# The Impact of Parental Engagement in an Electronic Health (EHealth) Intervention on Physical Activity, Dietary Behaviors, and Sleep in Preschool-Aged Children

## TL;DR

This study shows that active parental involvement in a digital health program improves preschoolers' physical activity and diet, but not sleep.

## Contribution

It identifies the 'engagement gap' between active and passive parents in eHealth interventions and its impact on child health outcomes.

## Key findings

- Active parental engagement in WeChat groups correlates with increased physical activity in preschoolers.
- Active engagement is linked to better dietary behaviors, including reduced food fussiness and satiety responsiveness.
- No significant effect of parental engagement on preschoolers' sleep outcomes was observed.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Targeting Early Childhood Obesity Risks: This work addresses critical lifestyle behaviors—physical activity, diet, and sedentary screen time—in preschoolers (aged 3–6), a developmental window essential for establishing lifelong health habits and preventing chronic disease.Leveraging Digital Health (eHealth) Platforms: It explores the utility of ubiquitous social media platforms (like WeChat) as a delivery mechanism for parent-based interventions, reflecting the modern shift toward scalable, technology-driven public health strategies.

Targeting Early Childhood Obesity Risks: This work addresses critical lifestyle behaviors—physical activity, diet, and sedentary screen time—in preschoolers (aged 3–6), a developmental window essential for establishing lifelong health habits and preventing chronic disease.

Leveraging Digital Health (eHealth) Platforms: It explores the utility of ubiquitous social media platforms (like WeChat) as a delivery mechanism for parent-based interventions, reflecting the modern shift toward scalable, technology-driven public health strategies.

Public health significance—Why is this work of significance to public health?
Identifying the “Engagement Gap”: The study highlights that the quality of parental participation (active posting vs. “lurking”) is a significant determinant of intervention success, suggesting that simply providing digital content is insufficient for behavior change.Impact on Multi-Domain Health Outcomes: The findings demonstrate that active parental engagement specifically correlates with improved physical activity intensity and better dietary behaviors (reduced food fussiness and satiety responsiveness), offering a clear pathway to more effective childhood health programs.

Identifying the “Engagement Gap”: The study highlights that the quality of parental participation (active posting vs. “lurking”) is a significant determinant of intervention success, suggesting that simply providing digital content is insufficient for behavior change.

Impact on Multi-Domain Health Outcomes: The findings demonstrate that active parental engagement specifically correlates with improved physical activity intensity and better dietary behaviors (reduced food fussiness and satiety responsiveness), offering a clear pathway to more effective childhood health programs.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
For Practitioners: Interventionists should move beyond “one-size-fits-all” digital delivery and develop specific strategies to convert “lurkers” into active participants to ensure the intended health benefits are realized by the children.For Policy Makers and Researchers: Future public health policies and research should prioritize the design of interactive, socially driven eHealth features that foster active engagement, rather than passive consumption, to maximize the return on investment for digital health initiatives.

For Practitioners: Interventionists should move beyond “one-size-fits-all” digital delivery and develop specific strategies to convert “lurkers” into active participants to ensure the intended health benefits are realized by the children.

For Policy Makers and Researchers: Future public health policies and research should prioritize the design of interactive, socially driven eHealth features that foster active engagement, rather than passive consumption, to maximize the return on investment for digital health initiatives.

Background/Objectives: The characterization of varying levels of parental engagement is important for increasing understanding of how to tailor and maximize the effectiveness of parent-based eHealth interventions. In this study, we aimed to determine if parental engagement in the WeChat group of a parent-based eHealth intervention affected preschoolers’ physical activity, diet, or sleep. Methods: We utilized baseline, post-test (12 weeks after baseline), and follow-up (12 weeks after post-test measurement) data from the intervention group in a parent-based eHealth intervention concerning children aged from three to six years, designed as a single-blinded randomized controlled trial with two parallel arms to explore the intervention’s influence on preschoolers’ physical activity, diet, and sleep. The parents in the intervention group were categorized into two groups: (1) The actively engaged group (53 parent–child dyads), defined as parents who actively posted and commented on modules at least once a week, either in the WeChat groups or through private messages with the researchers. (2) The lurker group (67 parent–child dyads), defined as parents who only responded to the weekly self-assessment messages and who, aside from this, showed no interaction within WeChat groups and did not privately message the researchers. Preschoolers’ physical activity was measured using ActiGraph wGT3X-BT, while their dietary behaviors and sleep were measured using parent-reported questionnaires. Generalized Estimating Equations using group and time as main effects and adjusted demographic information for covariates were computed to examine the effects of parental engagement in the eHealth intervention on preschoolers’ physical activity, diet, and sleep. Results: At post-test, higher levels of parental engagement were significantly associated with a marked increase in preschoolers’ moderate-to-vigorous and vigorous physical activity, alongside a notable reduction in weekend screen time. Furthermore, active parental engagement was linked to greater decreases in satiety responsiveness, desire to drink, and food fussiness compared to the ‘lurker’ group. However, no significant associations were observed between the level of parental engagement and preschoolers’ sleep-related outcomes. Conclusions: Further research with larger sample sizes and longer durations is needed to better investigate the potential of social media in parent-based interventions for promoting healthy lifestyles in children.