Healthy Online Parental Education (HOPE): A multicomponent ehealth intervention on child health behaviors among low-income families in Lubbock, Texas

Date
2022-07-20
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Abstract

Objective: The objective of this study was to evaluate a multicomponent eHealth intervention, called Healthy Online Parental Education (HOPE), aimed at improving child health behaviors and parental psychosocial attributes among low-income families in Lubbock, Texas. Our primary outcomes were child fruit and vegetable intake, physical activity levels, and sedentary behavior. Secondarily, this study investigated if parents would improve their knowledge, attitudes, self-efficacy, and feeding practices after the intervention. Methods: A pilot randomized controlled trial was conducted among 73 parents with toddlers between October and December 2021. Parents with toddlers aged between one and three years were recruited from Texas Tech University Center for Early Head Start, Young Women's Christian Association Early Head Start, and Early Learning Centers of Lubbock. Participants were randomly assigned into two groups: intervention group (IG; n = 37) and control group (CG; n = 36). The intervention was informed by the Social Cognitive Theory and utilized multicomponent strategies. IG participants completed biweekly family online cooking activities and received weekly educational videos and text messages for eight weeks. CG participants received printed materials about dietary recommendations for children, one time after baseline assessments. A parent-administered questionnaire was used for data collection, measuring child health behaviors and parental psychosocial attributes, at baseline and post intervention. Descriptive and inferential statistics and linear models were performed using R version 4.1.1. for data analysis. Results: The majority (56.20%) of children were male with an average age of 26.52±8.48 months. Slightly more than one-third (36.99%) children were biracial, followed by Hispanic (23.30%), Non-Hispanic White (21.90%), Black (16.40%), and Native Hawaiian and other Pacific Islanders (1.40%). Children in the IG had small but significant increases in intake of fruit (ΔΔ = 0.89 servings/day, p = 0.00057) and vegetable servings (ΔΔ = 0.60 servings/day, p = 0.0037), compared to the CG. There were no significant changes in child physical activity in both study groups at post intervention. Children in the IG significantly decreased time spent in sedentary behaviors (Δ = -43.38 minutes/day, p = 0.00018) and screen viewing (Δ = -27.47 minutes/day, p < 0.0001). However, such changes were not significantly greater than the CG. No significant improvements were observed in parental nutritional knowledge. In contrast, self-efficacy around feeding (p = 0.0068) and feeding practices (p = 0.0069) were significantly improved in IG parents, compared to the CG. Overall, 93.50% participants found the HOPE intervention very helpful. In an exit interview, 97.00% of participants commented positively on family cooking activities: “Receiving the fruits for the popsicles overall was very helpful. It was a very good addition to our lifestyle change. It made the activity fun, enjoyable, and accessible.” Conclusion and recommendations: This pilot study showed the feasibility and acceptability of the multicomponent eHealth HOPE intervention in improving child fruit and vegetable intake as well as parental self-efficacy and feeding practices. A bigger sample size representing a diversity of race/ethnicity, geographical region, and parental ages is needed in future research. In addition, long-term efficacy should be further investigated to examine whether behavior changes are maintained over time.


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Keywords
Child obesity, eHealth
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