Cobenefits for Participants of a Nurse-Led Telephone-Based Early Childhood Obesity Prevention Intervention: A Multimethod Qualitative Study

Abstract

Background

While preventive health behaviour change interventions target specific behaviours and health-related outcomes, there can be further benefits, that is, cobenefits, for participants. Healthy Beginnings is an established behavioural intervention targeting mothers of young children to promote optimal child nutrition, physical activity and screen time behaviours and to prevent obesity in early childhood.

Objective

To (1) identify the cobenefits among mothers and children participating in the one-to-one telephone support arm of the intervention and (2) explore the factors contributing to these identified cobenefits, both from the perspective of the intervention providers, the Child and Family Health Nurses.

Methods

The telephone-based Healthy Beginnings intervention was conducted as a randomised controlled trial in NSW, Australia from 2017 to 2019. The intervention, delivered by Child and Family Health Nurses, included nine staged intervention telephone calls from pregnancy to child age 24 months. The nurses' notes from all telephone calls were collated and analysed using content analysis to identify cobenefits. A focus group was conducted with four intervention nurses and analysed using thematic analysis to explore their experiences of delivering the calls and their perceptions of factors that enabled intervention cobenefits for participants.

Results

From the content analysis of the call notes, we derived categories for the types of issues, beyond the target behaviours, for which participants received support. This support primarily pertained to psychosocial and situational factors, for example, relationship challenges. From the thematic analysis of the focus group, we identified two main themes relating to factors that enabled intervention cobenefits for participants: (a) delivery features, relating to the way the intervention was structured and (b) nurse interactions, relating to the way nurses interacted with participants and approached care holistically. The nurses, via the nurse-initiated staged telephone calls, connected with participants, built rapport, offered tailored child–parent-centred support and addressed social determinants of health.

Discussion

Scheduled nurse telephone support was crucial for delivering tailored intervention messages for targeted behaviour changes and achieving further cobenefits for participants. Nurse-led early childhood interventions for optimal nutrition, sleep and movement behaviours have the potential to support families' broader social contextual factors for greater impacts. Behavioural intervention research must capture and consider a broader concept of participant benefits.