondary Analysis

To compare feeding practices within mother-father dyads and explore whether outcomes of an efficacious intervention for mothers generalised to fathers' feeding practices. The NOURISH RCT evaluated an early feeding intervention that promoted positive feeding practices to support development of healthy eating habits and growth. The intervention was delivered to first-time mothers via 2 × 12 week modules commencing when children were 4 and 14 months. Mothers self-reported feeding practice outcomes at child age 2 years using validated scales (1 = low to 5 = high) from the Child Feeding Questionnaire (CFQ). Nine months later, an independent cross-sectional descriptive study to investigate fathers' feeding practices was initiated. Fathers were recruited by contacting (via letter) mothers participating in two pre-existing studies, including the NOURISH trial. Fathers completed a feeding practices questionnaire, similar to that used for NOURISH outcome assessments. Seventy-five fathers recruited via the NOURISH cohort (21% response) returned questionnaires. Response data from this subset of fathers were then linked to the corresponding NOURISH maternal data. Complete data were available from 70 dyads. Compared with mothers, fathers self-reported higher concern about child overweight (2.2 vs. 1.3), restriction (3.6 vs. 2.9) and pressure (2.6 vs. 2.1), all p < 0.001. Fathers whose partners were allocated to the intervention group used less pressure (mean difference 0.46, p = 0.045) and were more willing to let the child decide how much to eat (-0.51, p = 0.032). Fathers' higher concern about child weight and more frequent use of non-responsive feeding practices, when compared with mothers, identify them as potentially potent contributors to child feeding. This preliminary evidence for modest generalisation of an efficacious maternal intervention to apparent effects on some paternal feeding practices speaks to the importance and promise of including fathers in early feeding interventions.

Investigating the Relationship Between Fatherhood and Provider Weight-Related Practices and Counseling in Clinical Settings

OBJECTIVE

To assess whether weight-related practices and counseling between men and their medical providers are associated with the patient's fatherhood status.

METHODS

Using the 2015-2017 National Survey of Family Growth, logistic regression models were constructed to examine the odds of men being weighed, told a weight status, or referred for nutrition/exercise counseling during a medical visit in the previous year.

RESULTS

The sample included 2,562 men and 1,272 fathers. Overall, 90%, 76%, and 49% of fathers were weighed by a provider, told their weight status, and referred for nutrition/exercise counseling, respectively. There were no associations between fatherhood status and being weighed or provider weight status communication. Fathers were more likely to be referred for nutrition/exercise counseling compared with those without children during a medical (adjusted odds ratio, 1.61; 95% confidence interval, 1.003-2.583) or routine visit (adjusted odds ratio, 1.81; 95% confidence interval, 1.04-3.16).

CONCLUSIONS AND IMPLICATIONS

The increased likelihood of nutrition or exercise counseling referrals among fathers presents an opportunity to address obesity within families.

Brazilian immigrant fathers' perspectives on child's eating and feeding practices: a qualitative study conducted in the United States

OBJECTIVES

Brazilians comprise a rapidly growing immigrant Latino group in the USA, yet little research has focused on health issues affecting Brazilian children in immigrant families. As increasing evidence is documenting fathers' influential role in their children's eating behaviours and ultimately weight status, the current study sought to explore the Brazilian immigrant fathers' perspectives and practices related to child's feeding practices and their preschool-aged children's eating.

DESIGN

Qualitative study using in-depth, semi-structured interviews. Interviews were conducted in Portuguese by native Brazilian research staff using a semi-structured interview guide. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed thematically using a hybrid approach that incorporated deductive and inductive analytical approaches.

SETTING

Massachusetts.

PARTICIPANTS

Twenty-one Brazilian immigrant fathers who had at least one child aged 2-5 years.

RESULTS

Results revealed fathers' awareness of the importance of healthy eating for their children, their influence as role models and their involvement in feeding routines of their preschool-aged children. Moreover, fathers were receptive to participating in family interventions to promote their children's healthy eating. Nearly all fathers reported wanting to learn more and to do 'what's right' for their children.

CONCLUSIONS

The current study provides new information about Brazilian immigrant fathers' views about factors influencing their children's healthy eating behaviours and paternal feeding practices. Future research should quantify fathers' feeding styles and practices and solicit fathers' input in the design of culturally appropriate family interventions targeting the home environment of preschool-aged children of Brazilian immigrant families.

Fathers' Perceptions of Their Role in Family Mealtimes: A Grounded Theory Study

OBJECTIVE

This study examines how fathers negotiate the role of feeding with other family members, and how this both impacts and is shaped by the structure of mealtimes.

DESIGN

Six separate focus groups.

SETTING

South East Queensland, Australia.

PARTICIPANTS

Fathers (N = 27) of children aged ≤12 years employed in blue-collar occupations or service industries.

PHENOMENON OF INTEREST

Fathers' perceptions of their role in family feeding.

ANALYSIS

Grounded theory.

RESULTS

Two major themes were identified: (1) mealtime structure, reflecting various arrangements and management procedures that give ultimate shape to mealtimes; and (2) division of labor, reflecting the work required to bring about such arrangements and how this work is allocated. These themes were interrelated and harmonized to create family mealtimes. Fathers felt that labor was assigned pragmatically; designated roles around feeding within the family facilitated structured mealtimes.

CONCLUSIONS AND IMPLICATIONS

Fathers' roles in balancing the labor and structured mealtimes to feed the family require further research attention, particularly across different family structures, to enhance their engagement in and contribution to the family meal environment. Offering cooking programs and meal planning education to fathers may support them in their different roles and enhance efficiency.

Recruitment, Engagement, and Retention of Fathers in Nutrition Education and Obesity Research

This article provides a perspective about recruiting, engaging, and retaining fathers in research and programming related to nutrition education and childhood obesity prevention. Recent research emphasizes the importance of fathers in childhood obesity prevention, and although father-friendly approaches can emulate other underserved populations, some researchers have acknowledged that differences may exist. Family sciences- related and nutritional sciences-related literature is summarized to provide guidance for nutrition and obesity scholars. Best practices may vary by the type of study and father characteristics; and the venues, content, structure, timing, and approach of research and interventions may need to be tailored for fathers.

The development and feasibility of a randomised family-based physical activity promotion intervention: the Families Reporting Every Step to Health (FRESH) study

Background

There is a need for high-quality research aiming to increase physical activity in families. This study assessed the feasibility and acceptability of FRESH (Families Reporting Every Step to Health), a child-led family-based physical activity intervention delivered online.

Methods

In a two-armed randomised feasibility study, 12 families (with an 8–10-year-old index child) were allocated to a ‘child-only’ (CO) or ‘family’ arm (FAM) of the theory-based FRESH intervention. Both received access to the FRESH website, allowing participants to select step challenges to ‘travel’ to target cities around the world, log their steps, and track their progress as they virtually globetrot. Only index children wore pedometers in CO; in FAM, all family members wore pedometers and worked towards collective goals. All family members were eligible to participate in the evaluation. Mixed-methods process evaluation (questionnaires and family focus groups) at 6-week follow-up consisted of completing questionnaires assessing acceptability of the intervention and accompanying effectiveness evaluation, focussed on physical (e.g. fitness, blood pressure), psychosocial (e.g. social support), and behavioural (e.g. objectively-measured family physical activity) measures.

Results

All families were retained (32 participants). Parents enjoyed FRESH and all children found it fun. More FAM children wanted to continue with FRESH, found the website easy to use, and enjoyed wearing pedometers. FAM children also found it easier to reach goals. Most CO families would have preferred whole family participation. Compared to CO, FAM exhibited greater website engagement as they travelled to more cities (36 ± 11 vs. 13 ± 8) and failed fewer challenges (1.5 ± 1 vs. 3 ± 1). Focus groups also revealed that most families wanted elements of competition. All children enjoyed being part of the evaluation, and adults disagreed that there were too many intervention measures (overall, 2.4 ± 1.3) or that data collection took too long (overall, 2.2 ± 1.1).

Conclusion

FRESH was feasible and acceptable to participating families; however, findings favoured the FAM group. Recruitment, intervention fidelity and delivery and some measurement procedures are particular areas that require further attention for optimisation. Testing the preliminary effectiveness of FRESH on family physical activity is a necessary next step.

Trial registration

This study was registered and given an International Standard Randomised Controlled Trials Number (ISRCTN12789422). Registered 16 March 2016. http://www.isrctn.com/ISRCTN12789422