Effectiveness of a parent-based electronic health (eHealth) intervention on physical activity, dietary behaviors, and sleep in preschoolers: A randomized controlled trial (Preprint)

Background The prevalence of physical inactivity, unhealthy diet, and sleep disturbance among preschoolers is increasing dramatically. Parents play a crucial role in fostering their children’s physical activity (PA), dietary behaviors, and sleep habits. Face-to-face interventions have barriers such as time commitment, making eHealth options appealing. However, current parent-based eHealth interventions have limitations in design (eg, focus on a single outcome, imbalanced content, and sequence), and their results cannot be generalized to other regions. Objective This study aims to assess the effectiveness of parent-based eHealth interventions targeting PA, dietary behaviors, and sleep in preschoolers in China. Methods This single-blinded randomized controlled trial with 2 parallel arms comprised a 12-week intervention followed by a 12-week follow-up, conducted from September 2023 to June 2024 in China. The intervention, grounded in social cognitive theory, included 12 interactive modules on PA (n=4), dietary behaviors (n=4), and sleep (n=4), each delivered weekly via social media. Each module consisted of videos, evidence-based information, parent interaction, goal setting, and feedback. The control group received a weekly electronic pamphlet via WeChat without interactive components. Preschoolers’ PA, sleep duration, and sleep quality were assessed using the wGT3X-BT ActiGraph, while dietary behaviors, sleep problems, and screen time were reported by parents through paper-based questionnaires. Generalized estimating equations, adjusting for demographic covariates, were used to examine the effects of the parent-based eHealth intervention on preschoolers’ outcomes. Results A total of 237 eligible parent-child dyads were randomly assigned to the intervention group (n=120, mean age 4.51 years, SD 0.72 years; n=67, 55.8%, boys) or the control group (n=117, mean age 4.31 years, SD 0.70 years; n=69, 59%, boys). At baseline, 237 parents completed questionnaires, and 196 preschoolers provided valid ActiGraph data. At posttest, 181 parents completed questionnaires, and 166 preschoolers provided valid ActiGraph data (intervention, n=90; control, n=91). At follow-up, 181 parents again completed questionnaires, and 170 preschoolers provided valid ActiGraph data (intervention, n=90; control, n=91). Educating parents about healthy lifestyles through social media had a positive impact on preschoolers’ light PA (vs control: adjusted mean difference –151.61 minutes/7 days, 95% CI –418.18 to –96.67, P=.002, Cohen d=0.28), vigorous PA (vs control: adjusted mean difference 138.47 minutes/7 days, 95% CI 117.61-183.10, P=.03, Cohen d=0.23), sleep latency (vs control: adjusted mean difference –21.04 minutes/day, 95% CI –16.07 to –6.00, P=.005, Cohen d=0.78), sleep efficiency (vs control: adjusted mean difference 4.61%, 95% CI 4.29-9.72, P<.001, Cohen d=0.34), and screen time (vs control: on weekdays, adjusted mean difference –16.42 minutes/weekday, 95% CI –30.83 to –2.01, P=.01, Cohen d=0.25; on weekends, adjusted mean difference –73.88 minutes/weekend day, 95% CI –98.48 to –49.28, P<.001, Cohen d=.46). Conclusions The findings may help address unhealthy lifestyles commonly observed in young children. Further efforts are needed to leverage cutting-edge technological advancements to support families in creating healthy living environments for children across broader regions. Trial Registration ClinicalTrials.gov NCT06025019; https://clinicaltrials.gov/ct2/show/NCT06025019 International Registered Report Identifier (IRRID) RR2-10.2196/58344