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Mavragani A, Holloway TP, Soward R, Patterson KAE, Ahuja KDK, Dalton L, Murray S, Hughes R, Byrne NM, Hills AP. "An Ounce of Prevention is Worth a Pound of Cure": Proposal for a Social Prescribing Strategy for Obesity Prevention and Improvement in Health and Well-being. JMIR Res Protoc 2023; 12:e41280. [PMID: 36800232 PMCID: PMC9985003 DOI: 10.2196/41280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Social and behavioral determinants of health are increasingly recognized as central to effective person-centered intervention in clinical practice, disease management, and public health. Accordingly, social prescribing (SP) has received increased attention in recent times. The rampant global prevalence of obesity indicates that the customary, reductionistic, and disease-oriented biomedical approach to health service delivery is inadequate/ineffective at arresting the spread and mitigating the damaging consequences of the condition. There is an urgent need to shift the focus from reactive downstream disease-based treatments to more proactive, upstream, preventive action. In essence, this requires more effort to affect the paradigm shift from the traditional "biomedical approach of care" to a "biopsychosocial model" required to arrest the increasing prevalence of obesity. To this end, an SP approach, anchored in systems thinking, could be an effective means of moderating prevalence and consequences of obesity at a community level. OBJECTIVE The proposed SP intervention has the following three key objectives: (1) build a sustainable program for Circular Head based on SP, peer education, and health screening to minimize the incidence of obesity and related lifestyle diseases; (2) increase service and workforce connectivity and collaboration and initiate the introduction of new services and activities for obesity prevention and community health promotion; and (3) enhance health and well-being and minimize preventable adverse health outcomes of obesity and related lifestyle diseases through enhancement of food literacy and better nutrition, enhancement of physical literacy and habitual personal activity levels, and improvement of mental health, community connectedness, and reduction of social isolation. METHODS This paper describes a prospective SP strategy aimed at obesity prevention in Circular Head, a local government area in Northwest (NW) Tasmania. SP is a prominent strategy used in the Critical Age Periods Impacting the Trajectory of Obesogenic Lifestyles Project, which is an initiative based in NW Tasmania focused on assessing obesity prevention capacity. A social prescription model that facilitates the linkage of primary health screening with essential health care, education, and community resources through a dedicated "navigator" will be implemented. Four interlinked work packages will be implemented as part of the initial plan with each either building on existing resources or developing new initiatives. RESULTS A multimethod approach to triangulate insights from quantitative and qualitative research that enables the assessment of impact on individuals, community groups, and the health care system will be implemented within the initial pilot phase of the project. CONCLUSIONS Literature is replete with rhetoric advocating complex system approaches to curtail obesity. However, real-life examples of whole-of-systems interventions operationalized in ways that generate relevant evidence or effective policies are rare. The diverse approach for primary prevention of obesity-related lifestyle diseases and strategies for improvement of health and well-being described in this instance will contribute toward closing this evidence gap. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/41280.
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Affiliation(s)
| | - Timothy P Holloway
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Robert Soward
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Kira A E Patterson
- College of Arts, Law and Education, University of Tasmania, Launceston, Australia
| | - Kiran D K Ahuja
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Lisa Dalton
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Sandra Murray
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Roger Hughes
- School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Nuala M Byrne
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
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Bolton KA, Fraser P, Lowe J, Moodie M, Bell C, Strugnell C, Hayward J, McGlashan J, Millar L, Whelan J, Brown A, Allender S. Generating change through collective impact and systems science for childhood obesity prevention: The GenR8 Change case study. PLoS One 2022; 17:e0266654. [PMID: 35544522 PMCID: PMC9094504 DOI: 10.1371/journal.pone.0266654] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/14/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Community-based interventions have shown promise in reducing childhood overweight and obesity. However, they have been critiqued for using linear logic models. Participatory community-based systems approaches are posited as addressing the complexity of non-linear relationships in a local context. Community members are empowered to understand and describe obesity causation, identify and prioritise possible solutions. The application of such approaches to childhood obesity is in its infancy. AIM To describe the first 12 months of a participatory whole-of-community systems approach to creating collective action to tackle childhood obesity, called GenR8 Change, in a local government area of Victoria, Australia. METHODS Three group model building (GMB) sessions focused on the development of a causal loop diagram (CLD), prioritised evidence-informed actions, and developed implementation strategies. The collective impact framework underpinned the approach, with a local backbone group supporting community members to implement prioritised actions. RESULTS The first two GMB sessions included 20 key community leaders where a CLD examining the factors contributing to childhood obesity in the community was constructed and refined (22 variables GMB1, 53 variables GMB2). In the third session, 171 members of the wider community further refined the CLD, identified priorities for childhood obesity prevention (72 variables in final CLD). One-hundred and thirteen individuals signed up across 13 working groups to plan and implement 53 prioritised actions. Agreed community actions included creating sugar free zones; developing healthy policies; increasing breastfeeding rates; improving drinking water access; and increasing physical activity options. Twelve months post-GMB3, 115 actions had been implemented. CONCLUSION GenR8 Change is one of the first communities to apply systems thinking to childhood obesity prevention. Knowledge on how to collectively identify relevant leverage points to tackle childhood obesity can now be shared with other communities.
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Affiliation(s)
- Kristy A. Bolton
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Penny Fraser
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Janette Lowe
- Southern Grampians Glenelg Primary Care Partnership, Hamilton, Victoria, Australia
| | - Marj Moodie
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Colin Bell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Claudia Strugnell
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Josh Hayward
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Jaimie McGlashan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Lynne Millar
- School of Population Health, Curtin University, Bentley, Western Australia, Australia
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Jillian Whelan
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Andrew Brown
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Walsh RJ, McKay VR, Hansen PE, Barco PP, Jones K, Lee Y, Patel RD, Chen D, Heinemann AW, Lenze EJ, Wong AWK. Using Implementation Science to Guide the Process of Adapting a Patient Engagement Intervention for Inpatient Spinal Cord Injury/Disorder Rehabilitation. Arch Phys Med Rehabil 2022; 103:2180-2188. [PMID: 35588857 DOI: 10.1016/j.apmr.2022.04.010] [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: 07/12/2021] [Revised: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES This study aimed to describe the process of adapting an evidence-based patient engagement intervention, Enhanced Medical Rehabilitation (E-MR), for inpatient spinal cord injury/disease (SCI/D) rehabilitation using an implementation science framework. DESIGN We applied the Collaborative Intervention Planning Framework (CIPF) and included a community advisory board (CAB) in an intervention mapping process. SETTING A rehabilitation hospital. PARTICIPANTS Stakeholders from inpatient SCI/D rehabilitation (N=7) serving as a CAB and working with the research team (N=7) to co-adapt E-MR. INTERVENTIONS E-MR MAIN OUTCOME MEASURES: Logic model and matrices of change used in CAB meetings to identify areas of intervention adaptation. RESULTS The CAB and research team implemented adaptations to E-MR, including (1) identifying factors influencing patient engagement in SCI/D rehabilitation (e.g., therapist training); (2) revising intervention materials to meet SCI/D rehabilitation needs (e.g., modified personal goals interview and therapy trackers to match SCI needs); (3) incorporating E-MR into the rehabilitation hospital's operations (e.g., research team coordinated with CAB to store therapy trackers in the hospital system); and (4) retaining fidelity to the original intervention while best meeting the needs of SCI/D rehabilitation (e.g., maintained core E-MR principles while adapting). CONCLUSIONS This study demonstrated that structured processes guided by an implementation science framework can help researchers and clinicians identify adaptation targets and modify the E-MR program for inpatient SCI/D rehabilitation.
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Affiliation(s)
- Ryan J Walsh
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108.
| | - Virginia R McKay
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130, and Dissemination and Implementation Research Core, Washington University Institute of Clinical and Translational Sciences, St. Louis, MO 63110.
| | - Piper E Hansen
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, IL 0661.
| | - Peggy P Barco
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108.
| | - Kayla Jones
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611.
| | - Yejin Lee
- Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO 63108.
| | - Riddhi D Patel
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611.
| | - David Chen
- Spinal Cord Injury Section, Shirley Ryan AbilityLab, Chicago, IL 60611, and Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
| | - Allen W Heinemann
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA, and Department of Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
| | - Eric J Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA.
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL 60611, USA, and Departments of Physical Medicine & Rehabilitation and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Gilfoyle M, MacFarlane A, Salsberg J. Conceptualising, operationalising, and measuring trust in participatory health research networks: a scoping review. Syst Rev 2022; 11:40. [PMID: 35249553 PMCID: PMC8900447 DOI: 10.1186/s13643-022-01910-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are many described benefits of community-based participatory research (CBPR), such as increased relevance of research for those who must act on its findings. This has prompted researchers to better understand how CBPR functions to achieve these benefits through building sustainable research partnerships. Several studies have identified "trust" as a key mechanism to achieve sustainable partnerships, which themselves constitute social networks. Although existing literature discusses trust and CBPR, or trust and social networks, preliminary searches reveal that none link all three concepts of trust, CBPR, and social networks. Thus, we present our scoping review to systematically review and synthesize the literature exploring how trust is conceptualised, operationalised, and measured in CBPR and social networks. METHODS This review follows the guidance and framework of Peters et al. which is underpinned by the widely used framework of Levac and colleagues. Levac and colleagues provided enhancements to the methodological framework of Arksey and O'Malley. We explored several electronic databases including Scopus, Medline, PubMed, Web of Science, CINAHL, Cochrane Library, Google Scholar, and PsychINFO. A search strategy was identified and agreed upon by the team in conjunction with a research librarian. Two independent reviewers screened articles by title and abstract, then by full-text based on pre-determined exclusion/inclusion criteria. A third reviewer arbitrated discrepancies regarding inclusions/exclusions. A thematic analysis was then conducted to identify relevant themes and sub-themes. RESULTS Based on the 26 extracted references, several key themes and sub-themes were identified which highlighted the complexity and multidimensionality of trust as a concept. Our analysis revealed an additional emergent category that highlighted another important dimension of trust-outcomes pertaining to trust. Further, variation within how the studies conceptualised, operationalised, and measured trust was illuminated. Finally, the multidimensionality of trust provided important insight into how trust operates as a context, mechanism, and outcome. CONCLUSIONS Findings provide support for future research to incorporate trust as a lens to explore the social-relational aspects of partnerships and the scope to develop interventions to support trust in partnerships.
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Affiliation(s)
- Meghan Gilfoyle
- Public & Patient Involvement Research Unit, School of Medicine and Health Research Institute (HRI), University of Limerick, Limerick, Ireland, V94 T9PX
| | - Anne MacFarlane
- Public & Patient Involvement Research Unit, School of Medicine and Health Research Institute (HRI), University of Limerick, Limerick, Ireland, V94 T9PX
| | - Jon Salsberg
- Public & Patient Involvement Research Unit, School of Medicine and Health Research Institute (HRI), University of Limerick, Limerick, Ireland, V94 T9PX.
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Zoellner JM, You W, Hill JL, Brock DJP, Yuhas M, Price B, Wilson J, Montague DR, Estabrooks PA. Comparing two different family-based childhood obesity treatment programmes in a medically underserved region: Effectiveness, engagement and implementation outcomes from a randomized controlled trial. Pediatr Obes 2022; 17:e12840. [PMID: 34396714 DOI: 10.1111/ijpo.12840] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Access to evidence- and family-based childhood obesity (FBCO) treatment interventions is a challenge, especially in underserved regions where childhood obesity disparities persist. OBJECTIVE Compare two 6-month FBCO treatment interventions, iChoose (high intensity, parent-child dyads) and Family Connections (low intensity, parents only), in one underserved US region. METHODS This unblinded, RCT reports on effectiveness and implementation outcomes. Eligibility included children ages 5-12 with BMI ≥85th percentile. Analyses included descriptive statistics and intention-to-treat Heckman treatment effect models. RESULTS Enrolled children (n = 139, mean age 10.1 ± 1.7 years, 30% with overweight, 70% with obesity, 45% black, 63% Medicaid) were randomly assigned to iChoose (n = 70) or Family Connections (n = 69). Retention rates were 63% for iChoose and 84% for Family Connection. Among children, 6-month BMI z-score changes were not statistically significant within iChoose [BMI z-score 0.03 (95% CI = -0.13, 0.19)] or Family Connections [BMI z-score 0.00 (95% CI = -0.16, 0.16)]. Likewise, parents' BMI changes were not statistically significant. No adverse events were reported. Both programmes were delivered with high fidelity (77%-100%). Engagement in core components was 25%-36% for iChoose and 52%-61% for Family Connections. Implementation costs per child with improved BMI z-score were $2841 for iChoose and $955 for Family Connections. CONCLUSIONS Neither intervention yielded significant improvements in child BMI z-score or parent BMI, yet both were delivered with high fidelity. Relative to iChoose, descriptive data indicated higher retention, better engagement, and lower costs for Family Connections-suggesting that a lower intensity and parent-focused programme may better fit the intended audience's context.
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Affiliation(s)
- Jamie M Zoellner
- Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia (UVA), Christiansburg, Virginia, USA
| | - Wen You
- Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia (UVA), Christiansburg, Virginia, USA
| | - Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Donna-Jean P Brock
- Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia (UVA), Christiansburg, Virginia, USA
| | - Maryam Yuhas
- Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, University of Virginia (UVA), Christiansburg, Virginia, USA
| | - Bryan Price
- Community Outreach and Education, UVA Cancer Center, Danville, Virginia, USA
| | - Jonathon Wilson
- Parks and Recreation, City of Danville, Danville, Virginia, USA
| | | | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Brock DJP, Estabrooks PA, Yuhas M, Wilson JA, Montague D, Price BE, Elliott K, Hill JL, Zoellner JM. Assets and Challenges to Recruiting and Engaging Families in a Childhood Obesity Treatment Research Trial: Insights From Academic Partners, Community Partners, and Study Participants. Front Public Health 2021; 9:631749. [PMID: 33692983 PMCID: PMC7937718 DOI: 10.3389/fpubh.2021.631749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background: There is need for the childhood obesity treatment literature to identify effective recruitment and engagement strategies for rural communities that are more likely to lack supportive infrastructure for healthy lifestyles and clinical research relative to their urban counterparts. This community case study examines recruitment and engagement strategies from a comparative effectiveness research (CER) trial of two family-based childhood obesity (FBCO) treatment interventions conducted in a medically underserved, rural region. Guided by a Community Based Participatory Research (CBPR) and systems-based approach, the primary aim was to analyze interviews from academic partners, community partners, and parent study participants for recruitment and engagement assets, challenges, and lessons learned. Methods: Over the 3-year lifespan of the study, researchers conducted 288 interviews with Community Advisory Board members (n = 14), Parent Advisory Team members (n = 7), and study participants (n = 100). Using an inductive-deductive approach, interviews were broadly coded for recruitment and engagement assets, challenges, and recommendations; analyzed for descriptive sub-coding; and organized into stakeholder/organization and participant level themes. Codes were analyzed aggregately across time and examined for differences among stakeholders and parent study participants. Results: Adherence to CBPR principles and development of strong community partnerships facilitated recruitment and engagement; however, variability in recruitment and engagement success impacted partner confidence, threatened outcome validity, and required additional resources. Specifically, assets and challenges emerged around eight key needs. Three were at the stakeholder/organization level: (1) readiness of stakeholders to conduct CBPR research, (2) development of sustainable referral protocols, and (3) development of participant engagement systems. The remaining five were at the participant level: (1) comfort and trust with research, (2) awareness and understanding of the study, (3) intervention accessibility, (4) intervention acceptability, and (5) target population readiness. Future recommendations included conducting readiness assessments and awareness campaigns, piloting and evaluating recruitment and engagement strategies, identifying participant barriers to engagement and finding a priori solutions, and fostering stakeholder leadership to develop sustainable protocols. Conclusion: Collective findings from multiple perspectives demonstrate the need for multi-leveled approaches focusing on infrastructure supports and strategies to improve stakeholder and participant awareness of, and capacity for, recruiting and engaging medically underserved, rural families in a FBCO CER trial.
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Affiliation(s)
- Donna-Jean P. Brock
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Paul A. Estabrooks
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Maryam Yuhas
- Department of Nutrition and Food Studies, Syracuse University, Syracuse, NY, United States
| | | | | | - Bryan E. Price
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Kenya Elliott
- Piedmont Access to Health Services, Danville, VA, United States
| | - Jennie L. Hill
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, United States
| | - Jamie M. Zoellner
- Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
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Alexander R, Estabrooks P, Brock DJP, Hill JL, Whitt-Glover MC, Zoellner J. Capacity Development and Evaluation of a Parent Advisory Team Engaged in Childhood Obesity Research. Health Promot Pract 2021; 22:102-111. [PMID: 31409144 PMCID: PMC11290559 DOI: 10.1177/1524839919862251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guided by community-based participatory research principles, this mixed-methods process evaluation explored the experience and capacity of a newly formed Parental Advisory Team (PAT) engaged in childhood obesity research in a medically underserved region. Following the successful completion of a 3-month evidence-based childhood obesity treatment program (iChoose), 13 parents/caregivers who completed iChoose consented to participate in the PAT. Between June 2015 and March 2016, the PAT had nine monthly meetings and completed mixed-methods capacity assessments. They engaged in activities related to understanding iChoose outcomes, defining their role and purpose as a partnership, initiating content development, and pilot testing maintenance intervention components for future iChoose efforts. Assessments included a quantitative survey administered at baseline and 9 months, and a qualitative interview completed at 9 months. Results indicated that PAT members' perceptions of the identified capacity dimensions were positive at baseline (3.8-4.3 on a 5-point scale) and remained positive at follow-up (3.9-4.4 on a 5-point scale); changes were not statistically significant. Qualitative data revealed that PAT members were satisfied with group participation and desired to enhance their role in subsequent iChoose research. Understanding and promoting parental engagement in the research process fills an important gap in childhood obesity literature.
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Eisenhauer CM, Brito FA, Yoder AM, Kupzyk KA, Pullen CH, Salinas KE, Miller J, Hageman PA. Mobile technology intervention for weight loss in rural men: protocol for a pilot pragmatic randomised controlled trial. BMJ Open 2020; 10:e035089. [PMID: 32295776 PMCID: PMC7200044 DOI: 10.1136/bmjopen-2019-035089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 01/02/2020] [Accepted: 03/04/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Men who are overweight or obese in the rural Midwestern USA are an unrepresented, at-risk group exhibiting rising rates of cardiovascular disease, poor access to preventive care and poor lifestyle behaviours that contribute to sedentary lifestyle and unhealthy diet. Self-monitoring of eating and activity has demonstrated efficacy for weight loss. Use of mobile technologies for self-monitoring eating and activity may address rural men's access disparities to preventive health resources and support weight loss. Our pilot trial will assess the feasibility and acceptability of two mobile applications for weight loss in rural men to inform a future, full-scale trial. METHODS AND ANALYSIS A 6-month randomised controlled trial with contextual evaluation will randomise 80 men using a 1:1 ratio to either a Mobile Technology Plus (MT+) intervention or a basic Mobile Technology (MT) intervention in rural, midlife men (aged 40-69 years). The MT+ intervention consists of a smartphone self-monitoring application enhanced with discussion group (Lose-It premium), short message service text-based support and Wi-Fi scale. The MT group will receive only a self-monitoring application (Lose-It basic). Feasibility and acceptability will be evaluated using number of men recruited and retained, and evaluative focus group feedback. We seek to determine point estimates and variability of outcome measures of weight loss (kg and % body weight) and improved dietary and physical activity behaviours (Behavioral Risk Factor Surveillance System (BRFSS) physical activity and fruit and vegetable consumption surveys, data from Lose-It! application (kcal/day, steps/day)). Community capacity will be assessed using standard best practice methods. Descriptive content analysis will evaluate intervention acceptability and contextual sensitivity. ETHICS AND DISSEMINATION This protocol was approved by the University of Nebraska Medical Center Institutional Review Board (IRB# 594-17-EP). Dissemination of findings will occur through ClinicalTrials.gov and publish pilot data to inform the design of a larger clinical trial. TRIAL REGISTRATION NUMBER NCT03329079; preresults. Protocol V.10, study completion date 31 August 2020. Roles and responsibilities funder: NIH/NINR Health Disparities Section 1R15NR017522-01.
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Affiliation(s)
- Christine M Eisenhauer
- College of Nursing- Northern Division, University of Nebraska Medical Center, Norfolk, Nebraska, USA
| | - Fabiana Almeida Brito
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Aaron M Yoder
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Carol H Pullen
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Katherine E Salinas
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jessica Miller
- College of Nursing- Northern Division, University of Nebraska Medical Center, Norfolk, Nebraska, USA
| | - Patricia A Hageman
- College of Allied Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Zoellner JM, You W, Hill JL, Brock DJP, Yuhas M, Alexander RC, Price B, Estabrooks PA. A comparative effectiveness trial of two family-based childhood obesity treatment programs in a medically underserved region: Rationale, design & methods. Contemp Clin Trials 2019; 84:105801. [PMID: 31260792 DOI: 10.1016/j.cct.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/13/2019] [Accepted: 06/27/2019] [Indexed: 12/18/2022]
Abstract
While there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) treatment interventions, there is little evidence that these interventions have been systematically translated into regular practice - particularly in health disparate regions. To address this research-practice gap, this project was guided by a community advisory board (CAB) and the RE-AIM planning and evaluation framework within a systems-based and community-based participatory research approach. Families with overweight or obese children between 5 and 12 years old, in the medically-underserved Dan River Region, were randomly assigned to one of two FBCO treatment programs (iChoose vs. Family Connections) delivered by local Parks & Recreation staff. Both programs have previously demonstrated clinically meaningful child BMI z-score reductions, but vary in intensity, structure, and implementation demands. Two clinical CAB partners embedded recruitment methods into their regional healthcare organization, using procedures representative to what could be used if either program was taken to scale. The primary effectiveness outcome is child BMI z-scores at 6-months, with additional assessments at 3-months and at 12-months. Secondary goals are to determine: (1) reach into the intended audience; (2) effectiveness on secondary child and parent outcomes; (3) intervention adoption by organizations and staff; (4) fidelity, cost, and capacity for intervention implementation; and (5) maintenance of individual-level changes and organizational-level sustainability. This research addresses literature gaps related to the features within clinical and community settings that could improve both child weight status and the translation of FBCO interventions into typical practice in medically-underserved communities. IDENTIFIERS: Clincialtrials.gov: NCT03245775.
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Affiliation(s)
- Jamie M Zoellner
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA.
| | - Wen You
- Virginia Tech, Department of Agricultural and Applied Economics, 304 Hutcheson Hall, 24060, USA
| | - Jennie L Hill
- Department of Epidemiology, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
| | - Donna-Jean P Brock
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Maryam Yuhas
- University of Virginia (UVA), Department of Public Health Sciences, UVA Cancer Center Research and Outreach Office, 16 East Main Street, Christiansburg, VA 24073, USA
| | - Ramine C Alexander
- Department of Family and Consumer Sciences, North Carolina A&T State University, Benbow 202-A, Greensboro, NC 27411, USA
| | - Bryan Price
- UVA Cancer Center, Community Outreach and Education, Main Street, Unit 102, Danville, VA 24541, USA
| | - Paul A Estabrooks
- Department of Health Promotion, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA
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Greenwood DA, Litchman ML, Ng AH, Gee PM, Young HM, Ferrer M, Ferrer J, Memering CE, Eichorst B, Scibilia R, Miller LMS. Development of the Intercultural Diabetes Online Community Research Council: Codesign and Social Media Processes. J Diabetes Sci Technol 2019; 13:176-186. [PMID: 30614252 PMCID: PMC6399805 DOI: 10.1177/1932296818818455] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND This case study describes the formation of the Intercultural Diabetes Online Community Research council (iDOCr) and community advisory board (CAB) to engage the diabetes community and researchers in the codesign of community-based participatory research (CBPR) to examine online peer support in type 2 diabetes (T2D). METHOD Social media engagement was the foundation for CBPR knowledge generation. During the project, the iDOCr council and CAB (n = 27) met quarterly via video conferencing and three times in person during national diabetes meetings. Data from four Twitter chats were used to explore the usefulness and utility of Twitter data to learn about concerns and priorities of the diabetes online community (DOC) and supported the evolution of iDOCr, the development of a research question and the design of a CBPR study. RESULTS The iDOCr project (1) created a diverse CAB; (2) raised awareness of iDOCr and online peer support, which resulted in support and trust from key opinion leaders within the DOC to enable future partnerships for research and funding; (3) engaged with English- and Spanish-speaking DOC users through social media; and (4) designed a CBPR study supported by Twitter chat data analyses. CONCLUSIONS Integrating the voice of people with diabetes (PWD) and the DOC in designing CBPR, through use of a CAB, ensures the most important and relevant research questions are asked. Additional research focused on online peer support may increase health care provider confidence in referring PWD to this low-cost and relatively accessible resource with the potential power to advance health.
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Affiliation(s)
| | | | - Ashley H. Ng
- La Trobe University, Department of Rehabilitation Nutrition and Sport, Bundoora, Victoria, Australia
| | | | - Heather M. Young
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, USA
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11
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Hill JL, Zoellner JM, You W, Brock DJ, Price B, Alexander RC, Frisard M, Brito F, Hou X, Estabrooks PA. Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation. BMC Public Health 2019; 19:122. [PMID: 30696420 PMCID: PMC6352451 DOI: 10.1186/s12889-019-6450-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/17/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community. METHODS A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months). RESULTS Bright Bodies rated highest on program characteristics and adoptability (p's < 0.05), while Home Environmental Model rated highest on implementation factors (p < 0.05). Qualitatively, the selection focused on important program characteristics and on matching those characteristics to the potential to fit within the community partner services. The adapted program-iChoose-had 18% reach and with participants that were representative of the target population on age, gender, ethnicity, and race. Effectiveness was demonstrated by modest, but significant reductions in BMI z-scores at post-program compared to baseline (MΔ = - 0.047; t = - 2.11, p = 0.046). This decrease returned to values similar to baseline 3 months (MΔ = 0.009) after the program was completed. Implementation fidelity was high and implementation fidelity did not differ between community or research delivery agents. CONCLUSION The process to help organizations identify and select evidence-based programs appropriate for their community led to consensus on a single EBP. While iChoose was successful in initiating changes in BMI z-scores, could be implemented in a low resource community with fidelity, it was insufficient to lead to sustained child BMI z-scores. In response to these data, maintenance of program effects and delivery are the current focus of the CBPR team.
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Affiliation(s)
- Jennie L. Hill
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, USA
| | - Jamie M. Zoellner
- Department of Public Health Sciences, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, VA 24061 USA
| | - Donna J. Brock
- Department of Public Health Sciences, School of Medicine, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Bryan Price
- Education and Outreach Specialist, University of Virginia and Cancer Center, P.O. Box 800717, Charlottesville, VA 22908-0717 USA
| | - Ramine C. Alexander
- Department of Family and Consumer Sciences, North Carolina Agricultural and Technical State University, Benbow 202-A, Greensboro, NC 27405 USA
| | - Madlyn Frisard
- Department of Human Nutrition, Foods and Exercise, Virginia Tech, 1981 Kraft Drive (0913), ILSB 23, Rm 1085, Blacksburg, VA 24061 USA
| | - Fabiana Brito
- College of Public Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE 68198-4365 USA
| | - Xiaolu Hou
- Virginia Tech University, Blacksburg, USA
| | - Paul A. Estabrooks
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075 USA
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Brock DJP, Estabrooks PA, Hill JL, Barlow ML, Alexander RC, Price BE, Marshall R, Zoellner JM. Building and Sustaining Community Capacity to Address Childhood Obesity: A 3-Year Mixed-Methods Case Study of a Community-Academic Advisory Board. FAMILY & COMMUNITY HEALTH 2019; 42:62-79. [PMID: 30431470 PMCID: PMC6713197 DOI: 10.1097/fch.0000000000000212] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Guided by a community-based participatory research and systems-based approach, this 3-year mixed-methods case study describes the experiences and capacity development of a Community-Academic Advisory Board (CAB) formed to adapt, implement, and evaluate an evidence-based childhood obesity treatment program in a medically underserved region. The CAB included community, public health, and clinical (n = 9) and academic partners (n = 9). CAB members completed capacity evaluations at 4 points. Partners identified best practices that attributed to the successful execution and continued advancement of project goals. The methodological framework and findings can inform capacity development and sustainability of emergent community-academic collaborations.
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Affiliation(s)
- Donna-Jean P Brock
- Public Health Sciences (Ms Brock and Dr Zoellner) and Cancer Center (Mr Price), University of Virginia, Charlottesville; Departments of Health Promotions (Dr Estabrooks) and Epidemiology (Dr Hill), University of Nebraska Medical Center, Omaha; DukeImmerse, Office of Undergraduate Education, Duke University, Durham, North Carolina (Ms Barlow); Department of Family and Consumer Sciences, North Carolina A&T State University, Greensboro (Dr Alexander); and Sovah Health, Danville, Virginia (Ms Marshall)
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13
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Brito FA, Zoellner JM, Hill J, You W, Alexander R, Hou X, Estabrooks PA. From Bright Bodies to iChoose: Using a CBPR Approach to Develop Childhood Obesity Intervention Materials for Rural Virginia. SAGE OPEN 2019; 9:1-14. [PMID: 34290901 PMCID: PMC8291387 DOI: 10.1177/2158244019837313] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This community-based participatory research (CBPR) project used a collaborative process to develop a culturally relevant workbook for parents of overweight children. We followed a mixed methods iterative process to assess clear communication using a CBPR approach. Materials were evaluated using readability tests, the Clear Communication Index (CCI), and the Suitability Assessment of Materials (SAM). In addition, we used surveys and focus groups to investigate parents' perceptions and gather feedback from delivery staff using the workbook. While workbook materials maintained adequate grade reading levels, our iterative process and the use of CCI and SAM led to significant improvements in (a) clearly communicating the objectives of the program, (b) being culturally relevant, and (c) reaching a high satisfaction among users. These findings suggest that evaluative measures for written materials should move beyond readability and need to account for level of clarity and cultural appropriateness of messages. Furthermore, we found that that an iterative process to intervention's material development using clear communication strategies while involving community members, parents, and research partners can lead to workbook materials that are culturally relevant to the target audience, and better communicate program objectives. Finally, this is a potentially generalizable process for improving clear communication of written health information materials.
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Affiliation(s)
| | | | - Jennie Hill
- University of Nebraska Medical Center, Omaha, USA
| | - Wen You
- Virginia Tech, Blacksburg, USA
| | - Ramine Alexander
- North Carolina Agricultural & Technical State University, Greensboro, USA
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14
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Farewell CV, Puma J, Mason MA, Peirce P, Shimomura M, Harms M. Training Child Care Inspectors to Deliver Health Messaging: A Quality Improvement Pilot Project. Health Promot Pract 2018; 21:188-197. [PMID: 29985063 DOI: 10.1177/1524839918786952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early childhood obesity is at epidemic proportions. Early child care providers have a unique opportunity to instill healthy eating and active living behaviors in children that can foster lifelong health. Academic-community partnerships that involve collaborations between child care centers, local public health departments, and universities provide one avenue to strengthening healthy eating and active living-related knowledge and skills among early child care providers. This quality improvement pilot intervention, titled Healthy Child Care Makes a Healthy Start, is one example of this type of collaboration. This quality improvement pilot project consisted of two complementary intervention components. Inspectors were trained to cofacilitate a strategic planning process with university researchers to help providers implement healthy eating and active living-related policy, system, and environment changes in their child care homes and centers. An average of five changes were implemented in participating child care locations. Inspectors also received training on health-related best practices and delivered 1-minute health messages to child care providers during routine inspection visits. This type of innovative partnership has the potential to leverage a currently existing relationship between child care providers and licensing and regulation inspectors and shift the relationship to include dissemination and implementation of health messaging in child care center and home settings.
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Affiliation(s)
| | - Jini Puma
- Colorado School of Public Health, Aurora, CO, USA
| | - Mondi A Mason
- Department of Public Health & Environment, Denver, CO, USA
| | - Paula Peirce
- University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Megan Harms
- Department of Public Health & Environment, Denver, CO, USA
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15
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Korn AR, Hennessy E, Hammond RA, Allender S, Gillman MW, Kasman M, McGlashan J, Millar L, Owen B, Pachucki MC, Swinburn B, Tovar A, Economos CD. Development and testing of a novel survey to assess Stakeholder-driven Community Diffusion of childhood obesity prevention efforts. BMC Public Health 2018; 18:681. [PMID: 29855295 PMCID: PMC5984309 DOI: 10.1186/s12889-018-5588-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/23/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Involving groups of community stakeholders (e.g., steering committees) to lead community-wide health interventions appears to support multiple outcomes ranging from policy and systems change to individual biology. While numerous tools are available to measure stakeholder characteristics, many lack detail on reliability and validity, are not context specific, and may not be sensitive enough to capture change over time. This study describes the development and reliability of a novel survey to measure Stakeholder-driven Community Diffusion via assessment of stakeholders' social networks, knowledge, and engagement about childhood obesity prevention. METHODS This study was completed in three phases. Phase 1 included conceptualization and online survey development through literature reviews and expert input. Phase 2 included a retrospective study with stakeholders from two completed whole-of-community interventions. Between May-October 2015, 21 stakeholders from the Shape Up Somerville and Romp & Chomp interventions recalled their social networks, knowledge, and engagement pre-post intervention. We also assessed one-week test-retest reliability of knowledge and engagement survey modules among Shape Up Somerville respondents. Phase 3 included survey modifications and a second prospective reliability assessment. Test-retest reliability was assessed in May 2016 among 13 stakeholders involved in ongoing interventions in Victoria, Australia. RESULTS In Phase 1, we developed a survey with 7, 20 and 50 items for the social networks, knowledge, and engagement survey modules, respectively. In the Phase 2 retrospective study, Shape Up Somerville and Romp & Chomp networks included 99 and 54 individuals. Pre-post Shape Up Somerville and Romp & Chomp mean knowledge scores increased by 3.5 points (95% CI: 0.35-6.72) and (- 0.42-7.42). Engagement scores did not change significantly (Shape Up Somerville: 1.1 points (- 0.55-2.73); Romp & Chomp: 0.7 points (- 0.43-1.73)). Intraclass correlation coefficients (ICCs) for knowledge and engagement were 0.88 (0.67-0.97) and 0.97 (0.89-0.99). In Phase 3, the modified knowledge and engagement survey modules included 18 and 25 items, respectively. Knowledge and engagement ICCs were 0.84 (0.62-0.95) and 0.58 (0.23-0.86). CONCLUSIONS The survey measures upstream stakeholder properties-social networks, knowledge, and engagement-with good test-retest reliability. Future research related to Stakeholder-driven Community Diffusion should focus on prospective change and survey validation for intervention effectiveness.
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Affiliation(s)
- Ariella R Korn
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Erin Hennessy
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA
| | - Ross A Hammond
- The Brookings Institution, 1775 Massachusetts Ave., NW, Washington, DC, 20036, USA
| | - Steven Allender
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Matthew W Gillman
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Landmark Center, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Matt Kasman
- The Brookings Institution, 1775 Massachusetts Ave., NW, Washington, DC, 20036, USA
| | - Jaimie McGlashan
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Lynne Millar
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Brynle Owen
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia
| | - Mark C Pachucki
- Department of Sociology, University of Massachusetts Amherst, 200 Hicks Way, Thompson Hall 532, Amherst, MA, 01003, USA
| | - Boyd Swinburn
- Global Obesity Centre (GLOBE), Deakin University, 1 Gheringhap St, Geelong, VIC, 3220, Australia.,School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Alison Tovar
- Department of Nutrition and Food Sciences, University of Rhode Island, 125 Fogarty Hall, Kingston, RI, 02881, USA
| | - Christina D Economos
- Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave., Boston, MA, 02111, USA.
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16
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Zoellner JM, Hill J, You W, Brock D, Frisard M, Alexander R, Silva F, Price B, Marshall R, Estabrooks PA. The Influence of Parental Health Literacy Status on Reach, Attendance, Retention, and Outcomes in a Family-Based Childhood Obesity Treatment Program, Virginia, 2013-2015. Prev Chronic Dis 2017; 14:E87. [PMID: 28957032 PMCID: PMC5621521 DOI: 10.5888/pcd14.160421] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction Few interventions have evaluated the influence of parent health literacy (HL) status on weight-related child outcomes. This study explores how parent HL affects the reach, attendance, and retention of and outcomes in a 3-month multicomponent family-based program to treat childhood obesity (iChoose). Methods This pre–post, quasiexperimental trial occurred in the Dan River Region, a federally designated medically underserved area. iChoose research protocol and intervention strategies were designed using an HL universal precautions approach. We used validated measures, standardized data collection techniques, and generalized linear mixed-effect parametric models to determine the moderation effect of parent HL on outcomes. Results No significant difference in HL scores were found between parents who enrolled their child in the study and those who did not. Of 94 enrolled parents, 34% were low HL, 49% had an annual household income of less than $25,000, and 39% had a high school education or less. Of 101 enrolled children, 60% were black, and the mean age was 9.8 (standard deviation, 1.3) years. Children of parents with both low and high HL attended and were retained at similar rates. Likewise, parent HL status did not significantly influence improvements in effectiveness outcomes (eg, child body mass index [BMI] z scores, parent BMI, diet and physical activity behaviors, quality of life), with the exception of child video game/computer screen time; low HL decreased and high HL increased screen time (coefficient = 0.52, standard error, 0.11, P < .001). Conclusion By incorporating design features that attended to the HL needs of parents, children of parents with low HL engaged in and benefited from a family-based childhood obesity treatment program similar to children of parents with high HL.
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Affiliation(s)
- Jamie M Zoellner
- Department of Public Health Sciences, School of Medicine, University of Virginia, PO Box 800717, Charlottesville, VA 22908-0717. .,University of Virginia Cancer Center, Charlottesville, Virginia
| | - Jennie Hill
- Department of Epidemiology, University of Nebraska Medical Center, Omaha, Nebraska
| | - Wen You
- Department of Agricultural and Applied Economics, Virginia Tech, Blacksburg, Virginia
| | - Donna Brock
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia
| | - Madlyn Frisard
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, Virginia
| | - Ramine Alexander
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Fabiana Silva
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Bryan Price
- University of Virginia Cancer Center, Charlottesville, Virginia
| | | | - Paul A Estabrooks
- Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, Omaha, Nebraska
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