Behaviour change techniques and theory use in healthcare professional-delivered infant feeding interventions to prevent childhood obesity: a systematic review

The conceptual basis of early childhood feeding interventions for obesity prevention is poorly understood. The aim of this systematic review is to characterise these interventions' use of behaviour change techniques (BCTs) and psychological theory, focusing on interventions delivered by healthcare professionals for children ≤ 2 years. We searched seven electronic databases from inception to January 2019 and identified 12 trials. BCTs and theory use were identified using the Behaviour Change Technique Taxonomy v1 and the Theory Coding Scheme respectively. Interventions used 19 BCTs, most commonly 'Instruction on how to perform the behaviour' (12 of 12 studies) and 'Social support (unspecified)' (8 of 12 studies). The mean number of BCTs used was 5.1. Six trials explicitly stated basing interventions on theory, most commonly social cognitive theory and responsive feeding (4 of 6 studies each). Links between theory use and BCTs were poor. Early childhood feeding interventions have insufficiently integrated psychological theories into their development and evaluation. We recommend greater consideration of psychological theory incorporating family and systems approaches and responsive feeding in future intervention development. Moreover, these theories should explicitly link with BCTs. These theories and BCTs should also be included in the evaluation phase.