4. Discussion
obesity
OBESITY
This study addressed the effectiveness of a theory-based, multicomponent eHealth intervention on fruit and vegetable intake, moderate-to-vigorous physical activity, sedentary behavior, and screen time among young children (1–3 years). Secondarily, this study investigated if there were any improvements in nutrition knowledge, attitudes, self-efficacy, and comprehensive feeding practices among their parents. Results of this study showed that intervention group children had significant improvements in fruit and vegetable intake by 0.91 and 0.54 servings/day, respectively, over the course of two months. Such increases in child fruit and vegetable intake in the intervention group remained significant when compared to the control group. Similar to the present study, Hunsaker and colleagues conducted a randomized controlled trial among 65 parents with preschoolers and kindergartners in Utah [In this study, intervention group children increased moderate-to-vigorous physical activity. However, this increase was not significant compared to the control group. Similar results were found in another study among preschoolers whose parents received a 10-week lifestyle intervention via Facebook, as well as a randomized controlled trial for early childhood health promotion among parents with preschoolers [Significant intervention effects on child sedentary behavior and screen time were observed in this study. Consistent with our findings, a systematic review of randomized controlled trials found a significant intervention effect in reducing sedentary time by an average of 18.91 min/day and screen time by 17 min/day among children aged 2 to 5 years [Parents in this study started with relatively high knowledge and attitude scores. For example, at baseline, the intervention and control group answered correctly to an average of 57.9% and 57.3% for knowledge question items and 65.4% and 63.5% for attitude question items. Higher baseline scores generally leave less room for improvement, which may contribute to an insignificant magnitude of change. In contrast to knowledge and attitudes, parents showed significant improvements in self-efficacy around feeding. Consistent with our findings, another study examining the effect of an online video intervention among parents with children aged 6 to 12 years found a significant effect on parental self-efficacy post-intervention [This study observed significant improvements in comprehensive parental feeding practices. For example, intervention group parents showed significant changes in their levels of agreement with utilizing less non-responsive feeding practices, such as emotion regulation, food as a reward, pressure to eat, and restriction for weight post-intervention. Such coercive, protective feeding practices are found to have unintentional outcomes in children. A systematic review found a significant association between controlling/restrictive parental feeding practices with high BMI-for-age z scores and, thus, obesity risk in young children [Interventions using digital methods have several notable strengths. Our intervention website was a user-friendly stand-alone product that has the potential for widespread application and sizable reach. Additionally, previous digital behavioral change interventions focused solely on parental psychosocial attributes regarding child obesogenic health behaviors. A unique aspect of this study is its holistic approach to enhancing parenting skills through awareness of responsive feeding practices, food preparation skills through cooking tutorials, and parental intentions through improved parental psychosocial determinants. This study facilitated health behavior changes in young children at home. Relatively few studies were undertaken among 1–3 year-old children and outside the preschool setting. Child screen time behavior also has not been considered in many early interventions. However, this study is not without some limitations. The researcher did not have follow-up measurements; thus, the maintenance of behavior changes in participants over time cannot be explained. Parent-administered proxy questionnaires were used to assess study outcomes, and therefore, there may be reporting bias among participants. The lack of standardized methods for eating and behavioral patterns remains a major limitation and challenge. This study did not track BMI-for-age for children or BMI for parents, so the impact of the intervention on actual weight status cannot be explained.