There is an urgent need to create effective interventions to help parents establish a healthy diet among their children early in life, especially among low-income and ethnically diverse families. 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. Contributing to this poor diet is consuming foods outside the home, having unhealthy foods available in the home and lack of home-prepared meals. 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 with low-income ethnically diverse families of preschool children to inform a future fully powered randomized controlled trial. 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 aims are as follows:
Aim 1. To conduct focus groups with 40 ethnically diverse parents of preschoolers to inform the development of and adaptation of the intervention components;
Aim 2. To conduct a pilot RCT with 60 parent-child pairs (30 intervention/30 control) to determine the feasibility and acceptability of the enhanced intervention and determine the preliminary efficacy on child diet quality, feeding practices and availability of healthy foods in the home. The proposed research will lay the groundwork for a larger RCT to educate, 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.
US children, especially low-income and ethnic minorities, eat too little fruits and vegetables and whole grains, and too many energy dense snacks and beverages, dietary behaviors associated with increased morbidity from cardiovascular diseases. The proposed research will build upon prior pre-pilot work to develop and pilot-test the feasibility, acceptability and efficacy of a novel home-based intervention to improve the diet quality and family food environment of preschool age, low-income, ethnically diverse children. The intervention will engage parents with video-clips of their own meal time behaviors together with motivational interviewing, in-home cooking demonstrations, and tailored materials based on their child's eating behaviors.
