Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review

Mahalakshmi Ekambareshwar, Swathi Ekambareshwar, Seema Mihrshahi, Li Ming Wen, Louise A. Baur, Rachel Laws, Sarah Taki, Chris Rissel

    Research output: Contribution to journalReview articlepeer-review

    10 Citations (Scopus)
    28 Downloads (Pure)


    Background: Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders' acceptability of interventions.

    Methods: A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers' behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools.

    Results: Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants' perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals.

    Conclusion: There is limited reporting of stakeholders' experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants' acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up.

    Trial registration: PROSPERO registration: CRD42019108658.

    Original languageEnglish
    Article number10
    Pages (from-to)1-25
    Number of pages25
    JournalInternational Journal of Behavioral Nutrition and Physical Activity
    Issue number1
    Publication statusPublished - 9 Jan 2021

    Bibliographical note

    Copyright the Author(s) 2021. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.


    • Childhood obesity prevention
    • Telephone
    • Text messages
    • SMS
    • Apps
    • Antenatal/postnatal women
    • Caregivers
    • Systematic review
    • Early childhood
    • Process evaluation


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