Development of the Parent-Focused SWITCH Intervention to Improve Fruit and Vegetable Intake Among Elementary School Children in Myanmar: A Social Cognitive Theory–Informed Approach

Abstract

Background: Fruit and vegetable (FV) intake among children in Myanmar remain below the WHO-recommended 400 g/day, with national averages around 230 g/day and substantial regional variation. Early dietary behaviours are strongly shaped by parents and the home environment, yet there is a lack of culturally adapted, parent-focused interventions in Myanmar. The SWITCH (Supporting Wellness in Children Through Home-based Change) intervention was developed to address the gap using Social Cognitive Theory (SCT).

Methods: Intervention development followed the GUIDED framework to ensure transparent and systematic reporting. Evidence from the literature, national dietary reports, and baseline assessments in a Yangon school identified key determinants, including low FV knowledge, limited parental self-efficacy, reduced home availability of FV, and high sugary drink intake. These findings informed the design of an eight-week parent-focused program featuring weekly in-person sessions, home-based challenges, digital reinforcement through Viber and Facebook, and child engagement activities. Materials including recipe cards, cooking videos, FV shopping guides, and lunchbox templates were culturally adapted to the Myanmar context. Prototype materials were pre-tested with 10 parents and refined for clarity, relevance, cost practicality, and overall feasibility.

Results: The finalized intervention incorporated eight weeks addressing FV knowledge, healthy cooking, meal planning, label reading, home-environment improvements, and coping strategies. Pre-testing demonstrated high acceptability: 90% found materials easy to understand, 80% found them culturally relevant, 100% considered them useful, and 90% indicated willingness to follow strategies. Cultural adaptation and digital reinforcement enhanced feasibility for urban Myanmar families.

Conclusion: SWITCH is a culturally grounded, SCT-based intervention designed to improve FV intake among schoolchildren by empowering parents. Its systematic development ensures theoretical coherence, contextual relevance, and high feasibility, providing a strong foundation for evaluation in a forthcoming quasi-experimental trial.