Healthy Adventures Book pack: evaluating a novel tool for supporting parents in the development of healthy lifestyle behaviours in the preschool years

Abstract

Parents are pivotal in shaping healthy eating, physical activity and screentime behaviours in the early years⁽¹⁾. Early Childhood Education and Care (ECEC) services provide an ideal setting for parent communication initiatives to promote positive lifestyle behaviours in young children⁽²⁾. This study aimed to determine the feasibility, acceptability and potential efficacy of the Healthy Adventures Book (HAB) pack in increasing parent and carer capacity to support positive dietary intake, physical activity and screen use behaviours of their 3–5-year-old children. ECEC services in western Sydney (n = 136) and families with 3–5-year-old children (n = 258) participated in the study. Families were provided with a HAB pack to take home, consisting of a scrapbook containing health information, a vegetable-shaped toy and story book. Families were encouraged to read the information and story book, and to support their child to complete the activity in the book. A quasi-experimental mixed-methods design was used. Parents completed pre- and post-intervention questionnaires that included questions on demographics, and readiness and confidence to support behaviour change. Process data were collected from parents and ECEC directors. Semi-structured interviews were conducted with parents post-intervention. Changes in parent readiness and confidence were analysed using Mann Whitney U tests. Thematic analysis was conducted on parent interview data. There was a significant improvement in parent confidence to support physical activity from pre- to post-intervention (p < 0.01). No significant changes were found for other behaviours. Process evaluation showed high acceptability, with 93% of parents reporting children were excited to use the pack, 91% finding it easy to complete, and 86% finding it useful for learning about healthy behaviours. All ECEC directors agreed the pack was well-received, easy to implement, appealing to families, and facilitated conversations about health behaviours. Qualitative analysis revealed six key themes: whole family involvement, easy access to relevant health information, reinforcement of key health behaviours, vegetable intake, screen time, and continuation of learning. Parents reported the pack encouraged family engagement, provided useful strategies, and reinforced health messages. However, parents expressed that they would like ongoing support to maintain behaviour changes. Study limitations included a small sample size, no control group, and potential selection bias of already health-conscious families. In conclusion, the HAB pack was feasible and acceptable to both ECECs and families, demonstrating potential as a health promotion tool, particularly for encouraging physical activity. Further, it has the capacity to improve communication between the ECEC setting and home environment to ensure consistency of health messaging to children. More research is needed to determine efficacy and explore strategies for sustained behaviour change.