An mHealth intervention to reduce the packing of discretionary foods in children’s lunchboxes in early childhood education and care services: a cluster randomised controlled trial (Preprint)

Abstract

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

Objectives: 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 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 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. Feasibility, appropriateness and acceptability were assessed via an ECEC service manager survey and a parent online survey. Use of the app was assessed via the app analytics.

Results: Data on packed lunchbox contents were collected for 89% of consenting children (N=355/400) at baseline and 84% of consenting children (N= 337/400) post intervention. There was no significant difference between groups in kilojoules from discretionary foods packed (77.84 kJ, CI=-163.49, 319.18, P= .53), nor for any of 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, CI= -343.87, 339.90, P=.86) or secondary outcomes. Approximately 62% (N= 102/165) of parents in the intervention group downloaded the app, and mean viewing rate of weekly within-app messages was 23%. Both parents who responded to the survey and participating services agreed that it was appropriate to receive lunchbox information via the app (80%, N= 40/50 and 75%, N= 6/8 respectively). The mean viewing rate across services was 26%.

Conclusion: The intervention was unable to demonstrate an impact on the amount of energy or associated nutrients from discretionary foods packed in children’s lunchboxes. Low app downloads and program message views indicates a need to explore how to improve factors relating to implementation prior to further testing of similar mHealth interventions in this setting.

Trial Registration: The trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12618000133235).