Effectiveness of a parent-based electronic health (eHealth) intervention on physical activity, dietary behaviors, and sleep in preschoolers: A randomized controlled trial (Preprint)
Authors: Peng Zhou , Wen Liming , Hammersley Megan J , Lau Patrick W.C. 
Published: January 2025

BACKGROUND

Background: The prevalence of physical inactivity, unhealthy diet, and sleep disturbance in preschoolers is dramatically increasing. Parents are critical in cultivating their children’s physical activity (PA), dietary behaviors (DB), and sleep. Face-to-face interventions exhibited barriers like time commitment, making eHealth options appealing. Current parent-based eHealth interventions have limitations in intervention design (i.e., emphasis on single outcome, imbalanced intervention contents and sequence) and the results cannot be generalized to other regions.

OBJECTIVE

Objective: To evaluate the effectiveness of parent-based eHealth interventions on PA, DB, and sleep among preschoolers in China

METHODS

Method: This single-blinded randomized controlled trial with two-paralleled arms comprised a 12-week intervention with a 12-week follow-up, designed to promote preschoolers’ PA, DB, and sleep by providing parents with relevant health information and recommendation through an eHealth modality (i.e., videos and WeChat which is similar to the WhatsApp) and motivating parents to create a family environment with healthy regulations in which their children live. The intervention, grounded upon Social Cognitive Theory, included 12 interactive modules on PA*4, DB*4, and sleep*4, with each module delivered through social media on a weekly basis. Each module consisted of videos and evidence-based information, parents’ interaction, goal setting, and feedback. Participants in the control group received a weekly pamphlet without interactive components. Preschoolers’ PA, sleep duration, and sleep quality were assessed using wGT3X-BT ActiGraph while preschoolers’ DB, sleep problems, and screen time were measured using parent-reported questionnaires. Generalized Estimating Equations (GEE) with adjusting demographic information for covariates was used to examine the effects of parent-based eHealth intervention on outcomes.

RESULTS

237 eligible parent-child dyads were randomly assigned to the intervention (n=120, 4.51±0.72 years old, 55.8% boys) or control group (n=117, 4.31±0.70 years old, 59% boys). A total of 237 participating parents completed questionnaires, and 196 participating preschoolers provided valid ActiGraph data at baseline. 181 parents completed the questionnaires and 166 preschoolers provided valid ActiGraph data at posttest (intervention group: 90; control group: 91). 181 parents completed questionnaire data and 170 preschoolers provided valid ActiGraph data at follow-up assessment (intervention group: 90; control group: 91). Educating parents about healthy lifestyles through social media had a positive impact on preschoolers’ VPA (vs control: 138. 47 mins/7 days, 95% CI: 117.61, 183.10, p=.03), sleep latency (vs control: -21.04 mins/ day, 95% CI: -16.07, -6.00, p=.005) and efficiency (vs control: 4.61%, 95% CI: 4.29, 9.72, p<.001), and screen time (vs control: -16.42 mins/ weekday, 95% CI: -30.83, -2.01, p=.012; -73.88 mins/weekend day, 95% CI: -98.48, -49.28, p<.001).

CONCLUSIONS

The findings may be of assistance to combat unhealthy lifestyle commonly seen in the young children. More work will need to be done to continue using cutting-edge technological advancements to help families in broader regions create healthy living environments for their children.

CLINICALTRIAL

This intervention study was approved by the research ethic committee of Hong Kong Baptist University (SOSC-SPEH-2022-23_115) and was registered with the ClinicalTrial.gov Protocol Registration and Results System (PRS): NCT06025019.