A Home-based Intervention to Improve the Diet Quality of Preschoolers
Condition: Diet Modification
Study type: Interventional

Summary: 
      U.S. children eat too little fruits and vegetables and whole grains, and too many energy
      dense foods, dietary behaviors associated with increased morbidity from cardiovascular
      diseases. Parents play a key role in shaping their child's diet and best practices suggest
      that parents should involve children in food preparation, offer, model and encourage a
      variety of healthy foods. In addition, while parents help to shape food preferences, not all
      children respond in the same way and certain appetitive traits, such as satiety
      responsiveness (sensitivity to internal satiety signals), food responsiveness (sensitivity to
      external food cues), and enjoyment of food may help explain some of these differences. Prior
      interventions among preschool aged children to improve their diet have not used a holistic
      approach that fully targets the home food environment, by focusing on food quality, food
      preparation, and positive feeding practices while acknowledging a child's appetitive traits.
      This proposal will build upon pre-pilot work to develop and pilot-test the feasibility,
      acceptability and preliminary efficacy of a novel home-based intervention. The proposed
      6-month intervention, will include 3 monthly home visits by a community health worker (CHW)
      trained in motivational interviewing, that include in-home cooking demos. In between visits,
      parents will receive tailored text-messages 2x/wk. and monthly mailed tailored materials.
      During the last 3 months CHW phone calls will replace the home visits. The intervention will
      be tailored for individual families based on the child's appetitive traits. The proposed
      research will lay the groundwork for a larger trial to support, motivate, and empower
      low-income parents to prepare healthy meals and use healthy feeding practices, which will
      improve children's diets and ultimately their health.
    

Detailed description: 
      There is a critical need for primary prevention interventions to help parents shape
      children's dietary behaviors early in life. These interventions need to be convenient for
      busy, working families and tailored to children's needs and the family environment. Although
      there have been several interventions among preschool aged children to improve dietary
      behaviors, none have used a holistic approach that fully targets the home food environment,
      by focusing on food quality, food preparation, and positive feeding practices while
      acknowledging a child's appetitive traits. The proposed research will develop and pilot-test
      the feasibility, acceptability and preliminary efficacy of a novel home-based intervention to
      improve the diet quality and family food environment of high-risk preschool age, low-income,
      ethnically diverse children. This research will build upon previous research including a
      pre-pilot intervention with 15 mother-child dyads which included two home visits: the first
      visit included a meal-recording and the second included a motivational interviewing (MI)
      session using coded video clips from the meal-recording as feedback on the parents' feeding
      practices. All families were retained and significant improvements in several parental
      feeding practices were found. Based on lessons learned in the pre-pilot, the proposed 6-month
      intervention will include home visits by a community health worker (CHW) trained in MI,
      enhanced by adding several innovative components. The home visits will include in-home
      cooking demonstrations; tailored text-messages, mailed materials and CHW phone calls. The
      intervention will be tailored for families based on the child's appetitive traits and eating
      behaviors. These strategies are expected to increase parental knowledge, self-efficacy, and
      motivation for serving easy, inexpensive healthy foods in the home, leading to increased
      child exposure to more healthy and varied foods, improvements in parental feeding practices,
      and ultimately, improvements in child diet quality. The specific aims are as follows:

      Aim 1: To conduct focus groups with 40 ethnically diverse low-income parents of preschoolers
      (2-5 years) to inform the adaptation and development of the enhanced intervention.

      Aim 2: To conduct a pilot randomized controlled trial with 60 parent-child pairs (30
      intervention/30 control) from ethnically diverse, low-income families with preschoolers to:

      Aim 2.1 Determine the feasibility and acceptability of the enhanced intervention.

      Aim 2.2 Determine the preliminary efficacy of the enhanced intervention on changes in
      children's diet quality (primary outcome) and parental feeding practices and availability of
      healthy foods in the home (secondary outcomes) and calculate effect sizes for a future
      randomized controlled trial (RCT).

      The investigators hypothesize that the intervention will be feasible and acceptable to
      parents and that parent-child pairs randomized to the intervention condition will demonstrate
      greater improvements in the outcomes after six months compared to the comparison condition
      (attention control of a school readiness intervention).

      Exploratory aim: Explore how parents' skills, self-efficacy and intrinsic motivation are
      related to changes in children's diet quality and parental feeding practices.
    

Intervention name(s): Healthy Feeding, Healthy Eating; Reading Readiness
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Home Based Motivational Interviewing to Improve Diet Quality of Preschoolers; Active Control that uses Motivational Interviewing to improve Reading Readiness of Preschool Children
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Intervention vs. Attention Control
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Prevention