Digitally Delivered Child Obesity Prevention for Parents in Home Visiting Programs

The SCFQ contains questions related to structure and controlling parental feeding practices. The validated questionnaire has two subscales: 1) Structure (meal routines, feeding environment, etc.) and 2) Control (pressure to eat, restriction, etc.). Responses are captured on a 5-point Likert scale with 1 indicating "never" and 5 indicating "always." Higher scores indicate greater structure or control while lower scores indicate lower structure or control.

Feeding to soothe practices will be captured using the BBNQ which assesses infant's feeding history and extent to which mothers use feeding to soothe their infants. Responses are captured on a 5-point Likert scale (1=Never; 5=Always). Higher scores indicate more frequent use of feeding to soothe while lower scores indicate less use of feeding to soothe.

Questions were adapted from the Beverage Intake Questionnaire, Preschool Version (BEVQ-PS), an instrument designed to assess the frequency of preschool children's intake of beverages, including 100% fruit juice. In the BEVQ-PS, parents report how often their child consumes specific beverages using responses options ranging from "Never" to "3 or more times per day." Higher responses indicate more frequent intake and lower responses indicate less frequent intake.

Other measures were adapted from the National Survey of Children's Health (NSCH) questionnaire, which includes standardized items assessing infant feeding practices. Parents report the age at which their child was first given food other than breastmilk or formula or juice, using response options as follows: <1 month, 2-3 months, 4-5 months, 6-8 months, 9-11 months, or 12 months or older. Responses will be compared to current solid food and juice guidance.

Checkpoint questions associated with digital intervention module topics will administered after parents complete the digital modules. These items evaluate parents' knowledge, attitudes, and intentions related to obesity-prevention behaviors, including feeding, sleep, screen time, and soothing practices. The questions are not part of a validated scale; responses are summarized descriptively based on accuracy of answers and qualitatively.

The 26-item Dietary Screener Questionnaire (DSQ) will be used to assess the frequency of consumption in the past month of selected foods and drinks. The DSQ captures intakes of fruits and vegetables, dairy/calcium, added sugars, whole grains/fiber, red meat, and processed meat. The DSQ can be interviewer-administered on paper or the web. Each of the 26 items on the screener was selected because of its relationship to one or more dietary factors of interest in dietary guidance.The scoring algorithms convert screener responses to estimates of dietary intake for fruits and vegetables (cup equivalents), dairy (cup equivalents), added sugars (tsp), whole grains (ounce equivalents), fiber (g), and calcium (mg). Responses to the red meat and processed meat questions may be used as qualitative indicators of intake frequency.

Parent and Child activity and screen time questions are adapted from a combination of project developed items and from the Infant Feeding Practices Study II (IFPS-II) and the National Survey of Children's Health (NSCH). The questionnaires are not operationalized on a validated scale; responses are summarized descriptively.

Infant sleep duration and awakenings are measured using the Brief Infant Sleep Questionnaire (BISQ). The BISQ does not equate to an overall score with minimum or maximum values. Individual sleep parameters are reported descriptively

The Multidimensional Scale of Perceived Social Support (MSPSS), a 12-item validated measure, will be used to assess social support of the parent and is scored from 1 to 7. Subscale and total mean scores also range from 1 to 7, with higher scores indicating greater perceived social support and lower scores indicating less perceived social support. Results are summarized using mean scores.

The Perceived Stress Scale (PSS), a validated 10-item measure of perceived stress over the past month, will be used to assess stress of the parent. Each item is scored from 0 to 4, with a total score ranging from 0 to 40. Higher scores indicate greater perceived stress, and lower scores indicate lower perceived stress.