Abstract
Web-based parent interventions designed to promote children's healthy eating patterns can enhance parents' engagement and facilitate behavior change. However, it is still unclear how much the existing programs focus on changing parental feeding practices, and if so, which behavioral methodologies are used and how effective these interventions are in changing these parental behaviors. This systematic review and meta-analysis studied randomized controlled trials of web-based interventions targeting parents of 0-12-year-old children, aiming to promote children's healthy diet or prevent nutrition-related problems and reporting parental feeding behaviors as one of the outcomes. We conducted an electronic search in four databases from the earliest publication date until February 2020. Of the 1271 records found, we retained twelve studies about nine programs, comprising 1766 parents that completed the baseline evaluation. We found recent interventions, mainly directed to parents of young children, with small, non-clinical samples, and mostly theory-based. The programs were heterogeneous regarding the type of intervention delivered and its duration. The most assessed parental feeding practices were Restriction, Pressure to eat, and Food availability/accessibility. The behavior change techniques Instruction on how to perform the behavior, Demonstration of the behavior, and Identification of self as role model were frequently used. Meta-analytic results indicated that most programs' effects were small for the evaluated parental practices, except for Food availability/accessibility that benefited the intervention group only when all follow-up measurements were considered. The development of high-quality and controlled trials with larger samples is needed to determine with greater certainty the interventions' impact on parental feeding behaviors. The more frequent inclusion of measures to evaluate parental practices to support children's autonomy and of self-regulatory strategies as intervention components should be considered when designing programs.
Highlights
A healthy diet in the first years of life contributes to the development of healthier food preferences and habits that can endure through adulthood [1], reducing the risk for several health and development problems [2]
The studies were eligible for analysis if: a) it targeted parents of children between 0 and 12 years old; b) the intervention aimed to promote children’s healthy diet and/or to prevent nutrition-related problems both in healthy or clinical populations; c) it included a web-based intervention as a stand-alone intervention for parents; we included studies where children received some intervention, as long as the parents were the main target of the intervention, and this intervention was exclusively web-based; d) parental feeding practices were one of the outcomes; e) parental feeding practices were assessed through quantitative measures; f) it used a randomized controlled trial (RCT) design
Considering that we aimed to identify which parental feeding practices were targeted as outcome variables and evaluate how effective these interventions were in changing those feeding practices, we focused on the instruments used to assess parenting practices as outcomes in each trial
Summary
A healthy diet in the first years of life contributes to the development of healthier food preferences and habits that can endure through adulthood [1], reducing the risk for several health and development problems (e.g., obesity) [2]. Parenting feeding practices can be organized in three higher-order constructs [8, 9]: i) coercive control (specific parent-centered strategies intended to change children’s eating behavior through dominance, intrusiveness, reinforcement or supervision, e.g., pressure to eat); ii) structure (when parents define a set of rules and boundaries and organize the home environment to facilitate or reduce specific children’s eating behaviors, e.g., food availability); and iii) autonomy support or promotion practices (parents’ actions that support the child’s initiatives and autonomy, or help the child to develop age-appropriate eating self-regulation skills, e.g., nutrition education). The distinction between overt restrictive feeding practices (that do not consider the child’s needs in the decisions about food and eating) and covert, non-coercive restrictions (that reflect parent’s actions to change the food environment and set rules with the child’s involvement) [8, 9] is relevant, considering the different implications of the two practices on children’s dietary intake and self-regulation development [10]. Positive parental feeding practices that are simultaneously high on demandingness and responsiveness can contribute to children’s healthier dietary and weight outcomes across childhood and adolescence [13]
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