Process evaluation of the Living Green, Healthy and Thrifty (LiGHT) web-based child obesity management program: combining health promotion with ecology and economy

Coupling Coordination Analysis of Regional IEE System: A Data-Driven Multimodel Decision Approach

Coordinating regional innovation–economy–ecology (IEE) systems is an important prerequisite for overall continuous regional development. To fully understand the coordination relationship among the three, this study builds a data-driven multimodel decision approach to calculate, assess, diagnose, and improve the regional IEE system. First, the assessment indicator system of the regional IEE system is established. Secondly, the range method, entropy weight method, and weighted summation method are employed to calculate the synthetic developmental level. Thirdly, a multimodel decision approach including the coupling degree model, the coordination degree model, and the obstacle degree model is constructed to assess the spatiotemporal evolution characteristics of the regional IEE system coupling coordination and diagnose the main obstacles hindering its development. Finally, the approach is tested using Anhui Province as a case study. The results show that the coupling coordination degree of the Anhui IEE system presents a stable growth trend, but the coupling degree is always higher than the coordination degree. The main obstacle affecting its development has changed from the original innovation subsystem to the current ecology subsystem. Based on this, some countermeasures are put forward. This study, therefore, offers decision support methods to aid in evaluating and improving the regional IEE system.

Efficacy of the Aim2Be intervention in changing lifestyle behaviours among adolescents with overweight and obesity: A Randomized Controlled Trial (Preprint)

BACKGROUND

Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families.

OBJECTIVE

The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants.

METHODS

A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents' assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected.

RESULTS

A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group.

CONCLUSIONS

The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-020-4080-2.

Experiences of parent-adolescent dyads regarding a Facebook-based intervention to improve overweight/obesity treatment in adolescents: A qualitative study

APOLO-Teens is a Facebook-based psychological intervention aiming to optimize hospital treatment for adolescents with overweight/obesity. The present qualitative study aims to explore (1) how adolescents experienced participation in APOLO-Teens and (2) how parents perceived adolescents' participation. Sixteen adolescent-parent dyads were interviewed by telephone using semistructured guides. An inductive approach of thematic analysis was used to analyze data by two independent codifiers. The consensus was used to resolve differences in coding/themes, and two independent auditors reviewed the codes and the themes proposed. We identified four themes from adolescents' interviews, namely, expectations, perception of outcomes, participation in the intervention, and sharing of acquired knowledge. From parents' interviews, we identified five themes: expectations for son/daughter participation, perception of adolescents' outcomes, son/daughter participation, parental role, and use of social networks in intervention programs for adolescents. Both elements of the dyad indicated that adolescents' participation in APOLO-Teens contributed to favorable outcomes, further highlighting the use of online interventions to complement the hospital treatment of adolescents with overweight/obesity. Future studies should address the viewpoints of adolescents and parents in the design of Facebook-based interventions, namely, to implement tailored, shorter, less time-demanding interventions that favor engagement between participants and parental involvement.

Professional stakeholder's views of adolescent weight management programmes: a qualitative study

OBJECTIVE

Family-based multi-component weight management programmes are recommended for adolescents with obesity in England and Wales, however, these programmes suffer from poor uptake and high attrition rates. This study aimed to gather the views of professional stakeholders in a UK weight management programme to identify potential areas to target to improve engagement and success for such programmes.

RESULTS

Semi-structured interviews were conducted with those involved in the commissioning, referral, coordination or delivery of a weight management programme (n = 11). Interviews were analysed using qualitative content analysis. Three main categories developed: professional support, tailoring and intervention content. Participants recognised the importance of support from experienced professionals, as well as family and peers. There was agreement that longer-term support was needed for adolescents with obesity; suggestions included integrating follow-up support with schools and leisure services. Emotional and psychological support must be prioritised. Having a variety of delivery modes, such as group and one to one, particularly in the home environment, were recommended. Stakeholders agreed that weight management programmes for adolescents need to be more proactive at incorporating technology. By acting on the views of those that work closely with adolescents, engagement with weight management programmes may be improved.

User Characteristics and Parenting Practices Associated with Adolescents' Initial Use of a Lifestyle Behavior Modification Intervention

Background and Purpose: E-health interventions can provide Canadian adolescents (13-17 years old) with personalized support to help them modify their obesogenic behaviors. However, use of e-health interventions among adolescents has not been extensively examined. This study examined user characteristics and parenting practices associated with adolescents' initial use of the Aim2Be app; a health behavior modification intervention delivered through a smartphone app. Methods: A total of 371 adolescent-parent dyads completed a baseline assessment and were invited to use the Aim2Be app. Mean adolescent age was 14.9 years and 50.1% were male (n = 186). Mean adult age was 44.1 years and 34.7% were male (n = 129). Using Mplus (v.8), path analyses were completed to identify adolescent characteristics and parenting practices that were significantly associated with initial use of the app. Analyses were then stratified to explore whether these associations were confounded by parents' gender. Results: 79.2% of adolescents (n = 294) initially used the Aim2Be app. Adolescent engagement in healthy behaviors was directly associated with increased odds of using the app (odds ratio [OR] = 1.08; 95% confidence interval [CI] = 1.01-1.14), whereas autonomous motivation was indirectly associated (OR = 1.02; 95% CI = 1.00-1.04). Structure parenting practices were indirectly associated with increased odds of using the app (OR = 1.02; 95% CI = 1.00-1.04). When analyses were stratified by parent's gender, differences in the associations emerged. Conclusions: Both user characteristics and parenting practices were significantly associated with adolescents' initial use of Aim2Be. These findings will help inform future e-health interventions increase user engagement by identifying the characteristics of individuals who are not accessing the intervention, as well as identifying factors of the household environment that support use.

Aim2Be mHealth intervention for children with overweight and obesity: study protocol for a randomized controlled trial

Background

The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person, family-based, multidisciplinary interventions that target lifestyle behaviors (e.g., diet, physical activity, and sedentary behaviors). These programs are costly to operate, have limited success, and report recruitment and retention challenges. With recent advances in technology, mobile health or mHealth has been presented as a viable alternative to in-person interventions for behavior change, especially with teens.

Purpose

The primary aim of this study is to test the efficacy of Aim2Be, a gamified app based on behavior change theory with health coaching to improve weight outcomes (i.e., decrease in standardized body mass index (zBMI)) and lifestyle behaviors (i.e., improve dietary quality, increase fruit and vegetable intake, reduce sugar-sweetened beverage intake, increase physical activity, and reduce screen time) among children 10- to 17-years old with overweight or obesity versus their peers randomized into a waitlist control condition. The secondary aims of this study are to 1) test whether supplementing the Aim2Be program with health coaching increases adherence and 2) examine the mediators and moderators of adherence to the Aim2Be intervention.

Methods

We will employ a randomized controlled trial design and recruit 200 child and parent dyads to participate in the study (2019–2020). Participants will be recruited from Canadian pediatric weight management clinics and through online advertisements. Child participants must be between the ages of 10 and 17 years, have overweight or obesity, be able to read English at least at a grade 5 level, and have a mobile phone or home computer with internet access. Following baseline data collection, participants will be randomized into intervention and waitlist control groups. Intervention participants will receive access to Aim2Be, with access to health coaching. After having their data collected for 3 months, the control group will gain access to Aim2Be, with no access to health coaching. Participants will control their frequency and duration of app usage to promote autonomy.

Discussion

Findings from this study will determine the efficacy of using Aim2Be in improving child weight outcomes and lifestyle behaviors and guide future mHealth interventions for pediatric weight management.

Trial registration

ClinicalTrials.gov, NCT03651284. Registered 29 August 2018.

Viewpoints of adolescents with overweight and obesity attending lifestyle obesity treatment interventions: a qualitative systematic review

BACKGROUND

Current UK guidance recommends that adolescents with obesity attend a family-based multi-component obesity intervention. However, these programmes suffer from low recruitment and high rates of attrition. Understanding the views of adolescents is necessary for developing future interventions. The aim of this systematic review was to synthesize and explore the views of adolescents who have attended an obesity intervention.

METHODS

Published literature was identified by searching six databases. Studies of adolescents (12-17 years) who attended an obesity intervention were examined. Only studies that collected and analysed data qualitatively were included. Full texts were analysed using thematic synthesis.

RESULTS

Twenty-eight studies were included. Thirty-five analytical themes were developed that were broadly divided into seven domains. Key themes included ensuring adolescents receive a 'tailored intervention' that involves 'active engagement'. Support from professionals, family and peers were valued highly. Adolescents expressed 'prior fears of attending interventions' and wanted 'longer term support'. 'Enjoyment of sport and physical activity' was evident, and adolescents were strongly motivated by improving body image and social desirability.

DISCUSSION

Considering the views of adolescents attending obesity interventions may help to inform policy makers in the development of future interventions. This may lead to an improvement in recruitment and attrition rates.

The Team to Address Bariatric Care in Canadian Children (Team ABC3): Team Grant Research Proposal

BACKGROUND

Severe obesity (SO) in Canadian children remains poorly understood. However, based on international data, the prevalence of SO appears to be increasing and is associated with a number of psychosocial, bio-mechanical, and cardiometabolic health risks. The purpose of our national Team to Address Bariatric Care in Canadian Children (Team ABC3) is to develop and lead a series of inter-related studies to enhance the understanding and management of SO in Canadian children and adolescents (0-18 years).

METHODS/DESIGN

From 2015 to 2019, Team ABC3 will conduct a series of projects at the regional, provincial, and national levels using multiple methods and study designs to respond to key knowledge gaps by (i) generating evidence on the prevalence of SO and its impact on health services utilization in children using existing Canadian data sources from primary care settings, (ii) exploring contemporary definitions of SO that link with health outcomes, (iii) comparing and contrasting health risks across the continuum of SO, (iv) understanding potential barriers to and facilitators of treatment success in children with SO, and (v) examining innovative lifestyle and behavioral interventions designed to successfully manage SO in children and their families. Furthermore, to examine the impact of innovative interventions on the management SO, we will (vi) evaluate whether adding a health coach, who provides support via text, email, and/or phone, improves children's ability to adhere to a web-based weight management program and (vii) test the feasibility and impact of a community-based weight management program for pre-school children with SO and their parents that combines group-based parenting sessions with in-home visits.

DISCUSSION

Our research aligns with national priorities in obesity research, brings together leading scientists, clinicians, and stakeholders from across Canada, and will inform health services delivery throughout the country to provide the best care possible for children with SO and their families.

Process evaluation results of a cluster randomised controlled childhood obesity prevention trial: the WAVES study

BACKGROUND

Increasing prevalence of childhood obesity and its related consequences emphasises the importance of developing and evaluating interventions aimed at prevention. The importance of process evaluation in health intervention research is increasingly recognised, assessing implementation and participant response, and how these may relate to intervention success or failure. A comprehensive process evaluation was designed and undertaken for the West Midlands ActiVe lifestyle and healthy Eating in School children (WAVES) study that tested the effectiveness of an obesity prevention programme for children aged 6-7 years, delivered in 24 UK schools. The four intervention components were: additional daily school-time physical activity (PA); cooking workshops for children and parents; Villa Vitality (VV), a 6-week healthy lifestyle promotion programme run by a local football club; and signposting to local PA opportunities.

METHODS

Data relating to six dimensions (Fidelity, Reach, Recruitment, Quality, Participant Responsiveness, Context) were collected via questionnaires, logbooks, direct observations, focus groups and interviews. Multiple data collection methods allowed for data triangulation and validation of methods, comparing research observations with teacher records. The 6-stage WAVES study model ((i) Data collection, (ii) Collation, (iii) Tabulation, (iv) Score allocation and discussion, (v) Consultation, (vi) Final score allocation) was developed to guide the collection, assimilation and analysis of process evaluation data. Two researchers independently allocated school scores on a 5-point Likert scale for each process evaluation dimension. Researchers then discussed school score allocations and reached a consensus. Schools were ranked by total score, and grouped to reflect low, medium or high intervention implementation.

RESULTS

The intervention was predominantly well-implemented and well-received by teachers, parents and children. The PA component was identified as the most challenging, VV the least. Median implementation score across schools was 56/75 (IQR, 51.0 - 60.8). Agreement between teacher logbooks and researcher observations was generally high, the main discrepancies occurred in session duration reporting where in some cases teachers' estimations tended to be higher than researchers'.

CONCLUSIONS

The WAVES study model provides a rigorous and replicable approach to undertaking and analysing a multi-component process evaluation. Challenges to implementing school-based obesity prevention interventions have been identified which can be used to inform future trials.

TRIAL REGISTRATION

ISRCTN97000586 . 19 May 2010.

Process evaluation design in a cluster randomised controlled childhood obesity prevention trial: the WAVES study

Background

The implementation of a complex intervention is heavily influenced by individual context. Variation in implementation and tailoring of the intervention to the particular context will occur, even in a trial setting. It is recognised that in trials, evaluating the process of implementation of a complex intervention is important, yet process evaluation methods are rarely reported. The WAVES study is a cluster randomised controlled trial to evaluate the effectiveness of an obesity prevention intervention programme targeting children aged 6–7 years, delivered by teachers in primary schools across the West Midlands, UK. The intervention promoted activities encouraging physical activity and healthy eating. This paper presents the methods used to assess implementation of the intervention.

Methods

Previous literature was used to identify the dimensions of intervention process and implementation to be assessed, including adherence, exposure, quality of delivery, participant responsiveness, context, and programme differentiation.

Results

Multiple methods and tools were developed to capture information on all these dimensions. These included observations, logbooks, qualitative evaluation, questionnaires and research team reflection.

Discussion

Data collection posed several challenges, predominantly when relying on teachers to complete paperwork, which they saw as burdensome on top of their teaching responsibilities. However, the use of multiple methods helped to ensure data on each dimension, where possible, was collected using more than one method. This also allowed for triangulation of the findings when several data sources on any one dimension were available.

Conclusions

We have reported a comprehensive approach to the assessment of the implementation and processes of a complex childhood obesity prevention intervention within a cluster randomised controlled trial. These approaches can be transferred and adapted for use in other complex intervention trials.

Trial registration number

ISRCTN97000586