Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: E-Health obesity programs offer benefits to traditionally-delivered programs and have shown promise in improving obesity-related behaviors in children. Objective: To assess the efficacy of a parent-focussed internet-based healthy lifestyle program for preschool-aged children, who are overweight or at risk of becoming overweight, on child BMI, obesity-related behaviors, parent modelling and parent self-efficacy. Methods: The Time2bHealthy randomized controlled trial was conducted in the Illawarra and surrounding areas of New South Wales and Melbourne, Victoria, Australia during 2016-2017. Participants were recruited both online and through more traditional means. Parent/carer and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, which was underpinned by Social Cognitive Theory, followed by fortnightly emails for 3-months thereafter. Intervention participants were encouraged to access and contribute to a closed (secret) Facebook group to communicate with other participants and a dietitian. Comparison participants received email communication only. Child BMI was the primary outcome, which was objectively measured. Secondary outcomes included objectively-measured physical activity, parent- and objectively-measured sleep habits, and parent-reported dietary intake, screen-time, child feeding, parent modelling and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3- and 6-months by blinded data collectors. Randomization was conducted using a computerized random number generator post-baseline data collection. Results: Eighty-six dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and one withdrawing. Mean child age was 3.46 years and 91% were in the healthy weight range. Sixty-nine percent of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared to children in the comparison group, those in the intervention group reduced frequency of discretionary food intake (estimate -0.360, 95% CI -2.272 to -0.447, P=0.00), and parents showed improvement in child feeding pressure to eat practices (-0.304, 95% CI 0.061 to -0.003, P=0.048) and nutrition self-efficacy (0.429, 95% CI 0.096 to 0.763, P=0.01). No significant time by group interaction was found for other outcomes. Conclusions: The trial demonstrated that a parent-focussed eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power. Clinical Trial: Australian and New Zealand Clinical Trials Registry (12616000119493). http://www.anzctr.org.au/

Experiential learning is the process where learners create meaning from direct experience. This systematic review aimed to examine the effects of experiential learning activities on dietary outcomes (knowledge, attitudes, behaviors) in children. Four databases: Education Research Complete, Scopus, Web of Science and PsychINFO were searched from database inception to 2020. Eligible studies included children 0–12 years, assessed effect of experiential learning on outcomes of interest compared to non-experiential learning and were open to any setting. The quality of studies was assessed using the revised Cochrane risk of bias tool by two independent reviewers and effect size was calculated on each outcome. Nineteen studies were conducted in primary school, six in pre-school and one in an outside-of-school setting and used nine types of experiential learning strategies. Cooking, taste-testing, games, role-playing, and gardening were effective in improving nutrition outcomes in primary school children. Sensory evaluation, games, creative arts, and storybooks were effective for preschool children. Multiple strategies involving parents, and short/intense strategies are useful for intervention success. Experiential learning is a useful strategy to improve children’s knowledge, attitudes, and behaviors towards healthy eating. Fewer studies in pre-school and outside of school settings and high risk of bias may limit the generalizability and strength of the findings.

Background: Few translational trials have provided detailed reports of process evaluation results. Objective: This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. Methods: Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P<.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. Results: Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention. Conclusions: This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes.

This translation study assessed the effectiveness of two remotely delivered healthy eating and active living interventions for parents of 2- to 6-year-old children in improving child fruit and vegetable intake, non-core food intake, body mass index (BMI), physical activity, screen time, and sleep. Parents (n = 458) were recruited to a partially randomised preference trial comprising three intervention groups. Healthy Habits Plus comprised six telephone calls, Time2bHealthy comprised six online modules, and the active control comprised ten information sheets and a summary booklet. Data were collected from parents via a telephone questionnaire at baseline and nine months post-baseline. Data were analysed for randomised participants alone (n = 240), preference participants alone (n = 218), and all participants combined (n = 458). There was no significant improvement in fruit and vegetable intake (primary outcome) when comparing the telephone and online interventions to the control. In both the randomised only and all participants combined analyses, there was a significant improvement in non-core food intake for the telephone intervention compared to the control (p < 0.001). Differences between interventions for other outcomes were small. In conclusion, the telephone and online interventions did not improve child fruit and vegetable intake relative to written materials, but the telephone intervention did improve non-core food intake.