Adapting a parental support app for preschoolers’ health behaviors (MINISTOP) in a multi-ethnic setting: A qualitative study on needs and preferences of Somali, Arabic and Swedish speaking parents and nurses within Swedish child health care (Preprint)

BACKGROUND Similar to other high-income countries, Sweden has a socioeconomic gradient of obesity. Preventive efforts in primary child health care to counteract this development already in the preschool age has been called for. Mobile health (mHealth) represents an attractive approach to deliver such obesity interventions as they are highly flexible and adaptable. We have previously evaluated the MINISTOP 1.0 app; a 6-month mHealth program aiming to support parents in promoting healthy diet and activity behaviors in preschool-aged children. This 1.0 version of the app was however available only in Swedish. To investigate how to make the app accessible and effective for multi-ethnic communities, interviews with Somali, Arabic and Swedish speaking parents, and Swedish primary child health care nurses were conducted. OBJECTIVE This study aimed to explore: (1) needs and concerns among Somali, Arabic and Swedish speaking parents in terms of supporting healthy diet and activity behaviors in their children; (2) nurses’ perceptions of parental needs and concerns in relation to diet and physical activity behaviors, and (3) how features and content of the MINISTOP 1.0 app could be refined to better support health behaviors in children, among both parents and nurses. METHODS Three focus group interviews with parents speaking Somali (n=5), Arabic (n=4) and Swedish (n=6), and 15 individual telephone interviews with Swedish primary child health care nurses from different geographic and socioeconomic areas in Sweden were conducted. All interviews were audio-recorded, transcribed verbatim, and analyzed using an inductive thematic approach. RESULTS Two main themes were identified. In the first theme, “Parenthood and health behaviors”, parents in the Somali, Arabic and Swedish speaking focus groups expressed challenges relating to supporting a healthy diet in their children. Nurses also highlighted the importance of strengthening parents to better support health behaviors in their children. In the second theme, “Preferences of content and features”, parents from all groups expressed the need of a tailored app following their child’s development, including age-appropriate tips on activities, healthy snacks and various features to choose from, to meet the needs of different families. Parents also stressed the need of alternative ways of accessing the app content (audio, video), while nurses talked about the value of a shared digital platform available in different languages, to aid parent/nurse communication. CONCLUSIONS This study contributes with valuable insights and knowledge about relevant adaptations in a parent-oriented app supporting health behaviors in children. Findings motivated addition of audio/video files to make the app more accessible. To address parental concerns regarding healthy diet in children, pictures of portion sizes, information about children´s eating behaviors and parental strategies to support these were also added. This adapted version of the app has the potential to be useful for childhood obesity prevention in multi-ethnic communities. CLINICALTRIAL ClinicalTrials.gov NCT04147039