1
|
Yudkin JS, Koym K, Hamad Y, Malthaner LQ, Burgess RM, Ortiz LN, Dhurjati N, Mitha S, Calvi G, Hill K, Brownell M, Wei E, Swartz K, Atem FD, Galeener CA, Messiah SE, Barlow SE, Allicock MA. Family-based pediatric weight management interventions in US primary care settings targeting children ages 6-12 years old: A systematic review guided by the RE-AIM framework. Transl Behav Med 2024; 14:34-44. [PMID: 37632769 DOI: 10.1093/tbm/ibad051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/28/2023] Open
Abstract
Obesity is a pandemic that disproportionately affects children from vulnerable populations in the USA. Current treatment approaches in primary care settings in the USA have been reported to be insufficient at managing pediatric obesity, primarily due to implementation challenges for healthcare systems and barriers for families. While the literature has examined the efficacy of pediatric obesity interventions focused on internal validity, it lacks sufficient reporting and analysis of external validity necessary for successful translation to primary care settings. We conducted a systematic review of the primary-care-setting literature from January 2007 to March 2020 on family-based pediatric weight management interventions in both English and/or Spanish for children ages 6-12 years in the USA using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. A literature search, using PRISMA guidelines, was conducted in January 2022 using the following electronic databases: Medline Ovid, Embase, and Cochrane Library. 22 270 records were screened, and 376 articles were reviewed in full. 184 studies were included. The most commonly reported dimensions of the RE-AIM framework were Reach (65%), Efficacy/Effectiveness (64%), and Adoption (64%), while Implementation (47%) and Maintenance (42%) were less often reported. The prevalence of reporting RE-AIM construct indicators ranged greatly, from 1% to 100%. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. It also suggests conducting additional research on sustainable financing for pediatric obesity interventions.
Collapse
Affiliation(s)
- Joshua S Yudkin
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kelsey Koym
- Texas Medical Center Library, Houston, TX, USA
| | - Yasmin Hamad
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Lauren Q Malthaner
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Rebecca Meredith Burgess
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Nalini Dhurjati
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sharmin Mitha
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Gabriela Calvi
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Kristina Hill
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | | | - Elena Wei
- Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Kyle Swartz
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Folefac D Atem
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Carol A Galeener
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Messiah
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
- Center for Pediatric Population Health, The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| | - Sarah E Barlow
- Children's Health, Children's Medical Center Dallas, Dallas, TX, USA
- Department of Pediatrics, Division of Pediatric Gastroenterology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marlyn A Allicock
- The University of Texas Health Science Center at Houston (UTHealth) School of Public Health, Dallas, TX, USA
| |
Collapse
|
2
|
Hammad NM, Kay MC. Perspectives on healthy eating practices and acceptance of WIC-approved foods among parents of young children enrolled in WIC. PLoS One 2023; 18:e0295902. [PMID: 38127887 PMCID: PMC10734995 DOI: 10.1371/journal.pone.0295902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 12/01/2023] [Indexed: 12/23/2023] Open
Abstract
INTRODUCTION The prevalence of childhood obesity remains high in the United States, particularly among children living in low-income households. Diet quality plays an important role in obesity prevention, particularly among mothers as they serve as role models. Those served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receive nutrient-rich foods aimed at increasing diet quality, yet redemption is low. Digital interventions targeting WIC parents show potential for behavior change and could be used for childhood obesity prevention. METHODS This study describes the formative research conducted to understand perspectives on healthy eating practices, acceptance of WIC-approved foods, and preferences for the use of digital tools to improve the purchasing and consumption of WIC-approved foods to improve diet quality. In-depth interviews were conducted with 13 WIC parents and caregivers. RESULTS A variety of definitions for and misconceptions about healthy eating exist among WIC caregivers. Most purchased foods were fruits, vegetables, milk, cheese, and eggs and the least purchased foods were yogurt and peanut butter. The biggest facilitator for purchasing WIC-approved foods was the preference of children and caregivers, whereas the biggest barrier was children's picky eating behaviors. Most caregivers reported using their phone to get nutrition information. Most caregivers reported their interest in receiving weekly text messages and indicated preferences about receiving recipes. CONCLUSION A text messaging program that includes sending weekly messages, recipes, and nutrition tips is hypothesized to improve diet quality and increase redemption of WIC-approved foods.
Collapse
Affiliation(s)
- Nour M. Hammad
- Department of Nutrition, Harvard University, Boston, Massachusetts, United States of America
| | - Melissa C. Kay
- Department of Pediatrics, Duke University, Durham, North Carolina, United States of America
| |
Collapse
|
3
|
Brock DJP, Yuhas M, Porter KJ, Chow PI, Ritterband LM, Tate DF, Zoellner JM. Outcomes of a Caregiver-Focused Short Message Service (SMS) Intervention to Reduce Intake of Sugar-Sweetened Beverages in Rural Caregivers and Adolescents. Nutrients 2023; 15:1957. [PMID: 37111178 PMCID: PMC10141983 DOI: 10.3390/nu15081957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
This study examined enrollment, retention, engagement, and behavior changes from a caregiver short message service (SMS) component of a larger school-based sugar-sweetened beverage (SSB) reduction intervention. Over 22 weeks, caregivers of seventh graders in 10 Appalachian middle schools received a two-way SMS Baseline Assessment and four monthly follow-up assessments to report their and their child's SSB intake and select a personalized strategy topic. Between assessments, caregivers received two weekly one-way messages: one information or infographic message and one strategy message. Of 1873 caregivers, 542 (29%) enrolled by completing the SMS Baseline Assessment. Three-quarters completed Assessments 2-5, with 84% retained at Assessment 5. Reminders, used to encourage adherence, improved completion by 19-40%, with 18-33% completing after the first two reminders. Most caregivers (72-93%) selected a personalized strategy and an average of 28% viewed infographic messages. Between Baseline and Assessment 5, daily SSB intake frequency significantly (p < 0.01) declined for caregivers (-0.32 (0.03), effect size (ES) = 0.51) and children (-0.26 (0.01), ES = 0.53). Effect sizes increased when limited to participants who consumed SSB twice or more per week (caregivers ES = 0.65, children ES = 0.67). Findings indicate that an SMS-delivered intervention is promising for engaging rural caregivers of middle school students and improving SSB behaviors.
Collapse
Affiliation(s)
- Donna-Jean P. Brock
- Department of Public Health Sciences, Community-Based Health Equity Research Program, University of Virginia, Christiansburg, VA 24073, USA; (D.-J.P.B.)
| | - Maryam Yuhas
- Department of Nutrition and Food Studies, Falk College, Syracuse University, Syracuse, NY 13244, USA;
| | - Kathleen J. Porter
- Department of Public Health Sciences, Community-Based Health Equity Research Program, University of Virginia, Christiansburg, VA 24073, USA; (D.-J.P.B.)
| | - Philip I. Chow
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908, USA; (P.I.C.)
| | - Lee M. Ritterband
- Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA 22908, USA; (P.I.C.)
| | - Deborah F. Tate
- Department of Nutrition, Communication for Health Applications and Interventions Core, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Jamie M. Zoellner
- Department of Public Health Sciences, Community-Based Health Equity Research Program, University of Virginia, Christiansburg, VA 24073, USA; (D.-J.P.B.)
| |
Collapse
|
4
|
Vilasboas T, Le Q, Greaney ML, Lindsay AC. Brazilian Immigrant Parents' Preferences for Content and Intervention Modalities for the Design of a Family-Based Intervention to Promote Their Preschool-Age Children's Healthful Energy Balance-Related Behaviors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4817. [PMID: 36981726 PMCID: PMC10048827 DOI: 10.3390/ijerph20064817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
Brazilians are a rapidly growing ethnic immigrant population in the United States (U.S.), and there is a lack of childhood obesity prevention interventions addressing the needs of Brazilian preschool-age children. Using the family ecological model (FEM) as a guide, this developmental cross-sectional study assessed the preferences (content, intervention modality, and language) of 52 individual Brazilian immigrant parents (27 mothers, 25 fathers) for a family-based intervention to promote healthful energy balance-related behaviors (EBRB). Overall, 85% or more of parents reported being interested or very interested in content related to five of the seven assessed EBRBs (increasing fruits and vegetables, reducing unhealthy foods and sugar-sweetened beverages, increasing physical activity, and reducing screen time). Parent-preferred intervention modalities were group sessions delivered by community health workers (CHWs, 86.5%), email (84.6%), and messaging (78.8%), with most parents (71.2%) indicating a preference for content in Portuguese. Interventions integrating multiple components, such as group sessions offered by CHWs and text messaging using SMS and WhatsApp, should be considered. Future steps for intervention development should include investigating different communication channels and their integration into a culturally and linguistically tailored family-based intervention designed to promote healthful EBRBs of preschool-age children in Brazilian families living in the U.S.
Collapse
Affiliation(s)
- Thaís Vilasboas
- Department of Biology, College of Science and Mathematics, University of Massachusetts Boston, Boston, MA 02125, USA
| | - Qun Le
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts—Lowell, Lowell, MA 01854, USA
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA
| | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, Robert and Donna Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA
| |
Collapse
|
5
|
Yuhas M, Brock DJP, Ritterband LM, Chow PI, Porter KJ, Zoellner JM. Retention and engagement of rural caregivers of adolescents in a short message service intervention to reduce sugar-sweetened beverage intake. Digit Health 2023; 9:20552076231160324. [PMID: 36949896 PMCID: PMC10026137 DOI: 10.1177/20552076231160324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/10/2023] [Indexed: 03/19/2023] Open
Abstract
Objective This study investigates a 6-month short message service (SMS) intervention to reduce adolescent sugar-sweetened beverage (SSB) intake. The objectives are to describe caregiver retention and SMS engagement as well as explore differences by caregiver characteristics. Methods Caregivers completed a baseline survey then messages were sent two times per week. Message types included the following: SSB intake assessments, educational information, infographic URLs, and strategies. Engagement was measured through interaction with these messages and included: assessment completion, reminders needed, number of strategies chosen, and URLs clicked. Results Caregivers (n = 357) had an average baseline SSB intake of 23.9 (SD = 26.8) oz/day. Of those, 89% were retained. Caregivers with a greater income and education were retained at a higher rate. Average engagement included: 4.1 (SD = 1.3) of 5 assessments completed with few reminders needed [4.1 (SD = 3.7) of 14 possible], 3.2 (SD = 1.1) of 4 strategies selected, and 1.2 (SD = 1.6) of 5 URLs clicked. Overall, average engagement was relatively high, even where disparities were found. Demographic characteristics that were statistically related to lower engagement included younger age, lower income, lower educational attainment, single caregivers, lower health literacy. Furthermore, caregivers with a reduced intention to change SSB behaviors completed fewer assessments and needed more reminders. Higher baseline SSB intake was associated with lower engagement across all indicators except URL clicks. Conclusions Results can be used to develop targeted retention and engagement strategies (e.g., just-in-time and/or adaptive interventions) in rural SMS interventions for identified demographic subsets. Trial registration Clincialtrials.gov: NCT03740113.
Collapse
Affiliation(s)
- Maryam Yuhas
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, USA
| | | | - Lee M Ritterband
- School of Medicine, University of Virginia, Christiansburg, VA,
USA
| | - Philip I Chow
- School of Medicine, University of Virginia, Christiansburg, VA,
USA
| | | | - Jamie M Zoellner
- School of Medicine, University of Virginia, Christiansburg, VA,
USA
| |
Collapse
|
6
|
Ben Othman R, Talbi E, Mizouri R, Ben Amor N, Gamoudi A, Lahmer I, Berriche O, Mahjoub F, Jamoussi H. Evaluation of anthropometric profile in obese children: risk factors & eating disorder. ALEXANDRIA JOURNAL OF MEDICINE 2022. [DOI: 10.1080/20905068.2022.2103884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Affiliation(s)
- rym Ben Othman
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - emna Talbi
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - ramla Mizouri
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - nadia Ben Amor
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - amel Gamoudi
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - ines Lahmer
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - olfa Berriche
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - faten Mahjoub
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| | - henda Jamoussi
- University of Tunis El Manar, Tunisia
- University of Medicine of Tunis, Tunisia
- National Institute of Nutrition of Tunis, Tunisia
| |
Collapse
|
7
|
Heerman WJ, Perrin EM, Yin HS, Schildcrout JS, Delamater AM, Flower KB, Sanders L, Wood C, Kay MC, Adams LE, Rothman RL. The Greenlight Plus Trial: Comparative effectiveness of a health information technology intervention vs. health communication intervention in primary care offices to prevent childhood obesity. Contemp Clin Trials 2022; 123:106987. [PMID: 36323344 DOI: 10.1016/j.cct.2022.106987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The first 1000 days of a child's life are increasingly recognized as a critical window for establishing a healthy growth trajectory to prevent childhood obesity and its associated long-term comorbidities. The purpose of this manuscript is to detail the methods for a multi-site, comparative effectiveness trial designed to prevent childhood overweight and obesity from birth to age 2 years. METHODS This study is a multi-site, individually randomized trial testing the comparative effectiveness of two active intervention arms: 1) the Greenlight intervention; and 2) the Greenlight Plus intervention. The Greenlight intervention is administered by trained pediatric healthcare providers at each well-child visit from 0 to 18 months and consists of a low health literacy toolkit used during clinic visits to promote shared goal setting. Families randomized to Greenlight Plus receive the Greenlight intervention plus a health information technology intervention, which includes: 1) personalized, automated text-messages that facilitate caregiver self-monitoring of tailored and age-appropriate child heath behavior goals; and 2) a web-based, personalized dashboard that tracks child weight status, progress on goals, and electronic Greenlight content access. We randomized 900 parent-infant dyads, recruited from primary care clinics across six academic medical centers. The study's primary outcome is weight for length trajectory from birth through 24 months. CONCLUSIONS By delivering a personalized and tailored health information technology intervention that is asynchronous to pediatric primary care visits, we aim to achieve improvements in child growth trajectory through two years of age among a sample of geographically, socioeconomically, racially, and ethnically diverse parent-child dyads.
Collapse
Affiliation(s)
- William J Heerman
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Eliana M Perrin
- Johns Hopkins University, Department of Pediatrics, Schools of Medicine and Nursing, 200 N. Wolfe St, Rubenstein Building-2071, Baltimore, MD 21287, United States of America.
| | - H Shonna Yin
- New York University School of Medicine, Departments of Pediatrics and Population Health, 550 First Avenue, New York, NY 10016, United States of America.
| | - Jonathan S Schildcrout
- Vanderbilt University Medical Center, Department of Biostatistics, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Department of Pediatrics, 1601 NW 12(th) Ave., Miami, FL 33136, United States of America.
| | - Kori B Flower
- University of North Carolina at Chapel Hill, Division of General Pediatrics and Adolescent Medicine, 231 MacNider Building, CB# 7225, 321 S. Columbia Street, UNC School of Medicine, Chapel Hill, NC 27599-7225, United States of America.
| | - Lee Sanders
- Stanford University School of Medicine, United States of America.
| | - Charles Wood
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Melissa C Kay
- Duke University School of Medicine, Department of Pediatrics, Division of General Pediatrics and Adolescent Health, 3116 N. Duke St., Durham, NC 27704, United States of America.
| | - Laura E Adams
- Vanderbilt University Medical Center, Department of Pediatrics, 2200 Children's Way, Suite 2404, Nashville, TN 37232, United States of America.
| | - Russell L Rothman
- Vanderbilt University Medical Center, Institute of Medicine and Public Health, 1161 21st Ave S # D3300, Nashville, TN 37232, United States of America.
| |
Collapse
|
8
|
Díaz EN, Le Q, Campos D, Reyes JM, Wright JA, Greaney ML, Lindsay AC. Central American Parents' Preferences for Content and Modality for a Family-Centered Intervention to Promote Healthful Energy Balance-Related Behaviors of Their Preschool-Age Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5080. [PMID: 35564475 PMCID: PMC9101972 DOI: 10.3390/ijerph19095080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 02/01/2023]
Abstract
This formative research used a cross-sectional survey to assess interest in informational content and intervention modalities for the design of an early childhood obesity prevention intervention for Central American families from the Northern Triangle countries (El Salvador, Guatemala, and Honduras) living in the United States. A total of 74 parents (36 mothers, 38 fathers) with a mean age of 31.6 years (SD = 5.6) completed the survey; 59.5% of whom were born outside of the United States. Although most parents reported being very interested in receiving information related to the seven assessed energy balance-related behaviors, there were significant differences by parents' gender and nativity. Most parents endorsed remote modalities for content delivery via text/SMS, WhatsApp, and e-mail. However, respondents were also receptive to in-person delivery provided by community health workers. There were also significant differences in parents' preferences for intervention modalities by parents' gender and nativity. Future steps should include investigating different intervention modalities and their integration into a linguistic and culturally sensitive family-based intervention to promote healthful energy balance-related behaviors of preschool-age children in Central American families originating from the Northern Triangle countries.
Collapse
Affiliation(s)
- Elizabeth N. Díaz
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| | - Qun Le
- Department of Public Health, Zuckerberg College of Health Sciences, University of Massachusetts Lowell, Lowell, MA 01854, USA;
| | - Daniel Campos
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| | - Jesnny M. Reyes
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| | - Julie A. Wright
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| | - Mary L. Greaney
- Department of Health Studies, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA;
| | - Ana Cristina Lindsay
- Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02125, USA; (E.N.D.); (D.C.); (J.M.R.); (J.A.W.)
| |
Collapse
|
9
|
Le D, Ozbeki H, Salazar S, Berl M, Turner MM, Price OA. Improving African American women's engagement in clinical research: A systematic review of barriers to participation in clinical trials. J Natl Med Assoc 2022; 114:324-339. [DOI: 10.1016/j.jnma.2022.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/24/2022] [Accepted: 02/14/2022] [Indexed: 12/26/2022]
|
10
|
Mörelius E, Robinson S, Arabiat D, Whitehead L. Digital Interventions to Improve Health Literacy Among Parents of Children Aged 0 to 12 Years With a Health Condition: Systematic Review. J Med Internet Res 2021; 23:e31665. [PMID: 34941559 PMCID: PMC8734927 DOI: 10.2196/31665] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/06/2021] [Accepted: 10/29/2021] [Indexed: 01/11/2023] Open
Abstract
Background Parental health literacy is associated with child health outcomes. Parents are increasingly turning to the internet to obtain health information. In response, health care providers are using digital interventions to communicate information to assist parents in managing their child’s health conditions. Despite the emergence of interventions to improve parental health literacy, to date, no systematic evaluation of the effectiveness of the interventions has been undertaken. Objective The aim of this review is to examine the effect of digital health interventions on health literacy among parents of children aged 0-12 years with a health condition. This includes evaluating parents’ engagement (use and satisfaction) with digital health interventions, the effect of these interventions on parental health knowledge and health behavior, and the subsequent impact on child health outcomes. Methods This systematic review was registered a priori on PROSPERO (International Prospective Register of Systematic Reviews) and developed according to the Joanna Briggs Institute methodology for systematic reviews. The databases CINAHL, MEDLINE, and PsycINFO were searched for relevant literature published between January 2010 and April 2021. Studies were included if they were written in English. A total of 2 authors independently assessed the search results and performed a critical appraisal of the studies. Results Following the review of 1351 abstracts, 31 (2.29%) studies were selected for full-text review. Of the 31 studies, 6 (19%) studies met the inclusion criteria. Of the 6 studies, 1 (17%) was excluded following the critical appraisal, and the 5 (83%) remaining studies were quantitative in design and included digital health interventions using web-based portals to improve parents’ health knowledge and health behavior. Owing to heterogeneity in the reported outcomes, meta-analysis was not possible, and the findings were presented in narrative form. Of the 5 studies, satisfaction was measured in 3 (60%) studies, and all the studies reported high satisfaction with the digital intervention. All the studies reported improvement in parental health literacy at postintervention as either increase in disease-specific knowledge or changes in health behavior. Of the 5 studies, only 1 (20%) study included child health outcomes, and this study reported significant improvements related to increased parental health knowledge. Conclusions In response to a pandemic such as COVID-19, there is an increased need for evidence-based digital health interventions for families of children living with health conditions. This review has shown the potential of digital health interventions to improve health knowledge and behavior among parents of young children with a health condition. However, few digital health interventions have been developed and evaluated for this population. Future studies with robust research designs are needed and should include the potential benefits of increased parent health literacy for the child. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42020192386; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=192386
Collapse
Affiliation(s)
- Evalotte Mörelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.,Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.,The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, WA, Australia
| | - Suzanne Robinson
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.,The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, WA, Australia
| | - Diana Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.,Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan.,Australian Research Council Centre of Excellence for the Digital Child, Joondalup, WA, Australia
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.,The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, WA, Australia
| |
Collapse
|
11
|
Evans MG, Fleckman J, Williams TT, Tokarz SM, Theall KP. Delivering Health Information to Parents via a Theory-Informed SMS-Based Intervention: Development and Results from a Pilot Study. Matern Child Health J 2021; 26:49-57. [PMID: 34625869 DOI: 10.1007/s10995-021-03233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Short message service (SMS), or text-based, health interventions offer a promising opportunity to deliver health education and have been shown to improve diet and exercise. However, few are theory-based or target low-income parents. This pilot study, informed by the Theory of Planned Behavior (TPB), primarily sought to determine if health education delivered via SMS was feasible and acceptable to low-income parents of young children. METHODS Using a one-group, pre- to post-test study design to assess a 12-week SMS-based health education program, parents enrolled in a health-related program at an early childhood development center for low-income families were sent three text messages per week that corresponded to a weekly diet or physical activity-related theme. Surveys assessed pre-post changes in TPB constructs and collected program feedback. RESULTS Among the 119 eligible parents invited to participate, 109 were sent all text messages for the duration of the study. Participants were mostly Black (98.9%), 25-39 years old (83.9%), female (93.8%), and in single-parent households (63.8%). More than half (n = 59) completed the pre-survey, answered a bi-directional program text, or completed the post-survey. Twelve participants completed both the pre- and post-survey and at least one bi-directional text. Post-survey results revealed that most participants liked the program design and enjoyed their experience with the program. CONCLUSIONS SMS-based interventions can simplify delivery of health information to low-income parents of young children. Although engagement was low, retention was high, and feedback was largely positive.
Collapse
Affiliation(s)
- Melissa Goldin Evans
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA.
| | - Julia Fleckman
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
| | - Tylar T Williams
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA. .,Institute of Women & Ethnic Studies, New Orleans, LA, USA.
| | - Stephanie M Tokarz
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
| | - Katherine P Theall
- The Department of Social, Behavioral, and Population Sciences, Mary Amelia Center for Women's Health Equity Research, Tulane School of Public Health and Tropical Medicine, 143 S. Liberty St, New Orleans, LA, 70112, USA
| |
Collapse
|
12
|
Moorman EL, Koskela-Staples NC, Mathai BB, Fedele DA, Janicke DM. Pediatric Obesity Treatment via Telehealth: Current Evidence and Future Directions. Curr Obes Rep 2021; 10:371-384. [PMID: 34302603 DOI: 10.1007/s13679-021-00446-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Telehealth delivery of pediatric weight management interventions may address time, travel, and cost barriers to in-person interventions, thus improving accessibility. This narrative review highlights findings from the past 5 years of pediatric lifestyle interventions for weight management that utilize telehealth for treatment delivery. We describe impressions and future directions. RECENT FINDINGS We identified and included 20 studies that described unique interventions from the past 5 years. The majority of reviewed studies indicated statistically significant reductions in BMI z-scores, high retention and attendance, and high satisfaction. However, mean decreases in BMI z-scores were marginal (approximately 0.10) in all but two studies. Studies did not often report effect sizes. Pediatric telehealth weight management interventions demonstrate good feasibility and acceptability. Improvement in reporting results and more rigorous research, including use of randomized designs, recruitment of larger samples, and incorporation of extended follow-up is needed to determine clinical impact and magnitude of effects.
Collapse
Affiliation(s)
- Erin L Moorman
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | | | - Babetta B Mathai
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - David A Fedele
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
| |
Collapse
|
13
|
Brigden A, Anderson E, Linney C, Morris R, Parslow R, Serafimova T, Smith L, Briggs E, Loades M, Crawley E. Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review. J Med Internet Res 2020; 22:e16924. [PMID: 32735227 PMCID: PMC7428934 DOI: 10.2196/16924] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/30/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
Background The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention. Methods A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents.
Collapse
Affiliation(s)
- Amberly Brigden
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emma Anderson
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Catherine Linney
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Richard Morris
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Roxanne Parslow
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Teona Serafimova
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lucie Smith
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emily Briggs
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Maria Loades
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom.,Department of Psychology, University of Bath, Bath, United Kingdom
| | - Esther Crawley
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| |
Collapse
|
14
|
Simione M, Sharifi M, Gerber MW, Marshall R, Avalon E, Fiechtner L, Horan C, Orav EJ, Skelton J, Taveras EM. Family-centeredness of childhood obesity interventions: psychometrics & outcomes of the family-centered care assessment tool. Health Qual Life Outcomes 2020; 18:179. [PMID: 32527270 PMCID: PMC7291578 DOI: 10.1186/s12955-020-01431-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incorporating family-centered care principles into childhood obesity interventions is integral for improved clinical decision making, better follow-through, and more effective communication that leads to better outcomes and greater satisfaction with services. The purpose of this study is to evaluate the psychometric properties of a modified version of the Family Centered-Care Assessment (mFCCA) tool and to assess the family-centeredness of two clinical-community childhood obesity interventions. METHODS Connect for Health was a randomized trial testing the comparative effectiveness of two interventions that enrolled 721 children, ages 2-12 years, with a body mass index (BMI) ≥ 85th percentile. The two arms were (1) enhanced primary care; and (2) enhanced primary care plus contextually-tailored, health coaching. At the end of the one-year intervention, the mFCCA was administered. We used Rasch analyses to assess the tool's psychometrics and examined differences between the groups using multiple linear regression. RESULTS 629 parents completed the mFCCA resulting in an 87% response rate. The mean (SD) age of children was 8.0 (3.0) years. The exploratory factor analysis with 24 items all loaded onto a single factor. The Rasch modeling demonstrated good reliability as evidenced by the person separation reliability coefficient (0.99), and strong validity as evidenced by the range of item difficulty and overall model fit. The mean (SD, range) mFCCA score was 4.14 (0.85, 1-5). Compared to parents of children in the enhanced primary care arm, those whose children were in the enhanced primary care plus health coaching arm had higher mFCCA scores indicating greater perception of family-centeredness (β = 0.61 units [95% CI: 0.49, 0.73]). CONCLUSIONS Using the mFCCA which demonstrated good psychometric properties for the assessment of family-centered care among parents of children with obesity, we found that individualized health coaching is a family-centered approach to pediatric weight management. TRIAL REGISTRATION Clinicaltrials.gov NCT02124460.
Collapse
Affiliation(s)
- Meg Simione
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA. .,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT, USA
| | - Monica W Gerber
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA, USA
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Division of Pediatric Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA, 02114, USA
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA
| | - E John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Joseph Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA, 02114, USA.,Department of Pediatrics, Harvard Medical School, Boston, MA, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
15
|
Tully L, Burls A, Sorensen J, El-Moslemany R, O'Malley G. Mobile Health for Pediatric Weight Management: Systematic Scoping Review. JMIR Mhealth Uhealth 2020; 8:e16214. [PMID: 32490849 PMCID: PMC7301268 DOI: 10.2196/16214] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 01/13/2020] [Accepted: 01/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The prevalence and consequences of obesity among children and adolescents remain a leading global public health concern, and evidence-based, multidisciplinary lifestyle interventions are the cornerstone of treatment. Mobile electronic devices are widely used across socioeconomic categories and may provide a means of extending the reach and efficiency of health care interventions. OBJECTIVE We aimed to synthesize the evidence regarding mobile health (mHealth) for the treatment of childhood overweight and obesity to map the breadth and nature of the literature in this field and describe the characteristics of published studies. METHODS We conducted a systematic scoping review in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, by searching nine academic databases in addition to gray literature for studies describing acceptability, usability, feasibility, effectiveness, adherence, or cost-effectiveness of interventions assessing mHealth for childhood obesity treatment. We also hand searched the reference lists of relevant articles. Studies aimed at the prevention of overweight or obesity were excluded, as were studies in which mHealth was not the primary mode of treatment delivery for at least one study arm or was not independently assessed. A random portion of all abstracts and full texts was double screened by a second reviewer to ensure consistency. Data were charted according to study characteristics, including design, participants, intervention content, behavior change theory (BCT) underpinning the study, mode of delivery, and outcomes measured. RESULTS We identified 42 eligible studies assessing acceptability (n=7), usability (n=2), feasibility or pilot studies (n=15), treatment effect (n=17), and fidelity (n=1). Change in BMI z-scores or percentiles was most commonly measured, among a variety of dietary, physical activity, psychological, and usability or acceptability measures. SMS, mobile apps, and wearable devices made up the majority of mobile interventions, and 69% (29/42) of the studies specified a BCT used. CONCLUSIONS Pediatric weight management using mHealth is an emerging field, with most work to date aimed at developing and piloting such interventions. Few large trials are published, and these are heterogeneous in nature and rarely reported according to the Consolidated Standards of Reporting Trials for eHealth guidelines. There is an evidence gap in the cost-effectiveness analyses of such studies.
Collapse
Affiliation(s)
- Louise Tully
- School of Physiotherapy, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Amanda Burls
- School of Health Sciences, Division of Health Services Research and Management, City University of London, London, United Kingdom
| | - Jan Sorensen
- Healthcare Outcomes Research Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Riyad El-Moslemany
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Grace O'Malley
- School of Physiotherapy, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
- W82GO Child and Adolescent Weight Management Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| |
Collapse
|
16
|
Hodder RK, O'Brien KM, Tzelepis F, Wyse RJ, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2020; 5:CD008552. [PMID: 32449203 PMCID: PMC7273132 DOI: 10.1002/14651858.cd008552.pub7] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Testing the effects of interventions to increase consumption of fruit and vegetables, including those focused on specific child-feeding strategies or broader multicomponent interventions targeting the home or childcare environment is required to assess the potential to reduce this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 January 2020. We searched Proquest Dissertations and Theses in November 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 80 trials with 218 trial arms and 12,965 participants. Fifty trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education only in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 23 of the 80 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption, equivalent to an increase of 5.30 grams as-desired consumption of vegetables (SMD 0.50, 95% CI 0.29 to 0.71; 19 trials, 2140 participants; mean post-intervention follow-up = 8.3 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.32, 95% CI 0.09 to 0.55; 9 trials, 2961 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.34 cups of fruit and vegetables a day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.13, 95% CI -0.02 to 0.28; 11 trials, 3050 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) or unintended adverse consequences of interventions (2 trials), limiting our ability to assess these outcomes. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 80 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited in terms of quality of evidence and magnitude of effect. Of the types of interventions identified, there was moderate-quality evidence that multicomponent interventions probably lead to, and low-quality evidence that child-feeding practice may lead to, only small increases in fruit and vegetable consumption in children aged five years and under. It is uncertain whether parent nutrition education or child nutrition education interventions alone are effective in increasing fruit and vegetable consumption in children aged five years and under. Our confidence in effect estimates for all intervention approaches, with the exception of multicomponent interventions, is limited on the basis of the very low to low-quality evidence. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Kate M O'Brien
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Flora Tzelepis
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Rebecca J Wyse
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| | - Luke Wolfenden
- Hunter New England Population Health, Hunter New England Local Health District, Wallsend, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
- Hunter Medical Research Institute, New Lambton, Australia
- Priority Research Centre in Health and Behaviour, University of Newcastle, Callaghan, Australia
| |
Collapse
|
17
|
Computerized decision support and machine learning applications for the prevention and treatment of childhood obesity: A systematic review of the literature. Artif Intell Med 2020; 104:101844. [DOI: 10.1016/j.artmed.2020.101844] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 03/09/2020] [Accepted: 03/12/2020] [Indexed: 12/20/2022]
|
18
|
Hodder RK, O'Brien KM, Stacey FG, Tzelepis F, Wyse RJ, Bartlem KM, Sutherland R, James EL, Barnes C, Wolfenden L. Interventions for increasing fruit and vegetable consumption in children aged five years and under. Cochrane Database Syst Rev 2019; 2019:CD008552. [PMID: 31697869 PMCID: PMC6837849 DOI: 10.1002/14651858.cd008552.pub6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Insufficient consumption of fruits and vegetables in childhood increases the risk of future non-communicable diseases, including cardiovascular disease. Interventions to increase consumption of fruit and vegetables, such as those focused on specific child-feeding strategies and parent nutrition education interventions in early childhood may therefore be an effective strategy in reducing this disease burden. OBJECTIVES To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase and two clinical trials registries to identify eligible trials on 25 August 2019. We searched Proquest Dissertations and Theses in May 2019. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included trials to identify further potentially relevant trials. SELECTION CRITERIA We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed the risks of bias of included trials; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS We included 78 trials with 214 trial arms and 13,746 participants. Forty-eight trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Fifteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Fourteen trials examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. Two trials examined the effect of a nutrition education intervention delivered to children in increasing child fruit and vegetable intake. One trial examined the impact of a child-focused mindfulness intervention in increasing vegetable intake. We judged 20 of the 78 included trials as free from high risks of bias across all domains. Performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining trials. There is very low-quality evidence that child-feeding practices versus no intervention may have a small positive effect on child vegetable consumption equivalent to an increase of 4.45 g as-desired consumption of vegetables (SMD 0.42, 95% CI 0.23 to 0.60; 18 trials, 2004 participants; mean post-intervention follow-up = 8.2 weeks). Multicomponent interventions versus no intervention has a small effect on child consumption of fruit and vegetables (SMD 0.34, 95% CI 0.10 to 0.57; 9 trials, 3022 participants; moderate-quality evidence; mean post-intervention follow-up = 5.4 weeks), equivalent to an increase of 0.36 cups of fruit and vegetables per day. It is uncertain whether there are any short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.12, 95% CI -0.03 to 0.28; 11 trials, 3078 participants; very low-quality evidence; mean post-intervention follow-up = 13.2 weeks). We were unable to pool child nutrition education interventions in meta-analysis; both trials reported a positive intervention effect on child consumption of fruit and vegetables (low-quality evidence). Very few trials reported long-term effectiveness (6 trials), cost effectiveness (1 trial) and unintended adverse consequences of interventions (2 trials), limiting their assessment. Trials reported receiving governmental or charitable funds, except for four trials reporting industry funding. AUTHORS' CONCLUSIONS Despite identifying 78 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains limited. There was very low-quality evidence that child-feeding practice may lead to, and moderate-quality evidence that multicomponent interventions probably lead to small increases in fruit and vegetable consumption in children aged five years and younger. It is uncertain whether parent nutrition education interventions are effective in increasing fruit and vegetable consumption in children aged five years and younger. Given that the quality of the evidence is very low or low, future research will likely change estimates and conclusions. Long-term follow-up of at least 12 months is required and future research should adopt more rigorous methods to advance the field. This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
Collapse
Affiliation(s)
- Rebecca K Hodder
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M O'Brien
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Fiona G Stacey
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
- University of NewcastlePriority Research Centre in Physical Activity and NutritionCallaghanAustralia
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Rebecca J Wyse
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Kate M Bartlem
- University of NewcastleSchool of PsychologyUniversity DriveCallaghanNew South WalesAustralia2308
| | - Rachel Sutherland
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Erica L James
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Courtney Barnes
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | - Luke Wolfenden
- Hunter New England Local Health DistrictHunter New England Population HealthLocked Bag 10WallsendAustralia2287
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia
- Hunter Medical Research InstituteNew LambtonAustralia
- University of NewcastlePriority Research Centre in Health and BehaviourCallaghanAustralia
| | | |
Collapse
|
19
|
Yuhas M, Porter KJ, Brock DJP, Loyd A, McCormick BA, Zoellner JM. Development and Pilot Testing of Text Messages to Help Reduce Sugar-Sweetened Beverage Intake Among Rural Caregivers and Adolescents: Mixed Methods Study. JMIR Mhealth Uhealth 2019; 7:e14785. [PMID: 31364600 PMCID: PMC6691674 DOI: 10.2196/14785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 06/21/2019] [Accepted: 06/26/2019] [Indexed: 01/30/2023] Open
Abstract
Background A high consumption of sugar-sweetened beverages (SSBs) poses significant health concerns, particularly for rural adults and adolescents. A manner in which the health of both caregivers and adolescents can be improved is by developing innovative strategies that target caregivers as the agents of change. Sending text messages through mobile phones has been cited as an effective way to improve behavioral outcomes, although little research has been conducted in rural areas, particularly focusing on SSB intake. Objective By targeting rural caregivers, this 2-phase study aimed to (1) understand caregivers’ perceptions and language preferences for SSB-related text messages to inform and refine message development and delivery and (2) evaluate the acceptability of text messages for SSB intake behavior change and examine short-term effects on SSB intake behavior. Methods A convergent mixed methods design was used to systematically develop and pilot-test text messages with caregivers in Southwest Virginia. In phase 1, 5 focus groups that included a card-sorting activity were conducted to explore advantages/disadvantages, language preferences (ie, tone of voice, audience, and phrase preferences), and perceived use of text messages. In phase 2, caregivers participated in a 5-week text message pilot trial that included weekly educational and personalized strategy messages and SSB intake assessments at baseline and follow-up. Before the focus groups and after completing the pilot trial, caregivers also completed a pre-post survey that assessed SSB intake, SSB home availability, and caregivers’ SSB-related practices. Caregivers also completed individual follow-up telephone interviews following the pilot trial. Results In phase 1, caregivers (N=33) reported that text messages were convenient, accessible, and easy to read. In addition, they preferred messages with empathetic and authoritative tones that provided useful strategies and stayed away from using absolute words (eg, always and never). In the phase 2 pilot trial (N=30), 87% of caregivers completed baseline and 77% completed follow-up assessment, suggesting a high utilization rate. Other ways in which caregivers reported benefiting from the text messages included sharing messages with family members and friends (80%), making mental notes (57%), and looking back at messages as reminders (50%). Caregivers reported significant improvements in home environment, parenting practices, and rulemaking around SSB (P=.003, P=.02, and P=.04, respectively). In addition, the frequency of SSB intake among caregivers and adolescents significantly decreased (P=.003 and P=.005, respectively). Conclusions Spending time in the formative phases of text message development helped understand the unique perspectives and language preferences of the target population. Furthermore, delivering an intervention through text messages has the potential to improve caregiver behaviors and reduce SSB intake among rural caregivers and adolescents. Findings from this study were used to develop a larger bank of text messages, which would be used in a future study, testing the effectiveness of a text message intervention targeting SSB intake–related caregiver behaviors.
Collapse
Affiliation(s)
- Maryam Yuhas
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Kathleen J Porter
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Donna-Jean P Brock
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Annie Loyd
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Brittany A McCormick
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| | - Jamie M Zoellner
- Department of Public Health Sciences, University of Virginia, Christiansburg, VA, United States
| |
Collapse
|
20
|
Brown T, Moore TH, Hooper L, Gao Y, Zayegh A, Ijaz S, Elwenspoek M, Foxen SC, Magee L, O'Malley C, Waters E, Summerbell CD. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2019; 7:CD001871. [PMID: 31332776 PMCID: PMC6646867 DOI: 10.1002/14651858.cd001871.pub4] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
EDITORIAL NOTE This Cochrane review is now out of date and should not be used for reference. It has been split into four age groups and updated. Please refer to the 5‐11 and 12‐18 age group Cochrane reviews which were published in May 2024: https://doi.org/10.1002/14651858.CD015328.pub2 https://doi.org/10.1002/14651858.CD015330.pub2 The 2‐4 age group Cochrane review is planned for publication in September 2024. BACKGROUND Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies to prevent obesity is very large and is accumulating rapidly. This is an update of a previous review. OBJECTIVES To determine the effectiveness of a range of interventions that include diet or physical activity components, or both, designed to prevent obesity in children. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsychINFO and CINAHL in June 2015. We re-ran the search from June 2015 to January 2018 and included a search of trial registers. SELECTION CRITERIA Randomised controlled trials (RCTs) of diet or physical activity interventions, or combined diet and physical activity interventions, for preventing overweight or obesity in children (0-17 years) that reported outcomes at a minimum of 12 weeks from baseline. DATA COLLECTION AND ANALYSIS Two authors independently extracted data, assessed risk-of-bias and evaluated overall certainty of the evidence using GRADE. We extracted data on adiposity outcomes, sociodemographic characteristics, adverse events, intervention process and costs. We meta-analysed data as guided by the Cochrane Handbook for Systematic Reviews of Interventions and presented separate meta-analyses by age group for child 0 to 5 years, 6 to 12 years, and 13 to 18 years for zBMI and BMI. MAIN RESULTS We included 153 RCTs, mostly from the USA or Europe. Thirteen studies were based in upper-middle-income countries (UMIC: Brazil, Ecuador, Lebanon, Mexico, Thailand, Turkey, US-Mexico border), and one was based in a lower middle-income country (LMIC: Egypt). The majority (85) targeted children aged 6 to 12 years.Children aged 0-5 years: There is moderate-certainty evidence from 16 RCTs (n = 6261) that diet combined with physical activity interventions, compared with control, reduced BMI (mean difference (MD) -0.07 kg/m2, 95% confidence interval (CI) -0.14 to -0.01), and had a similar effect (11 RCTs, n = 5536) on zBMI (MD -0.11, 95% CI -0.21 to 0.01). Neither diet (moderate-certainty evidence) nor physical activity interventions alone (high-certainty evidence) compared with control reduced BMI (physical activity alone: MD -0.22 kg/m2, 95% CI -0.44 to 0.01) or zBMI (diet alone: MD -0.14, 95% CI -0.32 to 0.04; physical activity alone: MD 0.01, 95% CI -0.10 to 0.13) in children aged 0-5 years.Children aged 6 to 12 years: There is moderate-certainty evidence from 14 RCTs (n = 16,410) that physical activity interventions, compared with control, reduced BMI (MD -0.10 kg/m2, 95% CI -0.14 to -0.05). However, there is moderate-certainty evidence that they had little or no effect on zBMI (MD -0.02, 95% CI -0.06 to 0.02). There is low-certainty evidence from 20 RCTs (n = 24,043) that diet combined with physical activity interventions, compared with control, reduced zBMI (MD -0.05 kg/m2, 95% CI -0.10 to -0.01). There is high-certainty evidence that diet interventions, compared with control, had little impact on zBMI (MD -0.03, 95% CI -0.06 to 0.01) or BMI (-0.02 kg/m2, 95% CI -0.11 to 0.06).Children aged 13 to 18 years: There is very low-certainty evidence that physical activity interventions, compared with control reduced BMI (MD -1.53 kg/m2, 95% CI -2.67 to -0.39; 4 RCTs; n = 720); and low-certainty evidence for a reduction in zBMI (MD -0.2, 95% CI -0.3 to -0.1; 1 RCT; n = 100). There is low-certainty evidence from eight RCTs (n = 16,583) that diet combined with physical activity interventions, compared with control, had no effect on BMI (MD -0.02 kg/m2, 95% CI -0.10 to 0.05); or zBMI (MD 0.01, 95% CI -0.05 to 0.07; 6 RCTs; n = 16,543). Evidence from two RCTs (low-certainty evidence; n = 294) found no effect of diet interventions on BMI.Direct comparisons of interventions: Two RCTs reported data directly comparing diet with either physical activity or diet combined with physical activity interventions for children aged 6 to 12 years and reported no differences.Heterogeneity was apparent in the results from all three age groups, which could not be entirely explained by setting or duration of the interventions. Where reported, interventions did not appear to result in adverse effects (16 RCTs) or increase health inequalities (gender: 30 RCTs; socioeconomic status: 18 RCTs), although relatively few studies examined these factors.Re-running the searches in January 2018 identified 315 records with potential relevance to this review, which will be synthesised in the next update. AUTHORS' CONCLUSIONS Interventions that include diet combined with physical activity interventions can reduce the risk of obesity (zBMI and BMI) in young children aged 0 to 5 years. There is weaker evidence from a single study that dietary interventions may be beneficial.However, interventions that focus only on physical activity do not appear to be effective in children of this age. In contrast, interventions that only focus on physical activity can reduce the risk of obesity (BMI) in children aged 6 to 12 years, and adolescents aged 13 to 18 years. In these age groups, there is no evidence that interventions that only focus on diet are effective, and some evidence that diet combined with physical activity interventions may be effective. Importantly, this updated review also suggests that interventions to prevent childhood obesity do not appear to result in adverse effects or health inequalities.The review will not be updated in its current form. To manage the growth in RCTs of child obesity prevention interventions, in future, this review will be split into three separate reviews based on child age.
Collapse
Affiliation(s)
- Tamara Brown
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Bala N, Price SN, Horan CM, Gerber MW, Taveras EM. Use of Telehealth to Enhance Care in a Family-Centered Childhood Obesity Intervention. Clin Pediatr (Phila) 2019; 58:789-797. [PMID: 30894004 DOI: 10.1177/0009922819837371] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Family-centered childhood obesity interventions have been found to be effective. We describe the use of telehealth for tailored behavior change support in a family-centered randomized trial. Children of 2 to 12 years with body mass index ≥85th percentile were randomized to Enhanced Primary Care (EPC) or Enhanced Primary Care + Coaching (EPC + C). EPC + C received 6 health coach visits (in-person or by video or phone call) over 1 year. Telehealth modalities included interactive text messaging, video calls, and an online community resource map. There were 360 children randomized to the EPC + C arm; 87% of parents completed ≥1 health coaching contacts. Overall, 93% parents were sent text messages of which 99% responded at least once. About 72% parents were very satisfied with the message content and 97% were satisfied with information provided about community health resources. The high level of participant engagement and satisfaction suggests that telehealth is feasible and acceptable in family-centered childhood obesity programs.
Collapse
Affiliation(s)
- Natasha Bala
- 1 Massachusetts General Hospital, Boston, MA, USA
| | - Sarah N Price
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Chrissy M Horan
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Monica W Gerber
- 2 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Elsie M Taveras
- 2 Massachusetts General Hospital for Children, Boston, MA, USA.,3 Harvard University, Boston, MA, USA
| |
Collapse
|
22
|
Bakırcı-Taylor AL, Reed DB, McCool B, Dawson JA. mHealth Improved Fruit and Vegetable Accessibility and Intake in Young Children. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:556-566. [PMID: 30638880 DOI: 10.1016/j.jneb.2018.11.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/28/2018] [Accepted: 11/12/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore the potential of mHealth using smartphones to improve fruit and vegetable intake in children. DESIGN A 10-week randomized control and intervention pilot study. SETTING Story time sessions at local libraries. PARTICIPANTS A convenience sample of 30 parents and children (aged 3-8 years). INTERVENTION Delivery of nutrition intervention through the mobile Jump2Health website, Facebook posts, and text messages. MAIN OUTCOME MEASURES Electronic food photos of children's meals and snacks, 10-question survey related to fruit and vegetable consumption, reflectance spectroscopy via Veggie Meter to measure skin carotenoid levels, body mass index percentiles, and a mobile learning survey. ANALYSIS Descriptive statistics and Wilcoxon matched-pairs signed-rank test. RESULTS Veggie Meter values for children and parents showed significant week × treatment interactions in the intervention group compared with the control group for both children (P < .001 and parents (P < .001). CONCLUSIONS AND IMPLICATIONS This pilot study offers a potentially effective program including a mobile Web site, social media, and test message components to increase fruit and vegetable intake of young children.
Collapse
Affiliation(s)
| | - Debra B Reed
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX
| | - Barent McCool
- Department of Restaurant, Hotel, and Institutional Management, Texas Tech University, Lubbock, TX
| | - John A Dawson
- Department of Nutritional Sciences, Texas Tech University, Lubbock, TX
| |
Collapse
|
23
|
Balci AS, Kadioglu H. Text Messages Based Interventions for Pregnant Women’s Health: Systematic Review. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2019. [DOI: 10.33808/marusbed.546694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
24
|
Kay MC, Burroughs J, Askew S, Bennett GG, Armstrong S, Steinberg DM. Digital Weight Loss Intervention for Parents of Children Being Treated for Obesity: A Prospective Cohort Feasibility Trial. J Med Internet Res 2018; 20:e11093. [PMID: 30573449 PMCID: PMC6320402 DOI: 10.2196/11093] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/06/2018] [Accepted: 09/10/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The prevalence of childhood obesity continues to increase, and clinic-based treatment options have failed to demonstrate effectiveness. One of the strongest predictors of child weight is parent weight. Parental treatment for weight loss may indirectly reduce obesity in the child. We have previously demonstrated the effectiveness among adults of a fully automated, evidence-based digital weight loss intervention (Track). However, it is unknown if it is feasible to deliver such a treatment directly to parents with obesity who bring their child with obesity to a weight management clinic for treatment. OBJECTIVE The objective of our study was to evaluate the feasibility of and engagement with a digital weight loss intervention among parents of children receiving treatment for obesity. METHODS We conducted a 6-month pre-post feasibility trial among parents or guardians and their children aged 4-16 years presenting for tertiary care obesity treatment. Along with the standard family-based treatment protocol, parents received a 6-month digital weight loss intervention, which included weekly monitoring of personalized behavior change goals via mobile technologies. We examined levels of engagement by tracking completed weeks of self-monitoring and feasibility by assessing change in weight. RESULTS Participants (N=48) were on average 39 years old, mostly female (35/42, 82% ), non-Hispanic Black individuals (21/41, 51%) with obesity (36/48, 75%). Over a quarter had a yearly household income of CONCLUSIONS It is feasible to deliver an evidence-based digital weight loss intervention to parents or guardians whose children are enrolled in a weight management program. Given the feasibility of this approach, future studies should investigate the effectiveness of digital weight loss interventions for parents on child weight and health outcomes.
Collapse
Affiliation(s)
- Melissa C Kay
- Duke Global Digital Health Science Center, Duke Center for Childhood Obesity Research, Duke University, Durham, NC, United States
| | - Jasmine Burroughs
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Sandy Askew
- Duke Global Digital Health Science Center, Duke University, Durham, NC, United States
| | - Gary G Bennett
- Duke Global Digital Health Science Center, Duke Department of Psychology and Neuroscience, Duke University, Durham, NC, United States
| | - Sarah Armstrong
- Duke Center for Childhood Obesity Research, Duke Department of Pediatrics, Duke University, Durham, NC, United States
| | - Dori M Steinberg
- Duke Global Digital Health Science Center, Duke School of Nursing, Duke University, Durham, NC, United States
| |
Collapse
|
25
|
Fiechtner L, Perkins M, Biggs V, Langhans N, Sharifi M, O'Connor G, Price S, Locascio J, Kuhlthau K, Kwass JA, Nelson C, Land T, Longjohn M, Lawson V, Hohman K, Taveras EM. Rationale and design of the Clinic and Community Approaches to Healthy Weight Randomized Trial. Contemp Clin Trials 2018; 67:16-22. [PMID: 29330083 PMCID: PMC5871582 DOI: 10.1016/j.cct.2018.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/27/2017] [Accepted: 01/08/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Recent studies have demonstrated the effectiveness of family-centered, pediatric weight management programs in reducing childhood obesity. Yet, programs to optimize the care of low-income children with obesity are needed. We sought to examine the comparative effectiveness of two, potentially scalable pediatric weight management programs delivered to low-income children in a clinical or community setting. MATERIALS AND METHODS The Clinic and Community Approaches to Healthy Weight Trial is a randomized trial in two communities in Massachusetts that serve a large population of low-income children and families. The two-arm trial compares the effects of a pediatric weight management program delivered in the Healthy Weight Clinics of two federally qualified health centers (FQHC) to the Healthy Weight and Your Child programs delivered in two YMCAs. Eligible children are 6 to 12 years old with a body mass index (BMI) ≥ 85th percentile seen in primary care at the two FQHCs. Both programs are one-year in duration and have at least 30 contact hours throughout the year. Measures are collected at baseline, 6 months, and 1 year. The main outcome is 1-year change in BMI (kg/m2) and percent change of the 95th percentile (%BMIp95). CONCLUSION The Clinic and Community Approaches to Healthy Weight Trial seeks to 1) examine the comparative effects of a clinical and community based intervention in improving childhood obesity, and 2) inform the care of >7 million children with obesity covered by the Children's Health Insurance Program or Medicaid.
Collapse
Affiliation(s)
- Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA; Department of Gastroenterology and Nutrition, MassGeneral Hospital for Children, 175 Cambridge St., 5th floor, Boston, MA 02114, USA.
| | - Meghan Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Vincent Biggs
- Holyoke Community Health Center, Department of Pediatrics, 230 Maple St., Holyoke, MA 01040, USA.
| | - Nancy Langhans
- Greater New Bedford Community Health Center, Department of Pediatrics, 874 Purchase St., New Bedford, MA 02740, USA.
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, PO Box 208064, New Haven, CT 06520, USA.
| | - Giselle O'Connor
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Sarah Price
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Joseph Locascio
- Department of Neurology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Karen Kuhlthau
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA.
| | - Jo-Ann Kwass
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108, USA.
| | - Candace Nelson
- Bureau of Community Health and Prevention, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108, USA.
| | - Thomas Land
- Office of Data Management and Outcomes Assessment, Massachusetts Department of Public Health, 250 Washington Street, Boston, MA 02108, USA.
| | - Matt Longjohn
- YMCA of the USA, 101 N Wacker Drive, Chicago, IL 60606, USA.
| | - Valerie Lawson
- YMCA of the USA, 101 N Wacker Drive, Chicago, IL 60606, USA.
| | | | - Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, 125 Nashua Street, Suite 860, Boston, MA 02114, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA.
| |
Collapse
|
26
|
Bottino CJ, Puente GC, Burrage A, Tannis C, Cheng JK, Epee-Bounya A, Cox JE. Primary Care Group Visits for Childhood Obesity: Clinical Program Evaluation. Clin Pediatr (Phila) 2018; 57:442-450. [PMID: 28929794 DOI: 10.1177/0009922817728696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted 29 group visits targeting children with elevated body mass index (BMI) and their families. Visit activities focused on social support, mind-body techniques, exercise, and nutrition. Measures included attendance, family satisfaction scores, and per-patient change in BMI percentile. Ninety-six patients attended ≥1 group visit, mean 2.0 (SD ±1.8; range 1-14). Mean patient age was 9.6 years (SD ±2.4; range 4-15 years); 53.1% were female; 44.8% had a BMI 95th to 99th percentile for age/sex; 35.4% had a BMI >99th percentile. Mean attendance per group visit was 6.8 patients (SD ±3.8; range 1-16 patients). Mean family satisfaction scores were 9.8 (SD ±0.8) with 10/10 "would recommend to family or friends." Of 42 patients who attended ≥2 group visits, 5 (11.9%) experienced a ≥5 BMI percentile reduction between first and last visits; 3 (7.1%) maintained this reduction 2 years later. Group visits were associated with high family satisfaction scores, though few patients experienced a reduction in BMI percentile.
Collapse
Affiliation(s)
- Clement J Bottino
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Gabriella C Puente
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - Amanda Burrage
- 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Candace Tannis
- 3 Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jennifer K Cheng
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Alexandra Epee-Bounya
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Joanne E Cox
- 1 Division of General Pediatrics, Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| |
Collapse
|
27
|
Criss S, Blaine RE, Palamé M, Perkins M, Davison K, Kwass JA, Taveras EM. Health Marketing for the Massachusetts Childhood Obesity Research Demonstration Study: A Case Study. Health Promot Pract 2018; 20:282-291. [PMID: 29566576 DOI: 10.1177/1524839918760842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. This case study describes the Massachusetts Childhood Obesity Research Demonstration Study (MA-CORD) health marketing campaign, examines the strategies used in such campaigns, and offers lessons learned to improve health marketing for future interventions. MA-CORD Health Marketing Components and Implementation. The three main components were an outdoor printed advertisement and texting campaign, social media with a focus on Facebook, and the Summer Passport Program, an event-based initiative in parks for children. The advertisements consisted of billboards, bus advertisements, and handouts. The text messaging component, which required families to actively text a keyword to join, had a low opt-in rate. Facebook page "likes" increased from 1,024 to 1,453 in New Bedford and from 175 to 1,091 in Fitchburg. Fitchburg received technical assistance and paid for ads on Facebook. The Summer Passport participation in parks ranged from 120 to 875 children with participation in the free park lunch program doubling in Fitchburg. Discussion. Key lessons learned are engage communication experts from each community at the beginning of the project, use text messaging components with in-person staff onsite to assist participants in the opt-in process, build momentum for a Facebook presence through purchasing Facebook advertisements, and partner with local park departments for programming.
Collapse
Affiliation(s)
| | | | | | | | | | - Jo-Ann Kwass
- Massachusetts Department of Public Health, Boston, MA, USA
| | | | | |
Collapse
|
28
|
Guillot-Wright SP, Lu Y, Torres ED, Le VD, Hall HR, Temple JR. Design and Feasibility of a School-Based Text Message Campaign to Promote Healthy Relationships. SCHOOL MENTAL HEALTH 2018. [DOI: 10.1007/s12310-018-9255-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
Martinez-Brockman JL, Harari N, Pérez-Escamilla R. Lactation Advice through Texting Can Help: An Analysis of Intensity of Engagement via Two-Way Text Messaging. JOURNAL OF HEALTH COMMUNICATION 2017; 23:40-51. [PMID: 29236569 DOI: 10.1080/10810730.2017.1401686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Rates of breastfeeding initiation and duration among women who attend the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are dramatically lower than nonparticipants. Innovative solutions are needed to improve breastfeeding rates in this population. The Lactation Advice through Texting Can Help (LATCH) study was one such approach, designed to augment and reinforce the WIC breastfeeding peer counseling process. The purpose of the present study was to examine engagement via two-way text messaging in a sample of women attending the WIC breastfeeding peer counseling program and enrolled in LATCH. The objectives were to: (1) describe text message engagement in the context of LATCH; and (2) assess the association between engagement variables and exclusive breastfeeding status. Text messaging data were first coded qualitatively by two independent researchers and engagement variables created. An analysis of engagement was conducted using descriptive statistics for normally distributed data and binary logistic regression. In the multivariable model, intensity of engagement during the first 2 weeks post partum was the single strongest predictor of exclusive breastfeeding status. LATCH is an innovative intervention designed to enhance the capacity of breastfeeding peer counselors and holds much potential for improving exclusive breastfeeding rates in this population.
Collapse
Affiliation(s)
| | - N Harari
- b Chinle Comprehensive Health Care Facility , Indian Health Service , Chinle , AZ , USA
| | | |
Collapse
|
30
|
Blake-Lamb T, Boudreau AA, Matathia S, Tiburcio E, Perkins ME, Roche B, Kotelchuck M, Shtasel D, Price SN, Taveras EM. Strengthening integration of clinical and public health systems to prevent maternal-child obesity in the First 1,000Days: A Collective Impact approach. Contemp Clin Trials 2017; 65:46-52. [PMID: 29225195 DOI: 10.1016/j.cct.2017.12.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/05/2017] [Accepted: 12/07/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Obesity interventions may be most effective if they begin in the earliest stages of life, support changes across family, clinical, and public health systems, and address socio-contextual factors. METHODS The First 1000Days is a systematic program starting in early pregnancy lasting through the first 24months of infancy to prevent obesity among low-income mother-infant pairs in three community health centers in Massachusetts. The program uses a Collective Impact approach to create the infrastructure for sustained, system-wide changes for obesity prevention across early life clinical and public health services, including Obstetrics, Pediatrics, Adult Medicine, Behavioral Health, Nutrition, Community Health, the Women, Infants and Children (WIC) program, and the Maternal, Infant and Childhood Home Visiting program. Program components include 1) staff and provider training; 2) enhanced gestational weight gain and infant overweight tracking; 3) universal screening of adverse health behaviors and socio-contextual factors; 4) universal patient navigation to support individual behavior change and social needs, while strengthening integration of clinical and public health services; 5) individualized health coaching for mother-infant pairs at high risk of obesity; and 6) educational materials to support behavior change. RESULTS A quasi-experimental evaluation design will examine changes, between 2015 and 2019, in gestational weight gain and prevalence of infant overweight from 0 to 24months of age. CONCLUSIONS The First 1000Days program will examine the effectiveness of an early life obesity prevention program for mother-infant pairs. If successful, the program could provide a model for chronic disease prevention and health promotion among vulnerable families starting in early life.
Collapse
Affiliation(s)
- Tiffany Blake-Lamb
- Kraft Center for Community Health, Massachusetts General Hospital, 125 Nashua St, Suite 860, Boston, MA 02114, United States; Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Alexy Arauz Boudreau
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States
| | - Sarah Matathia
- Kraft Center for Community Health, Massachusetts General Hospital, 125 Nashua St, Suite 860, Boston, MA 02114, United States; Department of Family Medicine, DotHouse Health, 1353 Dorchester Avenue, Dorchester, MA, United States
| | - Etna Tiburcio
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States
| | - Meghan E Perkins
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States
| | - Brianna Roche
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States
| | - Milton Kotelchuck
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States
| | - Derri Shtasel
- Kraft Center for Community Health, Massachusetts General Hospital, 125 Nashua St, Suite 860, Boston, MA 02114, United States; Division of Public and Community Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, United States
| | - Sarah N Price
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States
| | - Elsie M Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, 125 Nashua St, Suite 860, Boston, MA 02114, United States; Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA 02114, United States; Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA 02115, United States.
| |
Collapse
|
31
|
Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, Gerber MW, Orav EJ, Price SN, Sequist T, Slater D. Comparative Effectiveness of Clinical-Community Childhood Obesity Interventions: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:e171325. [PMID: 28586856 PMCID: PMC6075674 DOI: 10.1001/jamapediatrics.2017.1325] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Novel approaches to care delivery that leverage clinical and community resources could improve body mass index (BMI) and family-centered outcomes. OBJECTIVE To examine the extent to which 2 clinical-community interventions improved child BMI z score and health-related quality of life, as well as parental resource empowerment in the Connect for Health Trial. DESIGN, SETTING, AND PARTICIPANTS This 2-arm, blinded, randomized clinical trial was conducted from June 2014 through March 2016, with measures at baseline and 1 year after randomization. This intent-to-treat analysis included 721 children ages 2 to 12 years with BMI in the 85th or greater percentile from 6 primary care practices in Massachusetts. INTERVENTIONS Children were randomized to 1 of 2 arms: (1) enhanced primary care (eg, flagging of children with BMI ≥ 85th percentile, clinical decision support tools for pediatric weight management, parent educational materials, a Neighborhood Resource Guide, and monthly text messages) or (2) enhanced primary care plus contextually tailored, individual health coaching (twice-weekly text messages and telephone or video contacts every other month) to support behavior change and linkage of families to neighborhood resources. MAIN OUTCOMES AND MEASURES One-year changes in age- and sex-specific BMI z score, child health-related quality of life measured by the Pediatric Quality of Life 4.0, and parental resource empowerment. RESULTS At 1 year, we obtained BMI z scores from 664 children (92%) and family-centered outcomes from 657 parents (91%). The baseline mean (SD) age was 8.0 (3.0) years; 35% were white (n = 252), 33.3% were black (n = 240), 21.8% were Hispanic (n = 157), and 9.9% were of another race/ethnicity (n = 71). In the enhanced primary care group, adjusted mean (SD) BMI z score was 1.91 (0.56) at baseline and 1.85 (0.58) at 1 year, an improvement of -0.06 BMI z score units (95% CI, -0.10 to -0.02) from baseline to 1 year. In the enhanced primary care plus coaching group, the adjusted mean (SD) BMI z score was 1.87 (0.56) at baseline and 1.79 (0.58) at 1 year, an improvement of -0.09 BMI z score units (95% CI, -0.13 to -0.05). However, there was no significant difference between the 2 intervention arms (difference, -0.02; 95% CI, -0.08 to 0.03; P = .39). Both intervention arms led to improved parental resource empowerment: 0.29 units (95% CI, 0.22 to 0.35) higher in the enhanced primary care group and 0.22 units (95% CI, 0.15 to 0.28) higher in the enhanced primary care plus coaching group. Parents in the enhanced primary care plus coaching group, but not in the enhanced care alone group, reported improvements in their child's health-related quality of life (1.53 units; 95% CI, 0.51 to 2.56). However, there were no significant differences between the intervention arms in either parental resource empowerment (0.07 units; 95% CI, -0.02 to 0.16) or child health-related quality of life (0.89 units; 95% CI, -0.56 to 2.33). CONCLUSIONS AND RELEVANCE Two interventions that included a package of high-quality clinical care for obesity and linkages to community resources resulted in improved family-centered outcomes for childhood obesity and improvements in child BMI. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02124460.
Collapse
Affiliation(s)
- Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Department of Nutrition, Harvard School of Public Health; Boston, MA
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
| | - Mona Sharifi
- Section of General Pediatrics, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
- Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, MA
| | - Christine Horan
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - Monica W. Gerber
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | - E. John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Sarah N. Price
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA
| | | | - Daniel Slater
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA
| |
Collapse
|
32
|
Thompson D, Cantu D, Ramirez B, Cullen KW, Baranowski T, Mendoza J, Anderson B, Jago R, Rodgers W, Liu Y. Texting to Increase Adolescent Physical Activity: Feasibility Assessment. Am J Health Behav 2016; 40:472-83. [PMID: 27338994 DOI: 10.5993/ajhb.40.4.9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Feasibility trials assess whether a behavior change program warrants a definite trial evaluation. This paper reports the feasibility of an intervention consisting of Self Determination Theory-informed text messages, pedometers, and goal prompts to increase adolescent physical activity. METHODS A 4-group randomized design with baseline and immediate post-study assessments was used. Groups (pedometer; pedometer + goal prompt; pedometer + goal prompt + theory-informed texts; no-treatment control) were systematically varied to assess the additive effect of intervention components on objectively measured physical activity (ie, ActiGraph). The primary outcome of the 12-week intervention was program feasibility. Changes in average daily step counts and minutes of moderate-to-vigorous physical activity also were examined. Post-intervention research with a subset of participants examined program reactions. RESULTS Participants (N = 160) were evenly split by sex, mostly 14-15 years old, and of diverse race/ethnicity. Feasibility criteria were met. The attrition rate was less than 2%. Modest increases in average daily step counts and moderate-to-vigorous physical activity were observed in all groups except the control group. Participants reported positive reactions to the intervention. CONCLUSIONS An intervention consisting of pedometers, theory-informed texts, and goal prompts, is a feasible and acceptable method for promoting physical activity to adolescents.
Collapse
Affiliation(s)
- Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA.
| | - Dora Cantu
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Betsy Ramirez
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Karen W Cullen
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Tom Baranowski
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| | - Jason Mendoza
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
| | - Barbara Anderson
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Wendy Rodgers
- Department of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Yan Liu
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
33
|
Taveras EM, Marshall R, Sharifi M, Avalon E, Fiechtner L, Horan C, Orav J, Price SN, Sequist T, Slater D. Connect for Health: Design of a clinical-community childhood obesity intervention testing best practices of positive outliers. Contemp Clin Trials 2015; 45:287-295. [PMID: 26427562 PMCID: PMC4753774 DOI: 10.1016/j.cct.2015.09.022] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 09/25/2015] [Accepted: 09/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Connect for Health study is designed to assess whether a novel approach to care delivery that leverages clinical and community resources and addresses socio-contextual factors will improve body mass index (BMI) and family-centered, obesity-related outcomes of interest to parents and children. The intervention is informed by clinical, community, parent, and youth stakeholders and incorporates successful strategies and best practices learned from 'positive outlier' families, i.e., those who have succeeded in changing their health behaviors and improve their BMI in the context of adverse built and social environments. DESIGN Two-arm, randomized controlled trial with measures at baseline and 12 months after randomization. PARTICIPANTS 2-12 year old children with overweight or obesity (BMI ≥ 85th percentile) and their parents/guardians recruited from 6 pediatric practices in eastern Massachusetts. INTERVENTION Children randomized to the intervention arm receive a contextually-tailored intervention delivered by trained health coaches who use advanced geographic information system tools to characterize children's environments and neighborhood resources. Health coaches link families to community-level resources and use multiple support modalities including text messages and virtual visits to support families over a one-year intervention period. The control group receives enhanced pediatric care plus non-tailored health coaching. MAIN OUTCOME MEASURES Lower age-associated increase in BMI over a 1-year period. The main parent- and child-reported outcome is improved health-related quality of life. CONCLUSIONS The Connect for Health study seeks to support families in leveraging clinical and community resources to improve obesity-related outcomes that are most important to parents and children.
Collapse
Affiliation(s)
- Elsie M Taveras
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States; Department of Nutrition, Harvard School of Public Health, Boston, MA, United States.
| | - Richard Marshall
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA, United States
| | - Mona Sharifi
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | | | - Lauren Fiechtner
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Christine Horan
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - John Orav
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Sarah N Price
- Division of General Academic Pediatrics, Department of Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States
| | - Thomas Sequist
- Partners HealthCare System, Inc., Boston, MA, United States
| | - Daniel Slater
- Department of Pediatrics, Harvard Vanguard Medical Associates, Boston, MA, United States
| |
Collapse
|
34
|
Caregiver Preferences regarding Technology's Role in Supporting Adolescent Weight Management. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2015; 2015:153723. [PMID: 27347500 PMCID: PMC4897356 DOI: 10.1155/2015/153723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 10/05/2015] [Indexed: 11/18/2022]
Abstract
Background. Health technology provides a wealth of strategies to address chronic health issues, such as childhood obesity. Few studies have assessed parental preferences regarding use of health technology to support weight management for adolescents. Objective. This study determined caregiver beliefs, attitudes, and practices towards using traditional methods and technology-based health applications to address weight management among overweight adolescents. Methods. Self-administered surveys were distributed to caregivers of children ages 11-18 years in Stony Brook Children's Hospital outpatient offices with a BMI ≥ 85th percentile for age, gender. The data were entered into StudyTrax research platform and analyzed using SAS. Results. N = 114. Mean BMI z-score = 1.95 ± 0.50. Two-thirds (65.8%) of caregivers preferred a weight management program that includes both traditional and technology components. Most parents rated involvement in program development (68.1%), access to content (72.4%) as very important. Those who believed their child's weight was a problem (p = 0.01) were more likely than other parents to prefer a program that combined both traditional and technology components. Conclusions. Parents' perceptions of their child's weight drove preferences about incorporating technology elements into a weight management program. Future weight management programs should incorporate parental content preferences and be tailored to different age groups.
Collapse
|