JMIR Publications

ABSTRACT

Background:

Children in the US have poor diet quality increasing their risk for chronic disease burden later in life. Caregivers’ feeding behaviors are a critical factor in shaping lifelong dietary habits. The Strong Families Start at Home / Familias Fuertes Comienzan en Casa (SFSH) was a 6-month, home-based, pilot randomized-controlled feasibility trial that aimed to improve the diet quality of 2-5-year-old children and promote positive parental feeding practices among a predominantly Hispanic/Latine sample. The pilot saw significant improvements in children’s Healthy Eating Index-2015 total and whole fruit scores as well as multiple food parenting practices, and it was received well by participants.

Objective:

Building on the success of the pilot study, this protocol paper describes the modifications, study design, and procedures for a fully powered randomized control trial.

Methods:

Caregiver-child dyads are randomized to a “healthy eating” intervention group or a “reading readiness” attention control group. In the intervention group, a trained community health worker (CHW) conducts monthly home visits or phone calls for six months that focus on age-appropriate nutrition recommendations and food parenting practices. There are three home visits that include tailored nutrition education materials that address their child’s appetitive traits and eating habits, an interactive cooking activity, and review of a family meal video with feedback. CHWs use motivational interviewing and goal setting, which are key components to the program. The control group is similarly structured, with content focusing on reading and language development. Caregivers complete in-person and over the phone baseline and 6-month follow measurements to capture diet quality (primary outcomes: Healthy Eating Index 2015 scores via 2-24-hour dietary recalls and dermal carotenoids) and selected parental feeding practices and availability of healthy foods in the home (secondary outcomes).

Results:

This protocol was approved by the Brown University Institutional Review Board (protocol number 2022003389). As of March 2025, 81 participants were randomized. Of these, 29 completed the study, and eight withdrew. Recruitment will continue until 257 participants have been randomized.

Conclusions:

Findings will determine the efficacy of the intervention to improve child diet quality and parental feeding practices, which will ultimately inform future effectiveness and real-world of home-based food parenting programs. Clinical Trial: ClinicalTrials.gov NCT06099288