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      Key Lessons and Impact of the Growing Healthy mHealth Program on Milk Feeding, Timing of Introduction of Solids, and Infant Growth: Quasi-Experimental Study

      research-article
      , BSc (Nutrition), MSc (Nutrition & Diet), PhD 1 , 2 , , , BN, MPH, PhD 2 , 3 , 4 , , MPH 2 , 5 , , BSc, BHSc, PhD 2 , 5 , , BSc (Hons), PhD 1 , 2 , , BHSc (Hons) 1 , 2 , , BASc, PhD 6 , , BPthy, BA, MSc, PhD 2 , 7 , , RN, PhD 2 , 5 , , BSc, MPH, PhD 1 , 2
      (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications
      mHealth, obesity prevention, infancy, parents, breastfeeding, complementary feeding, formula feeding

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          Abstract

          Background

          The first year of life is an important window to initiate healthy infant feeding practices to promote healthy growth. Interventions delivered by mobile phone (mHealth) provide a novel approach for reaching parents; however, little is known about the effectiveness of mHealth for child obesity prevention.

          Objective

          The objective of this study was to determine the feasibility and effectiveness of an mHealth obesity prevention intervention in terms of reach, acceptability, and impact on key infant feeding outcomes.

          Methods

          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 and website containing information on infant feeding, sleep and settling, and general support for parents with infants aged 0 to 9 months. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed Web-based surveys when infants were less than 3 months old (T1), at 6 months of age (T2), and 9 months of age (T3). Survival analysis was used to examine the duration of any breastfeeding and formula introduction, and cox proportional hazard regression was performed to examine the hazard ratio for ceasing breast feeding between the two groups. Multivariate logistic regression with adjustment for a range of child and parental factors was used to compare the exclusive breastfeeding, formula feeding behaviors, and timing of solid introduction between the 2 groups. Mixed effect polynomial regression models were performed to examine the group differences in growth trajectory from birth to T3.

          Results

          A total of 909 parents initiated the enrollment process, and a final sample of 645 parents (Growing healthy=301, Baby’s First Food=344) met the eligibility criteria. Most mothers were Australian born and just under half had completed a university education. Retention of participants was high (80.3%, 518/645) in both groups. Most parents (226/260, 86.9%) downloaded and used the app; however, usage declined over time. There was a high level of satisfaction with the program, with 86.1% (143/166) reporting that they trusted the information in the app and 84.6% (170/201) claiming that they would recommend it to a friend. However, some technical problems were encountered with just over a quarter of parents reporting that the app failed to work at times. There were no significant differences between groups in any of the target behaviors. Growth trajectories also did not differ between the 2 groups.

          Conclusions

          An mHealth intervention using a smartphone app to promote healthy infant feeding behaviors is a feasible and acceptable mode for delivering obesity prevention intervention to parents; however, app usage declined over time. Learnings from this study will be used to further enhance the program so as to improve its potential for changing infant feeding behaviors.

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          Most cited references37

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          Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis.

          To assess the predictive ability of infant weight gain on subsequent obesity we performed a meta-analysis of individual-level data on 47,661 participants from 10 cohort studies from the UK, France, Finland, Sweden, the US and Seychelles. For each individual, weight SD scores at birth and age 1 year were calculated using the same external reference (British 1990). Childhood obesity was defined by International Obesity Task Force criteria. Each +1 unit increase in weight SD scores between 0 and 1 year conferred a twofold higher risk of childhood obesity (odds ratio = 1.97 [95% confidence interval (CI) 1.83, 2.12]), and a 23% higher risk of adult obesity (odds ratio = 1.23 [1.16, 1.30]), adjusted for sex, age and birthweight. There was little heterogeneity between studies. A risk score for childhood obesity comprising weight gain 0-1 year, mother's body mass index, birthweight and sex was generated in a random 50% selection of individuals from general population cohorts with available information (n = 8236); this score showed moderate predictive ability in the remaining 50% sample (area under receiving operating curve = 77% [95% CI 74, 80%]). A separate risk score for childhood overweight showed similar predictive ability (area under receiving operating curve = 76% [73, 79%]). In conclusion, infant weight gain showed a consistent positive association with subsequent obesity. A risk score combining birthweight and infant weight gain (or simply infant weight), together with mother's body mass index and sex may allow early stratification of infants at risk of childhood obesity. © 2011 Blackwell Publishing Ltd.
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            A parent-focused intervention to reduce infant obesity risk behaviors: a randomized trial.

            To assess the effectiveness of a parent-focused intervention on infants' obesity-risk behaviors and BMI. This cluster randomized controlled trial recruited 542 parents and their infants (mean age 3.8 months at baseline) from 62 first-time parent groups. Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge, skills, and social support around infant feeding, diet, physical activity, and television viewing. Control group parents received 6 newsletters on nonobesity-focused themes; all parents received usual care from child health nurses. The primary outcomes of interest were child diet (3 × 24-hour diet recalls), child physical activity (accelerometry), and child TV viewing (parent report). Secondary outcomes included BMI z-scores (measured). Data were collected when children were 4, 9, and 20 months of age. Unadjusted analyses showed that, compared with controls, intervention group children consumed fewer grams of noncore drinks (mean difference = -4.45; 95% confidence interval [CI]: -7.92 to -0.99; P = .01) and were less likely to consume any noncore drinks (odds ratio = 0.48; 95% CI: 0.24 to 0.95; P = .034) midintervention (mean age 9 months). At intervention conclusion (mean age 19.8 months), intervention group children consumed fewer grams of sweet snacks (mean difference = -3.69; 95% CI: -6.41 to -0.96; P = .008) and viewed fewer daily minutes of television (mean difference = -15.97: 95% CI: -25.97 to -5.96; P = .002). There was little statistical evidence of differences in fruit, vegetable, savory snack, or water consumption or in BMI z-scores or physical activity. This intervention resulted in reductions in sweet snack consumption and television viewing in 20-month-old children.
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              The use and value of digital media for information about pregnancy and early motherhood: a focus group study

              Background Many women in countries in the global North access digital media information sources during pregnancy and the early years of motherhood. These include websites, blogs, online discussion forums, apps and social media platforms. Little previous research has sought to investigate in detail how women use the diverse range of digital media now available to them and what types of information they value. A qualitative study using focus groups was conducted to address these issues. Methods Four focus groups were held in Sydney, Australia, including a total of 36 women who were either pregnant or had given birth in the previous three years. The participants were asked to talk about the types of digital media they used for pregnancy and parenting purposes, why they used them and in what ways they found them useful or helpful (or not). Group discussions were transcribed and thematically analysed, identifying the dominant information characteristics identified by women as valuable and useful. Results Nine characteristics emerged from the focus group discussions as most important to women: information that was: 1) immediate; 2) regular; 3) detailed; 4) entertaining; 5) customised; 6) practical; 7) professional; 8) reassuring; and 9) unbiased. These characteristics were valued for different purposes and needs. Digital media provided women with details when they most needed them or at times when they had opportunities to access them. The study showed that women value apps or digital platforms that are multi-functional. The findings revealed the importance of using digital information for establishing and maintaining social connections and intimate relationships with other mothers. However, participants also highly valued expert advice and expressed the desire for greater and more ready access to information and support offered by healthcare professionals. Conclusions Pregnant women and those with young children place a high value on the information and support they receive from and sharing using online sources and apps. They are accustomed to ready and immediate access to information using digital technologies and want better access to that offered by professionals. Recognising and finding ways to meet these needs should be included in planning healthcare provision and support for this group. Further research with women from socioeconomically disadvantaged backgrounds and non-urban locations is required to identify whether they have different information needs and values from the women who were included in the study reported here.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                April 2018
                19 April 2018
                : 6
                : 4
                : e78
                Affiliations
                [1] 1 Institute for Physical Activity and Nutrition School of Exercise and Nutrition Sciences Deakin University Geelong Australia
                [2] 2 Centre for Obesity Management and Prevention Research Excellence in Primary Health Care Sydney Australia
                [3] 3 School of Nursing University of Sydney Sydney Australia
                [4] 4 Sydney Local Health District Sydney Australia
                [5] 5 Faculty of Health University of Technology Sydney Sydney Australia
                [6] 6 La Trobe Analytics Lab La Trobe University Melbourne Australia
                [7] 7 Faculty of Pharmacy University of Sydney Sydney Australia
                Author notes
                Corresponding Author: Rachel A Laws r.laws@ 123456deakin.edu.au
                Author information
                http://orcid.org/0000-0003-4328-1116
                http://orcid.org/0000-0001-9879-4969
                http://orcid.org/0000-0002-7228-8993
                http://orcid.org/0000-0002-0848-2724
                http://orcid.org/0000-0002-4151-3502
                http://orcid.org/0000-0002-4618-1068
                http://orcid.org/0000-0003-4688-7674
                http://orcid.org/0000-0002-7876-6722
                http://orcid.org/0000-0002-9239-7126
                http://orcid.org/0000-0002-4499-3396
                Article
                v6i4e78
                10.2196/mhealth.9040
                5934537
                29674313
                4bc0320d-c1fb-4d80-b2be-6398725b1273
                ©Rachel A Laws, Elizabeth A Denney-Wilson, Sarah Taki, Catherine G Russell, Miaobing Zheng, Eloise-Kate Litterbach, Kok-Leong Ong, Sharyn J Lymer, Rosalind Elliott, Karen J Campbell. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 19.04.2018.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/, as well as this copyright and license information must be included.

                History
                : 26 September 2017
                : 26 October 2017
                : 4 December 2017
                : 7 December 2017
                Categories
                Original Paper
                Original Paper

                mhealth,obesity prevention,infancy,parents,breastfeeding,complementary feeding,formula feeding

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