Utilizing Digital Health Approaches to Promote Early Childhood Healthy Eating and Activity Behaviors
Phase: NA
Conditions: Health Behavior
Sponsor: Cornell University

eHEROs SOP 
 
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Official Title of the study:  Utilizing Digital Health Approaches to Promote Early Childhood 
Healthy Eating and Activity Behaviors 
NCT number (if available): Pending 
Date of the document: January 6, 2025 
 
 
 
 
 

eHEROs SOP 
 
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eHEROs (Know How) Pilot Study Overview 
 
 
The overall aim of the electronic HEalthy EnviROnments study (eHEROs) is to transform a 
tested, traditional, in-person parent intervention for families of young children to a digital 
platform promoting healthy eating and activity behaviors and environments, and ultimately 
healthy growth. The intervention program is called Know-How: Building Healthy Eaters and 
Movers (Know-How). The intervention will be 10 weeks. Week 0 will be an introduction to the 
overall study followed by 9 weeks of Know How programming. Please note that the formal 
name of the study is e-HEROs, but participants will only see the term Know How program/study 
use. 
 
Intervention Design 
The Know-How program provides parent education on the topics of mindful parenting, healthy 
eating, and physical literacy and will consist of 3 components: 1) a custom mobile application 
(app) ; 2) virtual group discussions and 3) child-centered support materials mailed to 
participating families. 
 
1. Know-How app 
The Know-How app will provide parent education using a variety of modalities The ‘know’ will 
provide parents with the core information on mindful parenting, healthy eating, physical literacy 
and the ‘how’ will give strategies to incorporate the information into daily routines and activities. 
To facilitate the transition from the ‘know’ to ‘how’, the app with have a ‘Kid Zone’ will content 
to engage in activities with the preschooler. Content will be based on the theoretical constructs of 
the Adult Learning Theory and Social Cognitive Theory. Content will be divided into five 
modules that include A) lessons (text, audio, video), B) activities, and C) assessments. 
 
A. Lessons  
Table 1. Know-How Topics by Content Area 
Content Area 
Topics 
Mindful Parenting 
• 
Parenting Mindfully 
• 
Non-Judgmental Acceptance  
• 
Listening Mindfully 
• 
Emotionally Mindful 
• 
Parenting Compassionately 
• 
Self-Regulation 
Healthy Eating 
• 
Offering New Foods 
• 
Mealtime Conversations 
• 
Home Food Environment 
Physical Literacy 
• 
Movement Skills 
• 
Active Play 
• 
Activity Opportunities 
Kid Zone 
• 
Intro to the Sporks Family 
• 
Let’s Eat 
• 
Let’s Move 
• 
Let’s Go 
 
 

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B. Activities  
To engage participants with the lesson content, activities will be interspersed within the lessons. 
Activities will include quizzes, goal setting and monitoring, and behavioral activities.  
• Quizzes will inquire about participants: 
- 
Confidence in offering healthy foods, providing PA opportunities to child, engaging 
in positive interactions with child related to healthy eating, PA and modifying the 
home environment. 
• Knowledge on feeding and practices and misconceptions; physical literacy; and other 
core content. 
• Goal Setting and monitoring activities will embed mindful parenting strategies to 
enactment of the 3 healthy eating topics and 3 physical literacy topics. Participants will 
choose at least 2 of the mindfulness prompts (watch, listen, talk, try) and plan how to 
practice a new behavior, record if they accomplished the plan, and reflect on the 
experience. 
• Behavioral activities and reflections will provide participants with experiences to move 
from the ‘know’ to the ‘how’. They will be asked to choose a new food to offering their 
child and reflect on how it went (child’s sensory behaviors, liking, their experience and 
observations). Secondly, they will be asked to upload photos of meals and snack offerings 
to reflect on meal composition (which food groups were provided, portion sizes), 
environmental factors (who did the child eat with, mealtime environment/distractions) 
and timing and frequency of snacks. Related to physical activity, participants will upload 
short videos (15-30 seconds) of their child participating in a Kid Zone activity or 
practicing a movement skill. Parents will reflect on their interactions with the child (e.g., 
modeling, verbal encouragement, instruction, etc.). 
 
C. Assessments 
Two assessments will be built into the app (to complement survey distributed via REDCap) and 
administered at baseline and post-intervention. These assessments – Food Photography and Child 
Movement Skills – will require photo and video upload. To reduce participant burden of learning 
a new system, we have built these 2 assessments into the app.  
• Food Photography: To assess mealtime food quality and intake, parents will be asked 
to take 2 photos of their child’s meal (before the child eats (pre-meal) and post-meal) 
on 3 days (2 weekday and 1 weekend day) over a 7-10, day period. Along with pre-
meal photo, participants will be asked to provide a text description of the meal 
components/ingredients. Parents will have the opportunity to provide any optional 
text about the meal with the post-meal photo (e.g., second servings, spilled items, an 
additional food item added mid meal). Photos will be downloaded and stored on  
• Child Movement Skills: To assess movement skills, parents will be asked to record 
their child attempting 11 movement skills in 4 groups: 
o Locomotor 1 – run, gallop slide 
o Ball skills 1 – overhand throw, underhand roll, catch 
o Locomotor 2 – hop, leap, horizontal jump 
o Ball skills 2 – dribbling and kick 
 
2. Group Discussions 
During the 9-week intervention, participants will meet via Zoom for 6, 45-60 minute sessions to 
connect with a trained group facilitator (member of the research team) and a group of peers (6-8) 

eHEROs SOP 
 
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from their cohort. The discussions will consist of 2-3 topics (e.g., picky eating, motor 
development) that complement the materials from the app and allow participants to discuss their 
experiences, successes or challenges with the material or activities. The purpose is to build 
community and provide social support to the participants. Embedded within the discussions will 
be questions about quality of conversation (Discussions 2 & 4), acceptability of program 
(Discussion 3) and community belongingness (Discussion 5). 
 
3. Support materials  
Materials to support both assessment (e.g., balls) and programming (e.g., chef’s hat and apron, 
activity dots, scarves, etc.) will be mailed to participants. We anticipate ~3 mailings spread out 
over the program. Materials are intended to support behavioral activities and to provide incentive 
to engage with the children’s activities (KidZone) and to continue with/complete the Know How 
program.  
 
Table 2: Know How Intervention Design 
 
Study Design 
This study is a feasibility study that will include 2 cohorts with a delayed control group 
(Figure2). Study assessments will be collected at Baseline (Time 1), pre-intervention and at Post-
Test (Time 2), post-intervention at the same time for both groups. No additional assessments will 
be collected for the delayed control group at the conclusion of implementation. 
 
Figure 1: Study Timeline by Cohort and Intervention Group 
 
 
 
 
 
 
 
 
 
 
 
 
 
Measure 
 
Activity 
Week 
0 
1 
2 
3 
4 
5 
6 
7 
8 
9 
Know 
How App 
Modules 
Study 
Overview 
Introduction 
Know Your 
Child 
Know Your 
Self 
Know Your 
Home 
Summary 
Group 
Discussion 
1 
 
2 
 
3 
 
4 
 
5 
6 
Support 
Materials 
X 
 
 
X 
 
 
 
X 
 
 
Recruitment 
Baseline 
(Time 1) 
Implementation 
Post-Test 
(Time 2) 
Focus Groups 
and Interviews 
Implementation 
All 
Intervention 
Group 
Delayed 
Control Group 
Jan 2025 
Sept 2025 
Feb 2025 
Oct 2025 
Cohort 1 
Cohort 2 
Feb – April 2025 
Oct -Dec 2025 
April 2025 
Dec 2025 
May 2025 
Jan 2025 
May – July 2025 
Jan -March 2026 

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Measures 
Table 2 outlines the measures that will be collected at either Baseline (Time 1) or Post-
Intervention (Time 2). Measures will be either included in the mobile app or provided to 
participants via REDCap.

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Table 2. Feasibility Pilot Study Measures 
Activity/Testing 
Measures 
Variables 
Data Source 
Time 
   1           2 
IRB 
Submission 
Screener 
Eligibility 
Criteria 
Inclusion:  Participants must have a preschool-aged child 
(3-5 years) with no disabilities or conditions that impact 
typical eating and activity behaviors. Adult participants 
must have access to a smartphone, reliable internet at 
home, and can make video calls. 
Exclusion:  Adults who do not have a child aged 3-5 or 
child has a disability/condition. Technology access is 
limited.  Adults who read, write or speak a language 
other than English. 
0. Screener 
Prior to 
enrollment 
 
Participant 
Information 
Demographics 
& Participant 
Characteristics 
Demographics: Age, Gender, Race, Ethnicity, Education, 
Income 
Participant Characteristics: Digital literacy, child food 
fussiness, physical activity ability 
1.Information Sheet 
X 
 
 
Feasibility 
Primary Outcome 
Recruitment 
Completed interest form, eligibility status, and 
enrollment 
Study records 
X 
 
 
Retention 
Proportion of intervention and app modules completers 
Study records and 
App backend data 
 
X 
 
Usability 
Ease of use, complexity, confidence in using, likelihood 
of use 
2. Experience with 
Know How Program 
 
X 
 
Acceptability 
Ratings of information helpfulness, goal setting, liking, 
willingness to recommend, desire for additional 
information 
2. Experience with 
Know How Program 
 
X 
 
Implementation 
Outcomes 
Primary Outcomes 
Digital 
Engagement 
Delivery, receipt, and dosage - amount of time engaged 
by topic, features, and temporal patterns; completion 
rates of modules and within-app activities. 
App backend data 
 
X 
 
Enactment  
Participation in target behaviors  
Data from behavioral 
outcomes (below); 
A.Focus groups and 
 
X 
 

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Time 1= Baseline, Time 2= Post-Intervention 
B.Interviews  
Intention to 
Sustain 
 
Identify intervention strategies relating to target 
behaviors which were implemented or adopted  
A.Focus groups and 
B.Interviews 
 
X 
 
 
Peer Support 
Gauge quality of conversations, sense of community as 
well as acceptability of programming. 
3. Group 
Discussions 
During 
Intervention 
 
Behavioral 
Outcomes  
Secondary 
Outcomes 
 
Mindful 
Parenting 
Listening with full attention, emotional awareness of self 
and child, self-regulation,  compassion of self and child, 
non-judgmental acceptance of self and child  
4. Parenting 
X 
X 
 
Parenting 
Practices 
Parent-Child Feeding Practices: Autonomy (encourages 
exploration of new foods, offers new foods, repeatedly 
presents new foods) and Structure (mealtime) 
Physical Activity Parenting Practices: Structure 
(nondirective support, supportive expectation, restriction 
of PA inside), Autonomy (support, guided choice) 
Snacking Parenting Practices: Snacks to manage 
behavior, snack planning, monitoring, and limit setting. 
5. Child Feeding 
6. Physical Activity 
and  
7. Snacking  
X 
X 
 
Behavioral 
Outcomes  
Exploratory 
Outcomes 
 
Home 
Environment 
Availability of Fruit, Convenience Foods, Beverages and 
Whole Grains; Physical activity equipment 
8. Home Health 
Environment   
X 
X 
 
Mealtime 
Food 
Photography 
Mealtime food quality & intake 
9. Mealtime photos  
(downloaded from 
app) 
X 
X 
 
Child 
Movement 
Skills 
Locomotor skills: run, gallop, hop, leap, horizontal jump, 
slide 
Ball skills: dribbling, catch, kick, overhand throw, 
underhand roll 
10. Movement 
videos   
(downloaded from 
app) 
X 
X 
 
Child Dietary 
Intake 
Frequency of child’s consumption of a subset of foods – 
fruits, vegetables, protein, grains, beverages, dairy. 
11. Child’s Diet  
X 
X 
 
Child Physical 
Activity 
Opportunities for structured and unstructured PA 
12. Physical Activity 
Opportunities  
X 
X 
