JMIR Publications

ABSTRACT

Background:

Interventions in early childhood education and care (ECEC) services have the potential to improve child diet at the population level.

Objective:

This study aims to test the efficacy of an mHealth intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar and/or sodium (discretionary foods) in children’s (3-6 years) lunchboxes.

Methods:

A cluster randomised controlled trial was undertaken with 355 parent/child dyads recruited by phone and in person from 17 ECEC services (8 intervention and 9 control services) . Parents in the intervention group received a 10-week fully automated program, targeting common barriers to packing healthy lunchboxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources including weblinks 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 lunchboxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients, and packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunchboxes were undertaken by trained researchers pre and post the trial to assess primary and secondary outcomes. Outcome assessors were blind to service allocation. A process evaluation assessed feasibility, acceptability and use of the app among parents via an online survey.

Results:

Data on packed lunchbox contents were collected for 355/400 (89%) consenting children at baseline and 337/400 (84%) at follow up. There was no significant difference between groups in kilojoules from discretionary foods packed (49.22 kJ, CI=-183.87, 282.31, P= .68), nor for any of the other primary or secondary outcomes. The additional analysis including only data from children of parents who owned the app also failed to detect any change in primary or secondary outcomes. Approximately 63% of parents downloaded the app, and mean viewing rate of weekly within-app messages was 23%. Parents reported that they liked the SWAP IT program (83%), and found the program useful (80%). Estimated viewing rates of within-app messages ranged from 11% to 39% per week.

Conclusions:

Parents found it acceptable to receive lunchbox information via an existing ECEC communication app, however the intervention did not decrease the amount of energy or associated nutrients from discretionary foods packed in children’s lunchboxes. Low app downloads and program message views indicate a need for further investigation of factors influencing parent engagement with such mHealth interventions. Clinical Trial: The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618000133235).