Women's experiences of social support during pregnancy: a qualitative systematic review.

BACKGROUND: Social support during pregnancy can alleviate emotional and physical pressures, improving the well-being of mother and child. Understanding women's lived experiences and perceptions of social support during pregnancy is imperative to better support women. This systematic review explores and synthesises the qualitative research on women's experiences of social support during pregnancy. METHODS: Databases PubMed, CINAHL, MEDLINE, APA PsycInfo and Scopus were searched with no year limit. Eligible studies included pregnant women or women who were up to one year postpartum and were assessed on their experiences of social support during pregnancy. The data were synthesised using the thematic synthesis approach. RESULTS: Fourteen studies were included with data from 571 participating women across ten countries; two studies used focus groups, and 12 used interviews to collect their data. Four main themes were developed ('a variety of emotional support', 'tangible and intangible instrumental support', 'traditional rituals and spiritual support', and 'the all-encompassing natal home'), and six sub-themes ('female network connections', 'care and affection from the husband', 'dissatisfaction with relationships', 'financial support from the husband and family', 'practical support from family and friends', 'health information support'). CONCLUSIONS: This systematic review sheds light on women's experiences of social support during pregnancy. The results indicate a broad variety of emotional support experienced and valued by pregnant women from different sources. Additionally, women expressed satisfaction and dissatisfaction with tangible and intangible support forms. It was also highlighted that spirituality played an essential role in reducing stress and offering coping mechanisms for some, whereas spirituality increased stress levels for others.

Psychological variables and lifestyle in children with type1 diabetes and their parents: A systematic review.

Diabetes may impact physical and psychosocial well-being; the diabetes incidence has seen a drastic increase globally. There is also a rise in poor mental health and well-being in children with and without chronic illness; problems are being seen at a younger age. The objective of this review was to understand the determinants of these problems in a family context. We conducted a systematic review to investigate what lifestyle and psychological factors influence children with Type 1 diabetes and their parents. A focused literature search was performed using a combination of keywords that covered the relevant terminology for diabetes, target population, and associated emotional distress, using electronic bibliographic databases containing publications until May 2022. Methodological quality was assessed using the Quality Assessment Tools for Quantitative Studies. Twenty articles met the inclusion criteria. Quality scores were weak because of a lack of comparison groups, information about the type of therapy, or adequate sample sizes. Many of the studies included a wide age range in their sample. The majority of the studies reported that parents and their children showed depression symptoms, fear of hypoglycaemia, and higher parenting stress. We conclude that sufficiently powered studies employing appropriate control groups and measures are needed to elucidate the psychological variables associated with Type1 diabetes in children and the effects on parents, especially considering primary-age children who are increasingly reported to suffer from poor mental health, and its implications. This should help to introduce better targeted interventions and improve behavioural outcomes.

Exploring the determinants of mental health, wellbeing, and lifestyle in 8-11 year old children with type 1 diabetes and their healthy counterparts in Kuwait.

Type 1 diabetes is a chronic disease with an early onset, but little is known about its psychological effects in middle childhood. The present study was the first to explore the relationship between mental health, wellbeing, and lifestyle of 8-11 years old children with Type 1 diabetes and their parents, and a healthy comparison group. A total of 200 parent-child dyads were recruited in diabetic clinics and from primary schools in Kuwait. Both groups completed a series of behavioural and physical assessments relating to health, wellbeing, and lifestyle. A significant relationship was found between higher Body Mass Index (BMI) and poorer mental health, including low academic self-esteem, depression, and anxiety, in the diabetes group. This group had significantly higher mean scores in mental health problems, and lower scores in wellbeing, compared with control group. Both groups had poor dietary habits and low levels of physical activity. Unlike previous studies, no differences were found between parents' mental health for children with Type 1 diabetes and parents of the control group. Although elevated problem scores on a variety of indices remained within normal range, the pattern of results indicates that children with diabetes would profit from early screening and preventative intervention to reduce the likelihood of psychological and behavioural difficulties later on.

Changes in the nutritional content of children's lunches after the Food Dudes healthy eating programme.

Previous research into the effectiveness of healthy eating programmes has shown increases in healthful eating behaviour in primary schools; however, data collection methods have not been sufficiently sensitive to detect micronutrient changes. The present study extends the literature by measuring individual children's intake of macro- and micronutrients at lunchtime, before and after a programme targeting children's consumption of fruit and vegetables, to identify evidence-based health benefits of programme participation. Baseline data were collected over 4 d at lunchtime in two primary schools. The Food Dudes programme was then implemented in the intervention school. Follow-up data were collected over 4 d in each school 2 months after baseline. We employed a validated and sensitive photographic method to estimate individual children's (N 112) consumption of fruit, vegetables, and their intake of calories, macro- and selected micronutrients. Significant changes were observed in the intervention school but not in the control school: Children's consumption of fruit, vegetables, vitamin C and E intake increased, while their total energy consumption, fat, saturated fat, and sodium intake decreased. The present results show that the Food Dudes programme produced a positive nutritional change, with implications for its application as a healthy eating and obesity prevention intervention. These optimistic conclusions should be tested by further research to establish the longevity of the positive effects presented here.

Nudge with caution: targeting fruit and vegetable consumption in primary schools.

Most children in the UK are not eating enough fruit and vegetables to support optimum health. Evidence-based interventions are needed to change this trend. In the present pilot study, effectiveness of simple behavioural nudges on children's lunchtime consumption of fruit and vegetables was tested in two primary (elementary) schools. Children's (n = 107) lunchtime consumption was measured directly through the use of a validated digital photography protocol; measures were taken at baseline and again after a 3-week long intervention. Changes to the choice architecture of dining rooms included improved presentation and provision of target foods, attractive advertisements and labelling, and prompting by staff. For children who took school lunches (n = 67), both selection and consumption of fruit increased as the result of the intervention. Their selection of vegetables did not change over time, however, and their consumption ether remained unchanged or declined. No changes were observed in the comparison group (n = 40), who brought their lunch boxes from home. These results caution against using selection (serving sizes), as estimates of consumption or a measure of behaviour changes. They also show that all evaluations should consider the effects of each intervention on children's eating overall, rather than just report changes in target item consumption, to check for any unintended consequences of the intervention.

Using Nudges to Promote Healthy Food Choices in the School Dining Room: A Systematic Review of Previous Investigations.

BACKGROUND: There is a growing interest in low-cost interventions that modify obesogenic environments and encourage positive behavior change. We conducted a systematic review of studies that used behavioral nudges to promote a healthy school cafeteria environment. METHODS: A literature search was conducted using 5 databases; of 381 papers noted, we included 25 and assessed them using the Quality Assessment Tool for Quantitative Studies. RESULTS: Most studies used relatively small, convenience samples and data collection methods that could not be described as robust, necessitating cautious interpretation of their results. A range of behavioral nudges were employed. Seventeen studies reported positive effects on children's selection and 11 studies reported improvements in their consumption of target foods, effected by changing the order of serving; increasing the convenience, attractiveness, and normativeness of selecting healthy options; increasing the variety available; and attractive target food labeling. CONCLUSIONS: Overall, this review identified the requirement for well-designed and well-controlled investigations into the effects of changing the choice architecture in school cafeterias, assessing short-, medium-, and long-term changes in individual children's consumption, utilizing validated measures, and conducted across a variety of settings, including dining rooms of schools outside the United States.

Measuring lunchtime consumption in school cafeterias: a validation study of the use of digital photography.

OBJECTIVE: The present study tested the validity of a digital image-capture measure of food consumption suitable for use in busy school cafeterias. DESIGN: Lunches were photographed pre- and post-consumption, and food items were weighed pre- and post-consumption for comparison. SETTING: A small research team recorded children's lunchtime consumption in one primary and one secondary school over seven working days.ParticipantsA primary-school sample of 121 children from North Wales and a secondary-school sample of 124 children from the West Midlands, UK, were utilised. Nineteen children were excluded because of incomplete data, leaving a final sample of 239 participants. RESULTS: Results indicated that (i) consumption estimates based on images were accurate, yielding only small differences between the weight- and image-based judgements (median bias=0·15-1·64 g, equating to 0·45-3·42 % of consumed weight) and (ii) good levels of inter-rater agreement were achieved, ranging from moderate to near perfect (Cohen's κ=0·535-0·819). This confirmed that consumption estimates derived from digital images were accurate and could be used in lieu of objective weighed measures. CONCLUSIONS: Our protocol minimised disruption to daily lunchtime routine, kept the attrition low, and enabled better agreement between measures and raters than was the case in the existing literature. Accurate measurements are a necessary tool for all those engaged in nutrition research, intervention evaluation, prevention and public health work. We conclude that our simple and practical method of assessment could be used with children across a range of settings, ages and lunch types.

A low-cost Behavioural Nudge and choice architecture intervention targeting school lunches increases children's consumption of fruit: a cluster randomised trial.

BACKGROUND: Research has consistently indicated that most children do not consume sufficient fruit and vegetables to provide them with a healthy, balanced diet. This study set out to trial a simple, low-cost behavioural nudge intervention to encourage children to select and consume more fruit and vegetables with their lunchtime meal in a primary school cafeteria. METHODS: Four primary schools were randomly allocated to either the control or the intervention condition and baseline data were collected over two days in each school. Following this, changes were made to the choice architecture of the school cafeterias in the intervention schools and maintained over a three-week period. The intervention included improved positioning and serving of fruit, accompanied by attractive labelling of both fruit and vegetables on offer. Next, data were collected over two days in each school, with menus matched in each instance between baseline and follow-up. We employed a validated and sensitive photographic method to estimate individual children's (N = 176) consumption of vegetables, fruit, vitamin C, fibre, total sugars, and their overall calorie intake. RESULTS: Significant increases were recorded in the intervention schools for children's consumption of fruit, vitamin C, and fibre. No significant changes were observed in the control condition. The increases in fruit consumption were recorded in a large proportion of individual children, irrespective of their baseline consumption levels. No changes in vegetable consumption were observed in either condition. CONCLUSIONS: These results are the first to show that modest improvements to the choice architecture of school catering, and inclusion of behavioural nudges, can significantly increase fruit consumption, rather than just selection, in primary-age children. This has implications for the development of national and international strategies to promote healthy eating in schools. TRIAL REGISTRATION: AsPredicted: 3943 05/02/2017. URL: https://aspredicted.org/see_one.php?a_id=3943.

Validity and reliability of the Fitbit Zip as a measure of preschool children's step count.

OBJECTIVES: Validation of physical activity measurement tools is essential to determine the relationship between physical activity and health in preschool children, but research to date has not focused on this priority. The aims of this study were to ascertain inter-rater reliability of observer step count, and interdevice reliability and validity of Fitbit Zip accelerometer step counts in preschool children. METHODS: Fifty-six children aged 3-4 years (29 girls) recruited from 10 nurseries in North Wales, UK, wore two Fitbit Zip accelerometers while performing a timed walking task in their childcare settings. Accelerometers were worn in secure pockets inside a custom-made tabard. Video recordings enabled two observers to independently code the number of steps performed in 3 min by each child during the walking task. Intraclass correlations (ICCs), concordance correlation coefficients, Bland-Altman plots and absolute per cent error were calculated to assess the reliability and validity of the consumer-grade device. RESULTS: An excellent ICC was found between the two observer codings (ICC=1.00) and the two Fitbit Zips (ICC=0.91). Concordance between the Fitbit Zips and observer counts was also high (r=0.77), with an acceptable absolute per cent error (6%-7%). Bland-Altman analyses identified a bias for Fitbit 1 of 22.8±19.1 steps with limits of agreement between -14.7 and 60.2 steps, and a bias for Fitbit 2 of 25.2±23.2 steps with limits of agreement between -20.2 and 70.5 steps. CONCLUSIONS: Fitbit Zip accelerometers are a reliable and valid method of recording preschool children's step count in a childcare setting.

Outcomes of a Comparison Study into a Group-Based Infant Parenting Programme.

This paper reports on a quantitative evaluation of a group-based programme designed to promote parent-infant attachment and child development. Whilst group-based parenting programmes are recommended for treating and preventing conduct disorder in older children, there is, as yet, little evidence as to whether they have a positive effect on very young children and their carers'. Recent UK Government initiatives to support families and improve parenting skills in the first 2 years of children's lives have increased the demand for the delivery and evaluation of community-based programmes. Eighty mother-child dyads were recruited from nine areas to intervention (n = 54) and control condition (n = 26). Baseline measures were collected in the children's home when the infants were on average 3-months-old, and follow-up measures were collected 6 months post-baseline (N = 63). Mothers' positive play behaviours were independently coded from video recordings taken in the home. Other measures included self-reported maternal confidence and mental well-being, assessed infant development and home environment. Socio-demographic data was collected once at baseline. After controlling for baseline scores, control mothers were observed to be significantly less sensitive during play with their baby at the 6 months follow-up with a significant increase in confidence. No differences were found between the groups on the other measures. This paper provides limited evidence for the effectiveness of the Incredible Years Parents and Babies group-based programme delivered in the first year of life. Further evaluation, particularly with parents at increased risk of poorer outcomes is needed to confirm and extend these results.

Validation of food diaries as measures of dietary behaviour change.

This study aimed to validate the ability of a 24-h food diary (the DIET-24) to accurately detect change in children's fruit and vegetable consumption at school snack time following implementation of the Food Dudes healthy eating intervention. Participants were 4- to 9-year-old children from two primary schools in England. There were 148 participants in the intervention school and 43 participants in the no intervention control school. For each child, snack-time fruit and vegetable consumption was measured separately by weight (grammes), and compared with teachers' estimates (to the nearest half portion) using the DIET-24. Both consumption measures were taken at T1 (pre-intervention) and T2 (post-intervention). At each time-point, Spearman rank correlations between the two measures were low to moderate, but significant. However, when compared with weighed measures, the DIET-24 did not always accurately detect significant changes in children's fruit and vegetable consumption following the intervention. To provide sensitive measures of behaviour change, it is important that dietary measures assess as accurately as possible the amount of food consumed, rather than, as is often the case, rely on all-or-none portion estimates. This issue is important for the establishment of a reliable evidence-base for healthy eating interventions.

The impact of body-part-naming training on the accuracy of imitative performances in 2- to 3-year-old children.

A series of three experiments explored the relationship between 3-year-old children's ability to name target body parts and their untrained matching of target hand-to-body touches. Nine participants, 3 per experiment, were presented with repeated generalized imitation tests in a multiple-baseline procedure, interspersed with step-by-step training that enabled them to (i) tact the target locations on their own and the experimenter's bodies or (ii) respond accurately as listeners to the experimenter's tacts of the target locations. Prompts for on-task naming of target body parts were also provided later in the procedure. In Experiment 1, only tact training followed by listener probes were conducted; in Experiment 2, tacting was trained first and listener behavior second, whereas in Experiment 3 listener training preceded tact training. Both tact and listener training resulted in emergence of naming together with significant and large improvements in the children's matching performances; this was true for each child and across most target gestures. The present series of experiments provides evidence that naming--the most basic form of self-instructional behavior--may be one means of establishing untrained matching as measured in generalized imitation tests. This demonstration has a bearing on our interpretation of imitation reported in the behavior analytic, cognitive developmental, and comparative literature.

Comprehension and production of body part labels in 2- to 3-year-old children.

This study examined which body part labels children could (i) produce when the experimenter touched different locations on her own body, asking each time 'What's this?' and (ii) comprehend by touching the correct locations on their own bodies in response to the experimenter asking 'Where's the [body-part label]?'. Seventeen children aged between 26 and 41 months, tested in a repeated measures procedure, were presented with 50 different body part stimuli in 200 test trials per child. Overall, the children produced fewer body part labels than they could comprehend. The accuracy of children's responses depended on (i) the location or extent of each body part (facial and broad body features were better known; joints and features in or attached to broad body parts the least well known); (ii) the amount of sensory (but not motor) representation each body part has in the human cortex; and (iii) whether a body part was commonly named by caregivers. These results present a precise mapping of the body parts that young children are able to name and locate on their own bodies in response to body part names; they suggest several possible determinants of lexical-semantic body knowledge and add to the understanding of how it develops in childhood.

Rapid word learning in 13- and 17-month-olds in a naturalistic two-word procedure: looking versus reaching measures.

This study investigated infants' rapid learning of two novel words using a preferential looking measure compared with a preferential reaching measure. In Experiment 1, 21 13-month-olds and 20 17-month-olds were given 12 novel label exposures (6 per trial) for each of two novel objects. Next, in the label comprehension tests, infants were shown both objects and were asked, "Where's the [label]?" (looking preference) and then told, "Put the [label] in the basket" (reaching preference). Only the 13-month-olds showed rapid word learning on the looking measure; neither age group showed rapid word learning on the reaching measure. In Experiment 2, the procedure was repeated 24h later with 10 participants per age group from Experiment 1. After a further 12 labels per object, both age groups now showed robust evidence of rapid word learning, but again only on the looking measure. This is the earliest looking-based evidence of rapid word learning in infants in a well-controlled (i.e., two-word) procedure; our failure to replicate previous reports of rapid word learning in 13-month-olds with a preferential reaching measure may be due to our use of more rigorous controls for object preferences. The superior performance of the younger infants on the looking measure in Experiment 1 was not straightforwardly predicted by existing theoretical accounts of word learning.

Increasing pre-school children's consumption of fruit and vegetables. A modelling and rewards intervention.

Using a repeated measures design, in a nursery setting, a modelling and rewards intervention targeted preschool children's consumption of 8 fruit and 8 vegetables (presented as 4 different food sets, each comprising 2 fruit and 2 vegetables). During the 16-day Baseline 1, and subsequent baselines, the children received a different food set daily, first at snacktime and again at lunchtime; consumption of these foods was not rewarded. In the 32-day fruit intervention phase, Food Set 2 and Food Set 3 were presented on alternate days; rewards were presented only at snacktime, and only for consumption of the fruit components. Following Baseline 2 and Baseline 3, the intervention targeted snack consumption of the vegetable components of Food Sets 1 and 4. Finally, Baseline 4, and 6-month Follow up were conducted. The interventions produced large and significant increases in target fruit and vegetable consumption with smaller, but significant, increases for the paired, opposite category, non-target foods. Immediately after each intervention, increases based on within-category generalisation were also evident. All increases generalised strongly to the no-rewards lunchtime context. Contrary to theories predicting response decrements, the increases in preschoolers' fruit and vegetable consumption were maintained at Follow up, six months after rewards were withdrawn.

Do infants show generalized imitation of gestures? II. The effects of skills training and multiple exemplar matching training.

The determinants of generalized imitation of manual gestures were investigated in 1- to 2-year-old infants. Eleven infants were first trained eight baseline matching relations; then, four novel gestures that the infants did not match in probe trials were selected as target behaviors. Next, in a generalized imitation test in which matching responses to baseline models were intermittently reinforced, but matching responses to target models were not eligible for reinforcement, the infants matched baseline models but not the majority of their target behaviors. To ensure their failure to match the target behaviors was not due to motor constraints, the infants were trained, in a multiple-baseline procedure, to produce the target responses under stimulus control that did not include an antecedent model of the target behavior. There was no evidence of generalized imitation in subsequent tests. When the infants were next trained to match each target behavior to criterion (tested in extinction) in a multiple-baseline-across-behaviors procedure, only 2 infants continued to match all their targets in subsequent tests; the remaining infants matched only some of them. Seven infants were next given mixed matching training with the target behaviors to criterion (tested in extinction); they subsequently matched these targets without reinforcement when interspersed with trials on which matching responses to baseline models were intermittently reinforced. In repeat tests, administered at 3-week intervals, these 7 children (and 2 that did not take part in mixed matching training) continued to match most of their target behaviors. The results support a trained matching account, but provide no evidence of generalized imitation, in 1- to 2-year-old infants.

The effects of modelling, local stimulus enhancement, and affordance demonstration on the production of object-directed actions in 6-month-old infants.

The present study investigated whether local stimulus enhancement and the demonstration of objects' affordances--both of which are inherent in modelling of object-directed target actions--are themselves sufficient to evoke the target behaviour on imitation test trials. Six-month-old infants were presented with a puppet wearing a removable mitten and observed either a demonstration of mitten removal (modelling group), the experimenter pointing at the mitten (stimulus enhancement group), the mitten falling off apparently by itself (affordance demonstration group), or no specific action directed at the mitten (control group). For all infants, the puppet was next presented without any accompanying demonstrations and infants' mitten removal behaviours in the response period were recorded. The results showed that local stimulus enhancement and affordance demonstration were as effective as full modelling in evoking the target action. This finding shows that the performances of 6-month-old infants on imitation tests can be multiply determined and evoked by variables other than modelling of target behaviour.

Determinants of imitation of hand-to-body gestures in 2- and 3-year-old children.

Twenty children, ten 2-year-olds and ten 3-year-olds, participated in an AB procedure. In the baseline phase, each child was trained the same four matching relations to criterion under intermittent reinforcement. During the subsequent imitation test, the experimenter modeled a total of 20 target gestures (six trials each) interspersed with intermittently reinforced baseline trials. In each session, target gestures were selected in a pre-randomized sequence from: Set 1--ear touches; Set 2--shoulder touches; Set 3--midarm touches; and Set 4--wrist touches; subjects' responses to targets were not reinforced. In each target set, half the gestures featured in nursery matching games and were termed common targets whereas the remainder, which were topographically similar but did not feature in the games, served as uncommon targets. The children produced significantly more matching responses to common target models than to uncommon ones. Common responses were also produced as mismatches to uncommon target models more often than vice versa. Response accuracy did not improve over trials, suggesting that "parity" did not serve as a conditioned reinforcer. All children showed a strong bias for "mirroring"--responding in the same hemispace as the modeler. The 2-year-olds produced more matching errors than the 3-year-olds and most children showed a bias for responding with their right hands. The strong effects of training environment (nursery matching games) are consistent with a Skinnerian account, but not a cognitive goal theory account, of imitation in young children.