Kids FIRST: Family-based Intervention to Reduce Snacking and Screen Time in Children
Condition: Sedentary Lifestyle; Sedentary Behavior; Diet Habit
Study type: Interventional

Summary: 
      Kids FIRST was a 12-week, four arm, home- and school-based pilot randomised controlled trial
      to reduce screen-time and unhealthy snacking with assessments at pre- (baseline) and
      post-intervention. Four UK schools were randomised to control or one of three interventions -
      Group 1: targeting reductions in screen-time and unhealthy snacking (ST+Sn), Group 2:
      targeting reductions in screen-time only (ST), Group 3: targeting reductions in unhealthy
      snacking only (Sn). Intervention group parents received four online 'sessions' and four
      packages of resources which were tailored to each intervention group and focused on specific
      mediators of screen-time and/or unhealthy snacking. Children received four 30-minute lessons
      during school time, followed by homework activities/challenges. Children and parents reported
      their own screen-time behaviours, children reported their own snacking behaviours, and
      completed questionnaires on individual, behavioural, social and physical home environmental
      variables. Descriptive analyses were undertaken using principles of intention to treat.
    

Detailed description: 
      The Kids FIRST intervention was performed and reported in accordance with the Consolidated
      Standards of Reporting Trials extension to randomised pilot and feasibility trials
      guidelines. The study was approved by the Ethical Advisory Committee of Loughborough
      University (R15-PO36).

      Setting and recruitment Kids FIRST was family based with a school component. The study
      targeted families with at least one 9-11 year old child. Families were recruited through
      schools in the East Midlands region of the United Kingdom between September and December
      2015. Twenty-five primary schools were selected from a database of schools and school
      contacts. Headteachers were sent study information via email, which was followed-up with a
      telephone call, inviting them to be part of the project. In participating schools,
      parents/caregivers of children aged 9-11 years (year 5 and 6 of Primary School) were sent
      information sheets via the school outlining the study details and inviting them and their
      child to participate.

      Study design The study was a pilot four-arm cluster randomised controlled trial with
      assessments at pre- (baseline) and post-intervention (13 weeks after baseline). The study
      arms were three intervention groups and a control group. The intervention groups were: Group
      1: targeting reductions in screen-time and unhealthy snacking (ST+Sn), Group 2: targeting
      reductions in screen-time (ST), and Group 3: targeting reductions in unhealthy snacking (Sn).
      Following consent by headteachers, schools were randomised to either one of the three
      intervention groups or the control group by NP using computer generated random sequences.
      Only NP had access to the randomisation sequences (which were on a password protected file).
      This method of randomisation eliminated the possibility of contamination between pupils and
      parents from the same school.

      Theoretical underpinning of the Kids FIRST intervention The Kids FIRST intervention was
      framed in a social ecological perspective, and was theoretically informed, drawing on
      constructs designed to address potential individual, behavioural, social and physical home
      environmental mediators derived from Habit Theory, Behavioural Choice, and Social Cognitive
      theories of individual behaviour change.

      The taxonomy of behaviour change techniques was applied to characterise the association
      between the potential mediators targeted in the Kids FIRST study, the intervention components
      / strategies developed, and the theoretical underpinning. Supplementary Table 1 describes the
      specific behaviours that were targeted by the intervention and the practical application of
      the behaviour change techniques applied in relation to the Kids FIRST intervention.

      Kids FIRST intervention overview The intervention was implemented over a 12-week period from
      October 2015 to May 2016 (rolling recruitment of schools) following the baseline assessments.
      Families in each of the three intervention arms received the same structure of intervention,
      but the content was tailored to the targeted behaviour(s). Parents and children attended an
      introductory group session at school which provided an overview of the programme. Families in
      the control group did not receive any resources or engage with any sessions. No changes to
      the trial methods were implemented after the commencement of the programme.

      Family setting The intervention consisted of four blocks of three weeks. Each block targeted
      and focused on specific evidence-based mediators. All intervention families were given access
      to the Kids FIRST website (which was live for the duration of the study only), which included
      a login page where families were directed to the content/pages that were specific to their
      intervention group (i.e. families in group 1 could only access the webpages for group 1) by a
      group sensitive password. During each block, parents in each intervention group received one
      online session, and a package of resources (e.g. newsletters, information sheets, charts
      etc.) delivered via their child from school. The online sessions introduced the topic of the
      block to the parents and were followed by the newsletters and resources which prompted 'try
      at home' activities and challenges with a focus on the specific mediators. Online sessions
      were delivered via PowerPoint or an audio file and were focused on providing parents with
      support in the form of informational and cognitive, behavioural, environmental, and social
      support intervention components as a means of empowering families to make behavioural changes
      that were specific to them. The newsletters and resources (e.g. monitoring charts, top tips,
      recipes, and alternative activity or snack ideas) aimed to support the key learning messages
      delivered in the online sessions and to the children in the classroom lessons (see below).

      The key messages of the programme, which were reinforced at each block of the intervention,
      were:

        -  Increase knowledge about ST/Sn outcomes (health and other);

        -  Increase awareness and implementation of strategies to participate in healthy ST and/or
           consumption of healthy snacks

        -  Guide parents on how to implement behaviour modification, such as planning and
           monitoring.

      School setting Children randomised to an intervention received four 30-minute lessons during
      school time over the intervention period (one per 'block'). Key learning messages
      incorporating key principles of behaviour change were delivered to whole year group classes
      by trained research personnel. The class lessons were followed by homework
      activities/challenges and were aimed at the children and were designed to (i) target habits
      and self-efficacy, (ii) target screen-time and/or nutritional knowledge; (iii) introduce
      alternative activities/snacks, and (iv) encourage role modelling. Lessons were designed with
      class teachers prior to the commencement of the programme and incorporated literacy and
      numeracy aspects that were aligned to the national curriculum specific for each age group.
    

Intervention name(s): Kids FIRST
Intervention type(s): Behavioral
Intervention description(s): family- and school-based intervention to reduce unhealthy screen-time and snacking
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: 4-arm intervention. 3 interventions that received the same model but tailored to behavioural target. control group received no treatment
Masking: Single (Investigator)
Primary purpose: Prevention