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

Abstract

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.

SmartFeeding4Kids, an online self-guided parenting intervention to promote positive feeding practices and healthy diet in young children: study protocol for a randomized controlled trial

“…In some programs, parents not always defined objective, reachable, and realistic goals [ 28 ], which might compromise the intervention’s efficacy. We systematically reviewed several parental online interventions to promote children’s healthy eating and positive feeding practices and found that parents rarely received feedback about monitoring their behaviors or information about accomplishing the goal set [ 8 ]. In our program, a list of goals based on the parents’ needs identified in the baseline guided parents in choosing the feeding behaviors to improve.…”

“…The study protocol was clearly described regarding the components and contents of the intervention, detailing the parental feeding practices and children’s dietary outcomes targeted by the intervention and providing a categorization of the BCTs used in both arms. The power size and the sample size estimation were based on systematic reviews carried out with similar studies [ 8 , 32 , 33 ]. For this calculation, we adopt a more conservative approach to determine the dropout rate, to accommodate some issues found in online parental interventions and further limitations due to the current coronavirus disease (COVID-19) pandemic context.…”

“…Statistical power analysis was performed for sample size estimation based on published data regarding this topic using G*Power 3.1.9.2. For our repeated measures within-between group comparison study, we used Cohen’s f criteria and considered a small effect size of 0.15 [ 8 , 31 ], an alpha equal to 0.05, and power of 0.80 for a two-group with four repeated measures design (with a moderate correlation pattern between time measurements of 0.35). The sample size needed is approximately 130 participants (i.e., 65 parents in each of the two-arm groups), but the total sample size was adjusted to account for a dropout rate of 50% [ 32 , 33 ].…”

“…Several programs for parents of young children support them in implementing alternative strategies to coercive or permissive practices [ 7 ]. However, systematic reviews showed that program efficacy studies rely mostly on children’s nutritional-related variables and rarely assess parental feeding practices as an outcome [ 8 – 10 ], specifically, children’s autonomy and self-regulation promotion practices [ 8 ].…”

Protocol for the Let’s Grow randomised controlled trial: examining efficacy, cost-effectiveness and scalability of a m-Health intervention for movement behaviours in toddlers

“…A systematic review 38 of web-based interventions to change parent feeding practices for children up to 12 years of age identified seven studies that included children younger than 5 years, one targeting parents of infants, and the remainder focused on preschool children. Some of these studies had a broader focus (eg, obesity prevention) and hence also included one or more movement behaviours in their intervention.…”