Fathers' perceived role, self-efficacy and support needs in promoting positive nutrition and physical activity in the first 2000 days of life: a mixed methods study.

BACKGROUND: The first 2000 days of life are a crucial and opportunistic time to promote positive dietary and physical activity behaviours that can continue throughout life. The bulk of research on the impact of parents promoting positive dietary and physical activity behaviours has been on mothers, with the impact of fathers rarely investigated. The aim of this study is to investigate fathers' perceived role, self-efficacy and support needs in promoting positive dietary and physical activity behaviours in early childhood. METHODS: A sequential explanatory mixed methods study design consisted of a cross sectional survey of Australian fathers (n = 200) from a convenience sample, followed by semi-structured qualitative interviews (n = 21) with a purposeful sample of Australian fathers. RESULTS: Quantitative survey data revealed that more than 90.0% of fathers agreed that it is important to role model healthy eating and participating in physical activity with their babies, toddlers and children. A majority of fathers were confident in getting their child to eat fruit/ vegetables (90%) and playing with their child (80%). When searching for information about nutrition and physical activity, the highest proportion of fathers nominated online sources (52%) as their preferred source in survey data. Qualitative interview data revealed that while fathers exhibited high self-efficacy in their abilities, this was susceptible to deterioration due to feelings of isolation, pressures of fatherhood, a lack of information and resources that are father specific, and difficulties navigating the different types of information/resources to find what is right for them. CONCLUSIONS: Although possessing self-efficacy, being committed and seeking knowledge, many fathers found that useful information was hard to find and understand. Appropriate resources are therefore required to support the specific needs of fathers to promote positive dietary and physical activity behaviours in their infants and young children.

A design thinking-led approach to develop a responsive feeding intervention for Australian families vulnerable to food insecurity: Eat, Learn, Grow.

BACKGROUND: Design thinking is an iterative process that innovates solutions through a person-centric approach and is increasingly used across health contexts. The person-centric approach lends itself to working with groups with complex needs. One such group is families experiencing economic hardship, who are vulnerable to food insecurity and face challenges with child feeding. OBJECTIVE: This study describes the application of a design thinking framework, utilizing mixed methods, including co-design, to develop a responsive child-feeding intervention for Australian families-'Eat, Learn, Grow'. METHODS: Guided by the five stages of design thinking, which comprises empathizing, defining, ideating, prototyping, and testing. We engaged with parents/caregivers of a child aged 6 months to 3 years through co-design workshops (n = 13), direct observation of mealtimes (n = 10), a cross-sectional survey (n = 213) and semistructured interviews (n = 29). Findings across these methods were synthesized using affinity mapping to clarify the intervention parameters. Parent user testing (n = 12) was conducted online with intervention prototypes to determine acceptability and accessibility. A co-design workshop with child health experts (n = 9) was then undertaken to review and co-design content for the final intervention. RESULTS: Through the design thinking process, an innovative digital child-feeding intervention was created. This intervention utilized a mobile-first design and consisted of a series of short and interactive modules that used a learning technology tool. The design is based on the concept of microlearning and responds to participants' preferences for visual, brief and plain language information accessed via a mobile phone. User testing sessions with parents and the expert co-design workshop indicated that the intervention was highly acceptable. CONCLUSIONS: Design thinking encourages researchers to approach problems creatively and to design health interventions that align with participant needs. Applying mixed methods-including co-design- within this framework allows for a better understanding of user contexts, preferences and priorities, ensuring solutions are more acceptable and likely to be engaged.

The impacts of an mHealth intervention targeting parents on health service usage and out-of-pocket costs in the first 9 months of life: The Growing healthy app.

Mobile health (mHealth) interventions provide a low-cost, scalable approach to supporting parents with infant feeding advice with the potential to reduce health care visits and associated costs for infant feeding support. This Australian study examined the impact of the Growing healthy (GH) app on health service utilisation and out-of-pocket costs for families in the first 9 months of their infants life. A quasi-experimental study with a comparison group was conducted in 2015-2016 with an mHealth intervention group (GH app, n = 301) and a nonrandomized usual care group (n = 344). The GH app aimed to support parents of young infants with healthy infant feeding behaviours from birth to 9 months of age. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed surveys at baseline when infants were less than 3 months old (T1), at 6 months (T2) and 9 months (T3) of age. At T3, participants reported health services used and any out-of-pocket costs for advice on infant feeding, growth or activity. App users had lower odds (odds ratio: 0.38 95% confidence interval: 0.25, 0.59) of using one or more services and had lower number of visits to a general practitioner (1.0 vs. 1.5 visits, p = 0.003) and paediatrician (0.3 vs. 0.4 visits, p = 0.049) compared to the usual care group. There was no difference in out-of-pocket costs between groups. Provision of an evidenced-based infant feeding app may provide substantial savings to the health system and potentially to parents through fewer primary health care and paediatrician visits.

The contribution of Australian fathers in getting food on the table among families with young children.

OBJECTIVE: To explore how fathers with young children contributed to healthy home food provisioning and the factors enabling or inhibiting their involvement in family food tasks. DESIGN: Cross-sectional study using purpose-designed online survey. The survey assessed the level of responsibilities and practices in family food tasks, food agency (Cooking and Food Provisioning Action Scale), and use of resources to support involvement in family food tasks. Data collection took place over 3 weeks in November-December 2020 when various COVID-19-related restrictions were in place. Descriptive and regression analyses were used to assess psychosocial factors influencing responsibilities in family food tasks and food agency. SETTING: Online survey. PARTICIPANTS: Included in the analysis were 435 Australian fathers with children aged under 5 years. RESULTS: Between 75 and 77 % of fathers in this study reported having at least half of the responsibilities in meal planning, shopping, and cooking. Health was frequently considered when deciding what to eat, but few used nutrition or food labels when shopping, tried new recipes or modified recipes to make them healthier. Involvement in family food tasks was promoted by a higher food agency, but time spent in employment was a significant barrier to reported food agency and greater involvement in food tasks. There was a high interest in resources to support healthy home food provisioning. CONCLUSIONS: The findings suggest the need to consider father-specific strategies to overcome time barriers and opportunities to enhance their capabilities for healthy home food provisioning.

Mothers' experiences of reducing family mealtime screen use in Australian households with young children.

OBJECTIVE: Screen use at mealtimes is associated with poor dietary and psychosocial outcomes in children and is disproportionately prevalent among families of low socio-economic position (SEP). This study aimed to explore experiences of reducing mealtime screen use in mothers of low SEP with young children. DESIGN: Motivational interviews, conducted via Zoom or telephone, addressed barriers and facilitators to reducing mealtime screen use. Following motivational interviews, participants co-designed mealtime screen use reduction strategies and trialled these for 3-4 weeks. Follow-up semi-structured interviews then explored maternal experiences of implementing strategies, including successes and difficulties. Transcripts were analysed thematically. SETTING: Australia. PARTICIPANTS: Fourteen mothers who had no university education and a child between six months and six years old. RESULTS: A range of strategies aimed to reduce mealtime screen use were co-designed. The most widely used strategies included changing mealtime location and parental modelling of expected behaviours. Experiences were influenced by mothers' levels of parenting self-efficacy and mealtime consistency, included changes to mealtime foods and an increased value of mealtimes. Experiences were reportedly easier, more beneficial and offered more opportunities for family communication, than anticipated. Change required considerable effort. However, effort decreased with consistency. CONCLUSIONS: The diverse strategies co-designed by mothers highlight the importance of understanding why families engage in mealtime screen use and providing tailored advice for reduction. Although promising themes were identified, in this motivated sample, changing established mealtime screen use habits still required substantial effort. Embedding screen-free mealtime messaging into nutrition promotion from the inception of eating will be important.

Mapping the behaviour change potential of meal kits to positively influence parental food literacy.

OBJECTIVE: This study aimed to examine the theoretical potential of meal kit subscription services in Australia to promote parental food literacy using the retrospective application of behaviour change frameworks. DESIGN: A one-week subscription was purchased for all Australian-based meal kit subscription services (n 9) to access content and features available to subscribers. Behaviour change techniques (BCTs) identified in the subscription and meal planning features, meal kit delivery (i.e. ingredients and recipes) and website were coded using the behaviour change technique taxonomy (BCTTv1) and associated behaviour change frameworks. Identified BCTs were mapped to the theoretical domains framework to identify potential mechanisms of action for influencing parental food literacy development. SETTING: Australia. RESULTS: Thirty-five BCTs were identified across the nine meal kit services reviewed, ranging from nineteen to twenty-nine BCTs per company. Sixteen BCTs were common to all meal kits services, from the hierarchical clusters of 'goals and planning', 'shaping knowledge', 'social support', 'natural consequences', 'comparison of behaviour', 'repetitions and substitution', 'associations', 'reward and threat', 'antecedents' and 'regulation'. Across the meal kit services, the most frequently identified mechanisms of action were motivation (n 27) and capability (n 19). CONCLUSION: These findings support the applicability of behaviour change frameworks to commercial meal kit subscription services and provide a theory-informed process for identifying BCTs that may be relevant for promoting parental food literacy within this context. Further research is required to explore how families engage with meal kit subscription services to determine the exposure and delivery of identified BCT content and to evaluate the potential influence on food literacy development.

"That's the routine": A qualitative exploration of mealtime screen use in lower educated Australian families with young children.

BACKGROUND: Family meals are an opportune context for initiating healthy eating habits in young children. However, using screens at family mealtimes may negate some of the associated nutritional and social benefits. In High Income countries, frequent mealtime screen use is common, particularly in families of low socioeconomic position (SEP). This study aimed to explore experiences and acceptability of mealtime screen use in families of low SEP with young children. METHODS: Qualitative interviews with 25 mothers of low SEP were conducted via telephone or Zoom™ using Photo Interviewing and a semi-structured interview script. Transcripts were analysed thematically using a Constructivist paradigm. RESULTS: Many parents reported an eagerness for reducing family mealtime screen use. Three major themes were identified in explaining the reasons behind levels of engagement in family mealtime screen use. These included parental self-efficacy, such as parental confidence in saying no to screens at mealtimes, physical resources such as having enough space in the home for a functioning dining table without view of a television, and temporal priorities such as prioritising screen use for managing children's difficult behaviour at mealtimes over long-term health considerations. CONCLUSIONS: This study highlights that although family mealtime screen use is likely linked with a range of child behaviours and parenting practices that may negatively influence children's dietary intake and social engagement, parents often considered screens acceptable at mealtimes. Nonetheless, parents' desire to reduce family mealtime screen use provides an important opportunity to determine how best to support parents to achieve this.

Meal kit subscription services and opportunities to improve family vegetable consumption.

Popular commercial meal kit subscription services (MKSSs) may support families to overcome barriers to cooking and eating at home, and facilitate improved vegetable consumption. The global meal kit market has expanded rapidly creating a gap in our understanding of the health-promoting potential of MKSSs. This paper describes the contemporary MKSS market in Australia and provides a vegetable-specific content analysis of a sample of recipes. A 1-week subscription was purchased for all Australian-based MKSSs (n = 9) and websites were systematically reviewed to document key characteristics and recipe features. Vegetable content of all available recipes within a 1-week period were analysed. Our findings highlight the rapid expansion and evolution of MKSS market offerings over the past decade and their potential to support family vegetable consumption. Across all analysed recipes (n = 179), MKSSs provided a median of 2.5 vegetable serves per person (range 0.7-7.5 serves) and a median of 3 different types of vegetables from 2 vegetable subgroups (i.e. dark green, red and orange, starchy, legumes and all other vegetables). This suggests that MKSSs may support family vegetable consumption if families select recipes with a greater number and variety of vegetables. However, an opportunity remains for MKSSs to improve both vegetable quantity and variety to positively influence population health. Further research is required to describe how families use meal kits promoting a greater understanding of their potential to improve family nutrition.

The influence of household structure and composition on the introduction of solid, semisolid and soft foods among children aged 6-8 months: An analysis based on Ethiopia Demographic and Health Surveys.

The early and late introduction of complementary food, both prevalent in Ethiopia, are associated with morbidities, growth faltering and developmental risks in children. The interhousehold network around the primary caregiver's intrahousehold network is critical in influencing the age of introducing complementary foods. This study examined the influence of household composition and structures on complementary food introduction. This is a secondary data analysis of four Ethiopian Demographic and Health Surveys conducted between 2000 and 2016. The household structure and composition variables were calculated from household members' kinship status and attribute, respectively. The introduction of solid, semisolid or soft foods was dichotomised as whether the children within 6 to 8 months have been given complementary foods. Multivariable logistic regression with adjustment for the primary caregiver and household characteristics was run to examine the associations between household structure and composition variables and the introduction of complementary foods. The marginal effects (ME) were calculated to facilitate the practical interpretation of the study findings. Large households (>3 nonredundant contacts) with extended family or unrelated people (high effective size, ME = 6.01%, 95% confidence interval [CI]: -8.53, -3.49) lowered the proportion of children starting food within the recommended 6-8 months. Households with close kins (high constraint) (ME = 7.22%, 95% CI: -13.65, 28.09) and greater age diversity (ME = 0.65%, 95% CI: 0.15, 1.15) increased the proportion of children receiving complementary food at an appropriate age. This study revealed that interhousehold structure and composition influence the age of introduction of complementary foods. These factors, therefore, need to be considered in designing interventions to improve age at the introduction of complementary foods.

Perinatal support for breastfeeding using mHealth: A mixed methods feasibility study of the My Baby Now app.

Despite the well-known benefits of breastfeeding, breastfeeding rates remain suboptimal, particularly for women with lower socioeconomic position. Although popular, breastfeeding apps are often poor quality; their impact on breastfeeding knowledge, attitudes, confidence and intentions is unknown. A mixed method pre-post feasibility study was conducted to: 1) explore the feasibility of the My Baby Now app in providing perinatal breastfeeding support; 2) examine the impact on breastfeeding knowledge, attitudes, confidence and intentions; 3) to examine any differences in acceptability and impact of the app according to maternal education. The My Baby Now app was offered to pregnant women 20-30 weeks gestation. Breastfeeding knowledge and intentions were collected at baseline (T1) and 36-38 weeks gestation (T2); attitudes and confidence were collected at baseline, T2 and T3 (8-12 weeks post-partum). App engagement was measured via app analytics. Qualitative interviews were conducted with a purposeful sample following T3. Of 266 participants recruited, 169 (64%) completed T2 and 157 (59%) completed T3. Mothers without university education rated the app to be higher quality, more useful and impactful than mothers with university education. From T1-T2, breastfeeding knowledge (59.6% vs. 66.5%, p < 0.001) and exclusive breastfeeding intentions (76.6% vs. 80.9%, p < 0.001) increased. Breastfeeding attitudes and confidence scores also increased significantly across T1-T2 and T1-T3. App engagement during pregnancy predicted changes in breastfeeding attitudes from T1-T2 among participants without university education. App engagement did not predict changes in breastfeeding knowledge, confidence or intentions. Future randomised controlled studies should examine the effectiveness of mHealth interventions on breastfeeding outcomes.

Parental work hours and household income as determinants of unhealthy food and beverage intake in young Australian children.

OBJECTIVE: This study examined parental work hours and household income as determinants of discretionary (energy dense, nutrient poor) food and beverage intake in young children, including differences by eating occasion. DESIGN: Secondary analysis of cross-sectional data. Three hierarchical regression models were conducted with percent energy from discretionary food and beverages across the day, at main meals, and at snack times being the outcomes. Dietary intake was assessed by 1x24-hour recall and 1-2x24-hour food record(s). Both maternal/paternal work hours were included, and total household income. Covariates included household, parent and child factors. SETTING: Data from the NOURISH/SAIDI studies were collected between 2008-13. PARTICIPANTS: Participants included 526 mother-child dyads (median(IQR) child age 1.99(1.96,2.03) years). Forty-one percent of mothers did not work while 57% of fathers worked 35-40 hours/week. Most (85%) households had an income of ≥$50k AUD/year. RESULTS: Household income was consistently inversely associated with discretionary energy intake (ß= -0.12 to -0.15). Maternal part-time employment (21-35 hours/week) predicted child consumption of discretionary energy at main meals (ß=0.10, p=0.04). Paternal unemployment predicted a lower proportion of discretionary energy at snacks (ß= -0.09, p=0.047). CONCLUSIONS: This work suggests that household income should be addressed as a key opportunity-related barrier to healthy food provision in families of young children. Strategies to reduce the time burden of healthy main meal provision may be required in families where mothers juggle longer part-time working hours with caregiving and domestic duties. The need to consider the role of fathers and other parents/caregivers in shaping children's intake was also highlighted.

Exploring the economics of public health intervention scale-up: a case study of the Supporting Healthy Image, Nutrition and Exercise (SHINE) cluster randomised controlled trial.

BACKGROUND: The costs and benefits of an intervention within the intervention testing phase may differ from those experienced when that intervention is implemented and delivered at scale. Yet limited empirical work has been undertaken to explore how economic constructs related to implementation and scale-up might have an impact on intervention cost. The aim of this study was to explore the potential economic impacts of implementation and scale-up on a healthy weight and body image intervention tested in a Type II translational research trial. METHODS: The Supporting Healthy Image, Nutrition and Exercise (SHINE) study is a cluster randomised controlled trial, aiming to deliver universal education about healthy nutrition, physical activity and wellbeing behaviours to adolescents in Australian secondary schools. Data on the cost of the intervention were collected alongside the trial using standard micro-costing techniques. Semi-structured interviews were conducted with key intervention stakeholders to explore the potential economic impacts of implementation and scale-up. Thematic content analysis was undertaken by two authors. RESULTS: Fifteen intervention group schools participated in the 8-week online intervention targeting students in 2019 (99 Grade 7 classes; 2,240 students). Booster sessions were delivered during one class session in Grades 8 and 9, in 2020 and 2021 respectively. Time costs of intervention delivery and co-ordination comprised the majority (90%) of intervention cost as per the trial, along with costs associated with travel for intervention training and equipment. Themes related to the benefit of the intervention emerged from interviews with six intervention stakeholders, including the potential for economies of scale afforded by online delivery. Contextual themes that may have an impact on intervention implementation and scale included acceptability across all school sectors, availability and reliability of IT infrastructure for intervention delivery and variations in population characteristics. A number of key alterations to the intervention program emerged as important in supporting and sustaining intervention scale-up. In addition, significant implementation costs were identified if the intervention was to be successfully implemented at scale. CONCLUSIONS: The findings from this study provide important information relevant to decisions on progression to a Type III implementation trial, including budget allocation, and will inform modelled economic evaluation.

A thematic cluster analysis of parents' online discussions about fussy eating.

Food fussiness is associated with non-responsive parent feeding practices, such as persuasive and instrumental feeding. Although most children described as 'fussy eaters' are likely exhibiting developmentally typical behaviours, up to half of the parents of children 2-5 years old express concerns. Concern for fussy eating may mediate the use of non-responsive feeding practices and so must be addressed in parent feeding interventions. Therefore, it is critical to better understand parents' concerns and how they may relate to feeding practices. This study aimed to explore how parents' feeding practices and the social cognitive factors that may drive them clustered based on parents' concern for fussy eating. Data were collected from parent discussions of fussy eating on a Reddit forum (80,366 posts). Latent Dirichlet allocation was used to identify discussions of fussy eating. Relevant posts (1542) made by users who identified as a parent of a fussy eater (n = 630) underwent qualitative coding and thematic analysis. Five clusters of parents were identified, ranging in size from 53 to 189 users. These were primarily characterised by parents' degree of concern and feeding practices: (1) High concern, nonresponsive; (2) Concerned, nonresponsive; (3) Low concern, responsive; (4) Low concern, mixed strategies; (5) Low concern, indulgent. Parents who used responsive practices tended to be less concerned for fussy eating, have greater trust in their child's ability to self-regulate hunger, have longer-term feeding goals, and exhibit greater ability for personal self-regulation. Future research should further examine how these constructs may be leveraged in parent feeding interventions.

Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review.

BACKGROUND: Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders' acceptability of interventions. METHODS: A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers' behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools. RESULTS: Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants' perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals. CONCLUSION: There is limited reporting of stakeholders' experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants' acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up. TRIAL REGISTRATION: PROSPERO registration: CRD42019108658.

Key stakeholder perspectives on the development and real-world implementation of a home-based physical activity program for mothers at risk of postnatal depression: a qualitative study.

BACKGROUND: Physical activity (PA) is a modifiable risk factor for postnatal depression (PND) and programs are needed to enhance PA amongst women at risk of PND. Key stakeholder involvement in informing development and implementation of such programs is vital. However, little research demonstrates key stakeholder insights to inform the design and delivery of PA programs for improving PND. The aim of this study was to explore key stakeholder perspectives on the design and delivery of a home-based PA program for mothers with PND symptoms to inform future real-world implementation and scale-up. METHODS: A descriptive qualitative study was undertaken whereby semi-structured interviews were conducted with representatives from various key stakeholder organisations involved in postnatal PA and/or mental health, public health and policy in Australia (n = 11). Interviews were conducted between September to November 2019 and explored stakeholder perceptions on the design and delivery of a home-based PA program for mothers with PND symptoms. The interview schedule was informed by both the Consolidated Framework for Implementation Research (CFIR) and the PRACTical planning for Implementation and Scale-up (PRACTIS) guide. Data were analysed thematically using both deductive and inductive coding. RESULTS: The relative priority of PND and PA was high for most organisations involved, although none implemented PA programs supporting women at risk of PND. Most stakeholders perceived the program as appealing due to addressing barriers to postnatal PA, although identified some feasibility issues regarding funding and delivery mechanisms. Suggestions for program adaptations included an equity focus (e.g. providing socioeconomically disadvantaged women with a greater program dose; translating web-app based content into various languages). Planned components of the program were suggested to align (i.e. relative advantage) with existing initiatives (e.g. equipment hire for nurseries scheme) and screening systems for PND (timing of referral). Perceived barriers to scale-up included logistics/cost of equipment, organisational capacity demands and safety risks/liability. Perceived enablers to scale-up included linking the program with 'adjunct' programs and services. CONCLUSIONS: While the program was appealing and most organisations could see a role in endorsing and/or referring to the program, funding and delivery mechanisms still need to be identified.

Fussy eating in toddlers: A content analysis of parents' online support seeking.

The development of healthy eating habits in childhood is essential to reducing later risk of obesity. However, many parents manage fussy eating in toddlerhood with ineffective feeding practices that limit children's dietary variety and reinforce obesogenic eating behaviours. Understanding parents' feeding concerns and support needs may assist in the development of feeding interventions designed to support parents' uptake of responsive feeding practices. A total of 130 original posts by parents of toddlers (12-36 months) were extracted from the online website Reddit's 'r/Toddlers' community discussion forum over a 12-month period. Qualitative content analysis was used to categorise the fussy eating topics that parents were most concerned about and the types of support they were seeking from online peers. The most frequently raised fussy eating concerns were refusal to eat foods offered, inadequate intake (quantity and quality), problematic mealtime behaviours and changes in eating patterns. Parents were primarily seeking practical support (69.2%) to manage emergent fussy eating behaviours. This consisted of requests for practical feeding advice and strategies or meal ideas. Nearly half of parents sought emotional support (47.7%) to normalise their child's eating behaviour and seek reassurance from people with lived experience. Informational support about feeding was sought to a lesser extent (16.2%). Fussy eating poses a barrier to children's dietary variety and establishing healthy eating habits. These results suggest parents require greater knowledge and skills on 'how to feed' children and support to manage feeding expectations. Health professionals and child feeding interventions should focus on providing parents with practical feeding strategies to manage fussy eating. Supporting parents to adopt and maintain responsive feeding practices is vital to developing healthy eating habits during toddlerhood that will continue throughout adulthood.

What hinders and helps academics to conduct Dissemination and Implementation (D&I) research in the field of nutrition and physical activity? An international perspective.

BACKGROUND: Ineffective research-practice translation is a major challenge to population health improvement. This paper presents an international perspective on the barriers and facilitators associated with the uptake of and engagement in Dissemination and Implementation (D&I) research in the fields of physical activity and nutrition. METHODS: A mixed methods study involving participants from the International Society for Behavioral Nutrition and Physical Activity (ISBNPA) network. Participants completed an online survey (May-July 2018) and/or participated in a focus group during the annual ISBNPA conference (June 2018). Descriptive statistics were generated for quantitative online and pre-focus group survey data. Fisher's exact tests investigated associations of (i) length of time in academia, (ii) career stage and (iii) country of work, and agreement with 'perceptions of D&I'. Qualitative data were analysed thematically. RESULTS: In total, 141 participants responded to the survey (76% female, 21% aged 35-39 years, 14 countries represented) and 25 participated in focus groups (n = 3). Participants self-identified as having knowledge (48%), skills (53%) and experience supporting others (40%) to conduct D&I research. The majority (96%) perceived D&I was important, with 66% having organizational support for D&I, yet only 52% reported prioritizing D&I research. Perceptions of D&I differed by length of time in academia, career stage and country of work. Barriers included: (i) lack of D&I expertise; (ii) lack of organisational support/value for D&I; (iii) embedded scientific beliefs/culture; (iv) methodological challenges with D&I research; (v) funding/publishing priorities and; (vi) academic performance structures. Facilitators included: (i) increased presence/value of D&I; (ii) collective advocacy; (iii) organisational support for D&I; (iv) recruitment of D&I scientists and; (v) restructure of academic performance models, funding/publishing criteria. CONCLUSIONS: Individual, organisational and system-wide factors hindered academics' engagement with and support for D&I research, which was perceived to reduce opportunities for research-practice translation. Factors were mostly consistent across countries and individual career stages/time spent in academia. Embedding D&I early within academic training, and system-wide reorientation of academic performance and funding structures to promote and facilitate D&I research, are some of the necessary actions to reduce the research-practice gap. Consistent with public health more broadly, these changes are long overdue in the fields of physical activity and nutrition.

Correction to: a narrative review of economic constructs in commonly used implementation and scale-up theories, frameworks and models.

An amendment to this paper has been published and can be accessed via the original article.

Promoting healthy weight for all young children: a mixed methods study of child and family health nurses' perceptions of barriers and how to overcome them.

BACKGROUND: Childhood obesity is a global health concern. Early intervention to help parents adopt best practice for infant feeding and physical activity is critical for maintaining healthy weight. Australian governments provide universal free primary healthcare from child and family health nurses (CFHNs) to support families with children aged up to five years and to provide evidence-based advice to parents. This paper aims to examine factors influencing the child obesity prevention practices of CFHNs and to identify opportunities to support them in promoting healthy infant growth. METHODS: This mixed methods study used a survey (n = 90) and semi-structured interviews (n = 20) with CFHNs working in two local health districts in Sydney, Australia. Survey data were analysed descriptively; interview transcripts were coded and analysed iteratively. Survey and interview questions examined how CFHNs addressed healthy infant feeding practices, healthy eating, active play and limiting sedentary behaviour during routine consultations; factors influencing such practices; and how CFHNs could be best supported. RESULTS: CFHNs frequently advised parents on breastfeeding, introducing solid foods, and techniques for settling infants. They spent less time providing advice on evidence-based formula feeding practices or encouraging physical activity in young children. Although nurses frequently weighed and measured children, they did not always use growth charts to identify those at risk of becoming overweight or obese. Nurses identified several barriers to promoting healthy weight gain in infants and young children, including limited parental recognition of overweight in their children or motivation to change diet or lifestyle; socioeconomic factors (such as the cost of healthy food); and beliefs and attitudes about infant weight and the importance of breastfeeding and physical activity amongst parents and family members. CONCLUSIONS: CFHNs require further education and support for their role in promoting optimal child growth and development, especially training in behaviour change techniques to increase parents' understanding of healthy infant weight gain. Parent information resources should be accessible and address cultural diversity. Resources should highlight the health effects of childhood overweight and obesity and emphasise the benefits of breastfeeding, appropriate formula feeding, suitable first foods, responsiveness to infant feeding cues, active play and limiting screen time.

Professional and non-professional sources of formula feeding advice for parents in the first six months.

Breastfeeding is beneficial to both the mother and infant, yet many infants are either partially or fully fed with formula milk. Those parents feeding with formula receive less support from professional sources than those breastfeeding and may rely on more non-professional sources for advice, and this contributes to negative emotional experiences such as guilt. This paper explores the sources of advice for formula feeding, factors associated with using professional or non-professional sources and compares these sources with those used for breastfeeding advice. A secondary analysis of Australian survey data from 270 mothers was performed. Mothers of six-month-old infants participated in an online survey, providing information on advice they received or read about formula feeding and/or breastfeeding from professional and non-professional sources. A fifth of mothers who were formula feeding did not receive any formula feeding advice from professional sources, and only a small fraction (4.5%) of mothers breastfeeding did not received any breastfeeding advice from professional sources. Compared with those mothers breastfeeding receiving breastfeeding advice, fewer mothers formula feeding receive formula feeding advice from both professional and non-professional sources. The tin of formula was the most used source of formula advice. Mothers feeding with formula at six months were more likely to have received formula feeding advice from professional sources if they had been fully formula feeding before their infant was under the age of three months. Further research is needed to understand the specific barriers to accessing formula feeding advice and what other factors influence access to formula feeding advice.