Skip to main content
. 2016 Aug 1;2016(8):CD003680. doi: 10.1002/14651858.CD003680.pub3

Morawska 2014.

Methods Design: Parallel randomised controlled trial
 Unit of randomisation: Individual parent
 Follow‐up: 6 months
Study dates: No information provided
Participants Participants: Parents (74 mothers; 12 fathers) who were concerned about and seeking assistance for their child's eating and/or mealtime difficulties
 Mean age of parents: Intervention (mother) 35.88 (SD 3.92; range: NR) years, (father) 38.06 (SD 4.22; range: NR) years; control (mother) 37.0 (SD 3.55) years, (father) 39.97 (SD 4.81); mean, SD, range for entire sample: NR
Mean age of child: Entire sample 3.72 (SD 1.13, range 2 to 5) years; intervention group mean 45.9 (SD 13.0; range: NR) months, control group mean 43.4 (SD 14.2; range: NR) months; 41 boys and 45 girls
 Ethnicity: Intervention: 95.3% Caucasian, 4.7% Asian; Control: 85.7% Caucasian, 14.3% Asian
 Number randomised: 86 (intervention 44; control 42)
 Country & setting: Australia; multi‐site; recruited from community settings; intervention delivered in centres
Eligibility criteria: Parents with a 2‐ to 5‐year‐old child currently experiencing feeding and/or mealtime difficulties, and parents wanted assistance for these difficulties. Parents were excluded if currently receiving professional help for child behavioural or emotional problems, or psychological help or counselling for personal or marital problems; if child had been diagnosed with a disability or developmental disorder; or if parents were intellectually disabled and/or hearing impaired
Interventions Two conditions: Group‐based parent training (Hassle Free Mealtime Triple P); wait‐list control
 Duration of intervention: 1 (2 hours) session in 1 week
 Therapist training: Psychologists (after training and accreditation)
Outcomes Externalising problems: Child Adjustment and Parent Efficacy Scales ‐ behavioural subscale, as completed by parents
Internalising problems: Child Adjustment and Parent Efficacy Scales ‐ emotional subscale, as completed by parents; data for Parent and Toddler Feeding Assessment ‐ child frequency and child problem, as completed by parents were not added to the meta‐analyses
Timing of outcomes: Outcomes reported for postintervention. Six‐month follow‐up data were only reported for intervention group and not added to the review
Secondary outcomes/adverse events: no other outcomes relevant to this review specified
Notes Level of prevention: Secondary or tertiary
Funding: no information provided
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk A random sequence was computer‐generated
Allocation concealment (selection bias) Low risk Study investigators reported that a person outside the research group generated and concealed the allocation sequence in sealed, numbered envelopes and that allocation to group was implemented by the third author, by sequentially drawing and opening the sealed envelopes
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Participants: It would not be possible to fully blind participants in this type of study (there is an obvious difference between receiving group training and in being placed on a waiting list). No indication of any specific additional measures taken to reduce the risk of bias that might result from differential behaviours by participants were found
Personnel: The design of the study means personnel delivering the intervention would be aware which groups had been assigned to the different study conditions
Blinding of outcome assessment (detection bias) 
 Independent observer reported outcomes Low risk There were no independent observer‐rated outcomes
Blinding of outcome assessment (detection bias) 
 Parent reported outcomes High risk Outcome assessments by parents were not blinded as parents were aware of the intervention condition
Incomplete outcome data (attrition bias) 
 All outcomes Low risk 8/44 (18%) of the intervention group and 4/42 (10%) of the control group withdrew from the study prior to follow‐up assessment. The study investigators reported that one parent withdrew from the intervention group due to inability to attend a group session, and seven intervention parents attended a group but did not complete time 2 assessment. Study investigators reported that the proportion of participants who withdrew before follow‐up assessment did not differ significantly between groups
Selective reporting (reporting bias) Low risk The published report includes all expected outcomes, including those that were prespecified
Other bias Low risk The study appears to be free of other sources of bias