Changing parental feeding practices through web-based interventions: A systematic review and meta-analysis

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.

Fig 1. PRISMA flow diagram about the study selection process [36].

Fig 2. Judgments about the risk of bias for each dimension (RoB2 tool) [60] presented as percentages across studies.

Fig 3. Forest plot of the effects of web-based interventions on parental feeding practices, estimated for all time points.

Legend: TE = treatment effect, and seTE = standard error treatment effect. About values on standardized mean differences: zero values indicate lack of effect, negative values favor the intervention group, and positive values favor the control group. Information about the outlier (Family Eats) for Modeling dimension: Family Eats: g = -54.4450, SE = 4.21, 95% CI [-62.69; -46.20].

Fig 4. Forest plot of the effects of web-based interventions on parental feeding practices, estimated at T2.

Legend: TE = treatment effect, and seTE = standard error treatment effect. About values on standardized mean differences: zero values indicate lack of effect, negative values favor the intervention group, and positive values favor the control group. Information about the outlier (Family Eats) for Food Preparation dimension: Family Eats: g = -15.10, SE = 4.04, 95% CI [-23.02, -7.18].