Translation of two healthy eating and active living support programs for parents of 2-6 year old children: a parallel partially randomised preference trial protocol (the 'time for healthy habits' trial)

Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial

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.

Parent Fruit and Vegetable Consumption Outcomes from the Translational 'Time for Healthy Habits' Trial: Secondary Outcomes from a Partially Randomized Preference Trial

Healthy eating and active living interventions targeting parents of young children could have benefits for both children and parents. The aim of this study was to assess the effectiveness of two remotely delivered healthy eating and active living interventions delivered at scale to parents, in increasing parent vegetable and fruit consumption (pre-specified secondary outcomes). Parents of children aged 2–6 years residing in New South Wales, Australia (n = 458), were recruited to a partially randomized preference trial consisting of three groups (telephone intervention (n = 95); online intervention (n = 218); written material (Control) (n = 145)). This design allowed parents with a strong preference to select their preferred intervention, and once preference trends had been established, all parents that were subsequently recruited were randomized to obtain robust relative effects. Parent vegetable and fruit consumption was assessed via telephone interview at baseline and 9 months later. At follow-up, randomized parents who received the telephone intervention (n = 73) had significantly higher vegetable consumption compared to those who received the written control (n = 81) (+0.41 serves/day, p = 0.04), but there were no differences in parents allocated to intervention groups based on preference. No differences in fruit consumption were found for randomized or preference participants for either the telephone or online intervention. There may be some benefit to parents participating in the Healthy Habits Plus (telephone-based) intervention aimed at improving the eating behaviors of their children.

Translation of Two Healthy Eating and Active Living Support Programs for Parents of 2-6-Year-Old Children: Outcomes of the 'Time for Healthy Habits' Parallel Partially Randomised Preference Trial

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.

A systematic review of economic evaluations of web-based or telephone-delivered interventions for preventing overweight and obesity and/or improving obesity-related behaviors

Obesity prevention interventions with behavioral or lifestyle-related components delivered via web-based or telephone technologies have been reported as comparatively low cost as compared with other intervention delivery modes, yet to date, no synthesized evidence of cost-effectiveness has been published. This study aimed to conduct a systematic review of economic evaluations of obesity prevention interventions with a telehealth or eHealth intervention component. A systematic search of six academic databases was conducted through October 2020. Studies were included if they reported full economic evaluations of interventions aimed at preventing overweight or obesity, or interventions aimed at improving obesity-related behaviors, with at least one intervention component delivered by telephone (telehealth) or web-based technology (eHealth). Findings were reported narratively, based on the Consolidated Health Economic Evaluation Reporting Standards. Twenty-seven economic evaluations were included from 20 studies meeting the inclusion criteria. Sixteen of the included interventions had a telehealth component, whereas 11 had an eHealth component. Seventeen interventions were evaluated using cost-utility analysis, five with cost-effectiveness analysis, and five undertook both cost-effectiveness and cost-utility analyses. Only eight cost-utility analyses reported that the intervention was cost-effective. Comparison of results from cost-effectiveness analyses was limited by heterogeneity in methods and outcome units reported. The evidence supporting the cost-effectiveness of interventions with a telehealth or eHealth delivery component is currently inconclusive. Although obesity prevention telehealth and eHealth interventions are gaining popularity, more evidence is required on their effectiveness and cost-effectiveness.

5-Year Follow-Up of a Telephone Intervention to Increase Fruit and Vegetable Consumption in Preschoolers: The 'Healthy Habits' Cluster Randomised Trial

Little is known about the long-term impact of telephone-based interventions to improve child diet. This trial aimed to assess the long-term effectiveness (after 5 years) of a telephone-based parent intervention in increasing children's fruit and vegetable consumption. Parents of 3-5 year olds were recruited from 30 Australian preschools to participate in a cluster randomised controlled trial. Intervention parents received four, weekly, 30-min support calls aimed at modifying the home food environment. Control parents received printed materials. Consumption was assessed using the Fruit and Vegetable subscale of the Children's Dietary Questionnaire (F&V-CDQ) (children) and daily servings of fruit and vegetables (children and parents) via parent telephone interview. Of the 394 parents who completed baseline, 57% (99 intervention, 127 control) completed follow-up. After 5-years, higher intervention F&V-CDQ scores, bordering on significance, were found in complete-case (+1.1, p = 0.06) and sensitivity analyses (+1.1, p = 0.06). There was no difference in parent or child consumption of daily fruit servings. Complete-case analysis indicated significantly higher consumption of child vegetable servings (+0.5 servings; p = 0.02), which was not significant in sensitivity analysis (+0.5 servings; p = 0.10). This telephone-based parent intervention targeting the family food environment may yield promising improvements in child fruit and vegetable consumption over a 5-year period.