A Text Messaging Intervention (Txt4HappyKids) to Promote Fruit and Vegetable Intake Among Families With Young Children: Pilot Study

Abstract

BackgroundIncreasing fruit and vegetable intake among low-income populations, especially children, is a priority for United States federal food assistance programs. With over 49 million federal food assistance program recipients, cost-effective and efficient methods are needed to effectively deliver nutrition education to such a large population.ObjectiveThe objective of our study was to examine the preliminary efficacy and acceptability of a text messaging intervention, Txt4HappyKids, to promote fruit and vegetable intake among families with young children.MethodsThe intervention was evaluated using a pre-post study design. Parents (N=72) in Alaska were recruited from venues that serve a predominantly low-income population to participate in an 11-week intervention based on social cognitive theory. Parents received two texts per week promoting child fruit and vegetable intake. Behaviors, self-efficacy, and attitudes related to fruit and vegetable intake were measured at baseline and postintervention. Perceived changes in behaviors and open-ended feedback were also collected postintervention.ResultsOf all participants, 67.3% (72/107) completed the intervention. We found no changes in behavior (P=.26), self-efficacy (P=.43), or attitudes (P=.35) related to fruit and vegetable intake from pre- to postintervention. Completers reported that since their participation in Txt4HappyKids, 92% (66/72) served more fruits and vegetables to their child because they thought fruits and vegetables were beneficial, 86% (62/72) tried to follow a healthier diet, 85% (61/72) tried different ways of preparing fruits and vegetables, and 81% (58/72) were more aware of the foods their child consumes. Additionally, 79% (57/72) of completers thought that Txt4HappyKids was credible, 71% (51/72) found texts useful, and 82% (59/72) would recommend it to a friend.ConclusionsA text messaging intervention was not sufficient to increase fruit and vegetable intake among families with young children. However, parents felt positively impacted by Txt4HappyKids and were receptive to nutrition information, despite the absence of face-to-face contact. High satisfaction among completers indicates that text messaging may be an acceptable complement to budget-constrained nutrition programs. These findings are an important first step in developing larger multi-level interventions utilizing mobile technology; however, a more rigorous evaluation of the Txt4HappyKids intervention is warranted.

SAlBi educa (Tailored Nutrition App for Improving Dietary Habits): Initial Evaluation of Usability

“…Message length is not always described in the studies. However, when it is mentioned (4/15 studies), all of them agree on 160 characters (about 2–3 sentences) ( 30 , 52 , 54 ). In most cases, message frequency was a key aspect in maintaining user adherence and reducing app use abandonment ( 14 ).…”

“…Although numerous nutrition apps are available for downloading onto users' smartphones, few have been based on scientific evidence, developed by health and nutrition professionals, subsequently tested to prove their usability and efficiency in terms of improving healthy eating habits, and referenced in the literature ( 6 , 25 – 27 ). A number of these applications focus exclusively on increasing or decreasing the consumption of a food group, such as fruits and vegetables or sugary drinks and juices ( 27 – 30 ). A few apps do in fact include a daily food record, nutritional evaluations, and feedback ( 6 , 26 , 31 , 32 ).…”

E-Health and M-Health Interventions to Improve Eating Behaviour of People with a Lower Socioeconomic Position: A Scoping Review of Behaviour Change Techniques

“…'Information about antecedents' (5x) was applied e.g. in the intervention reported by(Power & Bersamin, 2018), in which fruit and vegetable discounts at grocery stores were announced. Most common BCT from the cluster 'Natural consequences' was 'Information about health consequences' (13x), which was applied by e.g.Au et al (Au et al, 2017) by providing participants information about why skipping breakfast can lead to poorer health.…”

“…BCTs from the cluster 'Identity' were 'Identi cation of self as role model (3x), 'Framing/ reframing' (1x), 'Valued self-identity' (1x), and 'Identity associated with changed behaviour' (1x). Examples include motivating parents to be positive role models for their children by consuming fruits and vegetables, and portraying shopping and cooking with children as a great way to spend quality time together(Power & Bersamin, 2018). The BCT from 'Social support' was 'Social support (unspeci ed)' (5x), for example a moderated peer-to-peer discussion forum(Riper et al, 2008).…”

“…. We focus the results section on whether the e-health intervention was effective in changing dietary behaviour of the low SEP target group.Of the 17 included papers, four papers found no change(Power & Bersamin, 2018) or no effect in the low SEP group compared to a control group (Crombie et al, 2018; Springvloet et al, 2015a; Voogt et al, 2013). The other 13 studies observed at least some positive effects of the e-health intervention on eating behaviour among persons with a low SEP.…”