Limitations
MINOR, SECONDARY
This study has some limitations. First, we advertised the study in a variety of Facebook groups to reach a diverse population of women who fit the criteria. Even so, our participants were found to be a nonrepresentative population of women. Most of them had attended university or community college (612/638, 95.9%) and had an above-average SES (294/585, 50.3%). They mostly lived in the central and Hasharon areas of Israel (360/635, 56.7%) and reported a good or very good health status (591/634, 93.2%). There is evidence that education and health status influence participation in studies [Second, the intervention was conducted during the COVID-19 partial and then full lockdown. This had some advantages as the intervention was designed to help families create a healthier home environment at a time when they were constantly at home and needed it the most. The intervention was provided on Facebook, an online platform that enabled them to participate during the lockdown without exposing themselves to risks. However, the timing could also bias the results of the study as we cannot know how the intervention would have been accepted on regular days. Most mothers who answered the open-ended questionnaire shared with us that they thought that it would not have made any difference. We created the content of the intervention before the first COVID-19 outbreak and only made some minor adjustments in real time. Hence, the content is always relevant, not just for times of lockdown. COVID-19 probably also biased the results of our secondary outcome, the participants’ wellness. Some of the participants shared in the open-ended questions that being in lockdown affected their spirits. They asked us to acknowledge that their responses to the well-being questions were biased by it. Finally, the participants joined the study before the third lockdown began. Although some mothers were more available, others told us in the open-ended questions that they could not find the time to participate or implement ideas.Third, we used a self-report questionnaire to measure our end points, with a voluntary response sample. Online questionnaires can suffer from self-selection bias, and in addition, as all assessments were self-reported, reporting errors may have occurred. Even so, self-report questionnaires save time and money, provide access to diverse populations, enable researchers to collect large amounts of data with depth and details in a short period, and capture a range of thoughts and views [Fourth, this study lacked a long-term follow-up. It is possible that a longer follow-up might have produced better wellness outcomes.Fifth, we do not have information regarding the environment of each of the participants. In future studies, it would be important to devise ways to assess the health-promoting aspects of home environments at baseline to see whether that variable makes a difference in the study results.Finally, this study was conducted with Hebrew-speaking, educated Israeli mothers. Future studies should examine the effectiveness of this intervention in other cultures and populations and in languages other than Hebrew.