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Laws RA, Zheng M, Brown V, Lymer S, Campbell KJ, Russell CG, Taki S, Litterbach E, Ong KL, Denney-Wilson E. The impacts of an mHealth intervention targeting parents on health service usage and out-of-pocket costs in the first 9 months of life: The Growing healthy app. MATERNAL & CHILD NUTRITION 2024:e13662. [PMID: 38804571 DOI: 10.1111/mcn.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/15/2024] [Accepted: 04/25/2024] [Indexed: 05/29/2024]
Abstract
Mobile health (mHealth) interventions provide a low-cost, scalable approach to supporting parents with infant feeding advice with the potential to reduce health care visits and associated costs for infant feeding support. This Australian study examined the impact of the Growing healthy (GH) app on health service utilisation and out-of-pocket costs for families in the first 9 months of their infants life. A quasi-experimental study with a comparison group was conducted in 2015-2016 with an mHealth intervention group (GH app, n = 301) and a nonrandomized usual care group (n = 344). The GH app aimed to support parents of young infants with healthy infant feeding behaviours from birth to 9 months of age. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed surveys at baseline when infants were less than 3 months old (T1), at 6 months (T2) and 9 months (T3) of age. At T3, participants reported health services used and any out-of-pocket costs for advice on infant feeding, growth or activity. App users had lower odds (odds ratio: 0.38 95% confidence interval: 0.25, 0.59) of using one or more services and had lower number of visits to a general practitioner (1.0 vs. 1.5 visits, p = 0.003) and paediatrician (0.3 vs. 0.4 visits, p = 0.049) compared to the usual care group. There was no difference in out-of-pocket costs between groups. Provision of an evidenced-based infant feeding app may provide substantial savings to the health system and potentially to parents through fewer primary health care and paediatrician visits.
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Affiliation(s)
- Rachel A Laws
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Miaobing Zheng
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Sharyn Lymer
- Biostatistics Consultant, Sydney, NSW, Australia
| | - Karen J Campbell
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Catherine G Russell
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Sarah Taki
- Health Promotion Unit, Population Health Research & Evaluation Hub, Sydney Local Health District, Sydney, NSW, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Eloise Litterbach
- School of Exercise and Nutrition Science, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
- Institute for Health Transformation, The Australian Centre for Behavioural Research in Diabetes, Deakin University, Geelong, VIC, Australia
| | - Kok-Leong Ong
- Department of Information Systems and Business Analytics, AISSC, RMIT University, Melbourne, VIC, Australia
| | - Elizabeth Denney-Wilson
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Institute for Women, Children and their Families, Sydney Local Health District, Sydney, NSW, Australia
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Rashid AFA, Syed Saadun Tarek Wafa SWW, Talib RA, Bakar NMA. Interactive Malaysian Childhood Healthy Lifestyle (i-MaCHeL) programme: a single-arm pilot study. Pilot Feasibility Stud 2024; 10:80. [PMID: 38762727 PMCID: PMC11102176 DOI: 10.1186/s40814-024-01483-7] [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: 10/03/2023] [Accepted: 03/16/2024] [Indexed: 05/20/2024] Open
Abstract
BACKGROUND The growing obesity epidemic in Malaysia presents a public health challenge that requires innovative intervention strategies. In an effort to address this problem, an Interactive Malaysian Childhood Healthy Lifestyle (i-MaCHeL) programme, which is a web-based initiative designed for preschool child-parent dyads offers a novel approach. Nevertheless, the success of such a web-based intervention depends on several interrelated factors. This research aims to examine the feasibility of i-MaCHeL in the Malaysian context, its usability for preschool child-parent dyads, and the acceptability of the programme among these user groups. METHODS This was a single-arm pilot study involving 46 child-parent dyads recruited from six government preschools in Terengganu, Malaysia. The preschools were selected using a cluster random sampling technique at the preschool level. The intervention feasibility was determined based on the retention rate of participants in the pilot study. The System Usability Scale (SUS) and intervention process evaluation were used to assess the usability and acceptability of the web-based i-MaCHeL programme. RESULTS The retention data demonstrated that 42 out of 46 participants completed the 13-week intervention programme, which showed that the overall retention rate was 91.3%. A mean (SD) SUS score of 84.70 (13.82) was obtained from parents, indicating that the web-based i-MaCHeL had an acceptable usability level. The mean scores of the process evaluation items ranged from 4.52 (0.63) to 4.83 (0.38), demonstrating that the web-based i-MaCHeL was highly accepted by the parents. The acceptability data also indicated that at least 92.9% (39/42) of the parents agreed/strongly agreed that the web content, programme duration, intervention dose, WhatsApp group, and delivery mode were appropriate. CONCLUSIONS According to these findings, the i-MaCHeL intervention using a web-based approach was feasible, usable, and acceptable as part of a weight-related behaviour change intervention for preschool child-parent dyads. This pilot study demonstrated that the web-based i-MaCHeL was feasible and promising for delivering weight-related behavioural intervention to child-parent dyads. TRIAL REGISTRATION ClinicalTrials.gov, NCT04711525 . Registered on January 15, 2021.
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Affiliation(s)
- Ahmad Faezi Ab Rashid
- School of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Nerus, Terengganu, Malaysia
- Faculty of Hospitality, Tourism, and Wellness, Universiti Malaysia Kelantan, Kota Bharu, Kelantan, Malaysia
| | | | - Ruzita Abd Talib
- Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Nor Mazlina Abu Bakar
- Faculty of Business and Management, Universiti Sultan Zainal Abidin, Kuala Nerus, Terengganu, Malaysia
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Lozada-Tequeanes AL, Théodore FL, Kim-Herrera E, García-Guerra A, Quezada-Sánchez AD, Alvarado-Casas R, Bonvecchio A. Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e55509. [PMID: 38592753 PMCID: PMC11005909 DOI: 10.2196/55509] [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] [Received: 12/18/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. OBJECTIVE This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. METHODS NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children's age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants' experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. RESULTS Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was "good," "useful," and "helpful" for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. CONCLUSIONS While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. TRIAL REGISTRATION ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896.
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Affiliation(s)
| | - Florence L Théodore
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Edith Kim-Herrera
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Armando García-Guerra
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Amado D Quezada-Sánchez
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Rocio Alvarado-Casas
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
| | - Anabelle Bonvecchio
- National Institute of Public Health, Instituto Nacional de Salud Pública de México, Cuernavaca, Mexico
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Blakeslee SB, Vieler K, Horak I, Stritter W, Seifert G. Planting Seeds for the Future: Scoping Review of Child Health Promotion Apps for Parents. JMIR Mhealth Uhealth 2023; 11:e39929. [PMID: 37471125 PMCID: PMC10401193 DOI: 10.2196/39929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/12/2022] [Accepted: 05/02/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Increasingly, parents use child health promotion apps to find health information. An overview of child health promotion apps for parents currently does not exist. The scope of child health topics addressed by parent apps is thus needed, including how they are evaluated. OBJECTIVE This scoping review aims to describe existing reported mobile health (mHealth) parent apps of middle- to high-income countries that promote child health. The focus centers on apps developed in the last 5 years, showing how the reported apps are evaluated, and listing reported outcomes found. METHODS A scoping review was conducted according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews) guidelines to identify parent apps or web-based programs on child health promotion published between January 2016 and June 2021 in 5 databases: PubMed, ERIC, IEEE Xplore, Web of Science, and Google Scholar. Separate sources were sought through an expert network. Included studies were summarized and analyzed through a systematic and descriptive content analysis, including keywords, year of publication, country of origin, aims/purpose, study population/sample size, intervention type, methodology/method(s), broad topic(s), evaluation, and study outcomes. RESULTS In total, 39 studies met the inclusion criteria from 1040 database and 60 expert-identified studies. Keywords reflected the health topics and app foci. About 64% (25/39) of included studies were published after 2019 and most stemmed from the United States, Australian, and European-based research. Studies aimed to review or evaluate apps or conducted app-based study interventions. The number of participants ranged from 7 to 1200. Quantitative and qualitative methods were used. Interventions included 28 primary studies, 6 app feasibility studies, and 5 app or literature reviews. Eight separate topics were found: parental feeding and nutrition, physical activity, maternal-child health, parent-child health, healthy environment, dental health, mental health, and sleep. Study intervention evaluations cited behavior change theories in 26 studies and evaluations were carried out with a variety of topic-specific, adapted, self-developed, or validated questionnaires and evaluation tools. To evaluate apps, user input and qualitative evaluations were often combined with surveys and frequently rated with the Mobile App Rating Scale. Outcomes reported some positive effects, while several intervention studies saw no effect at all. Effectively evaluating changes in behavior through apps, recruiting target groups, and retaining app engagement were challenges cited. CONCLUSIONS New parents are a key target group for child health apps, but evaluating child health promotion apps remains a challenge. Whether tailored to parent needs or adapted to the specific topic, apps should be rooted in a transparent theoretical groundwork. Applicable lessons for parent apps from existing research are to tailor app content, include intuitive and adaptive features, and embed well-founded parameters for long-term effect evaluation on child health promotion.
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Affiliation(s)
- Sarah B Blakeslee
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kristin Vieler
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ingo Horak
- Digital Health Entrepreneur, Berlin, Germany
| | - Wiebke Stritter
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Seifert
- Department of Pediatrics, Division of Oncology and Hematology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Brown A, Nathan N, Janssen L, Chooi A, Lecathelinais C, Hudson N, Wolfenden L, Sutherland R. New models to support parents to pack healthy lunchboxes: Parents acceptability, feasibility, appropriateness, and adoption of the SWAP IT m-Health program. Aust N Z J Public Health 2023; 47:100043. [PMID: 37087847 DOI: 10.1016/j.anzjph.2023.100043] [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: 01/17/2023] [Accepted: 01/23/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVES This report aims to evaluate the acceptability, appropriateness, feasibility, and adoption of a healthy lunchbox program (SWAP IT), from the parent perspective. METHODS SWAP IT is an mobile health (m-Health) program aimed to support parents in swapping out discretionary foods for healthier alternatives. Following receipt of the program, parents completed validated scales assessing the Acceptability (AIM), Intervention Appropriateness (IAM), and Feasibility (FIM) via a computer-assisted telephone interview (CATI). Parents were asked about their awareness of strategies in SWAP IT and whether the program supported them to make lunchbox swaps from discretionary to everyday foods. RESULTS Of the 679 parents who consented, 413 completed the CATI (61% response rate). Parent's mean AIM score (out of a total score of 5) was 4.22 (SD 0.48); FIM score was 4.27 (SD 0.54); and IAM score was 4.24 (SD 0.54). Most parents reported receiving the lunchbox messages (54%), with 45% reporting opening all 10 messages and 64% of parents reporting the program helped swap out discretionary foods. CONCLUSION The m-Health lunchbox program, SWAP IT, is highly acceptable, easy to adopt, appropriate, and feasible to parents. IMPLICATIONS TO PUBLIC HEALTH Not only is SWAP IT effective, but favourable implementation factors highlight the potential scalability of the program in improving child nutrition.
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Affiliation(s)
- Alison Brown
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Nicole Nathan
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Lisa Janssen
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Amelia Chooi
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Christophe Lecathelinais
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Nayerra Hudson
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Luke Wolfenden
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
| | - Rachel Sutherland
- Hunter New England Population Health, Wallsend, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.
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Marshall S, Johnson BJ, Hesketh KD, Campbell KJ, Fraser K, Love P, Denney-Wilson E, Salmon J, McCallum Z, Laws R. Mapping intervention components from a randomized controlled trial to scale-up of an early life nutrition and movement intervention: The INFANT program. Front Public Health 2023; 10:1026856. [PMID: 36711339 PMCID: PMC9880042 DOI: 10.3389/fpubh.2022.1026856] [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: 08/24/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
Introduction Early life parent-focused interventions can effectively improve infant and child nutrition and movement (physical activity and sedentary behavior) as well as parents' health behaviors. Scale-up of such interventions to real-world settings is essential for population-wide benefits. When progressing to scale-up, intervention components may be modified to reflect contextual factors and promote feasibility of scale-up. The INFANT program, an efficacious early life nutrition and movement behavioral intervention began as a randomized controlled trial (RCT), was modified after a small-scale translation, and is currently being scaled-up in Victoria, Australia. This study mapped and compared discrete intervention components of both the original RCT and the scaled-up version of INFANT to examine modifications for scaling up. Methods Discrete intervention components, specifically the target behaviors (child-related and parent-related behaviors), delivery features and behavior change techniques (BCTs) from the RCT and the scaled-up program were coded and mapped using established frameworks and taxonomies. Publications and unpublished materials (e.g., facilitator notes, handouts, videos, app) were coded. Coding was performed independently in duplicate, with final coding validated in a meeting with interventionists. Interventionists reported the rationale for modifications made. Results The INFANT RCT and scaled-up version targeted the same obesity prevention-related nutrition and movement behaviors. Key modified delivery features at scale-up included reduced number of sessions, a broader range of professionals facilitating groups, the addition of a mobile app for parents replacing hard-copy materials and tangible tools (e.g., pedometers), and broadening of content (e.g., early feeding, updated 24-h movement guidelines). BCTs used across the RCT and scale-up sessions were unchanged. However, the BCTs identified in the between-session support materials were almost double for the scale-up compared with the RCT, primarily due to the reduced number of sessions and the app's capacity to include more content. Conclusions INFANT is one of few early life nutrition and movement behavioral interventions being delivered at scale. With INFANT as an example, this study provides critical understanding about what and why intervention components were altered as the RCT was scaled-up. Unpacking these intervention modifications provides important insights for scale-up feasibility, outcome effects, and how to optimize implementation strategies for population-level benefits.
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Affiliation(s)
- Sarah Marshall
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Brittany J. Johnson
- Transforming Obesity Prevention in CHILDren (TOPCHILD) Collaboration, Sydney, NSW, Australia,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Kylie Fraser
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia
| | - Elizabeth Denney-Wilson
- NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia,Sydney Nursing School, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Jo Salmon
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Zoe McCallum
- Department of Paediatrics, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
| | - Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia,NHMRC Centre of Research Excellence in Translating Early Prevention of Obesity in Childhood (EPOCH-Translate CRE), Sydney, NSW, Australia,*Correspondence: Rachel Laws ✉
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Karssen LT, Larsen JK, Burk WJ, Kremers SPJ, Hermans RCJ, Ruiter ELM, Vink JM, de Weerth C. Process and effect evaluation of the app-based parenting program Samen Happie! on infant zBMI: A randomized controlled trial. Front Public Health 2022; 10:1012431. [PMID: 36620259 PMCID: PMC9822729 DOI: 10.3389/fpubh.2022.1012431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Although energy balance-related parenting practices are regarded critical components in the prevention of childhood obesity, most programs targeting parenting practices with respect to a wide range of energy balance-related behaviors were not aimed at high-risk families with a lower socioeconomic position (SEP). Objective The Samen Happie! app-based program aimed to stimulate healthy child weight development especially among families with a lower SEP, by encouraging healthy energy balance-related parenting practices. Methods A two-armed randomized controlled trial examined the process and effectiveness of the Samen Happie! program on child zBMI outcomes at 6- and 12-months follow-up. In total, 357 Dutch parents with infants aged 5-15 months old at baseline participated. Parents in the app condition (n = 179) received access to the Samen Happie! app and were compared to a waitlist-control condition (n = 178). Changes in zBMI were examined through linear mixed-effects models based on intention-to-treat and exploratory per-protocol principles. Results Process data showed low levels of sustained app use and moderate app acceptability. A general increase in child zBMI was observed in both conditions after 6 and 12 months. Intention-to-treat analyses using multiple imputations showed several statistically significant differences between conditions and high-risk subgroups. Specifically, at 6-months follow-up, zBMI increase was least pronounced in the app condition among children of parents with lower educational level. These findings were supported by exploratory per-protocol analyses including only frequent app users. In addition, per-protocol analyses showed benefits of app use at 6-months follow-up for children of parents with higher BMI. However, these effects were reversed at 12-months follow-up in both intention-to-treat and per-protocol analyses, where children of parents in the app condition in general increased the most in zBMI. Conclusions This study suggests that the Samen Happie! program might prevent zBMI increases after 6 months among children of parents with lower educational level, and children of parents with higher BMI who more frequently use the app. However, the app did not prevent increases in zBMI after 12 months. Future research should investigate strategies to increase sustained app use and engagement in mHealth parenting programs for childhood obesity as well as options to combine app-based programs with additional support strategies aimed at high-risk families. Trial registration Netherlands trial register (ID: NTR6938), https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6938.
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Affiliation(s)
- Levie T. Karssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands,*Correspondence: Levie T. Karssen ✉
| | - Junilla K. Larsen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - William J. Burk
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Stef P. J. Kremers
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Roel C. J. Hermans
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, Netherlands
| | - Emilie L. M. Ruiter
- Academic Collaborative Centre AMPHI, Primary and Community Care, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Jacqueline M. Vink
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | - Carolina de Weerth
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, Netherlands
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Areemit R, Saengnipanthkul S, Sutra S, Lumbiganon P, Pornprasitsakul P, Paopongsawan P, Sripanidkulchai K. Effectiveness of a mobile app, KhunLook versus the maternal and child health handbook on Thai parent’s health literacy, accuracy of health assessments and convenience of use: A randomized controlled trial (Preprint). J Med Internet Res 2022; 25:e43196. [PMID: 37159258 DOI: 10.2196/43196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/17/2023] [Accepted: 03/28/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Children of parents who have higher health literacy (HL) benefit more from preventive child health care. Digital interventions have been used to improve parents' HL with high satisfaction. KhunLook is a Thai mobile app conceived using strategies to improve HL. It was developed to assist parents in assessing and keeping track of their child's health in complement to the standard Maternal and Child Health Handbook (MCHH). OBJECTIVE This trial focuses on the effectiveness of using the KhunLook app with the MCHH and standard care (intervention) compared with the conventional MCHH and standard care (control) on parents' HL. Data on accuracy of parents' assessment of their child's health and growth as well as convenience of use of the tool (app or MCHH) in the well-child clinic were collected at 2 visits (immediate=visit 1, and intermediate=visit 2). METHODS Parents of children under 3 years of age who (1) had a smartphone or tablet and the MCHH and (2) could participate in 2 visits, 2-6 months apart at Srinagarind Hospital, Khon Kaen, Thailand, were enrolled in this 2-arm parallel randomized controlled trial between April 2020 and May 2021. Parents were randomized 1:1 to 2 groups. At visit 1, data on demographics and baseline HL (Thailand Health Literacy Scales) were collected. Parents in the app group used the KhunLook app and the control group used their child's handbook to assess their child's growth, development, nutrition and feeding, immunization status and rated the convenience of the tool they used. At visit 2, they repeated the assessments and completed the HL questionnaire. RESULTS A total of 358 parents completed the study (358/408, 87.7%). After the intervention, the number of parents with high total HL significantly increased from 94/182 (51.6%) to 109/182 (59.9%; 15/182; Δ 8.2%; P=.04), specifically in the health management (30/182; Δ 16.4%; P<.001) and child health management (18/182; Δ 9.9%; P=.01) domains in the app group, but not in the control group. Parents in the app group could correctly assess their child's head circumference (172/182, 94.5% vs 124/176, 70.5%; P<.001) and development (173/182, 95.1% vs 139/176, 79.0%; P<.001) better than those in the control group at both visits. A higher proportion of parents in the app group rated their tool as very easy or easy to use (174-181/182, 95.6%-99.5% vs 141-166/176, 80.1%-94.3%; P<.001) on every item since the first visit. CONCLUSIONS Our results suggest the potential of a smartphone app (KhunLook) to improve parents' HL as well as to promote superior accuracy of parents' assessment of their child's head circumference and development, with a similar effect on weight, height, nutrition and feeding, and immunization as in traditional interventions. Using the KhunLook app is useful and more convenient for parents in promoting a healthy child preventive care during early childhood. TRIAL REGISTRATION Thai Clinical Trials Registry TCTR20200312003; https://www.thaiclinicaltrials.org/show/TCTR20200312003.
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Affiliation(s)
- Rosawan Areemit
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Sumitr Sutra
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | | | - Kunwadee Sripanidkulchai
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
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9
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Bunik M, Jimenez-Zambrano A, Solano M, Beaty BL, Juarez-Colunga E, Zhang X, Moore SL, Bull S, Leiferman JA. Mother's Milk Messaging™: trial evaluation of app and texting for breastfeeding support. BMC Pregnancy Childbirth 2022; 22:660. [PMID: 36002798 PMCID: PMC9400217 DOI: 10.1186/s12884-022-04976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New mothers experience BF challenges but have limited evidence-based technology-enabled support. OBJECTIVES 1) Determine if using the Mother's Milk Messaging™ app improved aspects of breastfeeding and breastfeeding rates and 2) Describe engagement as well as themes from the qualitative feedback on the app. METHOD Randomized Controlled Trial National sample of primiparous, singleton mothers recruited online and then randomized using stratification by language into three arms: 1) BF text messages plus app; 2) BF text messages, app and physician-moderated private Facebook (FB) group; 3) Attention control group who received injury prevention texts. Exclusive breastfeeding rates as primary outcome and knowledge/attitude, confidence, and social support as secondary outcomes. We determined engagement through analysis of app usage metrics. We conducted and content-coded interviews with participants to learn more about app usage and BF experience. Due to the nature of the intervention participants could not be blinded. RESULTS There were a total of 346 participants in the trial, with 227 in the Intervention (n = 154 group 1 and n = 156 group 2) and 119 in the control group. Because of minimal Facebook activity, the two intervention groups 1 and 2 were combined. There were no differences in breastfeeding exclusivity and duration. (NS). Women in the intervention arm reported significantly higher confidence with breastfeeding and perceived social support to the control group (p < .05). Greater than 80% registered the app and those that engaged with the app had higher scores with time. Mothers appreciated receiving text messages and videos with reliable information. No harm was reported in this study. CONCLUSION MMM increased confidence with breastfeeding and with gathering social supports. Exclusively BF was high in all participants. Mothers perceived it as useful and dependable especially the texting.
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Affiliation(s)
- Maya Bunik
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. .,Children's Hospital Colorado, 13123 E. 16th Ave B032, Aurora, CO, 80045, USA.
| | - Andrea Jimenez-Zambrano
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michael Solano
- Children's Hospital Colorado, 13123 E. 16th Ave B032, Aurora, CO, 80045, USA
| | - Brenda L Beaty
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Juarez-Colunga
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Xuhong Zhang
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Susan L Moore
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Sheana Bull
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jenn A Leiferman
- Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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10
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Petkovic J, Duench S, Trawin J, Dewidar O, Pardo Pardo J, Simeon R, DesMeules M, Gagnon D, Hatcher Roberts J, Hossain A, Pottie K, Rader T, Tugwell P, Yoganathan M, Presseau J, Welch V. Behavioural interventions delivered through interactive social media for health behaviour change, health outcomes, and health equity in the adult population. Cochrane Database Syst Rev 2021; 5:CD012932. [PMID: 34057201 PMCID: PMC8406980 DOI: 10.1002/14651858.cd012932.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Social networking platforms offer a wide reach for public health interventions allowing communication with broad audiences using tools that are generally free and straightforward to use and may be combined with other components, such as public health policies. We define interactive social media as activities, practices, or behaviours among communities of people who have gathered online to interactively share information, knowledge, and opinions. OBJECTIVES We aimed to assess the effectiveness of interactive social media interventions, in which adults are able to communicate directly with each other, on changing health behaviours, body functions, psychological health, well-being, and adverse effects. Our secondary objective was to assess the effects of these interventions on the health of populations who experience health inequity as defined by PROGRESS-Plus. We assessed whether there is evidence about PROGRESS-Plus populations being included in studies and whether results are analysed across any of these characteristics. SEARCH METHODS We searched CENTRAL, CINAHL, Embase, MEDLINE (including trial registries) and PsycINFO. We used Google, Web of Science, and relevant web sites to identify additional studies and searched reference lists of included studies. We searched for published and unpublished studies from 2001 until June 1, 2020. We did not limit results by language. SELECTION CRITERIA We included randomised controlled trials (RCTs), controlled before-and-after (CBAs) and interrupted time series studies (ITSs). We included studies in which the intervention website, app, or social media platform described a goal of changing a health behaviour, or included a behaviour change technique. The social media intervention had to be delivered to adults via a commonly-used social media platform or one that mimicked a commonly-used platform. We included studies comparing an interactive social media intervention alone or as a component of a multi-component intervention with either a non-interactive social media control or an active but less-interactive social media comparator (e.g. a moderated versus an unmoderated discussion group). Our main outcomes were health behaviours (e.g. physical activity), body function outcomes (e.g. blood glucose), psychological health outcomes (e.g. depression), well-being, and adverse events. Our secondary outcomes were process outcomes important for behaviour change and included knowledge, attitudes, intention and motivation, perceived susceptibility, self-efficacy, and social support. DATA COLLECTION AND ANALYSIS We used a pre-tested data extraction form and collected data independently, in duplicate. Because we aimed to assess broad outcomes, we extracted only one outcome per main and secondary outcome categories prioritised by those that were the primary outcome as reported by the study authors, used in a sample size calculation, and patient-important. MAIN RESULTS We included 88 studies (871,378 participants), of which 84 were RCTs, three were CBAs and one was an ITS. The majority of the studies were conducted in the USA (54%). In total, 86% were conducted in high-income countries and the remaining 14% in upper middle-income countries. The most commonly used social media platform was Facebook (39%) with few studies utilising other platforms such as WeChat, Twitter, WhatsApp, and Google Hangouts. Many studies (48%) used web-based communities or apps that mimic functions of these well-known social media platforms. We compared studies assessing interactive social media interventions with non-interactive social media interventions, which included paper-based or in-person interventions or no intervention. We only reported the RCT results in our 'Summary of findings' table. We found a range of effects on health behaviours, such as breastfeeding, condom use, diet quality, medication adherence, medical screening and testing, physical activity, tobacco use, and vaccination. For example, these interventions may increase physical activity and medical screening tests but there was little to no effect for other health behaviours, such as improved diet or reduced tobacco use (20,139 participants in 54 RCTs). For body function outcomes, interactive social media interventions may result in small but important positive effects, such as a small but important positive effect on weight loss and a small but important reduction in resting heart rate (4521 participants in 30 RCTs). Interactive social media may improve overall well-being (standardised mean difference (SMD) 0.46, 95% confidence interval (CI) 0.14 to 0.79, moderate effect, low-certainty evidence) demonstrated by an increase of 3.77 points on a general well-being scale (from 1.15 to 6.48 points higher) where scores range from 14 to 70 (3792 participants in 16 studies). We found no difference in effect on psychological outcomes (depression and distress) representing a difference of 0.1 points on a standard scale in which scores range from 0 to 63 points (SMD -0.01, 95% CI -0.14 to 0.12, low-certainty evidence, 2070 participants in 12 RCTs). We also compared studies assessing interactive social media interventions with those with an active but less interactive social media control (11 studies). Four RCTs (1523 participants) that reported on physical activity found an improvement demonstrated by an increase of 28 minutes of moderate-to-vigorous physical activity per week (from 10 to 47 minutes more, SMD 0.35, 95% CI 0.12 to 0.59, small effect, very low-certainty evidence). Two studies found little to no difference in well-being for those in the intervention and control groups (SMD 0.02, 95% CI -0.08 to 0.13, small effect, low-certainty evidence), demonstrated by a mean change of 0.4 points on a scale with a range of 0 to 100. Adverse events related to the social media component of the interventions, such as privacy issues, were not reported in any of our included studies. We were unable to conduct planned subgroup analyses related to health equity as only four studies reported relevant data. AUTHORS' CONCLUSIONS This review combined data for a variety of outcomes and found that social media interventions that aim to increase physical activity may be effective and social media interventions may improve well-being. While we assessed many other outcomes, there were too few studies to compare or, where there were studies, the evidence was uncertain. None of our included studies reported adverse effects related to the social media component of the intervention. Future studies should assess adverse events related to the interactive social media component and should report on population characteristics to increase our understanding of the potential effect of these interventions on reducing health inequities.
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Affiliation(s)
| | | | | | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Jordi Pardo Pardo
- Ottawa Hospital Research Institute, The Ottawa Hospital - General Campus, Ottawa, Canada
| | - Rosiane Simeon
- Bruyère Research Institute, University of Ottawa, Ottawa, Canada
| | - Marie DesMeules
- Social Determinants and Science Integration/ Direction des déterminants sociaux et de l'intégration scientifique, Public Health Agency of Canada/Agence de santé publique du Canada, Ottawa, Canada
| | - Diane Gagnon
- Department of Communication, University of Ottawa, Ottawa, Canada
| | | | - Alomgir Hossain
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Kevin Pottie
- Family Medicine, University of Ottawa, Ottawa, Canada
| | - Tamara Rader
- Canadian Agency for Drugs and Technologies in Health (CADTH), Ottawa, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
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11
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Ekambareshwar M, Ekambareshwar S, Mihrshahi S, Wen LM, Baur LA, Laws R, Taki S, Rissel C. Process evaluations of early childhood obesity prevention interventions delivered via telephone or text messages: a systematic review. Int J Behav Nutr Phys Act 2021; 18:10. [PMID: 33422066 PMCID: PMC7796572 DOI: 10.1186/s12966-020-01074-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Increasingly, public health interventions are delivered via telephone and/or text messages. Recent systematic reviews of early childhood obesity prevention interventions have not adequately reported on the way interventions are delivered and the experiences/perceptions of stakeholders. We aimed to summarise the literature in early childhood obesity prevention interventions delivered via telephone or text messages for evidence of application of process evaluation primarily to evaluate stakeholders' acceptability of interventions. METHODS A systematic search of major electronic databases was carried out using the Population, Intervention, Comparison, Outcomes framework. Studies were included if interventions were delivered via telephone/text messages; aimed at changing caregivers' behaviours to prevent early childhood obesity; with one or more outcomes related to early obesity risk factors such as breastfeeding, solid feeding, tummy time, sleep and settling, physical activity and screen time; published from inception to May 2020. All eligible studies were independently assessed by two reviewers using the Cochrane Collaboration tool for assessing risk of bias. Qualitative studies were assessed using the Consolidated Criteria for Reporting Qualitative Research and Standards for Reporting Qualitative Research tools. RESULTS Twenty-four studies were eligible, and the overall risk of bias was low. Eight studies (33%) had evidence of process evaluation that examined participants' perceptions of interventions. Participants appreciated the convenience of receiving interventions via telephone or text messages. 63% of all studies in this review showed improvement in one or more behaviours related to childhood obesity prevention. Participants were likely to modify behaviours if they received information from a credible source such as from health professionals. CONCLUSION There is limited reporting of stakeholders' experiences in early obesity prevention studies delivered by telephone or text messages. Only one-third of studies examined participants' acceptability and the potential for delivery of childhood obesity prevention interventions conveniently using this mode of delivery. Interventions delivered remotely via telephone or text messages have the potential to reach equal or a greater number of participants than those delivered via face-to-face methods. Future research should build in process evaluation alongside effectiveness measurements to provide important insight into intervention reach, acceptability and to inform scale up. TRIAL REGISTRATION PROSPERO registration: CRD42019108658.
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Affiliation(s)
- Mahalakshmi Ekambareshwar
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia.
| | - Swathi Ekambareshwar
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Seema Mihrshahi
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- Department of Health Systems and Populations, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Li Ming Wen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Louise A Baur
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rachel Laws
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Sarah Taki
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
- Health Promotion Unit, Population Health Research and Evaluation Hub, Sydney Local Health District, Sydney, Australia
| | - Chris Rissel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NHMRC Centre of Research Excellence in the Early Prevention of Obesity in Childhood, Sydney, Australia
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12
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Laws R, Love P, Hesketh KD, Koorts H, Denney-Wilson E, Moodie M, Brown V, Ong KL, Browne J, Marshall S, Lioret S, Orellana L, Campbell KJ. Protocol for an Effectiveness-Implementation Hybrid Trial to Evaluate Scale up of an Evidence-Based Intervention Addressing Lifestyle Behaviours From the Start of Life: INFANT. Front Endocrinol (Lausanne) 2021; 12:717468. [PMID: 34975744 PMCID: PMC8715861 DOI: 10.3389/fendo.2021.717468] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/21/2021] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Promoting healthy eating and active play in early life is critical, however few interventions have been delivered or sustained at scale. The evaluation of interventions at scale is a crucial, yet under-researched aspect of modifying population-level health behaviours. INFANT is an evidence-based early childhood healthy lifestyle intervention that aims to improve parents' knowledge and skills around promoting optimal energy balance-related behaviours that, in turn, influence children's diet, activity and adiposity. It consists of: 1) Four group sessions delivered via first time parent groups across the first 12 months of life; 2) access to the My Baby Now app from birth to 18 months of age. This research aims to assess real-world implementation, effectiveness and cost-effectiveness of INFANT when delivered at scale across Victoria, Australia. METHODS AND ANALYSIS A hybrid type II implementation-effectiveness trial applying a mixed methods design will be conducted. INFANT will be implemented in collaboration with practice and policy partners including maternal and child health services, population health and Aboriginal health, targeting all local government areas (n=79) in Victoria, Australia. Evaluation is based on criteria from the 'Outcomes for Implementation Research' and 'RE-AIM' frameworks. Implementation outcomes will be assessed using descriptive quantitative surveys and qualitative interviews with those involved in implementation, and include intervention reach, organisational acceptability, adoption, appropriateness, cost, feasibility, penetration and sustainability. Process measures include organizational readiness, fidelity, and adaptation. Effectiveness outcomes will be assessed using a sample of INFANT participants and a non-randomized comparison group receiving usual care (1,500 infants in each group), recruited within the same communities. Eligible participants will be first time primary caregivers of an infant aged 0-3 months, owning a personal mobile phone and able to communicate in English. Effectiveness outcomes include infant lifestyle behaviours and BMIz at 12 and 18 months of age. IMPACT This is the first known study to evaluate the scale up of an evidence based early childhood obesity prevention intervention under real world conditions. This study has the potential to provide generalisable implementation, effectiveness and cost-effectiveness evidence to inform the future scale up of public health interventions both in Australia and internationally. CLINICAL TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry https://www.anzctr.org.au/, identifier ACTRN12620000670976.
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Affiliation(s)
- Rachel Laws
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
- *Correspondence: Rachel Laws,
| | - Penelope Love
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Kylie D. Hesketh
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Harriet Koorts
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Denney-Wilson
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney and Sydney Local Health District, Sydney, NSW, Australia
| | - Marj Moodie
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Vicki Brown
- Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Kok-Leong Ong
- La Trobe Analytics Lab, La Trobe University, Melbourne, VIC, Australia
| | - Jennifer Browne
- Institute for Health Transformation, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| | - Sarah Marshall
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
| | | | | | - Karen J. Campbell
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, VIC, Australia
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13
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Susic D, Davis G, O' Sullivan AJ, McGovern E, Harris K, Roberts LM, Craig ME, Mangos G, Hold GL, El-Omar EM, Henry A. Microbiome Understanding in Maternity Study (MUMS), an Australian prospective longitudinal cohort study of maternal and infant microbiota: study protocol. BMJ Open 2020; 10:e040189. [PMID: 32933964 PMCID: PMC7493111 DOI: 10.1136/bmjopen-2020-040189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Pregnancy induces significant physiological and cardiometabolic changes, and is associated with alterations in the maternal microbiota. Increasing rates of prepregnancy obesity, metabolic abnormalities and reduced physical activity, all impact negatively on the microbiota causing an imbalance between the commensal microorganisms (termed dysbiosis), which may drive complications, such as gestational diabetes or hypertensive disorders. Considerable work is needed to define the inter-relationships between the microbiome, nutrition, physical activity and pregnancy outcomes. The role of the microbiota during pregnancy remains unclear. The aim of the study is to define microbiota signatures longitudinally throughout pregnancy and the first year post birth, and to identify key clinical and environmental variables that shape the female microbiota profile during and following pregnancy. METHODS AND ANALYSIS The Microbiome Understanding in Maternity Study (MUMS) is an Australian prospective longitudinal cohort study involving 100 mother-infant pairs. Women are enrolled in their first trimester and followed longitudinally. Assessment occurs at <13+0, 20+0-24+6 and 32+0-36+6 weeks gestation, birth and 6 weeks, 6 months and 12 months postpartum. At each assessment, self-collected oral, vaginal and faecal samples are collected with an additional postpartum skin swab and breastmilk sample. Each infant will have oral, faecal and skin swab samples collected. Measurements include anthropometrics, body composition, blood pressure, serum hormonal and metabolic parameters and vaginal pH. Dietary intake, physical activity and psychological state will be assessed using validated self-report questionnaires, and pregnancy and infant outcomes recorded. Parametric and non-parametric hypothesis tests will be used to test the association between high-risk and low-risk pregnancies and their outcomes. ETHICS AND DISSEMINATION The study received the following approval: South Eastern Sydney Local Health District Research Ethics Committee (17/293 (HREC/17/POWH/605). Results will be made available to the participants of MUMS, their families and the funding bodies; in the form of a summary document. Results for the greater maternity care community and other researchers will be disseminated through conferences, local, national and international presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER ACTRN12618000471280 (prospectively registered).
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Affiliation(s)
- Daniella Susic
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Microbiome Research Centre, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - Gregory Davis
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - Anthony J O' Sullivan
- St George and Sutherland Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Emily McGovern
- Microbiome Research Centre, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lynne M Roberts
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Maria E Craig
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - George Mangos
- St George and Sutherland Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Georgina L Hold
- Microbiome Research Centre, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Emad M El-Omar
- Microbiome Research Centre, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- St George and Sutherland Clinical School, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of New South Wales Faculty of Medicine, Sydney, New South Wales, Australia
- Department of Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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14
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Patchen L, Ellis L, Harrington CB, Ma T, Mohanraj R, Andrews V, Evans WD. Engaging African American Parents to Develop a Mobile Health Technology for Breastfeeding: KULEA-NET. J Hum Lact 2020; 36:448-460. [PMID: 32525434 PMCID: PMC11330581 DOI: 10.1177/0890334420930208] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND African Americans breastfeed less than other groups, which has implications for health throughout the life course. Little is known about mobile health technologies to support breastfeeding. RESEARCH AIMS This study proceeded in two phases. The aim of Phase 1 was to identify ideal technological components and content of a mobile health intervention. The aim of Phase 2 was to determine the usability of a prototype, KULEA-NET, based on the Phase 1 findings. METHODS For this mixed-methods study, we used community-based participatory research methods and user-centered technology design methods. We used open coding in NVivo 11 to organize data from focus groups and in-depth interviews, then we analyzed the data. We then developed a prototype and tested the prototype's usability with the System Usability Scale. Fifty pregnant and postpartum African Americans from the District of Columbia participated. RESULTS Participants preferred an app with text messaging technology and identified areas for intervention: self-efficacy, parent-child attachment beliefs, social support, public breastfeeding and social desirability, and returning to work. Desired features included local resources, support person access, baby care logs, identification of public breastfeeding venues, and peer discussions. The System Usability Scale score was 73.8, which indicates above average usability. CONCLUSIONS A mobile health technology like KULEA-NET can be used to meet the breastfeeding needs of African Americans, build social desirability, and complement traditional health care. The appeal of an African American-specific intervention is unclear. Responding to mixed feeding practices is challenging. KULEA-NET is a mobile breastfeeding intervention guided by the preferences of African American parents and offers promising usability metrics.
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Affiliation(s)
- Loral Patchen
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lindsey Ellis
- MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | | | - Tony Ma
- Benten Technologies, Manassas, VA, USA
| | | | - Virginia Andrews
- George Washington University, Washington, District of Columbia, USA
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15
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Doan TTD, Binns C, Pham NM, Zhao Y, Dinh TPH, Bui TTH, Tran TC, Nguyen XH, Giglia R, Xu F, Lee A. Improving Breastfeeding by Empowering Mothers in Vietnam: A Randomised Controlled Trial of a Mobile App. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5552. [PMID: 32752026 PMCID: PMC7432632 DOI: 10.3390/ijerph17155552] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022]
Abstract
Breastfeeding provides benefits to the infant and mother; however, the rates of breastfeeding, particularly exclusive breastfeeding, remain below optimal levels in many Asian countries. The aim of this study is to review the benefits of breastfeeding to mothers and infants and current rates of breastfeeding in Vietnam, and to evaluate the effectiveness of a mobile application on exclusive breastfeeding among mothers in Vietnam. A two-arm, parallel triple-blinded randomised controlled trial will be conducted among 1000 mothers in Hanoi City, Vietnam, during 2020-2021. Eligible participants are pregnant women who will seek antenatal care from health facilities at 24-36 weeks of gestation and plan to deliver at two participating hospitals, own a smartphone, and carry a singleton foetus. Permuted-block randomisation method stratified by maternal age, education and parity will be used to ensure an equal number of participants in each group. A smartphone app will be developed to deliver breastfeeding and non-breastfeeding information to the intervention and control group, respectively. Data will be collected at baseline, before hospital discharge, and at 1, 4, and 6 months postpartum. This study envisages demonstrating whether a smartphone-based intervention can be effective at improving breastfeeding in Vietnam. Trials registration: ACTRN12619000531112.
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Affiliation(s)
- Thi Thuy Duong Doan
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Colin Binns
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
| | - Ngoc Minh Pham
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
- Department of Epidemiology, Faculty of Public Health, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 250000, Vietnam
| | - Yun Zhao
- School of Public Health, Curtin University, Bentley, WA 6102, Australia; (N.M.P.); (Y.Z.)
| | - Thi Phuong Hoa Dinh
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Thi Thu Ha Bui
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
| | - Trung Chuyen Tran
- Faculty of Information Technology, Department of Hanoi University of Mining and Geology, 18 Vien Street-Bac Tu Liem District, Hanoi 10000, Vietnam;
| | - Xuan Hoai Nguyen
- Faculty of IT, Ho Chi Minh University of Technology (HUTECH), Ho Chi Minh 700000, Vietnam;
| | | | - Fenglian Xu
- Data Analysis & Surgical Outcomes Unit (DASO), Royal North Shore Hospital, St Leonards, NSW 2065, Australia;
| | - Andy Lee
- Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, 1A Duc Thang Street, Bac Tu Liem District, Hanoi 10000, Vietnam; (T.T.D.D.); (T.P.H.D.); (T.T.H.B.); (A.L.)
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16
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Simeon R, Dewidar O, Trawin J, Duench S, Manson H, Pardo Pardo J, Petkovic J, Hatcher Roberts J, Tugwell P, Yoganathan M, Presseau J, Welch V. Behavior Change Techniques Included in Reports of Social Media Interventions for Promoting Health Behaviors in Adults: Content Analysis Within a Systematic Review. J Med Internet Res 2020; 22:e16002. [PMID: 32525482 PMCID: PMC7317628 DOI: 10.2196/16002] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/26/2019] [Accepted: 03/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Social media are an increasingly commonly used platform for delivering health promotion interventions. Although recent research has focused on the effectiveness of social media interventions for health promotion, very little is known about the optimal content within such interventions, and the active ingredients to promote health behavior change using social media are not clear. Identifying which behavior change techniques (BCTs) are reported may help to clarify the content of interventions using a generalizable terminology that may facilitate future intervention development. OBJECTIVE This study aimed to identify which BCTs are reported in social media interventions for promoting health behavior change in adults. METHODS We included 71 studies conducted with adult participants (aged ≥18 years) and for which social media intervention was considered interactive in a Cochrane review of the effectiveness of such interventions. We developed a coding manual informed by the Behavior Change Technique Taxonomy version 1 (BCTTv1) to identify BCTs in the included studies. We identified BCTs in all study arms (including control) and described BCTs in the group and self-directed components of studies. We characterized the dose of delivery for each BCT by low and high intensity. We used descriptive analyses to characterize the reported BCTs. RESULTS Our data consisted of 71 studies published from 2001 to 2017, mainly conducted in high-income countries (n=65). Most studies (n=31) used tailored, interactive websites to deliver the intervention; Facebook was the most used mainstream platform. In developing our coding manual, we adapted some BCTTv1 instructions to better capture unique nuances of how BCTs were operationalized in social media with respect to likes, retweets, smiles, congratulations, and badges. Social support (unspecified), instruction on how to perform the behavior, and credible source were most frequently identified BCTs in intervention arms of studies and group-delivery settings, whereas instruction on how to perform the behavior was most commonly applied in self-directed components of studies, control arms, and individual participant settings. Instruction on how to perform the behavior was also the most frequently reported BCT in both intervention and control arms simultaneously. Instruction on how to perform the behavior, social support (unspecified), self-monitoring of behavior, information about health consequences, and credible source were identified in the top 5 BCTs delivered with the highest intensity. CONCLUSIONS This study within a review provides a detailed description of the BCTs and their dose to promote behavior change in web-based, interactive social media interventions. Clarifying active ingredients in social media interventions and the intensity of their delivery may help to develop future interventions that can more clearly build upon the existing evidence.
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Affiliation(s)
- Rosiane Simeon
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Omar Dewidar
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Jessica Trawin
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Stephanie Duench
- Department of Population Medicine, University of Guelph, Guelph, ON, Canada
| | - Heather Manson
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Jordi Pardo Pardo
- Cochrane Musculoskeletal Group, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jennifer Petkovic
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Janet Hatcher Roberts
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tugwell
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
| | | | - Justin Presseau
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, ON, Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Vivian Welch
- Bruyère Research Institute, University of Ottawa, Ottawa, ON, Canada
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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17
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Zarnowiecki D, Mauch CE, Middleton G, Matwiejczyk L, Watson WL, Dibbs J, Dessaix A, Golley RK. A systematic evaluation of digital nutrition promotion websites and apps for supporting parents to influence children's nutrition. Int J Behav Nutr Phys Act 2020; 17:17. [PMID: 32041640 PMCID: PMC7011240 DOI: 10.1186/s12966-020-0915-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 01/19/2020] [Indexed: 12/18/2022] Open
Abstract
Background Globally children’s diet quality is poor. Parents are primary gatekeepers to children’s food intake; however, reaching and engaging parents in nutrition promotion can be challenging. With growth in internet and smartphone use, digital platforms provide potential to disseminate information rapidly to many people. The objectives of this review were to conduct a comprehensive and systematic evaluation of nutrition promotion via websites and apps supporting parents to influence children’s nutrition, from three different perspectives: 1) current evidence base, 2) end user (parent) experience and 3) current commercial offerings. Methods Three systematic reviews were undertaken of (1) studies evaluating the effectiveness for digital platforms for improving nutrition in children and parents, (2) studies conducting user-testing of digital tools with parents, (3) websites and apps providing lunch-provision information to parents. Searches were conducted in five databases for reviews one and two, and systematic search of Google and App Store for review three. Randomised controlled trials, cohort and cross-sectional and qualitative studies (study two only) were included if published in English, from 2013, with the intervention targeted at parents and at least 50% of intervention content focused on nutrition. Search results were double screened, with data extracted into standardised spreadsheets and quality appraisal of included search results. Results Studies evaluating digital nutrition interventions targeting parents (n = 11) demonstrated effectiveness for improving nutrition outcomes, self-efficacy and knowledge. Six of the included randomised controlled trials reported digital interventions to be equal to, or better than comparison groups. User-testing studies (n = 9) identified that digital platforms should include both informative content and interactive features. Parents wanted evidence-based information from credible sources, practical tools, engaging content and connection with other users and health professionals. Websites targeting lunch provision (n = 15) were developed primarily by credible sources and included information-based content consistent with dietary guidelines and limited interactive features. Lunchbox apps (n = 6), developed mostly by commercial organisations, were more interactive but provided less credible information. Conclusions Digital nutrition promotion interventions targeting parents can be effective for improving nutrition-related outcomes in children and parents. As demonstrated from the lunchbox context and user-testing with parents, they need to go beyond just providing information about positive dietary changes, to include the user-desired features supporting interactivity and personalisation.
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Affiliation(s)
- Dorota Zarnowiecki
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia.
| | - Chelsea E Mauch
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Georgia Middleton
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Louisa Matwiejczyk
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
| | - Wendy L Watson
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Jane Dibbs
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Anita Dessaix
- Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo, NSW, 2011, Australia
| | - Rebecca K Golley
- Flinders University, Nutrition and Dietetics, College of Nursing and Health Sciences, Sturt Road, Bedford Park, SA, 5042, Australia
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18
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Willcox JC, Dobson R, Whittaker R. Old-Fashioned Technology in the Era of "Bling": Is There a Future for Text Messaging in Health Care? J Med Internet Res 2019; 21:e16630. [PMID: 31859678 PMCID: PMC6942182 DOI: 10.2196/16630] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/26/2019] [Accepted: 12/09/2019] [Indexed: 01/20/2023] Open
Abstract
In the quest to discover the next high-technology solution to solve many health problems, proven established technologies are often overlooked in favor of more "technologically advanced" systems that have not been fully explored for their applicability to support behavior change theory, or used by consumers. Text messages or SMS is one example of an established technology still used by consumers, but often overlooked as part of the mobile health (mHealth) toolbox. The purpose of this paper is to describe the benefits of text messages as a health promotion modality and to advocate for broader scale implementation of efficacious text message programs. Text messaging reaches consumers in a ubiquitous real-time exchange, contrasting the multistep active engagement required for apps and wearables. It continues to be the most widely adopted and least expensive mobile phone function. As an intervention modality, text messaging has taught researchers substantial lessons about tailored interactive health communication; reach and engagement, particularly in low-resource settings; and embedding of behavior change models into digital health. It supports behavior change techniques such as reinforcement, prompts and cues, goal setting, feedback on performance, support, and progress review. Consumers have provided feedback to indicate that text messages can provide them with useful information, increase perceived support, enhance motivation for healthy behavior change, and provide prompts to engage in health behaviors. Significant evidence supports the effectiveness of text messages alone as part of an mHealth toolbox or in combination with health services, to support healthy behavior change. Systematic reviews have consistently reported positive effects of text message interventions for health behavior change and disease management including smoking cessation, medication adherence, and self-management of long-term conditions and health, including diabetes and weight loss. However, few text message interventions are implemented on a large scale. There is still much to be learned from investing in text messaging delivered research. When a modality is known to be effective, we should be learning from large-scale implementation. Many other technologies currently suffer from poor long-term engagement, the digital divide within society, and low health and technology literacy of users. Investing in and incorporating the learnings and lessons from large-scale text message interventions will strengthen our way forward in the quest for the ultimate digitally delivered behavior change model.
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Affiliation(s)
- Jane C Willcox
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
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19
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Ni Mhurchu C, Te Morenga L, Tupai-Firestone R, Grey J, Jiang Y, Jull A, Whittaker R, Dobson R, Dalhousie S, Funaki T, Hughes E, Henry A, Lyndon-Tonga L, Pekepo C, Penetito-Hemara D, Tunks M, Verbiest M, Humphrey G, Schumacher J, Goodwin D. A co-designed mHealth programme to support healthy lifestyles in Māori and Pasifika peoples in New Zealand (OL@-OR@): a cluster-randomised controlled trial. LANCET DIGITAL HEALTH 2019; 1:e298-e307. [DOI: 10.1016/s2589-7500(19)30130-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/09/2019] [Accepted: 08/19/2019] [Indexed: 12/23/2022]
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20
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Taki S, Russell CG, Wen LM, Laws RA, Campbell K, Xu H, Denney-Wilson E. Consumer Engagement in Mobile Application (App) Interventions Focused on Supporting Infant Feeding Practices for Early Prevention of Childhood Obesity. Front Public Health 2019; 7:60. [PMID: 30984732 PMCID: PMC6448001 DOI: 10.3389/fpubh.2019.00060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 02/26/2019] [Indexed: 11/13/2022] Open
Abstract
Background and Aims: There has been increasing interest in using mobile applications ("apps") for innovative health service delivery and public health interventions. This paper describes two independent studies investigating mothers' or pregnant women's perceptions of, interest in and experiences with technological devices, apps and websites about infant feeding practices. Methods: Study 1 was a cross-sectional survey conducted with 107 pregnant women in their third trimester in late 2016 and early 2017. Multiple logistic regression analyses were conducted to examine factors associated with their app usage. The second was a qualitative study of 29 mothers of infants aged <1 year conducted in 2014. Thematic network analysis was used to explore the themes from the transcribed interviews. Results: Study 1 found that the use of apps was common among the pregnant women, with 100% having previously downloaded an app on their phone either free or paid. About 60% had used an app for health purposes. The majority reported that they were likely to use an app promoting healthy infant feeding practices, including 30% extremely likely and 53% very likely. Women with university or other tertiary level of education were more likely to use an app for promoting healthy infant feeding practices than those with other levels of education (adjusted odds ratio 3.22, 95% confidence interval 1.28-8.13). The qualitative interviews found that all the mothers were interested in a mobile program to support them with infant feeding practices. Participants felt they would benefit from individualized messages although did not want them to be sent too frequently. Further, participants also expressed the importance of having non-judgmental information and they were interested in receiving information using different modes such as videos, SMS or an app. Conclusions: Both studies suggest that using apps for promoting healthy infant feeding practices is acceptable from the perspective of mothers. There is great potential for health promotion practitioners to be engaged in app development for the purpose of promoting health in early years and health promotion in general.
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Affiliation(s)
- Sarah Taki
- Health Promotion Unit, Camperdown, NSW, Australia.,Sydney School of Public Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - Catherine G Russell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre for Advanced Sensory Science, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Li M Wen
- Health Promotion Unit, Camperdown, NSW, Australia.,Sydney School of Public Health, Sydney Medical School, University of Sydney, Camperdown, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia
| | - Rachel A Laws
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Karen Campbell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Huilan Xu
- Health Promotion Unit, Camperdown, NSW, Australia
| | - Elizabeth Denney-Wilson
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, NSW, Australia.,Centre of Research Excellence, Early Prevention of Obesity in Childhood, Sydney, NSW, Australia.,Sydney Nursing School, University of Sydney, Camperdown, NSW, Australia
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21
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Sehhatie FS, Mirghafourvand M, Havizari S. Effect of prenatal counseling on exclusive breastfeeding frequency and infant weight gain in mothers with previous unsuccessful breastfeeding: a randomized controlled clinical trial. J Matern Fetal Neonatal Med 2019; 33:3571-3578. [PMID: 30720379 DOI: 10.1080/14767058.2019.1579191] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Breastfeeding counseling and mother support provision positively affect the duration of exclusive breastfeeding and infant growth and development. This study aimed to determine the effect of prenatal counseling on the frequency of exclusive breastfeeding and infant weight gain in mothers with previous unsuccessful breastfeeding.Methods: This was a randomized clinical trial on 108 pregnant women who visited the healthcare centers in Tabriz-Iran from November 2017 to May 2018. Participants were randomly allocated either to an intervention or a control group. The intervention group received four breastfeeding counseling sessions in the third trimester, whereas the control group merely received routine care. Counseling was offered to mothers until day 15, 2 months and the end of the month 4 postpartum, in case of experiencing any problem. A researcher-made breastfeeding performance checklist was completed by the groups on three occasions (p < .05 considered as the significance level).Findings: The frequency of exclusive breastfeeding in the intervention group was 75.9, 72.2, and 72.2% on day 15, and 2 and 4 months postpartum, respectively. It was 31.5, 16.7, and 16.7% in the control group, respectively. The probability of exclusive breastfeeding on day 15, month 2, and month 4 was significantly higher in the intervention group. The mean infant weight on day 15 postpartum was significant in the intervention group (mean difference = 112.2; 95% confidence interval = 29.8-194.5; p = .008). No statistically significant difference was observed between the groups in terms of infant weight gain in months 2 (p = .221) and 4 (p = .128) postpartum.Result: The results of the study showed that pregnancy counseling increases the frequency of exclusive breastfeeding in mothers.
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Affiliation(s)
- Fahimeh Shafaei Sehhatie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shiva Havizari
- Student Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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22
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Russell CG, Denney-Wilson E, Laws RA, Abbott G, Zheng M, Lymer SJ, Taki S, Litterbach EKV, Ong KL, Campbell KJ. Impact of the Growing Healthy mHealth Program on Maternal Feeding Practices, Infant Food Preferences, and Satiety Responsiveness: Quasi-Experimental Study. JMIR Mhealth Uhealth 2018; 6:e77. [PMID: 29695373 PMCID: PMC5943630 DOI: 10.2196/mhealth.9303] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/22/2017] [Accepted: 12/22/2017] [Indexed: 01/22/2023] Open
Abstract
Background Infancy is an important life stage for obesity prevention efforts. Parents’ infant feeding practices influence the development of infants’ food preferences and eating behaviors and subsequently diet and weight. Mobile health (mHealth) may provide a feasible medium through which to deliver programs to promote healthy infant feeding as it allows low cost and easy access to tailored content. Objective The objective of this study was to describe the effects of an mHealth intervention on parental feeding practices, infant food preferences, and infant satiety responsiveness. Methods A quasi-experimental study was conducted with an mHealth intervention group (Growing Healthy) and a nonrandomized comparison group (“Baby's First Food"). The intervention group received access to a free app with age-appropriate push notifications, a website, and an online forum that provided them with evidence-based advice on infant feeding for healthy growth from birth until 9 months of age. Behavior change techniques were selected using the Behaviour Change Wheel framework. Participants in both groups completed three Web-based surveys, first when their infants were less than 3 months old (baseline, T1), then at 6 months (time 2, T2), and 9 months of age (time 3, T3). Surveys included questions on infant feeding practices and beliefs (Infant Feeding Questionnaire, IFQ), satiety responsiveness (Baby Eating Behaviour Questionnaire), and infant’s food exposure and liking. Multivariate linear regression models, estimated using maximum likelihood with bootstrapped standard errors, were fitted to compare continuous outcomes between the intervention groups, with adjustment for relevant covariates. Multivariate logistic regression adjusting for the same covariates was performed for categorical outcomes. Results A total of 645 parents (Growing Healthy: n=301, Baby's First Food: n=344) met the eligibility criteria and were included in the study, reducing to a sample size of 546 (Growing Healthy: n=234, Baby's First Food: n=312) at T2 and a sample size of 518 (Growing Healthy: n=225, Baby's First Food: n=293) at T3. There were approximately equal numbers of boy and girl infants, and infants were aged less than 3 months at baseline (Growing Healthy: mean 7.0, SD 3.7 weeks; Baby's First Food: mean 7.9, SD 3.8 weeks), with Growing Healthy infants being slightly younger than Baby's First Food infants (P=.001). All but one (IFQ subscale “concerns about infant overeating or becoming overweight” at T2) of the measured outcomes did not differ between Growing Healthy and Baby's First Food. Conclusions Although mHealth can be effective in promoting some health behaviors and offers many advantages in health promotion, the results of this study suggest that design and delivery characteristics needed to maximize the impact of mHealth interventions on infant feeding are uncertain. The sensitivity of available measurement tools and differences in baseline characteristics of participants may have also affected the results.
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Affiliation(s)
- Catherine Georgina Russell
- Centre for Advanced Sensory Science, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Burwood, Australia.,Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia
| | - Elizabeth Denney-Wilson
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Sydney Nursing School, The University of Sydney, Sydney, Australia.,Sydney Local Health District, Sydney, Australia
| | - Rachel A Laws
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Gavin Abbott
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Miaobing Zheng
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Sharyn J Lymer
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,The Boden Institute of Obesity Nutrition Exercise & Eating Disorders, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Sarah Taki
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Health Promotion Unit, Sydney Local Health District, and University of Sydney, Sydney, Australia
| | - Eloise-Kate V Litterbach
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Kok-Leong Ong
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Department of Accounting and Data Analytics, La Trobe Business School, College of Arts, Social Sciences and Commerce, La Trobe University, Melbourne, Australia
| | - Karen J Campbell
- Centre for Obesity Management and Prevention Research Excellence in Primary Health Care, Sydney, Australia.,Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
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