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Infancy is an important life stage for obesity prevention efforts. Parents’ infant feeding practices influence the development of infants’ food preferences and eating behaviors and subsequently diet and weight. Mobile health (mHealth) may provide a feasible medium through which to deliver programs to promote healthy infant feeding as it allows low cost and easy access to tailored content.
The objective of this study was to describe the effects of an mHealth intervention on parental feeding practices, infant food preferences, and infant satiety responsiveness.
A quasi-experimental study was conducted with an mHealth intervention group (Growing Healthy) and a nonrandomized comparison group (“Baby's First Food"). The intervention group received access to a free app with age-appropriate push notifications, a website, and an online forum that provided them with evidence-based advice on infant feeding for healthy growth from birth until 9 months of age. Behavior change techniques were selected using the Behaviour Change Wheel framework. Participants in both groups completed three Web-based surveys, first when their infants were less than 3 months old (baseline, T1), then at 6 months (time 2, T2), and 9 months of age (time 3, T3). Surveys included questions on infant feeding practices and beliefs (Infant Feeding Questionnaire, IFQ), satiety responsiveness (Baby Eating Behaviour Questionnaire), and infant’s food exposure and liking. Multivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups, with adjustment for relevant covariates. Multivariate logistic regression adjusting for the same covariates was performed for categorical outcomes.
A total of 645 parents (Growing Healthy: n=301, Baby's First Food: n=344) met the eligibility criteria and were included in the study, reducing to a sample size of 546 (Growing Healthy: n=234, Baby's First Food: n=312) at T2 and a sample size of 518 (Growing Healthy: n=225, Baby's First Food: n=293) at T3. There were approximately equal numbers of boy and girl infants, and infants were aged less than 3 months at baseline (Growing Healthy: mean 7.0, SD 3.7 weeks; Baby's First Food: mean 7.9, SD 3.8 weeks), with Growing Healthy infants being slightly younger than Baby's First Food infants (
Although mHealth can be effective in promoting some health behaviors and offers many advantages in health promotion, the results of this study suggest that design and delivery characteristics needed to maximize the impact of mHealth interventions on infant feeding are uncertain. The sensitivity of available measurement tools and differences in baseline characteristics of participants may have also affected the results.
Childhood obesity is a strong risk factor for adult overweight or obesity [
Parental feeding practices affect infants’ and children’s food intakes, as well as the development of their food preferences and eating behaviors (such as responding to the hunger and satiety cues) [
Parental cognitions such as concerns about an infant eating too much, or that a child is at risk of becoming overweight, may affect their feeding practices. Parents who are concerned about their infant or child being or becoming underweight or not gaining enough weight are more likely to use pressuring feeding practices to promote greater consumption [
Also significant in the development of weight status are children’s emerging food preferences: these are an important determinant of whether children consume particular foods or avoid them [
Despite the range of studies now indicating that particular parental feeding practices and associated cognitions in early stages of children’s lives are important for children’s healthy weight gain, there are still substantial gaps in our understanding of the most effective approaches for helping parents to achieve this [
mHealth programs also offer advantages over traditional approaches in the types of behavior change approaches that can be employed, which may enhance intervention effectiveness. For instance, content can be readily tailored to participants’ individual needs (eg, infant’s age and whether breast- or formula-feeding), and because they offer programming flexibility, numerous behavior change techniques (BCTs) can be readily utilized (eg, video demonstrations and feedback on behaviors) or features be incorporated (eg, prompts). For these reasons, mHealth approaches to health promotion provide an attractive medium through which interventions could be delivered to time-poor groups such as new parents. Available evidence from the wider mHealth field suggests that mHealth interventions are more effective in promoting some health behaviors than others [
To this end, this paper reports on data from the
Details of the study design are reported elsewhere [
Eligibility criteria for participation in the intervention group (Growing Healthy) included pregnant (30+ weeks gestation) or parent or main caregiver of an infant aged under 3 months, owned any type of mobile phone, spoke and read English, aged 18 years or older, and lived in Australia. Participants were recruited three ways: via their primary health care providers in socioeconomically disadvantaged communities in two Australian states (New South Wales and Victoria), face-to-face by researchers, and through Web advertising. Enrollment to the study included completion of a Web-based screening form, a consent form, and a baseline survey. A concurrent nonrandomized comparison group (Baby's First Food) was recruited via Web forums, social networking sites, and blogs and received usual care that involves regular face-to-face appointments with a maternal and child nurse to monitor and advise on the infant’s health, growth, and development. Further details can be found in the study by Laws et al [
The Growing Healthy program consisted of an app, website, and Web-based forum, providing parents with evidence-based advice on infant feeding for healthy growth from birth until 9 months of age. The program aims included promoting healthy infant feeding practices (eg, recognizing and appropriately responding to infant cues of hunger and satiety) and promoting high exposure to fruits and vegetables [
Participants in Growing Healthy and Baby's First Food completed a baseline survey when their infant was between 2 weeks and 3 months of age, a follow up survey when infants were approximately 6 months of age, and a final survey when infants were approximately 9 months. The baseline survey collected information on sociodemographics, including the child’s age and gender and the mothers’ age, country of birth (Australia or overseas born), relationship status (single or married), employment status (currently employed or unemployed), education level (low: no formal education or high school; medium: certificate or diploma; high: university degree and higher), and annual household income (Aus $≤51,999, 52,000-77,999, 78,000-99,999, ≥100,000). Mothers also self-reported their prepregnancy weight in kilograms and current height in centimeters. Maternal prepregnancy body mass index (BMI) was calculated as prepregnancy weight divided by height squared (kg/m2). Feeding mode (exclusively breastfeeding, formula feeding, or mixed feeding) was also collected.
Parental feeding practices and beliefs were collected at all three time points using questions from the Infant Feeding Questionnaire (IFQ) [
Respondents were also asked about perceptions of their infant’s ability to respond to their internal satiety cues (
Frequency of food exposure, infant food preference, and parents’ intentions to offer foods again were reported at time 3 (T3) with purpose-developed items. Thirty-two foods were included to provide a range of foods, typically available in the Australian food supply and being characteristic of foods recommended to be consumed in high or low amounts [
For baseline characteristics, group comparisons were made using
To assess infants’ food exposure, we calculated core and noncore food offering frequency scores and variety scores. Frequency of consumption of each food item was converted to daily equivalent scores (never=0, less than once a month=0.017, 1-3 times a month=0.067, once a week=0.143, 2-4 times a week=0.429, 5-6 times a week=0.786, and once a day or more=1). Adding daily equivalent scores of the 22 core food categories and ten noncore food categories, respectively, generated core and noncore food frequency scores. For the food variety score, frequency of consumption of each item was first coded into a binary variable indicating offered or not offered. Core and noncore food variety scores were created by adding individual binary variables together, resulting in a score ranging from 0 to 22 for core foods and 0 to 10 for noncore foods. Similarly, by adding binary variables (offer again yes or no) of individual foods together, the number of core or noncore foods that parent will offer again was also obtained. For infants who disliked one or more core foods, a score was created for the proportion of disliked core foods that the parent intended to offer again in the next 6 months. For infant food preferences, individual food item preference was coded as either yes or no, with “has not tried” coded to missing. The proportions of core and noncore foods that the infant tasted and disliked, as well as the proportion of disliked core foods the parent intended to offer again, were dichotomized into all versus not all. Questions asking whether parents added sugar or salt to baby foods were combined into a single outcome and dichotomized as never versus some of the time (sometimes or often or always).
Descriptive analyses (ie, means and SDs for continuous variables and percentages for categorical variables) were conducted to compare baseline characteristics between the two groups. Multivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups, with adjustment for baseline parental feeding practice and belief variables, and covariates including infant’s age, maternal age, maternal BMI, whether first born, maternal country of birth, and feeding method. These covariates were chosen as they each differed between Growing Healthy and Baby's First Food groups and were associated with at least one outcome variable with
There were 645 eligible participants at baseline (Growing Healthy: 301, Baby's First Food: 344), reducing to a sample size of 546 (Growing Healthy: n=234, Baby's First Food: n=312) at time 2 (T2) and a sample size of 518 (Growing Healthy: n=225, Baby's First Food: n=293) at T3. Thus 82 participants (82/645, 12.7%) dropped out between baseline and T2, and a further 28 participants (making a total of 110 [28/645, 17%]) dropped out between T2 and T3. Most (151/301, 50.3%) of the intervention group was recruited via the Web, 7.7% (23/301) through face-to-face methods, 29.3% (88/301) via practitioners, and the remainder (38/301, 12.7%) via word of mouth. Further details are described in the papers by Laws et al [
Details of recruitment and retention of study participants are reported elsewhere [
There were some statistically significant differences between the retained samples and study dropouts with respect to baseline characteristics. Participants who had dropped out by T2 had lower baby birth weight (mean 3321.6, SD 738.4 g vs mean 3485.6, SD 644.3) than the retained T2 sample. Participants who had dropped out by T3 had lower baby birth weight (mean 3350.6, SD 776.3 vs mean 3492.7, SD 624.1), parents perceived them to have an easier or better baby temperament (mean 2.2, SD 0.9 vs mean 2.4, SD 0.8), greater awareness of infant hunger and satiety cues (mean 13.0, SD 2.1 vs mean 12.6, SD 2.0), were less likely to be married (118/127, 92.3% vs 503/518, 97.1%), more likely to have a health care card (28/127, 22.1% vs 73/518, 14.1% ), and less likely to be tertiary educated (48/124, 38.7% vs 263/507, 51.9%) than the retained T3 sample.
Five outcomes relating to parental feeding practice and belief outcomes and one outcome on infant satiety responsiveness scores were examined at T2 when infant mean age was 6 months (26.6 weeks). Comparison of these outcomes by intervention groups is presented in
Sociodemographic characteristics of the Baby's First Food and Growing Healthy samples at baseline.
Characteristics | Growing Healthy (n=301) | Baby's First Food (n=344) | |||
Age (weeks) | 7.0 (3.7) | 7.9 (3.8) | .001 | ||
Boys | 150 (49.8) | 167 (48.5) | .74 | ||
Girls | 151 (50.2) | 177 (51.5) | |||
First born baby, n (%) | 173 (57.5) | 133 (38.7) | <.001 | ||
Mother’s age (years) | 30.4 (4.7) | 31.2 (4.4) | .04 | ||
Mother prepregnancy body mass index (kg/m2), mean (SD) | 26.6 (5.7) | 27.2 (6.8) | .23 | ||
Maternal smoking status (currently smoking), n (%) | 18 (6.0) | 15 (4.4) | .35 | ||
Maternal country of birth (Australian born), n (%) | 253 (84.1) | 310 (90.1) | .02 | ||
Relationship status (married), n (%) | 289 (96.0) | 332 (96.5) | .74 | ||
Health care card (yes), n (%) | 48 (16.0) | 53 (15.4) | .85 | ||
Poor or fair | 30 (10.0) | 28 (8.1) | .51 | ||
Good | 116 (38.5) | 152 (44.2) | |||
Very Good | 124 (41.2) | 131 (38.1) | |||
Excellent | 31 (10.3) | 33 (9.6) | |||
Low | 61 (21.1) | 56 (16.4) | .29 | ||
Medium | 88 (30.5) | 115 (33.6) | |||
High | 140 (48.4) | 171 (50.0) | |||
Not working | 261 (86.7) | 298 (87.1) | .87 | ||
Working | 40 (13.3) | 44 (12.9) | |||
Low | 56 (19.4) | 64 (19.3) | .56 | ||
Medium | 144 (49.8) | 153 (46.1) | |||
High | 89 (30.8) | 115 (34.6) | |||
Not working | 12 (4.2) | 7 (2.1) | .14 | ||
Working | 277 (95.8) | 324 (97.9) | |||
≤51,999 | 35 (13.7) | 44 (15.3) | .02 | ||
52,000-77,999 | 79 (31.0) | 57 (19.8) | |||
78,000-99,999 | 66 (25.9) | 81 (28.1) | |||
≥100,000 | 75 (29.4) | 106 (36.8) | |||
Exclusive breastfeeding | 196 (65.1) | 245 (71.2) | <.001 | ||
Formula feeding | 52 (17.3) | 48 (14.0) | |||
Mixed feeding | 53 (17.6) | 51 (14.8) |
Baseline parental feeding practice and beliefs (Infant Feeding Questionnaire) and infant satiety responsiveness (Baby Eating Behaviour Questionnaire) in the Baby's First Food and Growing Healthy samples. IQR: interquartile range.
Baseline (mean infant age: 7.4 weeks) | Baby's First Food (n=344) | Growing Healthy (n=301) | ||||
n | Mean (SD) | Median (IQR) | n | Mean (SD) | Median (IQR) | |
Concerns about infant undereating or becoming underweight (4 items, maximum score 20) | 343 | 7.1 (2.8) | 6.0 (5.0-8.0) | 301 | 7.3 (2.7) | 7.0 (5.0-9.0) |
Awareness of infant hunger and satiety cues (3 items, maximum score 15) | 344 | 12.8 (2.1) | 13.0 (12.0-15.0) | 301 | 12.6 (2.0) | 13.0 (11.0-14.0) |
Concerns about infant overeating or becoming overweight (3 items, maximum score 15) | 344 | 5.0 (2.1) | 4.0 (3.0-6.0) | 301 | 5.3 (2.0) | 5.0 (4.0-7.0) |
Feeding infant on a schedule (2 items, maximum score 10) | 343 | 3.8 (1.8) | 3.0 (2.0-5.0) | 301 | 3.8 (1.7) | 3.0 (2.0-5.0) |
Using food to calm infant fussiness (2 items, maximum score 10) | 344 | 6.8 (1.8) | 7.0 (6.0-8.0) | 301 | 6.6 (1.7) | 7.0 (5.0-8.0) |
Infant satiety responsiveness score (3 items, maximum score 15) | 296 | 7.3 (2.0) | 7.0 (6.0-9.0) | 262 | 7.3 (2.0) | 7.0 (6.0-9.0) |
Comparison of parent feeding practice and belief outcomes at time 2 between Baby's First Food and Growing Healthy. Mean difference coefficients estimated from linear regression analysis. IQR: interquartile range.
Parent feeding practice and belief items | Distribution of outcomes | Effects of intervention | ||||||
Baby's First Food | Growing Healthy | Mean difference (95% CI) | ||||||
n | Mean (SD) | Median (IQR) | n | Mean (SD) | Median (IQR) | |||
Concerns about infant undereating or becoming underweight (4 items) | 281 | 7.2 (2.7) | 7.0 (5.0-9.0) | 229 | 7.2 (2.8) | 7.0 (5.0-9.0) | −0.14 (−0.61 to 0.34) | .57 |
Awareness of infant hunger and satiety cues (3 items) | 281 | 13.2 (1.9) | 14.0 (12.0-15.0) | 229 | 12.9 (2.1) | 13.0 (12.0-15.0) | −0.11 (−0.44 to 0.23) | .54 |
Concerns about infant overeating or becoming overweight (3 items) | 281 | 4.5 (1.7) | 4.0 (3.0-6.0) | 229 | 4.9 (2.0) | 4.0 (3.0-6.0) | 0.30 (0.01 to 0.59) | .04 |
Feeding infant on a schedule (2 items) | 282 | 4.9 (2.2) | 5.0 (3.0-7.0) | 229 | 5.1 (2.2) | 5.0 (3.0,-7.0) | 0.05 (−0.28 to 0.39) | .76 |
Using food to calm infant fussiness (2 items) | 281 | 6.2 (1.9) | 6.0 (5.0-8.0) | 229 | 6.1 (1.9) | 6.0 (5.0-7.0) | 0.06 (−0.22 to 0.34) | .69 |
Infant satiety responsiveness score (3 items) | 241 | 7.0 (2.4) | 7.0 (5.0-8.0) | 228 | 7.2 (2.2) | 7.0 (6.0-8.0) | 0.08 (−0.36 to 0.52) | .72 |
aMultivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups with adjustment for baseline parental feeding practice and belief variable, age, maternal age, maternal body mass index, whether first born, maternal country of birth, and feeding mode.
At T3, the IFQ and BEBQ satiety responsiveness scores were similar between the two groups (
Comparison of parent feeding practice and beliefs, dietary exposure, and infant food preference continuous outcomes at time 3 between Baby's First Food and Growing Healthy. Mean difference coefficients estimated from linear regression analysis. IQR: interquartile range.
Parent feeding practice and belief items | Distribution of outcomes | Effects of intervention | ||||||
Baby's First Food | Growing Healthy | Mean difference (95% CI) | ||||||
n | Mean (SD) | Median (IQR) | n | Mean (SD) | Median (IQR) | |||
Concerns about infant undereating or becoming underweight (4 items) | 279 | 7.5 (3.0) | 7.0 (5.0-9.0) | 201 | 7.7 (3.2) | 7.0 (5.0-10.0) | −0.02 (−0.59 to 0.54) | .94 |
Awareness of infant hunger and satiety cues (3 items) | 279 | 13.0 (1.7) | 13.0 (12.0-14.0) | 201 | 12.6 (1.9) | 13.0 (12.0-14.0) | −0.20 (−0.54 to 0.14) | .26 |
Concerns about infant overeating or becoming overweight (3 items) | 279 | 4.6 (1.8) | 4.0 (3.0-6.0) | 202 | 4.7 (1.8) | 4.0 (3.0-6.0) | −0.06 (−0.39 to 0.28) | .74 |
Feeding infant on a schedule (2 items) | 279 | 5.4 (1.9) | 6.0 (4.0-7.0) | 202 | 5.5 (1.9) | 5.0 (4.0-7.0) | −0.10 (−0.41 to 0.21) | .54 |
Using food to calm infant fussiness (2 items) | 279 | 5.8 (1.9) | 6.0 (4.0-7.0) | 201 | 5.7 (1.8) | 6.0 (4.0-7.0) | 0.06 (−0.24 to 0.37) | .69 |
Infant satiety responsiveness score (3 items) | 250 | 7.2 (2.1) | 7.0 (6.0-8.0) | 181 | 6.8 (2.1) | 7.0 (6.0-8.0) | −0.21 (−0.62 to 0.19) | .30 |
Core food offer frequency score | 276 | 5.2 (2.0) | 5.0 (3.8-6.4) | 202 | 5.1 (1.9) | 5.0 (3.7-6.4) | −0.07 (−0.44 to 0.30) | .70 |
Non-core offer food frequency score | 275 | 0.3 (0.5) | 0.1 (0.0-0.5) | 202 | 0.3 (0.4) | 0.1 (0.0, 0.4) | −0.06 (−0.15 to 0.03) | .19 |
Core food variety score (0-22) | 276 | 14.8 (3.1) | 15.0 (13.0-17.0) | 202 | 15.0 (3.0) | 15.0 (13.0-17.0) | 0.18 (−0.40 to 0.76) | .55 |
Non-core food variety score (0-10) | 275 | 2.6 (2.0) | 2.0 (1.0-4.0) | 202 | 2.5 (2.2) | 2.0 (1.0-4.0) | 0.03 (−0.34 to 0.41) | .87 |
Number of core foods parent will offer again (0-22) | 277 | 18.7 (2.7) | 19.0 (17.0-21.0) | 202 | 19.1 (2.4) | 20.0 (18.0-21.0) | 0.39 (−0.10 to 0.88) | .12 |
Number of non-core foods parent will offer again (0-10) | 277 | 3.2 (2.3) | 3.0 (1.0-5.0) | 202 | 3.2 (2.5) | 3.0 (1.0-5.0) | 0.00 (−0.43 to 0.44) | .99 |
aMultivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups with adjustment for baseline parental feeding practice and beliefs variable, age, maternal age, maternal body mass index, whether first born, maternal country of birth, and feeding method.
Comparison of parent feeding practice and belief binary outcomes at time 3 between Baby's First Food and Growing Healthy.
Parent feeding practice and belief items | Baby's First Food, n (%) | Growing Healthy, n (%) | Effects of intervention | ||
Odds ratio (95% CI) | |||||
0.96 (0.59 to 1.55) | .81 | ||||
No | 54 (19.6) | 44 (21.8) | |||
Yes | 221 (80.4) | 158 (78.2) | |||
1.22 (0.83 to 1.80) | .36 | ||||
Not all | 162 (58.3) | 111 (54.7) | |||
All | 116 (41.7) | 92 (45.3) | |||
1.27 (0.67 to 2.41) | .46 | ||||
Not all | 35 (15.3) | 19 (11.9) | |||
All | 194 (84.7) | 140 (88.1) | |||
1.17 (0.64 to 2.14) | .61 | ||||
Not all | 42 (25.9) | 26 (23.4) | |||
All | 120 (74.1) | 85 (76.6) | |||
0.82 (0.48 to 1.41) | .47 | ||||
Never | 235 (84.8) | 174 (86.1) | |||
Some of the time | 42 (15.2) | 28 (13.9) |
This study considered the effects of an mHealth intervention on parental feeding practices and cognitions, infants’ food preferences, and infants’ satiety responsiveness. In this study, we noted very few differences between the intervention and comparison groups in the measured outcomes, suggesting that although mHealth offers many advantages to both the researcher and participant over traditional approaches, further evidence on the most effective approaches for achieving and measuring outcomes in infant feeding are needed.
At each of the time points, just one of the tested relationships (concern about infant overeating or becoming overweight at T2) differed between the two groups. The majority of other studies using traditional intervention approaches (face-to-face) have been able to support parents to use some desirable infant feeding practices and eating outcomes for children, but not all. The NOURISH trial, for instance, which recruited first-time mothers and their 4- to 7-month old infants to a responsive feeding intervention, was able to influence infant satiety responsiveness [
In relation to the findings on food exposure, infants in the intervention group were equally likely as those in the comparison group to be exposed to and like core (as well as noncore) foods and were equally likely to be reoffered those foods that they initially disliked. The Growing Healthy program aimed to encourage parents to repeatedly expose their infants to core foods, even when initially rejected, and to avoid exposure to noncore foods. This could be a result of selection bias: it appeared that parents in both groups had similar intentions and behaviors, and in many (though not all) instances, these were close to ideal. For this reason, showing an effect of the intervention was challenging with the available sample size and measurement tools. Less ideal feeding practices may also only emerge later when children present more behavioral challenges such a food neophobia or fussy eating at older ages [
The influence of the unique design features of the intervention on participants’ behaviors may have also affected results. Health behavior programs delivered by mHealth are likely to be more effective when they meet several criteria including that they have a theoretical basis, suitable BCTs are employed over a suitable period of time, the content is appropriate, and the design characteristics and mode of delivery of the intervention are appealing to the participants [
Another important consideration in explaining the effects reported here relates to the dose of the intervention. Although many of the challenges faced in an mHealth intervention of healthy infant feeding are similar to those faced in other parent feeding interventions (eg, effective BCTs and measurement of outcomes), there are some unique challenges associated with the mHealth delivery mode that may have affected the results. For instance, there were indications that improvements could be made to the delivery of the program: technical problems related to operating system upgrades that saw the app temporarily cease functioning likely affected the dose of the intervention received by some of the participants and consequently, may have reduced potential impact of the intervention. This may have affected participant engagement. Participant engagement describes how often participants accessed various elements of the app, read push notifications, participated in the forum, looked at the website, and over what period of time [
The Growing Healthy program drew on the BCW framework and, as part of this, the Capability, Opportunity, Motivation, and Behavior (COM-B) framework to select BCTs likely to be effective in changing the target behaviors [
An additional challenge, common to all studies of parental feeding, is the effective measurement of parental feeding practices. In this study, the IFQ was used to measure parental infant feeding practices. At the time of designing the study, this was the only available self-reported measure of relevant parent infant feeding practices (to the authors’ knowledge). The IFQ was developed with infants from 6 months of age. In this study though, parents were initially asked to complete it when their infant was aged less than 3 months, and it is not known how appropriate the IFQ is with younger infants. Furthermore, the IFQ has not been validated against observational measures of parental feeding, or against objective measures of infant’s eating and weight, and therefore its capacity to accurately reflect parent’s feeding practices and beliefs is unknown. Additionally, the measure of infant food liking and parental intentions to reoffer foods were purpose-developed for this study and has not been validated, although it is possible that parent measures of their infant feeding practices and their infant’s food preferences are affected by social desirability and recall bias. Greater attention to validating measures of parent feeding practices and infant food preferences is urgently needed if the effects of interventions are to be confidently demonstrated.
A final but important consideration in interpretation of the results is that this study used a quasi-experimental design, and as such, the participants were not randomly assigned. Consequently, the two groups differed at baseline in some infant (eg, age) and parent (eg, parity) characteristics (although were similar in the majority of key criteria). The analyses took account of these differences; however, adequately powered RCTs are needed to confidently demonstrate effects.
Although mHealth can be effective in promoting health behaviors and offers many advantages in health promotion, the results of this study suggest that design and delivery characteristics needed to maximize the impact of mHealth interventions on infant feeding are uncertain. Further tailoring of content, including BCTs, to individual circumstances and characteristics may improve efficacy in different contexts. Furthermore, improved measures of outcomes, including those that are objectively measured or sensitive enough to reveal small changes in behaviors that are likely achieved by low-dose mHealth interventions, may be needed if the effects of mHealth interventions are to be detected.
Items under each parental feeding practice and belief outcome and infant satiety responsive score and their Cronbach alpha.
behavior change technique
Behaviour Change Wheel
Baby Eating Behaviour Questionnaire
body mass index
Capability Opportunity Motivation and Behavior
Infant Feeding Questionnaire
interquartile range
mobile health
randomized controlled trial
baseline, time 2, time 3
The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which was supported by a grant from the Australian Government Department of Health and Ageing. The information and opinions contained in it do not necessarily reflect the views or policy of the Australian Primary Health Care Research Institute or the Australian Government Department of Health and Ageing. The authors would like to thank the parents who participated in the trial and the participating practitioners for their time in recruiting participants and their valuable insights throughout the trial. They would also like to thank Kate Dullaghan for her editorial work on the app content and Professor Cathrine Fowler for her support and review of app content. Thanks also to Louisa Wilson for research assistant support. RL is supported by a National Health and Medical Research Council Early Career Research Fellowship, ID 1089415.
CGR, EDW, RL, ST, EL, and KC all contributed to the conceptualization of the study and development of the app content. KL developed the programming behind the app and website and measurement of program analytics. MZ and GA undertook the data analysis, with input from SL. CGR drafted the manuscript, and all authors reviewed and contributed to drafts of the paper and approved the final manuscript.
None declared.