Examining the feasibility of a brief parent intervention designed to promote positive food communication with infants.

BACKGROUND: Few prevention interventions exist focusing on supporting parents to use positive food communication at mealtimes, for the prevention of disordered eating. "Mealtime chatter matters (MCM)" is a brief intervention designed for parents of infants. The intervention was designed in collaboration with child health nurses (CHNs) to be embedded into usual care. The overall aim of this study was to test the feasibility of the intervention through examining the acceptability of the MCM content and resources and the potential impact of the intervention on parents. METHODS: This pilot study utilised a mixed methods approach and took place within a regional child health service in Queensland, Australia (October 2021 to June 2022). Participants were parents of infants attending child health education groups and CHNs. The intervention consisted of a brief education session (including accompanying resources), facilitated by a Paediatric Dietitian. The acceptability of MCM content and resources was assessed by both parents and CHNs via self-reported questionnaires and the potential impact on parents assessed via pre-/post-self-reported questionnaires. RESULTS: Forty-six parents of infants (aged < 8 months) and six CHNs who hosted the intervention and observed the program's delivery participated in the study. MCM content and resources were highly acceptable to parents and CHNs, as both qualitative and quantitative data concurred. How the program may have potentially impacted parenting practices was unclear from the survey results and further investigation is required to better understand these. Tangible lessons and opportunities to further test this intervention were clear from current results. CONCLUSION: Overall, MCM was acceptable to both parents and CHNs, with the content and resources both being highly valued. Parents reported the content to be informative and engaging and CHNs were keen to have such an intervention available in the future. However, further modification and testing is required of MCM. This feasibility study is an essential first step in supporting parents and CHNs to access an evidence-based intervention with the aim of preventing disordered eating. TRIAL REGISTRATION: Griffith University Human Research Ethics Committee (2021/577) and Gold Coast Hospital and Health Service Human Research Ethics Committee (QGC/76618).

Disordered eating prevention: Co-designing a brief intervention for use in Community Child Health Services.

Dietary habits established in childhood, often persist into adulthood highlighting the importance of early intervention. However, limited interventions exist promoting "how" to establish healthful eating behaviors in children. To create impactful interventions, it is important they are based on evidence and co-designed with end-users. Fifteen child health nurses participated in this co-design study, underpinned by the Knowledge to Action Framework. Child health nurses reviewed evidence-based statements and then workshopped practical strategies. Findings from the co-design sessions were used to inform the development of a preventive intervention. The study has important health marketing implications for conducting co-design with child health nurses.

Why "mealtime chatter matters": A process evaluation of a preventive health brief intervention.

How parents communicate about food is important for building children's emotional relationships with food. "Mealtime Chatter Matters" (MCM) is an evidence-informed brief intervention providing behavioral strategies for parents focusing on positive communication at mealtimes. This process study explored parents' experiences of the brief intervention. Nine mothers participated in interviews, followed by a qualitative inductive analysis. Findings revealed the strengths and weaknesses of MCM and critical reflections of participants' experiences that can be used to inform future program strategies. This study has important health marketing implications for developing preventive health resources and indicates that future research on mealtime communication is warranted.

Parental food communication and child eating behaviours: A systematic literature review.

AIM: To review current evidence for parental food communication practices and their association with child eating behaviours. METHODS: The PRISMA framework guided the reporting of the review; registered with Prospero in July 2020. Eligible studies were critically appraised using the Joanna Briggs Institute tools. Only quantitative studies that included a parental measure of food communication and a child measure of eating behaviour were included. RESULTS: From 11 063 articles 23 were eligible for synthesis. The vast majority (82%) of studies used observational cross-sectional designs. Three involved observing parent-child dyads, with the remainder using questionnaires. Two quasi-experimental designs tested interventions and two randomised control trial were reported. The majority of measures assessing parental food communication were subscales of larger questionnaires. The Caregiver's Feeding Style Questionnaire (CFSQ) was the most direct and relevant measure of parental food communication. Findings of reviewed studies highlighted that "how" parents communicate about food appears to impact child eating behaviours. Using child-centred communication provided promising outcomes for positive child eating behaviours, while parental "diet" communication was found to be associated with poorer dietary outcomes in children. CONCLUSIONS: Food communication research is in its infancy. However, evidence for the importance of parents' child-focused food communication is emerging, providing a focus for future research and interventions. SO WHAT?: Given the gaps in our understanding about prevention of disordered eating, there is a significant opportunity to explore what food communication strategies may assist parents to communicate about food in a positive way.

Multicomponent approaches to promoting healthy behaviours in people with Type 2 diabetes: an integrative review.

The progression of diabetes-related complications can be delayed with multifactorial interventions that support healthy behaviours. However, many initiatives have focused on educational or individual-level activities and observed limited or modest sustained improvements in healthy behaviours. A multicomponent approach to behaviour change, which simultaneously considers numerous social determinants of health across multiple socio-ecological model levels, may be required to achieve meaningful health outcomes for people with Type 2 diabetes. Applying a multicomponent method of inquiry, this integrative review aimed to synthesize the evidence on interventions using multifactorial interventions to promote healthy behaviours in adults with Type 2 diabetes. Interventions promoting healthy behaviours in adults with Type 2 diabetes were considered for the review. A total of 7205 abstracts retrieved from eight databases were screened for inclusion. Thirteen articles were included, of these 11 achieved statistically significant clinical and/or behavioural changes in outcomes such as glycated haemoglobin, blood pressure, cholesterol, diet and physical activity. The multifactorial components utilized included the coordination of multi-disciplinary health care teams, in-person self-care classes, group activities, incorporation of peer-leaders, the development of community partnerships, economic relief and built-environment support. The proportion of included studies published within recent years indicates a trend towards multicomponent interventions and the growing recognition of this approach in promoting public health. Our findings provide early support for the potential of extending intervention components beyond educational, individual-level and health care system-level focus to incorporate multiple socio-ecological model components that contribute to the system of influence affecting the health of people with diabetes.

Promoting Confident Body, Confident Child in community child health: A mixed-methods implementation study.

OBJECTIVE: To evaluate population-level implementation of Confident Body, Confident Child (CBCC); an evidence-based program providing parenting strategies to promote healthy eating, physical activity and body satisfaction in children aged 2-6 years; with community child health nurses (CHNs). METHODS: This study utilised an implementation-effectiveness hybrid design, with dual focus on assessing: (a) CBCC implementation into Child Health Centres at a regional health service in Queensland, Australia (process evaluation); and (b) CBCC's effect on CHNs' knowledge and attitudes (outcomes evaluation). Process (CBCC reach, dose, fidelity) and outcome data (CHN knowledge of child body image; and attitudes towards higher body weights) were collected during implementation, and pre- and post-intervention delivery to CHNs, respectively. RESULTS: Twenty-six CHNs (all female; mean age 52.7 ± 9.5 years) participated in the study by attending a 1-day CBCC training workshop and completing demographic and outcome surveys. Process evaluation found that CBCC was implemented as planned and reached 56% of CHNs across the health service. Outcome evaluation showed small but non-significant improvements in CHN knowledge (P = .077) and attitudes towards overweight (using Anti-Fat Attitudes scale; significant improvements on willpower sub-scale only (P < .05)). DISCUSSION: This is the first study to evaluate population-wide CBCC implementation in a real-world health service setting with CHNs. Findings highlight the potential for using pragmatic, implementation-focused methodologies to translate preventive eating disorder programs into community child health services.

What Factors Predict the Use of Coercive Food Parenting Practices among Mothers of Young Children? An Examination of Food Literacy, Disordered Eating and Parent Demographics.

Parents have the most significant influence on the development of young children's eating patterns. Understanding what parental factors best predict specific negative feeding practices is important for designing preventive interventions. We examined the relationship between parents' use of coercive food parenting practices (pressure to eat and restriction) and parents' disordered eating, food literacy, Body Mass Index (BMI) and socio-economic status (SES). Adult mothers, with a mean age of 33 years, at least one child aged between 6 months and 5 years and living in Australia (n = 819) completed an online questionnaire. Regression models were used to examine predictors of pressure to eat and restriction, respectively. Although the amount of variance accounted for by the models was small, maternal eating disorder symptoms were found to be the most important predictor of coercive food parenting practices. This finding has implications for early nutrition education, which has traditionally focused heavily on nutrition literacy. Parental disordered eating may be a more important preventive target and thus including behavioral strategies for positive feeding practices may better assist mothers in promoting positive eating habits with their children, rather than traditional approaches that aim to increase nutrition literacy.

Child health nurse perceptions of using confident body, confident child in community health: a qualitative descriptive study.

BACKGROUND: Confident Body, Confident Child (CBCC) is an innovative, evidence-based program providing parenting strategies to promote healthy eating, physical activity and body satisfaction in children aged 2-6 years. This study aimed to explore Child Health Nurse (CHN) experiences with using CBCC in their community health clinics with parents of young children. This work is part of a larger study involving tailoring, implementing and evaluating CBCC in a community child health setting. METHODS: This qualitative descriptive study was conducted within community child health centres at a public health service in Queensland, Australia. Participants included CHNs who had recently attended a tailored CBCC training workshop providing training/education, group activities/discussions and CBCC resources for CHN use in clinical practice. Semi-structured interviews were conducted to explore CHN perceptions of CBCC training, content and resources; and how CBCC was used in practice. Interviews were recorded and transcribed verbatim and analysed thematically. RESULTS: Eleven CHNs participated in interviews, with three themes emerging from the data. In Theme 1, High CHN satisfaction with CBCC messages, resources and utility, nurses expressed CBCC was highly valuable, useful and easy to enact in their practice. In Theme 2, Effects of CBCC on CHN knowledge, behaviour and practice, CHNs said they experienced increased awareness around body image, improved confidence in addressing issues with clients, and positive changes in their own behaviour and practice after attending CBCC training. In Theme 3, CHNs discussed Ideas for future implementation of CBCC, including challenges and considerations for practice, ongoing education/training for CHNs and broadening the target audience for wider CBCC dissemination. CONCLUSIONS: This study found CHNs were highly accepting of CBCC as it was useful and valuable in practice, increased their awareness and confidence around body image issues, and positively affected their attitudes and behaviours. CHNs' suggestions for making CBCC delivery more efficient and broadening its reach in the community were valuable and will likely inform local policy and future research. Further research is required on the wider dissemination of CBCC to parents of young children for promoting positive body image and healthy eating, ultimately for the long-term prevention of eating disorders.

Randomised controlled trial: A parent-based group education programme for overweight children.

AIM: Childhood overweight and obesity is a significant community health problem with severe long-term complications. This paper aims to evaluate a four-by-two-hour weekly group parent education programme targeting children who are overweight. METHODS: A randomised time series design with wait-list controls was conducted for overweight and obese children aged 3-10 years. RESULTS: A statistically significant reduction in child body mass index and energy intake was found post treatment; no differences were reported for child sedentary electronic media time, physical activity and waist circumference. Children's baseline activity levels were found to be at or slightly above national recommended standards. No change occurred in primary parent body mass index or waist circumference after treatment. CONCLUSIONS: A brief group education programme for parents was effective in reducing childhood overweight at 3 months follow-up.

Perceptions of psychosocial support groups by parents who have a child with diabetes: a needs analysis.

Psychosocial support groups play an important role in assisting parents to understand and manage the demands of having a child with diabetes. Actual participation in such groups is marred by problems of poor uptake, irregular attendance and attrition. A survey was conducted with a convenience sample of parents to determine their knowledge needs about preferred program characteristics, the management of diabetes, perceived barriers to program participation, and factors facilitating group attendance. A response rate of 66% (n = 40) was achieved. Parents favoured a program that was only conducted monthly or three to six times a year, held during the evening or weekend and of two or three hours duration. Parents were keen to know more about new developments in the treatment of diabetes, and strategies to assist their child when they refuse medication or treatment. The most commonly reported barriers to group attendance were distance, timing of groups, and employment demands. Participants were more likely to attend a support group in order to learn new information or skills, keep up to date, as well as meet parents in the same situation. Support groups need to address both content and practical issues for enhanced support and empowerment of families.