Table 4 Examples of how selected BCTs were operationalised in early child obesity prevention interventions

1.2 Problem solving

Parents identify factors impacting behaviour and select solutions

• The group format promoted discussion of strategies, successes and overcoming barriers to key messages

• Extra home visit(s), phone or email contact involved providing specific individualized advice to address problems with breastfeeding (or formula feeding)

• ‘Think about a tricky situation with your child. How do you want to respond? If you make a plan for this, it will work out better!’

2.1 Monitoring of behaviour by others without feedback

Interventionists observe parent behaviours with the intent this will change behaviour but do not give feedback or advice

• At each visit, the nurse will spend time with the mother and infant, monitoring the parent–child feeding interaction and practice, and make note of their practices

• ‘Did you buy more fruit, berries and vegetables last week? Do you think the family has eaten more than usual?’ [not in the context of data collection]

3.1 Social support (unspecified)

Provide general support or referral to further services/ resources

• Proactive telephone support will be provided between home visits to support behaviour maintenance and change

• Families were encouraged to seek additional support with handouts providing with local support services

• Intervention activities involved family members (i.e., infant father, grandparents, aunts and uncles)

4.1 Instruction on how to perform a behaviour

Information about recommendations and strategies

• Advice on breastfeeding establishment including length and number of feeds, positioning and attachment

• The curriculum includes recommendations on establishing adequate sleep hygiene

• ‘Let your child walk by themselves as much as possible. That way, they will exercise more and discover the world along the way.’

5.1 Information about health consequences

Positive or negative health consequences of the behaviour

• Participants are shown a figure illustrating the relationship between healthy diet and health

• ‘Continue to breastfeed your baby for as long as you both desire. Breastmilk continues to give your baby nutritional and health benefits – now and for life’

• ‘Tummy time and floor play with your baby will help with their physical and mental development’

5.2 Salience of consequences

Use visuals to make the consequences of performing the behaviour more memorable

• Pictures of children’s teeth and gums with decay from putting children to bed with a bottle of milk

• Videos of examples of pleasurable mealtimes and fun times playing with children

6.1 Demonstration of the behaviour

Image, video, or live demonstration of how to do the behaviour

• Instructional booklet with pictures demonstrating alternative ways of doing tummy time

• Video of a parent modelling the responsive bottle feeding

6.3 Information about others’ approval

Provide parents with information on whether others will like, approve or disapprove of the behaviour

• Share details of other parents’ disapproval of giving infants mobile devices when in the pram

• ‘Baby-led introduction to solids isn’t new – parents all over the world have used this approach for reasons such as: their baby wouldn’t let them feed them purées with a spoon, or their baby helped themselves to food off their plate.’

8.1 Behavioural practice / rehearsal

Encourage repeating the behaviour

• The end of each session the facilitator summarises ‘things to practice at home’

• Parents attend a cooking class where they make healthy and nutritious meals for their infant

• ‘Encourage practising active play with your child every day.’

9.1 Credible source

Person with expertise or celebrity to persuade for or against the behaviour

• Home visits were provided by a specially trained community nurse

• Sessions were co-led by a dietitian and exercise physiologist

• Video includes a parent sharing their positive experience changing behaviour

9.3 Comparative imagining of future outcomes

Encourage parents to think about future outcomes of changing vs not changing a behaviour

• Participants were asked to imagine two situations of an unchanged and changed behaviour – imagine this situation at home…; you could…; discussion of favourable action

• ‘Imagine this situation at home… You would like your toddler to try a new food. What would you do as they taste the new food?’

11.2 Reduce negative emotions

Promote strategies to reduce negative emotions or stress

• ‘Try not to get stressed or upset if your child does not eat the new foods. The more you fuss about what you would like your child to eat, the more they will fuss and may have a negative experience with the food.’

11.3 Conserving mental resources

Advise on how to reduce mental resources to performing a wanted behaviour

• The intervention provided a behaviour swap reference guide mobile device screen-saver with alternatives to screen time

• ‘Write a list and keep on the fridge so that when your kids are asking for food you can easily be reminded of what healthy options you could offer.’

13.1 Identification of self as role model

Promote parents as a role model

• Sessions highlighted the importance of parental role modelling health behaviours to children

• ‘Be a good role model. Be active with your infant and limit your own screen use around them.’

• ‘Toddlers look to their caregivers to set positive examples for them such as eating and being active.’

15.1 Verbal persuasion about capability

Telling parents they can change the behaviour

• ‘Learning about breastfeeding before birth can help boost your confidence. See ‘Breastfeeding your Baby’ booklet.’

• ‘You know your child and your family better than anyone – be confident in yourself as a parent and in your ability to influence your child’s sleep routine.’

15.2 Mental rehearsal of successful performance

Advise parents to imagine themselves performing target behaviour successfully

• Activities include a mental task where parents are asked to imagine breastfeeding in different contexts

• ‘Use visualisation strategies to imagine a scenario taking infant out to play or to a group.’