A systematic review of the evaluation of interventions to tackle children’s food insecurity

Purpose of Review: To synthesise the research which has sought to evaluate interventions aiming to tackle children’s food insecurity and the contribution of this research to evidencing the effectiveness of such interventions. Recent Findings: The majority of studies in this review were quantitative, non-randomised studies, including cohort studies. Issues with non-complete outcome data, measurement of duration of participation in interventions, and accounting for confounds are common in these evaluation studies. Despite the limitations of the current evidence base, the papers that were reviewed provide evidence for multiple positive outcomes for children participating in attended and subsidy interventions, inter alia, reductions in food insecurity, poor health and obesity. However, current evaluations may overlook key areas of impact of these interventions on the lives and outcomes of participating children. Summary: This review suggests that the current evidence base which evaluates food insecurity interventions for children is both mixed and limited in scope and quality. In particular, the outcomes measured are narrow, and many papers have methodological limitations. With this in mind, a systems-based approach to both implementation and evaluation of food poverty interventions is recommended

Opportunities and challenges arising from holiday clubs tackling children’s hunger in the UK: Pilot club leader perspectives

With the school holidays being recognised as a high-risk time for children to experience food insecurity, there is a growing prevalence of school holiday initiatives that include free food. However, information is lacking into what constitutes effective practice in their delivery, and how this can be evaluated. This paper provides insight from individuals who implemented a pilot of a national project which provided free food for children at UK community summer holiday sports clubs in 2016. Focus groups were conducted with all 15 leaders of the holiday clubs that participated in the pilot to understand: (1) what opportunities are provided by community holiday sports clubs which include free food; (2) what challenges arose as a result of offering free food within a broader community holiday club sports offer. Results indicate that offering free food at such clubs creates multiple opportunities for attending children, including: experiencing social interactions around food; enhancing food experiences and food confidence; and promoting positive behaviour. However, free food provision is associated with challenges including resource constraints and tensions around project aims. Future work should determine whether holiday clubs can positively impact children’s wellbeing and healthy eating

'Why don't you try it again?' A comparison of parent led, home based interventions aimed at increasing children's consumption of a disliked vegetable

Previous research suggests that the use of modelling and non-food rewards may be effective at increasing tasting, and consequential liking and acceptance, of a previously disliked food. Although successful school-based interventions have been developed, there is a lack of research into home-based interventions using these methods. This study aimed to develop and investigate the efficacy of a parent led home-based intervention for increasing children's acceptance of a disliked vegetable. A total of 115 children aged 2-4 years were allocated to one of four intervention groups or to a no-treatment control. The four intervention conditions were: repeated exposure; modelling and repeated exposure; rewards and repeated exposure; or modelling, rewards and repeated exposure. Children in all of the intervention conditions were exposed by a parent to daily offerings of a disliked vegetable for 14 days. Liking and consumption of the vegetable were measured pre and post-intervention. Significant increases in post-intervention consumption were seen in the modelling, rewards and repeated exposure condition and the rewards and repeated exposure condition, compared to the control group. Significant post-intervention differences in liking were also found between the experimental groups. Liking was highest (>60%) in the modelling, rewards and repeated exposure group and the rewards and repeated exposure group, intermediate (>26%) in the modelling and repeated exposure and repeated exposure groups, and lowest in the control group (10%). Parent led interventions based around modelling and offering incentives may present cost efficient ways to increase children's vegetable consumption

Investigating offering of vegetables by caregivers of preschool age children

Background: Research into the methods which caregivers use to encourage children to eat vegetables is limited, with minimal evidence about what the barriers are to offering these foods. Vegetable consumption in children is typically low and so gaining information on these factors is vital in order to develop further caregiver-centred interventions to increase children’s vegetable consumption. This study aimed to investigate the methods caregivers use to offer vegetables to preschool aged children, as well as the factors which influence whether and how caregivers present vegetables to their children. Method: Seventeen caregivers with a preschool aged child participated in focus groups to assess these questions. Results: Thematic analysis indicated that caregivers use a range of methods to offer their children vegetables, with these methods falling into three broad categories: behavioural/active methods, passive methods, and food manipulations. Influences on caregiver offering which emerged from the focus groups formed four categories: information, cost, parent factors, and child factors. Conclusions: Together with large scale quantitative data, this information can be used to shape future interventions aiming to increase children’s vegetable intake as well as to tailor advice given to caregivers striving to achieve a healthful diet for their children

If at first you don’t succeed: assessing influences associated with mothers’ reoffering of vegetables to preschool age children

Repeatedly offering vegetables has been shown to be one of the most effective methods for increasing acceptance and subsequent intake in young children. In order to increase successful offerings of vegetables and resultant consumption amongst young children, it is necessary to consider the influences on maternal reoffering of vegetables. This study aimed to investigate the relationships between mothers' tendency to reoffer vegetables and a range of demographic factors and psychological variables. A cross-sectional design was used, where mothers completed questionnaires assessing how often they reoffer rejected vegetables, concerns for economic factors, and a range of possible child and maternal influences. Mothers of preschool children were recruited from toddler groups across Leicestershire, UK, as well as online. Spearman's correlations were run to look for associations between demographic and psychological factors with maternal reoffering of vegetables. Significantly associated factors were then entered into a stepwise regression to predict maternal reoffering of vegetables. Mothers were significantly less likely to reoffer rejected vegetables if they were concerned about time, money, and waste, were influenced by their child's mood, or were concerned about their child having tantrums. Moreover, mothers who consumed more vegetables themselves reoffered vegetables more frequently. Regression analyses revealed that mothers' concern about food waste and tantrums, as well as maternal vegetable consumption, all significantly predicted mothers' reoffering of vegetables. With these findings in mind, mothers should be educated and supported with how to tackle and minimise children's tantrums during feeding, as well as being made aware of effective methods for avoiding food waste. Moreover, given that mothers' own vegetable consumption is associated with lower reoffering of vegetables to their child, interventions which seek to increase familial vegetable consumption should be pursued

Mothers’ perceptions of self-efficacy and satisfaction with parenting are related to their use of controlling and positive food parenting practices

Perceptions of parenting competence are comprised of self-efficacy and satisfaction with parenting. Parenting competence is linked to differential outcomes across numerous parenting domains. To date, few studies have explored the relationships between maternal self-efficacy and food parenting practices, deploying different measures and age ranges, and yielding conflicting findings. Therefore, the current study sought to explore relationships between the two dimensions of perceived parenting competence and the use of controlling and positive food parenting practices. UK mothers (N=269) of 18- to 59-month-old children completed measures of both dimensions of perceived parenting competence (i.e. parenting self-efficacy and satisfaction), controlling (maladaptive) and positive (health promoting) food parenting practices. Correlational analyses identified relationships between perceptions of competence and use of food parenting practices. Self-efficacy and satisfaction with parenting were positively associated with the use of most positive food parenting practices. Greater parenting satisfaction, but not parenting efficacy, was associated with lower use of some of the potentially detrimental controlling food parenting practices. Neither parenting self-efficacy nor satisfaction with parenting was related to mothers’ reported use of pressure to eat. In conclusion, supporting and promoting greater maternal self-efficacy and satisfaction with parenting may be a useful target for public health interventions and for professionals working with families with the aim of promoting optimal parenting to support children’s development of healthy eating habits. Future research should seek to further elucidate the current findings with a longitudinal design.</div

Staff perspectives on the feeding practices used in holiday clubs to promote healthy eating in disadvantaged communities

An increasing number of holiday clubs provide free meals to alleviate children's hunger during the school holidays. Holiday clubs are well-placed to promote healthy eating among children from disadvantaged communities who may be at risk of experiencing food insecurity, but currently little is known about the feeding practices used by staff and whether these are conducive to maximising opportunities to promote healthy eating. Unlike previous research which has predominantly studied feeding practices in parent-child dyads and childcare settings, this qualitative study explored staff perspectives on the feeding practices they use to promote healthy eating within nine UK holiday clubs working with children from disadvantaged communities. Nine individual interviews and four focus groups were completed with 27 holiday club staff during the 2019 summer holidays. Thematic analysis revealed seven feeding practice themes, including teaching about nutrition; encouraging balance and variety; modelling; involvement; non-food rewards; restriction; and reoffering foods. The results revealed that some staff implement various positive feeding practices which align with the existing evidence-base of feeding practices in other contexts, which is a promising finding given the current lack of information and guidance from which to draw on. However, staff also sometimes reported using maladaptive feeding practices, including overt restriction and punishment. These results emphasise the need for guidance on effective ways to implement feeding practices with children in holiday clubs. Indeed, staff demonstrated their receptivity to engaging with training resources to maximise their opportunities to promote healthy eating behaviours among children

Unpacking the relationships between positive feeding practices and children’s eating behaviours: The moderating role of child temperament

Evidence suggests that children’s eating behaviours are influenced by the feeding practices which parents employ. Furthermore, parents may alter the feeding practices they use according to their child’s temperament. However, there is a paucity of literature on how children’s temperament moderates the relationship between parents’ use of feeding practices and children’s eating behaviours. One hundred and eleven mothers of 2 to 4-year-old children completed questionnaire measures of their feeding practices along with their child’s eating behaviours and temperament. Two-tailed Spearman’s correlations revealed that mothers’ use of a range of positive (health promoting) feeding practices was associated with greater enjoyment of food and lower food fussiness among children. Moderation analyses found that relationships between mothers involving their children in food choice and preparation and children’s eating behaviours were moderated by children’s temperament. Involvement in food choice and preparation was no longer associated with higher enjoyment of food and lower fussiness for children who were either highly emotional or low in sociability. These findings suggest that while many previously identified positive feeding practices may be associated with more healthy eating for all children, some may be less helpful or less achievable with children who have particular temperamental traits. Future research should seek to develop interventions to promote healthy eating which are tailored towards children’s individual characteristics. <br

Adaptations to holiday club food provision to alleviate food insecurity during the Covid-19 pandemic

Holiday clubs play a pivotal role in providing food and vital enrichment opportunities to alleviate food insecurity among children during the school holidays (holiday hunger). The need for these opportunities increased substantially for families throughout 2020, as food insecurity quadrupled in the UK during the Covid-19 pandemic. In this qualitative study, holiday club staff from England and Wales reflected on the adaptations they implemented in order to maintain food supplies and food-related enrichment activities for families during the first UK national Covid-19 lockdown and subsequently throughout the summer of 2020. Staff also reflected on the opportunities and challenges related to implementing these adaptations during this period. Twenty-five holiday club staff engaged in video-based interviews during August and September 2020. The findings revealed a range of innovative changes to holiday club food provision, and the challenges and opportunities faced varied across holiday clubs. Challenges during the pandemic in some clubs included staff shortages (typically due to furloughing and/or increased working demands) and difficulties sourcing adequate funding. However, staff identified that the opportunities for holiday clubs included enhanced partnership working during the pandemic, increased engagement with digital technology to communicate with families and deliver their online cooking sessions, and their ability to continue providing food and much needed creative opportunities for children unable to attend school and/or the holiday club. The ability of clubs to adapt their models of working when faced with adversity was essential in protecting their organisational resilience and delivering their vital services. The findings emphasise the important role that holiday clubs play in their communities and highlight their willingness to adapt and expand their role in response to the pandemic to continue to tackle food insecurity and provide vital food and food-related enrichment opportunities to families. The findings also identify lessons that can be applied to practise in the future

Role-model, reoffer, reward: A thematic analysis and TDF mapping of influences on families’ use of evidence-based vegetable feeding practices

Children's vegetable intake is low, despite benefits for immediate and long-term health. Repeatedly reoffering vegetables, role-modelling consumption, and offering non-food rewards effectively increase children's vegetable acceptance and intake. However, a number of barriers prevent families from reoffering previously-rejected vegetables. This study used the Theoretical Domains Framework (TDF) and the COM-B model of behaviour to explore barriers and enablers to reoffering, role-modelling and offering non-food rewards among parents of 2-4-year-old children. Twenty-five semi-structured interviews were conducted, from which eleven core inductive themes were generated: ‘Child factors’, ‘Eating beliefs’, ‘Effectiveness beliefs’, ‘Past experience’, ‘Current family behaviours’, ‘Harms’, ‘Knowledge’, ‘Need for change’, ‘Parent effort’, ‘Parent values’ and ‘Practical issues’. The codes underpinning these themes were inductively mapped to 11 of the 14 TDF domains, and five of the six COM-B components. Previously-reported influences on families' vegetable feeding practices were confirmed, including concerns about child rejection of foods/meals, cost of vegetables, and food waste. Novel findings included some parents' perceptions that these practices are pressurising, and that certain beliefs/knowledge about children's eating behaviour can provide a “protective mindset” that supports families' perseverance with reoffering over time. Future interventions should be tailored to better reflect the diversity of needs and previous experiences of feeding that families have, with some families likely to find that troubleshooting and further signposting is appropriate for their needs while others might benefit from more persuasive and educational approaches. The mapping of codes to the TDF and COM-B will facilitate the identification of appropriate intervention functions and behaviour change techniques when designing new interventions to support families with increasing their children's vegetable intake.</p