Exploring the Potential for Technology-Based Nutrition Education Among WIC Recipients in Remote Alaska Native Communities

Development of a colorectal cancer screening intervention for Alaska Native people during a pandemic year

Objectives

Alaska Native (AN) people experience twice the rate of colorectal cancer (CRC) as US Whites. There is a need for increased screening and early detection. We describe the development and implementation of a randomized controlled trial of the multi-target stool DNA test (mt-sDNA; Cologuard® Exact Sciences, Madison WI) to increase CRC screening among AN people.

Methods

A total of 32 rural/remote AN communities were randomized to a varied intensity intervention (patient navigation vs mailed health education) compared to 14 communities receiving usual opportunistic care. Outcome measures include screening completion and method used (mt-sDNA vs colonoscopy). Health care provider interviews and AN patient focus groups will be used to assess patient-, provider-, and system-level CRC screening promoters and barriers.

Results

The study began in April 2020 during the COVID-19 pandemic, resulting in a number of challenges and study adaptations. These included difficulty finding laboratory space, lack of timely mail service due to flight reductions across the state, and travel restrictions that led to postponement of in-person focus groups. Videoconferencing platforms for Tribal engagement replaced face-to-face interactions. After an extensive search, a laboratory with space available was identified and the preprocessing laboratory established. Study staff will work closely with patients to monitor mail service to get mt-sDNA kits sent on time. We are also exploring the use of videoconferencing platforms as alternatives to in-person focus groups.

Conclusions

Despite the challenges encountered during the COVID-19 pandemic, we successfully initiated the intervention and established the first mt-sDNA preprocessing laboratory in Alaska.

Use of new technologies and promotion of breastfeeding: integrative literature review

Objective:

To identify the most used social networks and the most consumed contents by women seeking support and further understanding of breastfeeding/breast milk.

Data source:

An integrative literature review was performed using the Psychology & Behavioral Sciences Collection, MEDLINE Complete, CINAHL Complete, MedicLatina, Academic Search Complete and ERIC databases. The search was conducted in April, 2020. The inclusion criteria were: publications in Portuguese, English or Spanish with several keywords, such as “Breastfeeding”, “Social Networking”, “Social Media”, “Breastfeeding Promotion”, in the title and in the abstract, with the combination of the Boolean operators “AND” and “OR”, in original articles of primary source, which were available in full text and were published between 2015 and 2020.

Data synthesis:

Out of the 93 articles that were first examined, 10 were used in the descriptive summary. Studies from the United States, Sweden, New Zealand, Brazil, Australia, Indonesia, and Switzerland were included in the review. Women were found to use several social networks, which is facilitated by an easy access to the Internet and to its content through several electronic resources, often using more than one device simultaneously. Most issues were universally recognized as some of the most common reasons for interrupting breastfeeding.

Conclusions:

The analyzed studies show that women seek to clarify their doubts outside the traditional health services’ environment, using Facebook, apps, websites, online videos, podcasts and e-mail. We stress the importance of these support groups for promoting breastfeeding and the need for health professionals to introduce themselves in social networks to reach mothers.

Interest in Receiving Nutrition Information Through Social Media Among Food-Security Program Participants in Washington, DC

Introduction

Effective communication approaches are necessary to reach food-security program participants. Accessing food-security programs has been especially challenging during the COVID-19 pandemic. Social media can play an important role in reducing some communication barriers. We examined interest in receiving nutrition information via social media among adults participating in food-security programs in Washington, DC.

Methods

We developed and administered a 22-item survey to adults participating in food-security programs (N = 375). Participants were recruited at Martha’s Table, in Washington, DC, from January through March 2020. We performed bivariate analyses and multinomial logistic regressions to examine predictors of interest in receiving nutrition information via social media.

Results

Sixty-nine percent of participants reported using social media, and 49% expressed interest in receiving nutrition information via social media. Higher levels of self-efficacy and belief in the value of digital technology were associated with greater likelihood of interest in receiving nutrition information via social media (χ²₆ = 139.0; Nagelkerke R² = 0.35; P < .001). We found no differences by sex or digital technology access in interest in receiving nutrition information via social media.

Conclusion

Social media is a widely used and a feasible method to reach food-security program participants. Understanding program participants’ interest in receiving health information via social media may help food-security programs plan effective communication strategies to improve food security, especially when in-person participation is limited, such as during the COVID-19 pandemic.

Technology-based Health Education Resources for Indigenous Adults: A Scoping Review

Indigenous peoples experience a disparate burden of chronic diseases and lower access to health education resources compared with other populations. Technology can increase access to health education resources, potentially reducing health inequities in these vulnerable populations. Although many Indigenous communities have limited access to the Internet, this barrier is decreasing as tribes and Indigenous-serving organizations work to improve TechQuity. Using Arksey and O'Malley's framework, we conducted a scoping literature review to identify technology-based health education interventions designed for Indigenous adults. We searched multiple databases, limiting papers to those written in English, describing interventions for participants 18 years of age or older, and published between 1999-2020. The review yielded 229 articles, nine of which met eligibility criteria. Findings suggest a paucity of technology-based health education interventions designed for Indigenous peoples and limited testing of the existing resources. Future health disparity research should focus on development and rigorous testing of such interventions.

A Text Messaging Intervention (Txt4HappyKids) to Promote Fruit and Vegetable Intake Among Families With Young Children: Pilot Study

Background

Increasing fruit and vegetable intake among low-income populations, especially children, is a priority for United States federal food assistance programs. With over 49 million federal food assistance program recipients, cost-effective and efficient methods are needed to effectively deliver nutrition education to such a large population.

Objective

The objective of our study was to examine the preliminary efficacy and acceptability of a text messaging intervention, Txt4HappyKids, to promote fruit and vegetable intake among families with young children.

Methods

The intervention was evaluated using a pre-post study design. Parents (N=72) in Alaska were recruited from venues that serve a predominantly low-income population to participate in an 11-week intervention based on social cognitive theory. Parents received two texts per week promoting child fruit and vegetable intake. Behaviors, self-efficacy, and attitudes related to fruit and vegetable intake were measured at baseline and postintervention. Perceived changes in behaviors and open-ended feedback were also collected postintervention.

Results

Of all participants, 67.3% (72/107) completed the intervention. We found no changes in behavior (P=.26), self-efficacy (P=.43), or attitudes (P=.35) related to fruit and vegetable intake from pre- to postintervention. Completers reported that since their participation in Txt4HappyKids, 92% (66/72) served more fruits and vegetables to their child because they thought fruits and vegetables were beneficial, 86% (62/72) tried to follow a healthier diet, 85% (61/72) tried different ways of preparing fruits and vegetables, and 81% (58/72) were more aware of the foods their child consumes. Additionally, 79% (57/72) of completers thought that Txt4HappyKids was credible, 71% (51/72) found texts useful, and 82% (59/72) would recommend it to a friend.

Conclusions

A text messaging intervention was not sufficient to increase fruit and vegetable intake among families with young children. However, parents felt positively impacted by Txt4HappyKids and were receptive to nutrition information, despite the absence of face-to-face contact. High satisfaction among completers indicates that text messaging may be an acceptable complement to budget-constrained nutrition programs. These findings are an important first step in developing larger multi-level interventions utilizing mobile technology; however, a more rigorous evaluation of the Txt4HappyKids intervention is warranted.