None listed
Conditions
Brief summary
Childhood obesity is a serious public health challenge. About one in five Australian children aged 2 to 3 years is now either overweight or obese. Early intervention is important as excess weight and fast weight gain in early childhood are related to being overweight later in life with considerable impact upon health and health services. Over the past 7 years we have developed, implemented and evaluated an early obesity intervention program funded by NHMRC. The project tilted Healthy Beginnings Trial (HBT) was designed to improve infant feeding practices, eating habits, active play, and reduce TV viewing time to prevent childhood obesity in the first two years of life through staged home visiting. However, the high cost associated with home visits potentially limits population reach. To translate the successful evidence from the HBT into scaled-up practice applicable across the state with low-cost and broad-reach approaches, we propose this study to promote healthy infant feeding and active play using telephone support and Short Message Service (SMS). The proposed study aims to test the effectiveness of telephone support or SMS with mail-outs in reducing child BMI z-score, promoting healthy infant feeding practice and active play in the first 24 months of life; and examine the cost-effectiveness of these interventions. We hypothesise that the staged early intervention using either mailed self-motivating written materials plus SMS or plus telephone support delivered in the antenatal period and over the first 24 months of life, relative to usual care, will: 1) lead to reduced child BMI z-score and rapid weight gain at age 12 and 24 months compared to usual care. 2) improve infant feeding practices and decrease the prevalence of obesity-related behaviours at 12 and 24 months compared to usual care. 3) be more cost-effective compared to usual care, and SMS will be more cost-effective than telephone support. Both qualitative and quantitative methods will be used in this study. A total of 1155 women at late pregnancy were recruited from main hospitals in four Local Health Districts. They were randomly allocated to one of three arms. Randomisation was stratified by Local Health District. Telephone surveys were used to collect data at baseline, 6 months, 12 months, and will be used at 24 months. Children’s weight and length at 24 months will be measured by research nurses.
Interventions
This is a three arm randomised controlled trial
The proposed interventions are based upon the principles of the successful HBT intervention, to be delivered starting in the late antenatal period and over the first 24 months after birth (26 months). The timing of the staged intervention corresponds to milestones in early childhood development, in particular with regard to healthy feeding practices, nutrition and play as well as parent-child interactions. Below are the stages and contents of the
This is a three arm randomised controlled trial The proposed interventions are based upon the principles of the successful HBT intervention, to be delivered starting in the late antenatal period and over the first 24 months after birth (26 months). The timing of the staged intervention corresponds to milestones in early childhood development, in particular with regard to healthy feeding practices, nutrition and play as well as parent-child interactions. Below are the stages and contents of the interventions as well as intervention approaches: 3rd trimester: Health benefits of breastfeeding; strategies to address breastfeeding barriers; importance of ‘tummy time’ - when and for how long; social support mechanisms. 1 month: Breastfeeding support, overcome problems initiating breastfeeding; referral to Child and Family Health nurse team establishment of breastfeeding pattern and management of problems; if formula feeding - safe preparation; baby cues; sleep and settling routines; “tummy time”. 3 months: Establishment of breastfeeding patterns; support & management of problems; “tummy time”; introduction of solids around 6 months; discuss breastfeeding and work; postnatal exercise and nutrition. 5-6 months: Reinforce breastfeeding pattern; support management of problems; when and what food to introduce from around 6 months; encourage continued breastfeeding; activities that help develop baby’s strength & control – continue ‘tummy time’; avoid distractions like TV. 8-9 months: Encourage sustained breastfeeding; advice on balanced infant feeding; healthy snack ideas; quantity & variety of fruits and veg; introduce cup feeding; discuss healthy drinks; maternal-child relationship & feeding. 10-11 months: Encourage active play and motor skills development; discuss play ideas and screen time 12-15 months: Toddler nutrition including continuing breastfeeding and introducing family foods; toddler play and screen time, development of motor skill, emotional, social and language; immunisation 15-18 months Reinforce toddler nutrition, establish healthy eating behaviour, food label reading and food marketing; reinforce toddler play, screen time and development 18-24 months Toddler nutrition including milk feeding, lunch box ideas, portions, healthy meals and snack ideas; reinforce toddler play, screen time and development including positive rewards and managing tantrums The SMS + Mail-outs intervention: Written materials and checklists will be posted according to the developmental stage of the main issues at set times (3rd trimester, 1 month, 3 months, 5-6 months, 8-9 months, 10-11 months, 12-15 months, 15-18 months, 18-24 months). The resources will be translated into Arabic or Chinese if indicated. Following the postage of the stage-specific intervention resource, mothers will be sent text messages to reinforce the health promotion messages 2 times/week for 4 weeks. We will employ three part-time research nurses to deliver both SMS and telephone support interventions. The SMS and telephone support will not be administered in Arabic or Chinese. The telephone support + Mail-outs intervention: Following each posting of materials, the research nurses will contact mothers via phone to discuss the health promotion messages and address mothers’ concerns and needs regarding healthy beginnings of life and childhood obesity. It is anticipated that the duration of each telephone session will be ~20 minutes. Ongoing process evaluations will be conducted by research officers supervised by research advisory committee.
Sponsors
A/Prof. Li Ming Wen
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Prevention
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
16 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
Women will be eligible to participate if they are aged 16 years and over, at third trimester, are able to communicate in English (or can communicate with written information in Chinese or Arabic), have a mobile phone and live in the recruitment areas.
Exclusion criteria
Women will be excluded from the study if they have a severe medical condition based on advice given by their doctors. Women who cannot give informed consent, and those with babies with known major fetal anomalies will also be excluded.
Outcome results
None listed