Results from the Strong Families Start at Home/Familias Fuertes Comienzan en Casa: feasibility randomised control trial to improve the diet quality of low-income, predominantly Hispanic/Latinx children

Abstract

Objective: To describe the feasibility, acceptability, and results of Strong Families Start at Home, a 6-month pilot trial of a home-based food parenting/nutrition intervention. Design: Pilot randomized controlled trial Participants: Parents and their 2–5-year-old child were randomized into intervention (responsive food parenting practices/ nutrition) or control (reading readiness) groups. Setting: Participants received 6 visits with a community health worker trained in motivational interviewing (3 home visits; 3 phone calls); an in-home cooking or reading activity; personalized feedback on a recorded family meal or reading activity; text messages; and tailored printed materials. Results: Parents (n=63) were mostly mothers (90%), Hispanic/Latinx (87%), born outside the United States (62%), with household incomes <$25k (54%). Despite delivery during COVID-19, 63% of dyads were retained at 6 months. The intervention was delivered with high fidelity. All parents in the intervention group (n=24) expressed high levels of satisfaction with the intervention, which produced positive treatment effects for whole and total fruit component HEI-2015 scores (PE=2.14, 95%CI 0.17-1.48; PE= 1.71,95%CI 0.16-1.47, respectively) and negative treatment effects for sodium (PE=-2.09,95%CI -1.35-0.04). Positive treatment effects also resulted for the following food parenting practices: regular timing of meals and snacks (PE=1.08, 95%CI 0.61-2.00), reducing distractions during mealtimes (PE=-0.79,95%CI -1.52- -0.19), using food as a reward (PE=-0.54, 95% CI -1.35- -0.04) and providing a supportive meal environment (PE=0.73, 95% CI 0.18-1.51). Conclusion: Given the continued disparities in diet quality among low-income, and diverse families, continued efforts to improve child diet quality in fully powered intervention trials are needed.

Responsive Feeding Practices to Promote Healthy Diets: A Mixed Method Study among Low-Income Caregivers with Toddlers

“…This work may be used to better the understanding of RF and responsive parenting frameworks among scholars working with low-income families [ 15 ]. Existing interventions to improve RF practices in low-income caregivers with young children have been pilot-tested [ 45 , 46 ] and can support increases in RF behaviors [ 46 , 47 ], with potential to improve diet quality [ 46 ] and decrease the child’s risk of overweight/obesity [ 45 ]. However, given that most observational studies of barriers to RF have been conducted among families with higher incomes [ 48 ], these and other interventions could be tailored to reflect the greater understanding of RF practices among families with low incomes generated in our work.…”