Strong Families Start at Home/Familias Fuertes Comienzan en Casa: A Novel Video and Motivational Interviewing Intervention to Improve Diet Quality of Low-income, Ethnically Diverse Children
Trial Snapshot
- Phase
- Not Applicable
- Status
- Recruiting
- Sponsor
- Brown University
- Enrollment
- 257
- Locations
- 1
- Primary Endpoint
- Child Diet Quality
Study Overview
Brief Summary
The goal of this clinical trial is to test the ability of a home-based parental nutrition intervention to improve diet quality in preschool aged children within low-income, Latinx/Hispanic families. The main questions it aims to answer are:
- Does this enhanced intervention change children's diet quality?
- Does this enhanced intervention change parental feeding practices?
- Does this enhanced intervention change the availability of healthy foods in the home?
Participants will:
- Work with a support coach
- Have a home visit with a support coach once a month, for three months
- Have a phone call with a support coach once a month, for three months
- Receive written materials and text messages over the six months
Researchers will compare a control group receiving different written materials and messages to see if the enhanced intervention changes diet quality in children.
Detailed Description
Investigators will build on the recently completed R34 (R34HL140229) that developed and pilot-tested the feasibility, acceptability, and preliminary efficacy of a novel home-based intervention to improve the diet quality and home food environment of low-income, ethnically diverse preschool children (87% Latinx). Despite the study occurring during COVID-19, the intervention delivery was feasible and acceptable to participants and achieved encouraging improvements in children's diet quality and positive food parenting practices. For the proposed research the investigators will build upon lessons learned in the pilot to evaluate the efficacy of the novel Strong Families intervention to improve food parenting practices, home food environment, parent, and children's diet quality in a fully powered randomized controlled trial (RCT) with 257 families of a 2-5-year-old child. The intervention will include:
- Home visits by a community health worker (CHW) trained in brief motivational interviewing; screening for social-determinants of health and connecting families to federal/state/local resources; in-home cooking demonstrations to prepare a meal involving their child; feedback about a family meal-time video
- Text-messages
- Tailored materials/messages
- CHW phone calls
These strategies are expected to connect families to community systems, increase parental knowledge, self-efficacy, and motivation for serving easy, inexpensive healthy foods leading to increased child exposure to more healthy and varied foods, improvements in parental feeding practices and ultimately, improvements in child diet quality. The RCT will include baseline, 6 & 12-month measurements to test the following aims:
- Aim 1: Improve the dietary intakes of 2-5-year-old children
- Aim 2: Improve food parenting practices
- Aim 3. Improve the availability of healthy foods in the home
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Prevention
- Masking
- Double (Participant, Outcomes Assessor)
Masking Description
Intervention staff (Project coordinator & Community Health Workers) will know what group each participant has been allocated to. Evaluation teams will be masked. Additionally, participants will know if they have been assigned to the group focused on "child feeding" or the group focused on "child reading readiness", but will not be told that one is the intervention group and one is the comparison group.
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- •At least 18 years old
- •Self-identity as Latinx/Hispanic
- •Speak English or Spanish
- •Be the primary caregiver of a child between 2- 5 years of age
- •Live with the child most of the time
- •Eat a minimum of three evening meals per week with the child
- •Not have participated in the R34 study
- •Have a smart phone
- •Be willing to have a meal video recorded in the home
Exclusion Criteria
- •A doctor or WIC provider has told them that their child was underweight in the past 6 months
- •The child has a diagnosed feeding disorder or dietary restriction that impacts how they eat
Arms & Interventions
Home-Based Video and Motivational Interviewing Intervention
The intervention will be delivered in English or Spanish by a trained CHW and consists of three home-based visits with tailored print materials, text-messages delivered 2x/week, followed by monthly tailored print materials and phone calls during the last three months of the intervention. For in-home visits, the CHW will deliver a Motivational Interviewing session based on scripts developed in the R34. For phone calls, parents will receive a 30-minute Motivational Interviewing phone call to check in on goals and barriers and reinforce earlier concepts. For text messages, parents will be sent two times/week messages related to objectives targeted during that month's visit, such as parents setting good examples and giving children autonomy in eating. For print materials, parents will receive printed materials, highlighting nutrition and parental feeding guidance.
Intervention: Home-Based Video and Motivational Interviewing Intervention (Behavioral)
Read Educate and Develop Youth (READY) Comparison
As done in the R34, the comparison group will receive an attention contact control intervention about school readiness promotion adapted from R.E.A.D.Y. (Read Educate and Develop Youth) designed by the Michigan Department of Education (Refs). Families in the comparison arm will receive the same intervention components as the intervention arm, but these will be focused on child reading rather than nutrition. Parents will send a video of themselves reading with a child, receive 3 home visits and 48 text-messages as well as newsletters for each visit. Instead of receiving cooking materials during the second home visit, they will receive books to read with their children.
Intervention: Read Educate and Develop Youth (READY) Comparison (Behavioral)
Outcomes
Primary Outcomes
Child Diet Quality
Time Frame: 2-24-Hour Recalls at Baseline and 2-24-Hour Recalls at 6-Month follow-up
Caloric and macronutrient intake will be averaged over two dietary recalls. Caloric and macronutrient intake will be averaged over the two recalls. Healthy Eating Index (HEI)-2015 components (total fruit, whole fruit, total vegetable, dark green and orange vegetables and legumes, total grain, whole grain, milk, meat and beans, saturated fat, sodium, added sugars, and solid fats) are assessed per 1000 kcal to provide a density-based score except for saturated fats and added sugars with are % of energy. Component scores are then summed to provide a total HEI score.
Child's Dermal Carotenoids
Time Frame: Baseline, 6-Month Follow-up
The Veggie Meter device will provide an objective, non-invasive and quick measure reflecting fruit and vegetable intake. This device uses reflection spectroscopy to detect the level of carotenoids in human skin. Three measures (10 seconds each spaced by 30-seconds) will be taken and averaged. Scores range from 0 to 800 with higher scores indicating greater fruit and vegetable intake.
Secondary Outcomes
- Food Parenting Practices(Baseline, 6-Month Follow-up)
- Availability of Healthy Foods in the Home(Baseline, 6-Month Follow-up)