MINISTOP 2.0: a smartphone app integrated in primary child health care to promote healthy diet and physical activity behaviours and prevent obesity in preschool-aged children: protocol for a hybrid design effectiveness-implementation study.
BACKGROUND
Childhood obesity is still a major health problem in many countries, including Sweden. Childhood obesity and obesity-related behaviours in childhood, such as low physical activity and unhealthy eating habits, tend to track into adulthood, which highlights the need for early prevention. Our aims are to evaluate whether a parent-oriented mobile health app (the MINISTOP 2.0 app) integrated into primary child health care can improve diet and physical activity behaviours and reduce the prevalence of overweight and obesity in preschool-aged children as well as to evaluate the implementation among child health care nurses and parents.


METHODS
This trial uses a hybrid type 1 effectiveness-implementation design. Families (n = 500) who attend a routine visit to one of 15-20 primary child health care centres throughout Sweden, when their child is 2.5 years, are offered participation in a randomised controlled trial (effectiveness evaluation). After acceptance, families will be randomised (1:1) to control or intervention groups. The intervention group receives a 6-month parent-oriented smartphone intervention aimed at improving the dietary and activity behaviours of their child (the MINISTOP 2.0 app) and the control group receives routine child health care. Dietary habits, physical activity and screen time (primary outcomes), body weight and height in children, and parental self-efficacy (secondary outcomes) are measured at baseline and at 6 months post randomisation. Implementation outcomes (i.e. perceived acceptability, appropriateness, and feasibility) of the intervention will be assessed among primary child health care nurses and parents in the trial through questionnaires and qualitative interviews.


DISCUSSION
This trial will evaluate whether the MINISTOP 2.0 app can be used in primary child health care to improve diet and physical activity behaviours, and prevent overweight and obesity, in preschool-aged children. If effectiveness is proven, and the MINISTOP 2.0 app is considered acceptable, appropriate and feasible, it can be implemented nationally as part of the preventive strategies to combat childhood obesity provided by routine child health care.


TRIAL REGISTRATION
The trial was registered at the Clinicaltrials.gov register platform (ID NCT04147039 ) on 31 October 2019.
['Henriksson|Hanna|H|http://orcid.org/0000-0003-3571-1497', 'Alexandrou|Christina|C|', 'Henriksson|Pontus|P|', 'Henström|Maria|M|', 'Bendtsen|Marcus|M|', 'Thomas|Kristin|K|', 'Müssener|Ulrika|U|', 'Nilsen|Per|P|', 'Löf|Marie|M|']
D002675:Child, Preschool D000072001:Diet, Healthy D015444:Exercise D005260:Female D006293:Health Promotion D006801:Humans D008297:Male D063731:Mobile Applications D063766:Pediatric Obesity D011320:Primary Health Care D015397:Program Evaluation D012107:Research Design D000068997:Smartphone D013548:Sweden
Primary child health care Diet Physical activity Childhood obesity Randomised controlled trial Preschool mHealth