Behavioural components and delivery features of early childhood obesity prevention interventions: intervention coding of studies in the TOPCHILD Collaboration systematic review
Authors: Johnson Brittany J. , Chadwick Paul M. , Pryde Samantha , Seidler Anna Lene , Hunter Kylie E. , Aberoumand Mason , Williams Jonathan G. , Lau Hei In , Libesman Sol , Aagerup Jannik , Barba Angie , Baur Louise A. , Morgillo Samantha , Sanders Lee , Taki Sarah , Hesketh Kylie D. , Campbell Karen , Manson Alexandra , Hayes Alison , Webster Angela , Wood Charles , O’Connor Denise A. , Matvienko-Sikar Karen , Robledo Kristy , Askie Lisa , Wolfenden Luke , Taylor Rachael , Yin H. Shonna , Brown Vicki , Fiks Alexander , Ventura Alison , Ghaderi Ata , Taylor Barry J. , Stough Cathleen , Helle Christine , Palacios Cristina , Perrin Eliana M. , Reifsnider Elizabeth , Rasmussen Finn , Paul Ian M. , Savage Jennifer S. , Thomson Jessica , Banna Jinan , Larsen Junilla , Joshipura Kaumudi , Ong Ken K. , Karssen Levie , Wen Li Ming , Vitolo Márcia , Røed Margrethe , Bryant Maria , Rivera Maribel Campos , Messito Mary Jo , Golova Natalia , Øverby Nina Cecilie , Gross Rachel , Lakshman Rajalakshmi , Byrne Rebecca , Rothman Russell L. , O’Reilly Sharleen , Anzman-Frasca Stephanie , Verbestel Vera , Maffeis Claudio , de la Haye Kayla , Salvy Sarah-Jeanne , Mihrshahi Seema , Ramachandran Janani , Baratto Paola Seffrin , Golley Rebecca K. ,   on behalf of the TOPCHILD Collaboration, Heath Anne-Louise , McCormick David , Angotti Katie , Roberts Kim , Valmorbida Julia , Nguyen David , Shrestha Nipun , Rissel Chris , Espinoza David , Marschner Ian , Bell Lucinda , Staub Lukas , Sue-See Michelle , Godolphin Peter , Smith Wendy , Karasz Alison , Thompson Amanda , Linares Ana Maria , Exposito Ana Perez , Acero Carolina González , Dennis Cindy-Lee , McCormick David , Jacobvitz Deborah , Widen Elizabeth , Oken Emily , Hodges Eric , Corpeleijn Eva , Wasser Heather , Raat Hein , Xia Hongping , Ong Ken , Kierkegaard Lene , Manikam Logan , Daniels Lynne , Rivera Maribel Campos , Goran Michael , Patil Priyanka , Wickramasinghe Pujitha , Rybak Tiffany , Pedersen Trine , Whaley Shannon , Kiridana Vasana , Verbeste Vera 
Published: February 2025

Abstract

Background
Early childhood obesity prevention interventions that aim to change parent/caregiver practices related to infant (milk) feeding, food provision and parent feeding, movement (including activity, sedentary behaviour) and/or sleep health (i.e. target parental behaviour domains) are diverse and heterogeneously reported. We aimed to 1) systematically characterise the target behaviours, delivery features, and Behaviour Change Techniques (BCTs) used in interventions in the international Transforming Obesity Prevention for CHILDren (TOPCHILD) Collaboration, and 2) explore similarities and differences in BCTs used in interventions by target behaviour domains.

Methods
Annual systematic searches were performed in MEDLINE, Embase, Cochrane (CENTRAL), CINAHL, PsycINFO, and two clinical trial registries, from inception to February 2023. Trialists from eligible randomised controlled trials of parent-focused, behavioural early obesity prevention interventions shared unpublished intervention materials. Standardised approaches were used to code target behaviours, delivery features and BCTs in both published and unpublished intervention materials. Validation meetings confirmed coding with trialists. Narrative syntheses were performed.

Results
Thirty-two trials reporting 37 active intervention arms were included. Interventions targeted a range of behaviours. The most frequent combination was targeting all parental behaviour domains (infant [milk] feeding, food provision and parent feeding, movement, sleep health; n[intervention arms] = 15/37). Delivery features varied considerably. Most interventions were delivered by a health professional (n = 26/36), included facilitator training (n = 31/36), and were interactive (n = 28/36). Overall, 49 of 93 unique BCTs were coded to at least one target behaviour domain. The most frequently coded BCTs were: Instruction on how to perform a behaviour (n[intervention arms, separated by domain] = 102), Behavioural practice and rehearsal (n = 85), Information about health consequences (n = 85), Social support (unspecified) (n = 84), and Credible source (n = 77). Similar BCTs were often used for each target behaviour domain.

Conclusions
Our study provides the most comprehensive description of the behaviour change content of complex interventions targeting early childhood obesity prevention available to date. Our analysis revealed that interventions targeted multiple behaviour domains, with significant variation in delivery features. Despite the diverse range of BCTs coded, five BCTs were consistently identified across domains, though certain BCTs were more prevalent in specific domains. These findings can be used to examine effectiveness of components and inform intervention development and evaluation in future trials.

Trial registration
PROSPERO registration no. CRD42020177408.