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Research Project: Interplay of the Physical Environment, Social Domain, and Intrapersonal Factors on Nutrition and Physical Activity Related Health Behaviors in Children and Adolescents

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Title: Behavioural components and delivery features of early childhood obesity prevention interventions: intervention coding of studies in the TOPCHILD Collaboration systematic review

Author
item JOHNSON, BRITTANY - Flinders University
item CHADWICK, PAUL - University College London
item PRYDE, SAMANTHA - Flinders University
item Thomson, Jessica

Submitted to: International Journal of Behavioral Nutrition and Physical Activity
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/14/2025
Publication Date: 2/5/2025
Citation: Johnson, B., Chadwick, P., Pryde, S., Thomson, J.L. 2025. Behavioural components and delivery features of early childhood obesity prevention interventions: intervention coding of studies in the TOPCHILD Collaboration systematic review . International Journal of Behavioral Nutrition and Physical Activity. 22:14. https://doi.org/10.1186/s12966-025-01708-9.
DOI: https://doi.org/10.1186/s12966-025-01708-9

Interpretive Summary: Interventions targeting parental behavior to positively impact their infant’s growth and health in the first 1,000 days are growing in number and some have been successful. Yet the components of behavior change interventions are not well defined in published reports making it difficult to determine which components were most effective at changing behavior. Thus, to address gaps in knowledge, the objective of this work was to characterize targeted parental behaviors, delivery features, and behavior change techniques of early childhood obesity prevention interventions using both published and unpublished materials. Additionally, similarities and differences in the behavior change techniques used for parental behaviors were explored. Of the 51 eligible trials in the Transforming Obesity Prevention for Children (TOPCHILD) Collaboration, 32 trials provided information and completed the validation process for synthesis. Four clusters of parental behaviors were identified – infant milk feeding practices, food provision and parental feeding practices, movement practices, and sleep health practices. Targeting all 4 clusters of parental behaviors was the most common approach (15 interventions) with only 5 interventions targeting a single cluster. The majority of interventions were delivered by health professionals and used an interactive mode of delivery. A wide variety of behavior change techniques were used within and among parental behavior clusters. The most frequently used techniques included instruction on how to perform a behavior, behavioral practice and rehearsal, information about health consequences, social support, and credible source of information. These findings provide a solid foundation for the design of future early childhood obesity prevention interventions. The work will be extended to determine which intervention components are associated with positive changes in child health and reduced risk of childhood obesity.

Technical 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.