Storybook-Based Nutrition Education for Preschoolers

Nutrition Education for Preschool Children: The Effect of Designing an Educator Storybook on Nutrition Behaviors

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.

Study Overview

• Status: Completed
• Conditions: Pediatric Obesity; Pediatric Nutrition; Nutrition Education; Nutrition Education Program
• Intervention / Treatment: Behavioral: Behavioral Treatment

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Istanbul, Turkey (Türkiye), 34349
    • Bahcesehir University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Children aged 5-6 years and free from any diagnosed chronic health conditions.

Exclusion Criteria:

• Children younger than 5 years or older than 6 years, and those diagnosed with any chronic health conditions.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Screening
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Intervention group; Healthy preschool age children	Behavioral: Behavioral Treatment; 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; Other Names: nutrition education
No Intervention: Control group; Healthy preschool age children

What is the study measuring?

Primary Outcome Measures

Outcome Measure	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).

Secondary Outcome Measures

Outcome Measure	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: Food and liquid intake; Physical growth and development; Physical activity and sedentary behavior; Factors affecting food intake and nutritional behavior	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)

Other Outcome Measures

Outcome Measure	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.
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.

Collaborators and Investigators

• Sponsor: Bahçeşehir University

Study record dates

Study Major Dates

• Study Start (Actual): November 1, 2025
• Primary Completion (Actual): January 21, 2026
• Study Completion (Actual): January 21, 2026

Study Registration Dates

• First Submitted: July 31, 2025
• First Submitted That Met QC Criteria: April 17, 2026
• First Posted (Actual): April 20, 2026

Study Record Updates

• Last Update Posted (Actual): April 20, 2026
• Last Update Submitted That Met QC Criteria: April 17, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: preschool nutrition; picky eating; eating behaviour intervention; child nutrition education; educational storybook
• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Overweight; Obesity; Pathological Conditions, Signs and Symptoms; Behavior; Nutritional and Metabolic Diseases; Signs and Symptoms; Feeding Behavior; Pediatric Obesity; Food Fussiness; Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Psychotherapy; Behavioral Disciplines and Activities; Epidemiologic Measurements; Nutrition Assessment; Behavior Therapy
• Other Study ID Numbers: E-85646034-604.01-107411

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No