Evaluating a multi-behavioural home-based intervention for reducing depressive symptoms in postnatal women : The food, move, sleep (FOMOS) for postnatal mental health randomised controlled trial protocol.

BACKGROUND: Postnatal depression (PND) is a leading cause of illness and death among women following childbirth. Physical inactivity, sedentary behaviour, poor sleep, and sub-optimal diet quality are behavioural risk factors for PND. A feasible, sustainable, and scalable intervention to improve healthy behaviours and reduce PND symptoms among women at postpartum is needed. This study aims to examine the effectiveness of a multi-behavioural home-based program Food, Move, Sleep (FOMOS) for Postnatal Mental Health designed to improve PND symptoms in women at postpartum. METHODS: This randomised clinical trial will recruit 220 Australian women (2-12 months postpartum) experiencing heightened PND symptoms (Edinburgh Postnatal Depression Scale score ≥ 10). Participants will be randomised to FOMOS or wait-list control receiving standard clinical care. FOMOS is a 6-month mobile health (mHealth) intervention targeting diet quality, physical activity, sedentary behaviour, sleep, and mental health. The intervention, informed by the Social Cognitive Theory and incorporating behaviour change techniques defined in the CALO-RE taxonomy and Cognitive Behavioural Treatment of Insomnia, provides exercise equipment, and educational/motivational material and social support via mHealth and social media. Data collection pre-intervention and at 3, 6 and 12 months will assess the primary outcome of PND symptoms and secondary outcomes (diet quality, physical activity, sitting time, sleep quality) using self-report and device measures. Process evaluation will explore acceptability, appropriateness, cost-effectiveness, feasibility, and sustainability via analytic tools, record keeping, interviews, and surveys. DISCUSSION: If effective, FOMOS could be a feasible and potentially scalable management strategy to support improvement of health behaviours and mental health for women with PND symptoms. TRIAL REGISTRATION: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12622001079730p.

Fussy Eating Rescue, a mobile-web app for responsive feeding practises among parents of toddlers: protocol for a pilot randomised controlled feasibility trial.

BACKGROUND: Fussy eating is most often a developmentally typical behaviour, generally presenting during toddlerhood. However, up to half of parents of young children are concerned about fussy eating, and this concern may mediate the use of nonresponsive feeding practises, such as coercive or unstructured feeding and using food to reward eating. Despite the high prevalence of parental concern for fussy eating and the negative impacts nonresponsive feeding practises have on children's health and diets, no previous digital intervention to improve the feeding practises of parents of toddlers concerned about fussy eating has been evaluated. AIM: This article describes the protocol of a randomised controlled feasibility pilot aiming to evaluate Fussy Eating Rescue, a purely web app based intervention for parents of toddlers. The primary aim is to investigate feasibility and acceptability; secondary aims are to explore indications of intervention effect on parents' feeding practises or children's eating behaviours. METHODS: Fussy Eating Rescue features include: (1) a Tracker, that allows parents to track repeated offers of food, (2) Topics, providing information on fussy eating, effective feeding strategies, and general nutrition, (3) Rescues, containing quick references to material supporting Topics contents, (4) Recipes, and (5) SMS notifications. Parents of toddlers (12-36 months old, n = 50) who have concerns about fussy eating will be recruited via Facebook. Parents will be randomised to an intervention group, which receives access to the app for 6 weeks, or to wait-listed control. Outcomes will be assessed at baseline and 6 weeks after app use, using online questionnaires and app usage statistics. Primary outcomes include participant retention rate, intervention engagement, app usability, perceived ease in using the app, perceived usefulness of the app, and user satisfaction. Secondary outcome measures include parents' feeding practises and children's eating behaviours. DISCUSSION: Results will inform whether Fussy Eating Rescue is a feasible way to engage parents concerned for their toddler's fussy eating behaviours. If feasible and acceptable to users, a larger trial will further examine the efficacy of the Fussy Eating app in improving parents' feeding practises and children's eating behaviours. TRIAL REGISTRATION: Prospectively registered with the Australian New Zealand Clinical Trials Registry on 15 July, 2021 (ACTRN12621000925842).

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.

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.

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.

High Protein Intake Among Preschoolers in Childcare in a Region at Elevated Risk for Obesity.

OBJECTIVES: To compare diet quality of convenience samples of children 2-3 and 4-5 years attending 11 of 75 childcare centers in Hays County, Texas to a nationally representative sample, as part of a needs assessment to inform a childcare center-based intervention. METHODS: Parents completed 24-h recalls of their child's diet in 2014. Usual dietary intake of the regional and age-matched sample from the National Health and Nutrition Examination Survey (2011-2014) was estimated using the National Cancer Institute method. Diet quality was assessed using the Healthy Eating Index. Quantile regression and t-tests compared nutrient intake and Healthy Eating Index scores between the two samples. RESULTS: Children ages 2-3 and 4-5 years in the regional sample (n = 124) consumed a higher percent of calories from protein (19%) than children in the national sample (n = 1613; 14%, P < .0.0001). In the regional sample, 21% of children 2-3 years consumed protein in excess of the AMDR compared to fewer than 1% of children in the national sample. CONCLUSIONS FOR PRACTICE: Assessing regional diet while planning health outreach is important. Among children in childcare in this community, high protein intake may contribute to weight disparity. Workshops with childcare center staff to address center policies, environments, and parent outreach could address replacing some high-protein foods with other nutrient-rich foods.

Staff Workshop Improves Child Care Center Menus in South Central Texas: A Best Food for Families, Infants, and Toddlers (Best Food FITS) Intervention.

OBJECTIVE: To assess the efficacy of an educational workshop for child care center staff to improve menus. METHODS: Staff from 18 centers attended a nutrition educational workshop that included an activity that compared center menus to MyPlate standards. Four weeks of menus collected before and after the workshop were imported into SuperTracker; the Food Details report produced menu data clustered by day and center. Changes in pre-post menus were assessed using Healthy Eating Index scores and the SAS software macro, MIXCORR. RESULTS: After the workshop, there was a lower probability that fruit juice (P = .03) and starchy vegetables (P = .004) and a higher probability that non-starchy vegetables (P < .001) and whole grains (P = .004) were on menus; amounts of refined grains (P = .004), savory snacks (P < .001), and cheese (P = .004) were significantly lower. Total Healthy Eating Index scores improved after the workshop (P = .009). CONCLUSIONS AND IMPLICATIONS: Comparing 4 weeks of menus revealed menu changes. Workshop interventions show promise for improving children's health.

User-centered Design of a Texas WIC App: A Focus Group Investigation.

OBJECTIVE: The purpose of this research was to conduct the first stages of a user-centered design of a smartphone app designed to improve health behaviors among participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Texas. METHODS: Focus groups explored facilitators and barriers to health behaviors, current use of apps, and desired features in a WIC app. RESULTS: Facilitators to improve health behaviors included access to information, support from healthcare practitioners and family, and implementation of strategies. Current app use themes included texting/chatting, accessing information, tracking/locating, planning/scheduling, sharing, and gaming. Frequencies of key themes within and across groups were used to inform app prototype design. Mock-ups of 15 prototype features were developed based on themes of facilitators and currently used app features. Participants agreed that having all features combined into a single WIC app would be convenient and provide trustworthy information from WIC. CONCLUSIONS: The enthusiasm of focus group participants for a comprehensive WIC app suggests that this initiative is timely, and that an app has potential to improve health behaviors. Future research should continue the user-centered design process through further evaluation of prototype features, incorporating cultural preferences at every step.