The goal of this study is to test whether a 4-week online program can help parents better support health behaviors of their preschool children (aged 3-6 years). Preschool children often rely on their parents to build health behaviors, such as being physically active, limiting screen time, drinking fewer sugar-sweetened beverages, and washing their hands regularly. The main questions this study aims to answer are: Does the program improve parents' motivation, planning, and habits related to supporting their children's health behaviors? Do parents who receive the program provide more support for their children? Do preschool children in the program show improvements in health behaviors? Can improvements explained by changes in parents' psychological factors? Researchers will compare parents who receive the program immediately to parents in a waitlist control group. Participants will: Complete online questionnaires before the program, after the program, and one month later (Intervention group only). Complete eight online sessions over four weeks using a mobile program.
Background Early childhood is a critical developmental period for establishing long-term health habits. Preschool children have limited capacity for self-regulation and depend heavily on parental guidance to adopt and maintain health behaviors. Therefore, interventions targeting parents may be particularly effective in promoting child health behaviors during this stage. Previous research has primarily focused on motivational and self-regulatory determinants of parental support behaviors. However, intention-based models often fail to account for automatic processes, such as habit formation, which may contribute to the intention-behavior gap. To address this limitation, the present study integrates motivational, volitional, and automatic processes into a integrated social cognitive framework to better explain parental decision-making in supporting children's health behaviors. Study Objectives and Hypotheses The primary objective is to evaluate the effectiveness of a 4-week theory-based intervention targeting parental psychological determinants and behavioral outcomes. It is hypothesized that: 1. Parents in the intervention group will demonstrate greater improvements in motivational variables (e.g., attitudes, perceived norms, self-efficacy), volitional variables (e.g., action planning, coping planning, action control), and habit compared to the waitlist control group. 2. Parents in the intervention group will report greater increases in supporting behaviors, and their children will show greater improvements in health behaviors compared to the waitlist control group. 3. Changes in motivational, volitional, and automatic variables will mediate the relationship between group assignment and behavioral outcomes. Study Design This study employs a longitudinal two-arm randomized controlled trial design. Participants are randomly assigned to either an intervention group or a waitlist control group. Assessments are conducted at baseline (T1), post-intervention (T2), and one-month follow-up (T3). The intervention group also provides feedback regarding program experience. The intervention targets multiple child health behaviors, including physical activity, screen time, sugar-sweetened beverage consumption, and handwashing. Intervention Overview The intervention consists of eight sessions delivered over four weeks via a mobile program. Each session lasts approximately 20-30 minutes and includes multimedia materials and interactive exercises. Weeks 1-2 focus on motivational processes (attitudes, perceived norms, self-efficacy, and social support). Week 3 focuses on volitional processes (action planning, coping planning, and action control). Week 4 focuses on habit formation, cue-based strategies, and multiple health behaviors. Behavior change techniques include goal setting, action planning, self-monitoring, prompts/cues, modeling, Information about health consequences, social support and reward. Statistical Analysis Plan Intervention effects will be examined using 2 (group) × 3 (time) repeated-measures analyses of variance. Significant interaction effects will be followed by simple effects analyses. To examine mediation, social cognitive variables will be tested as mediators. Group assignment (intervention = 1, control = 0) will serve as the independent variable, and parental support and child health behaviors will serve as dependent variables. Separate mediation analyses will be conducted for each mediator.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
80
The intervention consists of eight sessions delivered over four weeks via a mobile program. Each session lasts approximately 20-30 minutes and includes multimedia materials and interactive exercises.
Department of Psychology, Sun Yat-Sen University
Guangzhou, Guangdong, China
RECRUITINGMean score on the Parental Support for Child Physical Activity Scale
Parental support for child physical activity will be assessed using a 3-item parent-reported questionnaire. Each item is rated on a 5-point Likert scale. The total score is calculated as the mean of the three items, with higher scores indicating greater parental support for child physical activity. Items assess encouragement of outdoor play, co-participation in physical activity, and providing transportation for physical activity.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Mean score on the Parental Support for Child Screen Time Reduction Scale
Assessed using a 2-item parent-reported questionnaire rated on a 7-point Likert scale. The outcome is calculated as the mean score across items, with higher scores indicating greater parental support for reducing child screen time. Items assess encouraging children to stop screen use and reminding children to follow screen-time rules.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Mean score on the Parental Support for Child Handwashing Scale
Measured using a 3-item parent-reported questionnaire rated on a 7-point Likert scale. The outcome is the mean item score, with higher scores indicating greater parental support for child handwashing. Items assess teaching proper handwashing methods, reminders before meals and after toilet use, and parental modeling of handwashing behavior.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Mean score on the Parental Support for Sugar-Sweetened Beverage Reduction Scale
Measured using a 4-item parent-reported questionnaire rated on a 7-point Likert scale. The outcome is calculated as the mean score across items, with higher scores indicating greater parental support for reducing children's sugar-sweetened beverage intake. Items assess limiting beverage intake, encouraging healthier alternatives, discussing health consequences, and parental role modeling.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Average daily outdoor physical activity time of the child (hours/day)
Parent-reported child outdoor physical activity time assessed separately for weekdays and weekends over the past two weeks. Average daily physical activity is calculated as: (5 × weekday activity hours + 2 × weekend activity hours) / 7. Higher values indicate greater physical activity.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Average daily child screen time (hours/day)
Parent-reported average daily time the child spends using screens (television, computers, tablets, mobile phones, or video games).
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Mean score on the Child Handwashing Behavior Scale
Measured using a 3-item parent-reported questionnaire rated on a 7-point Likert scale. The mean score across items is calculated, with higher scores indicating more frequent handwashing behavior. Items assess handwashing after returning home, before meals, and adherence to recommended handwashing procedures.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Frequency of child sugar-sweetened beverage consumption
Parent-reported frequency of child consumption of sugar-sweetened beverages (excluding 100% fruit juice), rated on a 6-point scale ranging from 1 (none) to 6 (three or more times per week). Higher scores indicate greater consumption frequency.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Parental Attitude Toward Supporting Child Health Behaviors
Parental attitude will be assessed using a self-report questionnaire consisting of 4 items evaluating parents' positive or negative evaluations of supporting their child's health behaviors. Items are rated on a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree).
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Subjective Norm Toward Supporting Child Health Behaviors
Subjective norm will be measured using a self-report scale assessing perceived social pressure from important others to support children's health behaviors. Items are rated on a 7-point Likert scale (1-7)
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Parental Self-Efficacy for Supporting Child Health Behaviors
Self-efficacy will be assessed using a 2-item self-report questionnaire measuring parents' confidence in supporting their child's healthy behaviors under various situations.Items are rated on a 7-point Likert scale
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Perceived Social Norm Supporting Child Health Behaviors
Perceived social norm reflects parents' perceptions of common practices among peers regarding supporting children's health behaviors.Items are rated on a 7-point Likert scale and averaged.Higher scores indicate stronger perceived normative support
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Social Support for Parental Support Behaviors
Social support will be measured using a self-report scale assessing emotional and practical support received from family members or others. Items are rated on a 7-point Likert scale.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Behavioral Intention to Support Child Health Behaviors
Behavioral intention will be assessed using items measuring parents' intention to engage in supportive health behavior practices (each of the four health behavior includes 1 item). Items are rated on a 7-point Likert scale.
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Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Action Planning for Supporting Child Health Behaviors
Action planning assesses the extent to which parents formulate specific plans regarding when, where, and how to support child health behaviors. Items are rated on a 7-point Likert scale and averaged.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Coping Planning for Supporting Child Health Behaviors
Coping planning evaluates parents' preparation for managing barriers to supporting child health behaviors. Items are rated on a 7-point Likert scale.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Action Control for Supporting Child Health Behaviors
Action control reflects self-monitoring, awareness of behavioral standards, and regulatory effort during behavior implementation. Items are rated on a 7-point Likert scale.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up
Behavioral Automaticity of Parental Support
Automaticity will be measured using a self-report habit scale assessing the extent to which parental support behaviors are performed automatically with little conscious effort.
Time frame: Baseline, post-intervention (4 weeks), and 1-month follow-up