The effects of including parents in nutrition education on what children eat

Many nutrition education programs target not only the child, but also the parents and others involved in buying and preparing a family’s food. This summary of a NEL review presents what we know from research about the effects of nutrition education with and without involving parents on what children eat.

Conclusion

Limited and inconsistent evidence is available to assess the effects of involving parents in nutrition education on children’s (ages 9 and older) dietary intake-related behaviors. Some evidence suggests that involving parents in a nutrition education intervention improves outcomes, while other evidence finds no added benefit of including parents. In children less than 9 years of age, there is no evidence to assess the effects of nutrition education with parental involvement on dietary intake-related behaviors.

What the Research Says

• The results of the 10 studies in this review were mixed.
• All studies looked at children age 9 to 18 years. There were no studies done in children under 9 years of age, so more research is needed in this age group.
• Three studies found that girls’ diets improved more than boys when parents were involved in nutrition education.
• Two studies looked at how much time parents were involved. One study found that the more time parents were involved, the more children improved their diets. The other study found that the amount of time did not matter.
• Results differed depending on where the study was done. U.S. studies found that involving parents in nutrition education did not improve children’s diets. Non-U.S. studies found that children ate better when parents were involved in nutrition education.
• It is difficult to make stronger conclusions, because the results were mixed, and the studies were so different.

The studies involved parents in different ways, but none looked at which method was best. More research is needed in this area.

Background

Many nutrition education programs target not only the child, but also the parents and/or nutritional gatekeepers. The objective of this systematic review was to determine the effects of nutrition education with parental involvement compared to no parental involvement on children’s dietary intake-related behaviors.

Conclusion Statement

Limited and inconsistent evidence is available to assess the effects of involving parents in nutrition education on children’s (ages 9 and older) dietary intake-related behaviors. Some evidence suggests that involving parents in a nutrition education intervention improves outcomes, while other evidence finds no added benefit of including parents. In children less than 9 years of age, there is no evidence to assess the effects of nutrition education with parental involvement on dietary intake-related behaviors

Grade: Limited

Methods

Literature searches were conducted using PubMed, EBSCOhost, Education Fulltext, and Global Health to identify studies that compared nutrition education with and without parental involvement.

• Inclusion criteria: published between January 1995 and December 2010; conducted in subjects aged 0–18 years; randomized controlled trials, nonrandomized controlled trials, or quasi-experimental studies; subjects from countries with high or very high human development (based on the Human Development Index); subjects who were healthy or at elevated chronic disease risk; published in English in a peer-reviewed journal.
• Exclusion criteria: systematic reviews, meta-analyses, narrative reviews, or prospective cohort, cross-sectional, or case-control designs; studies with no control group; subjects hospitalized, diagnosed with disease, and/or receiving medical treatment.

The results of each included study were summarized in evidence worksheets (including a study quality rating), an evidence paragraph, and evidence table. A group of subject matter experts were involved in a qualitative synthesis of the body of evidence, development of a conclusion statement, and assessment of the strength of the evidence (grade) using pre-established criteria including evaluation of the quality, quantity, consistency, magnitude of effect, and generalizability of available evidence.

Findings

• Ten randomized controlled studies were included in this systematic review. Seven RCTs received a positive quality rating, and three received of neutral quality rating.
• All 10 studies were done in subjects age 9 to 18 years, with no studies identified in children less than 9 years. Younger children may respond differently to parental involvement than older children, but it is not possible to assess the impact of age due to the lack of research in younger children.
• Three out of the ten studies found that girls demonstrated greater improvements in dietary intake compared to boys.
• Studies that found nutrition education with parental involvement was more effective for changing children’s dietary intake were conducted outside of the United States, while the studies conducted in the United States found that including parental involvement in nutrition education did not improve outcomes.
• The studies used a variety of strategies to involve parents (e.g., direct, indirect, or a combination of direct and indirect methods), though none directly examined which method of parental involvement was most effective.
• Two of the studies reviewed directly examined the dose or level of parental involvement in relation to outcomes. One found that children with the highest dose of parental involvement improved dietary intake the most, while the other found no significant effects on dietary behaviors related to dose of adult participation.

Discussion

The ability to draw strong conclusions as to the effect of parental involvement in nutrition education on children’s dietary intake is limited by the small number of relevant studies and the large degree of variation in intervention design and study characteristics. Specifically, research is needed to determine the effects of parental involvement among younger children, especially those younger than age 9 years. Furthermore, because several studies found greater improvements in dietary intake among girls compared to boys, there is some suggestion that girls may be more affected by parental involvement than boys. Finally, the method and dose of parental involvement may impact the degree to which children’s dietary intake changes following nutrition education. However, the limited number of studies and inconsistency in study designs used limits the conclusions that can be drawn.