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This project aims to design a nutrition-based educational storybook for preschool children and to evaluate its effect on improving general nutrition behaviors and reducing possible picky eating habits.
This study aims to develop a nutrition-focused educational storybook for preschool children (ages 5-6) and assess its impact on improving eating behaviors and reducing picky eating. Picky eating is common in early childhood and can negatively affect nutrition and growth, potentially leading to health issues later in life. The study will use a crossover design with 60 healthy children from kindergartens in Istanbul. Participants will experience both the intervention (storybook) and control conditions. Parental consent will be obtained, and data confidentiality will be maintained.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Other | Healthy preschool age children |
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| Control group | No Intervention | Healthy preschool age children |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Behavioral Treatment | Behavioral | In the first week, children in the intervention group were exposed to a structured, story-based nutrition education program. On the first day, the teacher read the designed storybook to the children for approximately 12-15 minutes. Children in the control group continued their routine classroom activities without exposure to nutrition-related content. During the remaining four days of the week, reinforcement activities were implemented to support the main message of the story, which emphasized the importance of fruit and vegetable consumption and healthy eating. These activities were developed in consultation with a child development specialist and were based on active learning and repetition principles. The reinforcement activities included age-appropriate tasks such as coloring, cutting, pasting, and drawing. Specifically, children participated in activities involving coloring story-related characters, selecting and pasting healthy food items onto visual materials, drawing their fa |
| Measure | Description | Time Frame |
|---|---|---|
| Choice of Snack (Healthy vs. Unhealthy) Measured by Direct Observation | At the baseline and right after the storybook intervention ends, each child will be offered a snack choice: fruit/vegetables (healthy) or cookies (unhealthy). The selection will be recorded using a standardized observation form. The primary outcome will be analyzed as the number and percentage of children selecting the healthy snack. Unit of Measure: Number and Percentage of Children Choosing a Healthy Snack | Baseline (before intervention) and immediately after the storybook intervention ends (5 days of intervention). |
| Measure | Description | Time Frame |
|---|---|---|
| NutriSTEP Questionnaire (OBTA Questionnare) | Turkish version of NutriSTEP Questionnaire (OBTA Questionnare) will be used to detect children's nutritional status. The scale will be filled by the parents of the children. It is fast and simple to use to scan eating habits and identify nutritional problems. It is a form that can identify preschool children who are and are not in risky nutritional status.Each question has 2-5 response options, with each option scored from 0 (no risk) to 4 (high risk). The total score is calculated by summing the scores obtained from all questions. Higher total scores indicate greater risk in dietary behavior. The total score can range from 0 to 68. According to the OBTA cut-off points: ≤20 points = low risk 21-25 points = moderate risk ≥26 points = high risk OBTA four It contains 17 questions in the category:
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| Measure | Description | Time Frame |
|---|---|---|
| Height measurement | Children will be barefoot with their heads in the Frankfurt plane; heels, hips, back, and head aligned as upright as possible; knees straight; and standing comfortably. The headpiece will be gently placed at a right angle. Measurements will be recorded to the nearest millimeter and repeated twice, with the average taken. | At the baseline (before intervention) of the study. |
Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Bahcesehir University | Istanbul | 34349 | Turkey (Türkiye) |
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| ID | Term |
|---|---|
| D063766 | Pediatric Obesity |
| D000081010 | Food Fussiness |
| ID | Term |
|---|---|
| D009765 | Obesity |
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
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| ID | Term |
|---|---|
| D001521 | Behavior Therapy |
| D015596 | Nutrition Assessment |
| ID | Term |
|---|---|
| D011613 | Psychotherapy |
| D004191 | Behavioral Disciplines and Activities |
| D003625 | Data Collection |
| D004812 | Epidemiologic Methods |
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| Baseline (before intervention) and immediately after the storybook intervention ends (5 days of intervention) |
| Nine-Item Avoidant/Restrictive Food Intake Disorder Screen (NIAS) Parent-Report | In order to evaluate their nutritional behaviors and detect potential disrupted eating habits, the "Avoidant/Restrictive Food Intake Disorder (ARFID) Parent Questionnaire", which is a 9-item scale that has been validated in Turkish (as ARFID scale) and applied to the parents of individuals between the ages of 2-18, will be filled out by the mothers of the participants. There NIAS has three subscales. The maximum score is 15 for the subscales and the total maximum score is 45 points. As the score increases the risk of ARFID increases too. | Baseline (before intervention) and immediately after the storybook intervention ends (5 days of intervention) |
| Visual Scales | Various questions will be asked to assess the children's cognitive, automatic, and detailed emotional responses. To measure children's cognitive, automatic and detailed emotional reactions, various questions will be asked and their reactions will be observed using a 4-point visual scale. For example, when measuring cognitive response, "How strong does eating fruit/vegetables make you?" and children's answers will be evaluated using a 4-point visual scale with squares from smallest to largest. Automatic emotional response to children quickly determine whether they like fruits/vegetables or not. Children's immediate liking of fruits/vegetables will be assessed using a two-choice facial expression scale (happy vs. sad). Detailed emotional response will be measured with two questions ("How much do you like fruits/vegetables?" and "How do you like the taste of fruit/vegetables?") using a 4-point facial expression scale (1 = not at all, 4 = like a lot). | Baseline (before intervention) and immediately after the storybook intervention ends (5 days of intervention) |
| Weight Measurement | Weight will be measured using a digital scale: children will wear light clothing and be barefoot; the scale will be placed on a flat, calibrated surface. Children will stand balanced, not move, and distribute weight evenly. Each measurement will be performed twice and averaged. Weight will be recorded in kilograms with 0.1 kg precision. | At the baseline (before intervention) of the study. |
| Body Mass Index Calculation and BMI z-scores | Body Mass Index (BMI) and BMI z-scores BMI will be calculated as weight (kg) divided by height squared (m²), and BMI z-scores will be determined according to WHO standards. Unit of Measure: kg/m² (for BMI) and z-score (unitless) [Time Frame: At the baseline (before intervention) of the study.] | At the baseline (before intervention) of the study. |
| D009750 |
| Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D005247 | Feeding Behavior |
| D001519 | Behavior |
| D008919 | Investigative Techniques |
| D017531 | Health Care Evaluation Mechanisms |
| D011787 | Quality of Health Care |
| D017530 | Health Care Quality, Access, and Evaluation |
| D015991 | Epidemiologic Measurements |
| D011634 | Public Health |
| D004778 | Environment and Public Health |