JMIR Publications

ABSTRACT

Background:

Early childhood (0-5 years) is a crucial time for establishing health behaviours, yet optimal behaviours are not often achieved. Digital health promotion interventions offer promising, cost-effective, and scalable solutions. However, most research has focused on childhood more broadly, leaving limited evidence capturing the early childhood period.

Objective:

The primary aim of this systematic review was to examine whether autonomously delivered digital interventions targeting parents are effective at increasing physical activity, reducing sedentary behaviour, improving nutrition (breastfeeding, feeding practices), and/or optimising sleep among children aged 0-5 years. The secondary aim was to review the reporting of co-design practices, user engagement and process evaluation, and to assess how engagement influences intervention effectiveness.

Methods:

Embase, Academic Search Complete, CINAHL Complete, Global Health, MEDLINE Complete, PsycINFO, and SPORTDiscus were searched for randomized controlled trials that examined the effectiveness of digital interventions on health behaviours in children aged 0-5 years in studies published up until August 2024. The study outcomes included physical activity, sedentary behaviour, sleep, and nutrition. The JBI Critical Appraisal Checklist for Randomized Controlled Trials was used to assess study quality and bias risk.

Results:

Of the 7339 identified records, 26 interventions (21 RCTs, 4 pilot RCTs, 1 feasibility RCT) were included. Most studies focused on pregnancy to infancy (n=18; 0-1 year), followed by preschoolers (n=6; 3-5 years) and toddlers (n=2; 1-2 years). Intervention duration ranged from 2 weeks to 12 months and various delivery channels of digital technologies were used (apps n=10, SMS n=5, web- or internet-based platforms n=5, WeChat n=2, a combination of website and emails n=1, emails and SMS n=1, tablet-based program n=1, and automated voice calls n=1). Interventions spanning pregnancy to infancy reported mixed findings for breastfeeding and feeding practices. Studies targeting toddlers showed improvements in diet, screen time and sleep, but no differences in physical activity. Most studies targeting preschoolers reported significant improvements for feeding practices and diet, but no differences in physical activity, sedentary behaviour and sleep as well as mixed findings for screen time. Most studies reported some form of co-design or engagement with parents (n=18), but few examined the impact of engagement on intervention effectiveness (n=3) and those that did, reported no impact of engagement on the degree of effectiveness.

Conclusions:

Autonomously delivered digital interventions for improving health behaviours in early childhood are heterogeneous and report varying degrees of effectiveness which make it challenging to identify successful intervention components. Studies targeting toddlers and preschoolers are largely lacking, and few studies report on the impact of engagement on intervention effectiveness, highlighting the need for more research in this area.