A Digital Intervention to Promote Preschool Nutrition and Activity: The eHEROs Study

Number of completed interest forms resulting in enrollment.

Proportion of intervention activities (e.g., app modules and assessments) completed.

Mean scores using the System Usability Scale (SUS) to estimate ease of use, complexity, confidence in using, and likelihood of use (scale 0-5, with higher scores indicating higher rankings of usability)

Mean ratings of information helpfulness, goal setting, liking of the program, willingness to recommend, and desire for additional information (scale 0-5, with higher scores indicating higher acceptibility)

Percentage of participants engaging with the app (i.e., engagement by topic, features, and temporal patterns), and by dosage (i.e., completion rates of modules and within-app activities).

Qualitatively capture, via individual interviews, intervention strategies relating to target behaviors which were implemented or adopted.

Mean scores using the Interpersonal Mindfulness in Parenting survey (I-MP) will assess five constructs of mindful parenting: parent/caregiver listening with full attention, emotional awareness of self and child, self-regulation, compassion of self and child, non-judgmental acceptance of self and child). Scale, 0-5, with higher scores indicating higher mindful parenting.

Mean scores from the Food Parenting Inventory (FPI) will assess Autonomy (encourages exploration of new foods, offers new foods, repeatedly presents new foods) and Control (pressure to eat, food as reward). Scale, 0-5, with higher scores indicating more positive child feeding practices.

Mean scores from teh PA Parenting Practices (PAPP) will assess three parenting domains: Structure (nondirective support, supportive expectation, restriction of physical activity inside), Autonomy (autonomy support, guided choice), and Control (coercive control). Scale, 0-5, with higher scores indicating more positive PA practices.

Mean scores of questions adapted from the Generalized Self-Efficacy Scales and will assess the offering of healthy foods, providing physical activity opportunities for their child, and engaging in positive interactions with their child related to healthy eating, physical activity, and modifying the home environment. Scale, 0-5, with higher scores indicating higher self-efficacy.

Means scores of questions adapted from the Feeding Knowledge Questionnaire to assess parent feeding knowledge and misconceptions, and the PLAYshop instrument adapted for use in parents of preschool-age children to assess physical literacy knowledge and confidence. Scale, 0-5, with higher scores indicating more higher behavioral capability.

Measured via food photography, meal quality will be assessed using Healthy Meal Index adequacy score (mean of 3 meals, range 0-55).

Measured via food photography, meal quantity will be determined by visual estimation of serving sizes (e.g., 1/4 c.)

Mean scores of children's consumption of foods will be collected using the Dietary Screener Questionnaire (DSQ). Quantitative estimates of food and nutrient intake (e.g., cups of fruit, vegetables and ounce equivalents of whole grains). These quantitative estimates will be compared to recommended serving sizes from the Dietary Guidelines of Americans to determine if consumption of food groups is meeting, above or below guidelines.

Mean scores for objective control and locomotor skills will be assessed using Test for Gross Motor Development, 2nd Ed (TGMD-2) scoring protocol. Each skill is scored on a scale of 0-1 with subscale ranges of 0-6 for locomotor skills and 0-5 for object control skills.

Mean scores of opportunities for structured and unstructured PA will be assessed (scale, 0-5, with higher scores indicating more positive opportunities).

Frequency of the availability of Fruit, Convenience Foods, Beverages and Whole Grains; Physical activity equipment will be assessed via the HomeIDEAv3 instrument.