Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review

Abstract

Background Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders’ acceptability of interventions. Methods A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers’ behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools. Results Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants’ perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals. Conclusion There is limited reporting of stakeholders’ experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants’ acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up. Trial registration PROSPERO registration: CRD42019108658

Trial collaborators’ perceptions of the process of delivering Healthy Beginnings advice via telephone calls or text messages

“…20,42,49,50 Interventions delivered via telephone calls, text messages or mobile applications have led to improvements in behaviours related to healthy growth in children. 10,16,51,52 Significant advantages of these modes of delivery are participants' access to the program and convenience. Intervention delivery via text messages and telephone calls is cost-effective and has the potential to reach large segments of the population.…”

“…15 There is a lack of research on reporting of stakeholders' perspectives and a need to understand the contextual influences upon intervention processes for future translation or scale-up. 16 This research was one of four studies conducted during the intervention phase, to evaluate the process of delivering the Communicating Healthy Beginnings Advice by Telephone (CHAT) 2016 (TRGS 200) and Sydney Local Health District (SLHD). ME is a PhD scholar funded by the University of Sydney Postgraduate Award scheme.…”

“…28 It has been demonstrated that there is a lack of evidence that existing studies have examined the perceptions of intervention deliverers and health professionals. 16 The aim of this study was to explore the perceptions of trial…”

What works to protect, promote and support breastfeeding on a large scale: A review of reviews

“…were moderately effective (Kassianos et al, 2019), and theory-based interventions using theories of self-efficacy or planned behaviour were more effective at improving exclusive breastfeeding (Chipojola et al, 2020). A growing area of research supports the use of digital health interventions at the individual level, in the form of SMS/text messaging, and other online formats (Ekambareshwar et al, 2021;Lau et al, 2016;Palmer et al, 2020), although with low certainty due to the quality of the studies (Table 7). Over half of reviews in the past five years are high-or moderate quality, with the remaining low or critically low quality due to weaknesses in assessment of bias.…”

Participants’ Engagement With Telephone Support Interventions to Promote Healthy Feeding Practices and Obesity-Protective Behaviours for Infant Obesity Prevention

“…Intervention delivery commenced from the third trimester of pregnancy to 12 months of child’s age and beyond. In behavioural intervention trials, it is important to evaluate the process that occurred during intervention delivery and the extent to which participants engaged with the interventions ( 12 ). This research was one of four studies solely conducted to evaluate the process of delivering the CHAT program.…”