Comparison of the agreement between WeChat-based self-administered and interviewer-administered data on infant and young child feeding in China: A test-retest study

Suboptimal status of tummy time for infants in early childhood education institutions in urban China: A cross-sectional study

Background

Although tummy time is recommended as a form of physical activity for non-movable infants worldwide, little is known regarding the current status of tummy time practices among Chinese infants. Early childhood education (ECE) institutions provide children with rich learning experiences; however, tummy time practices among infants in these ECE institutions were unclear. This study aimed to investigate the status of tummy time among infants within the context of ECE institutions.

Methods

We conducted a cross-sectional survey with primary caregivers of infants aged 0-11 months across 31 provinces of China from 1 March to 30 April 2023. To recruit participants, we collaborated with Gymboree Play & Music, an ECE institution with over 500 centres in nearly 200 cities in urban China. Our survey instrument was developed based on the World Health Organization (WHO) guidelines and literature to collect data on infants' tummy time practices, caregivers' tummy time knowledge and information sources. We used self-administered questionnaires through WeChat, in which participants scanned a quick response (QR) code to complete the questionnaire.

Results

We included 1040 infants and their primary caregivers, with 504 infants aged 0-5 and 536 infants aged 6-11 months old. Less than half of infants (48.2%) started tummy time in the neonatal period, with 20.5% starting within two weeks after birth. Only 27.2% of infants engaged in at least 30 minutes of tummy time during the last 24 hours, with infants aged 0-5 months significantly lower than those aged 6-11 months (21.6 vs 32.5%, P < 0.0001). No significant difference was found between attending ECE class and non-attending ECE class groups for the proportion of infants with tummy time ≥30 minutes per day (28.9 vs 23.4%, P = 0.0625); however, infants aged 0-5 months in the attending group engaged in longer duration of tummy time than those in the non-attending group (P = 0.0005). The compliance with the tummy time guidelines in infants receiving long-nurturing care was significantly higher than those receiving short-nurturing care (30.4 vs 22.1%, P = 0.0036). Only 42.7% of caregivers knew that at least 30 minutes daily tummy time was necessary for infant, and more primary caregivers in the attending group knew that, compared to the non-attending group (45.3 vs 36.8%, P = 0.0098).

Conclusions

The current status of infants' tummy time practices and caregivers' knowledge are generally suboptimal within the context of ECE institutions in urban China. Longer nurturing time contributes to higher compliance with tummy time guidelines. Effectively promoting tummy time practices through multiple channels in China is crucial.

Complementary feeding practices for children aged 6-23 months in early childhood education institutions in urban China: A cross-sectional study

Background

Appropriate infant and young child feeding (IYCF) plays a crucial role in promoting the healthy growth of children. Currently, many Chinese urban parents are seeking care of children from the early childhood education (ECE) institutions, however, little is known about the feeding practices of infants and young children in ECE institutions. This study aims to investigate the complementary feeding practices for Chinese urban children aged 6-23 months in ECE institutions and explore potential factors influencing their feeding practices.

Methods

This cross-sectional study was conducted among primary caregivers of children aged 6-23 months in ECE institutions across 31 provinces in China from 1 March to 30 April 2023. Convenience sampling was used to recruit caregivers from centres of Gymboree Play & Music (an ECE institution). Self-administered questionnaires were designed using the online survey tool Sojump and distributed through WeChat platform, which collected information on 1) children's complementary feeding practices; 2) food frequency of seven food groups; 3) caregivers' feeding knowledge and practices; 4) frequency of children attended ECE classes and the primary caregivers' daily nurturing care time; 5) source of information on complementary feeding.

Results

A total of 2731 children and their caregivers were surveyed, with 416 children aged 6-11 months and 2315 children aged 12-23 months. The prevalence of minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD) was 59.4, 60.6, and 39.2%, respectively. Only 17.3% caregivers believed that continued breastfeeding should be at two years or above, and 29.5% children were continuously breastfed at 12-23 months (CBF). The proportion of non-responsive feeding practices among caregivers ranged from 28 to 64%. Except for CBF, the prevalence of other key complementary feeding practices was higher among children who attending ECE classes than those not attending ECE classes (all P < 0.05). Moreover, children aged 12-23 months who received long-nursing care time (≥4h/d) had significantly higher MMF and MAD prevalence than those in short-nursing care time group (MMF = 66.2 vs. 58.8%, P = 0.0003; MAD = 44.2 vs. 38.3%, P = 0.0047).

Conclusions

The complementary feeding practices of children aged 6-23 months in ECE institutions in urban China remained suboptimal, and non-responsive feeding practices among caregivers were common. The attendance of ECE classes and the caregivers' daily nurturing care time could be beneficial in ensuring children to comply with complementary feeding recommendations.

The effectiveness of a WeChat-based self-assessment with a tailored feedback report on improving complementary feeding and movement behaviour of children aged 6-20 months in rural China: a cluster randomized controlled trial

Background

Appropriate infant feeding and movement behaviour (i.e. physical activity, sedentary behaviour, sleep) play an important role in children's healthy development during the first two years of life. The popular Chinese social media app 'WeChat' has become a potential data collection and health promotion tool. We aimed to evaluate the effectiveness of a WeChat-based self-assessment with a tailored feedback report on improving complementary feeding practices and movement behaviour of children aged 6-20 months in rural China.

Methods

We conducted a two-armed cluster randomized control trial in Datong County, Qinghai Province, China. There were 106 clusters from 257 villages allocated (1:1) to two groups: the feeding group, which received a complementary feeding recommendations feedback report; the movement behaviour group, which received movement behaviour recommendations feedback report. The feeding group acted as a control for the movement behaviour group and vice versa. Children aged 6-20 months and their primary caregivers were invited to be participants. WeChat was used to collect the data on outcomes and to deliver the interventions. Participants received the interventions by filling out the WeChat self-assessment questionnaire and reading tailored feedback reports at baseline, at the first 1-month follow-up and at the second 2-month follow-up. Outcome measures included changes in the prevalence of minimum dietary diversity (MDD), minimum meal frequency (MMF), minimum acceptable diet (MAD); and the proportion of children who met physical activity time (PAT), outdoor time (OT) and screen time (ST) recommendation between the two groups at the two follow-ups. This study is registered at Chinese Clinical Trial Registry-ChiCTR2200062529.

Findings

Between September 28th and October 12th 2022, we recruited 1610 children in 106 clusters, of which 53 clusters (800 children) were randomized to the feeding group and 53 clusters (810 children) to the movement behaviour group. All caregivers of children completed questionnaires at three time points without loss to follow-up. From baseline to the second follow-up, the prevalence of MDD (OR: 1.62 [95% CI, 1.16-2.28; p = 0.0058]), MMF (OR: 1.45 [95% CI, 1.03-2.04; p = 0.032]) and MAD (OR: 1.51 [95% CI, 1.12-2.05; p = 0.0081]) in the feeding group were significantly higher than that in the movement behaviour group. The proportion of children who met PAT during the last 24 h at the second follow-up (OR: 2.22 [95% CI, 1.26-2.17; p < 0.0001]) and OT at the second follow-up (OR: 1.94 [95% CI, 1.49-2.54; p < 0.0001]) significantly improved in the movement behaviour group compared to the feeding group. Furthermore, ST in the movement behaviour group showed a significant increase only at the first follow-up (OR: 1.36 [95% CI, 1.02-1.82; p = 0.036]).

Interpretation

WeChat-based self-assessment with tailored feedback was an effective channel to deliver feeding and movement behaviour recommendations in rural China in our study. This approach can be applied to change feeding practices of caregivers of young children alongside routine child health care in rural China.

Funding

Capital Institute of Pediatrics.

WeChat-based mobile health management for short-stature children with long-term growth hormone therapy: A nonexperimental study

Objective

To evaluate the role of a WeChat-based mobile platform in growth hormone therapy.

Method

Growth hormone therapy and health education information for height growth were embedded in a WeChat-based mobile platform, and the platform was evaluated through medical staff assessments, patient volunteer assessments and quantitative scoring criteria.

Results

In the medical staff evaluation, both clinicians and nurses had a positive attitude towards the mobile platform, believing that the design of the mobile platform was clearly visualized and easy to operate. In family volunteers' evaluations, the summary of β-testing results showed that 90-100% of parents had a positive attitude towards the WeChat-based mobile platform. Parents of the patients and doctors and nurses assessed the mobile platform by reviewing quantitative scoring standards developed by professional researchers. All scores were >16 (the average score was 18-19.3). Children treated with growth hormone therapy were included for compliance tracking for one year, and patient adherence was described in this study.

Conclusion

The interaction based on the WeChat platform and the health education of the public have greatly increased the interaction between doctors and patients, and improved patient satisfaction and compliance.

High response rate and low cost of WeChat-based data collection of infant and young child feeding data in rural Qinghai Province, China

Background

Measuring the infant and young child feeding (IYCF) indicators is key to effectively tracking the progress of child health programs and making evidence-based decisions. WeChat is the most popular mobile social media platform in China and has become a promising tool for collecting health data. This study aims to explore the response rate and costs of a WeChat-based questionnaire on IYCF information in rural China.

Methods

We conducted two cross-sectional surveys with caregivers of children aged 6-23 months in two rural counties in Qinghai Province (Menyuan and Datong County), China, from January to March 2022. Both surveys used the same WeChat IYCF questionnaire to collect household information, infant feeding practices, and caregivers’ feeding knowledge. Village doctors sent a quick response (QR) code to caregivers that was linked to the WeChat IYCF questionnaire. Participating caregivers scanned the QR code using their own WeChat account on their smartphone and filled in the questionnaire online. If they could not use WeChat themselves, village doctors administered the questionnaire. Once caregivers finished the questionnaires, they received a personalized report with infant feeding recommendations.

Results

We recruited 1274 caregivers of children aged 6-23 months in Menyuan County and 1748 caregivers in Datong County. The total response rate in the two counties was 98.2%; 77.6% of questionnaires were self-administered by caregivers and 20.6% were interviewer-administered by village doctors. The questionnaires were filled in twice by 209 (6.9%) caregivers. The cost of these two WeChat IYCF surveys was much lower than the cost of a previously conducted face-to-face survey: 11.8 yuan (US$1.85) in Menyuan County and 7.5 yuan (US$1.18) in Datong County for the WeChat survey vs 112.7 yuan (US$17.70) for the face-to-face survey in Huzhu County.

Conclusions

This study showed that using WeChat for IYCF surveys can achieve a very high response rate at a low cost in rural China. Village doctors played a very important role in achieving this high response rate. Providing feedback to caregivers may improve their feeding practices and this intervention could be incorporated into the data collection process.