MEDIATING AND MODERATING EFFECTS OF A PARENT-BASED ELECTRONIC HEALTH (EHEALTH) INTERVENTION ON PRE-SCHOOLERS’ PHYSICAL ACTIVITY, DIETARY BEHAVIORS, AND SLEEP

Background:
Preschool children are characterized by physical inactivity, poor diet, and disturbed sleep quality, negatively impacting long-term health. Parental involvement is crucial in reversing unhealthy trend, and eHealth interventions can help engage parents by overcoming barriers like time and travel costs. Investigating the mechanisms by which parent- base eHealth interventions work and who they work for is particularly important.

Objectives:
To evaluate the mediators and moderators of a parent-based eHealth intervention on preschoolers’ physical activity, diet, and sleep at 12-week posttest.

Method:
The mediation and moderation analyses utilized dataset from a 24-week electronic health intervention study of Chinese preschoolers aged from 3 to 6 years (N=237 parent-child dyads), which was designed as a two-arm single- blinded randomized controlled trial to improve preschoolers’ physical activity, diet, and sleep. Preschoolers’ PA and sleep duration and quality were objectively examined using wGT3X ActiGraph accelerometer. Data related to parents and preschoolers’ eating behaviors and sleep problems were subjectively assessed using parent-reported questionnaires. The generalized estimating equation analysed the changes in preschoolers’ physical activity, diet, and sleep from base- line to 12 weeks between the two groups. Significant changes in the intervention group were assessed using PROCESS macro version 4.2 to determine potential mediators and moderators on these outcomes.

Results:
After 12 weeks of intervention, significant improvements were observed in children’s diet, sleep, and screen time, which were associated with an increase in corresponding parenting self-efficacy. Enhancements in childrens diet and sleep were mediated by authoritative parenting style, while improvements in diet were also influenced by the feeding practice of control overeating. The exploratory analysis of moderators indicated that the effectiveness of intervention on preschoolers’ physical activity varied based on the children’s age and the parents’ BMI.

Conclusion:
It is suggested that future parent-based eHealth intervention research could focus on parenting self-efficacy, parenting styles, and parenting feeding practices to enhance the effectiveness of interventions targeting preschoolers’ lifestyle behaviors.