Hunter New England Population Health, Wallsend, Australia.
School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
J Med Internet Res. 2022 Mar 17;24(3):e27760. doi: 10.2196/27760.
Interventions in early childhood education and care (ECEC) services have the potential to improve children's diet at the population level.
This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children's (aged 3-6 years) lunch boxes.
A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children's lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children's lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics.
Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI -163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (-1.98 kJ, 95% CI -343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively).
The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children's lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting.
Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379.
儿童早期教育和保育（ECEC）服务中的干预措施有可能改善儿童的整体饮食。
本研究旨在测试 ECEC 服务中移动健康干预措施的功效，以减少父母为 3-6 岁儿童（儿童）午餐盒中包装高脂肪、高糖和高钠（随意食物）食物的情况。
采用 355 对父母和儿童的亲子对，通过电话和亲自从 17 个 ECEC 服务中招募（8[47%]干预组和 9[53%]对照组）。干预组的父母接受了一项为期 10 周的完全自动化计划，该计划针对包装健康午餐盒的障碍进行了目标设定，通过现有的服务通讯应用程序提供。该计划包括每周推送通知、应用内消息和链接到进一步的资源，包括网站和视频。对照组未接受任何干预。主要结局是儿童午餐盒中随意食物和相关营养素（饱和脂肪、游离糖和钠）的千焦耳含量。次要结局包括随意食物和相关营养素的消耗量以及随意食物和核心食物组的包装和消耗量。在试验前后，由经过培训的研究人员对儿童午餐盒中的食物进行摄影和称重，以评估主要和次要结局。结局评估者对服务分配保持盲态。通过 ECEC 服务经理调查和家长在线调查评估了可行性、适当性和可接受性。通过应用程序分析评估了应用程序的使用情况。
在基线时，有 88.8%（355/400）的同意儿童和干预后有 84.3%（337/400）的儿童收集了包装午餐盒内容的数据。组间包装的随意食物的千焦耳含量（77.84 kJ，95%CI-163.49 至 319.18；P=.53）或其他主要或次要结局均无显著差异。包括仅来自下载应用程序的父母的孩子的数据的方案分析也未发现主要（-1.98 kJ，95%CI-343.87 至 339.90；P=.86）或次要结局有任何统计学上的显著变化。干预组中约有 61.8%（102/165）的父母下载了应用程序，每周应用内消息的平均服务查看率为 26%（SD 14.9）。对调查做出回应并参与调查的服务提供者认为，通过应用程序接收午餐盒信息是合适的（分别为 40/50，80%和 6/8，75%）。
该干预措施未能证明能减少儿童午餐盒中随意食物的千焦耳或相关营养素的摄入量。低应用程序下载量和计划消息查看量表明，在该环境中进一步测试类似的移动健康干预措施之前，有必要探讨如何改善与实施相关的因素。
澳大利亚和新西兰临床试验注册 ACTRN12618000133235；https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379。
