Food4toddlers. Fostering healthy dietary habits through targeting toddlers' food and eating environment : The Food4toddlers study

Aims and objectives: 1) to develop, implement, and evaluate an eHealth intervention, aiming to promote healthy dietary habits in toddlers by targeting parents’ awareness of their child’s food and eating environments, and 2) to examine associations between parental food choice motives, parental feeding practices, and children’s fruit and vegetable intake. Results: The study’s rationale and development were described in a protocol paper, along with a presentation of the baseline characteristics of the included participants. In total, 404 parents signed up for participation, and 298 answered baseline questionnaires and were randomized into either the control (n=150) or intervention (n=148) group. Most of the parents were highly educated mothers. From baseline to the first follow-up there was a significant time by group interaction for the frequency of vegetable intake (p = 0.02), showing a higher change in intake in the intervention group compared with the control group (paper III). A borderline significant between-group difference in the variety of vegetable intake in favor of the intervention group was seen from baseline to both follow-ups. No significant differences were observed for other food groups. The process evaluation of the study (paper IV) revealed that 86.5% of the participants in the intervention group visited the website. Most parents found the website appropriate to the child’s age as well as self-explanatory (86–95%) and appreciated the layout and interface (55–63%). The recipes were valued as the most appreciated element included in the website. Highly educated participants (> 4 years of university/college) reported that they used end learned more from the website than participants with ≤ 4 years of education. Regarding the second aim (paper II), the results showed that higher parental scores on health motives were associated with a higher child intake of vegetables (τ = 0.394 (SE = 0.098), p < 0.001). No associations with fruit or vegetables were found for other parental food choice motives. Some associations between food choice motives and child vegetable or fruit intakes were mediated by the feeding practices assessed, though solely for health and sensory appeal motives. Effect sizes of the observed associations were generally small. Conclusions: Our findings support the use of eHealth interventions for supporting parents in their children's dietary upbringing. Through making the parents aware of dietary determinants and encouraging them to create a healthy food and eating environment, child diet was slightly improved, i.e., higher vegetable intake in the intervention group was observed. The intervention was well received by the parents, although especially by highly educated parents. Still, we did not manage to engage 13% of the participants, who did not enter the website at all. Health motives were associated with child vegetable intake, and healthpromoting feeding practices had some mediation effect. Our findings contribute to a better understanding of the relations affecting toddler’s eating habits. However, more research is needed to examine the prospective and experimental evidence of interventions to enhance toddlers’ diet and to clarify interactions between elements in the child’s food and eating environment that affect the diet.publishedVersio