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Lister NB, Melville H, Jebeile H. What adolescents see on Instagram: Content analysis of #intermittentfasting, #keto, and #lowcarb. Nutr Diet 2024; 81:316-324. [PMID: 37963606 DOI: 10.1111/1747-0080.12853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/05/2023] [Accepted: 10/10/2023] [Indexed: 11/16/2023]
Abstract
AIM To describe popular diet content visible on #intermittentfasting, #keto, and #lowcarb on adolescent social media accounts. METHODS An adolescent Instagram profile captured 200 'top' images from three popular diet hashtags (#intermittentfasting, #keto, and #lowcarb) across two timepoints. Images were coded using a pre-determined ontology as food (core or discretionary; common foods/food groups), people (group, individual, before/after), or informative. Descriptive statistics were used to summarise these categories across hashtags. RESULTS At the time of first data collection, there were 3.8 million #intermittentfasting, 19 million #keto, and 22 million #lowcarb posts on Instagram. At the second timepoint there were 4.3 million #intermittentfasting, 21.5 million #keto, and 24.3 million #lowcarb posts. Images tagged #intermittentfasting were categorised as 44% food, 39% people, 10% information; #keto were 64% food, 28% people, 5% information; and #lowcarb were 69% food, 14% people, 16% information. Food images mostly depicted animal proteins (58.6% of #intermittentfasting; 62.9% of #keto; and 40.1% of #lowcarb). Images of people were individual (44%) or before/after (39%); mostly female (77%), of white (53%) ethnicity. Across all posts, 12.5% were linked to a commercial product/program, and 2.3% provided nutrition information. CONCLUSION Diet-related images visible when adolescents search #intermittentfasting, #keto, and #lowcarb on Instagram promote animal-based foods with or without vegetables. These diet hashtags on Instagram do not provide nutrition information and are not helpful for young people searching for diet information online.
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Affiliation(s)
- Natalie B Lister
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Hannah Melville
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
| | - Hiba Jebeile
- Children's Hospital Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
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Soltero EG, Musaad SM, O'Connor TM, Thompson D, Norris K, Beech BM. Feasibility of Fit24, a Digital Diabetes Prevention Program for Hispanic Adolescents: Qualitative Evaluation Study. JMIR Form Res 2024; 8:e54595. [PMID: 38758584 PMCID: PMC11143392 DOI: 10.2196/54595] [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: 11/15/2023] [Revised: 03/27/2024] [Accepted: 04/12/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Digital health interventions are promising for reaching and engaging high-risk youth in disease prevention opportunities; however, few digital prevention interventions have been developed for Hispanic youth, limiting our knowledge of these strategies among this population. OBJECTIVE This study qualitatively assessed the feasibility and acceptability of Fit24, a 12-week goal-setting intervention that uses a Fitbit watch (Fitbit Inc) and theoretically grounded SMS text messages to promote physical activity and sleep among Hispanic adolescents (aged between 14 and 16 years) with obesity. METHODS After completing the intervention, a subsample of youth (N=15) participated in an in-depth interview. We categorized the themes into dimensions based on participant perspectives using the Practical, Robust Implementation, and Sustainability Model (PRISM) framework. RESULTS Participants shared positive perceptions of wearing the Fitbit and receiving SMS text messages. Youth were highly engaged in monitoring their behaviors and perceived increased activity and sleep. Almost all youth organically received social support from a peer or family member and suggested the use of a group chat or team challenge for integrating peers into future interventions. However, most youth also expressed the need to take personal responsibility for the change in their behavior. Barriers that impacted the feasibility of the study included the skin-irritating material on the Fitbit watch band and environmental barriers (eg, lack of resources and school schedules), that limited participation in activity suggestions. Additionally, sync issues with the Fitbit limited the transmission of data, leading to inaccurate feedback. CONCLUSIONS Fit24 is a promising approach for engaging Hispanic youth in a diabetes prevention program. Strategies are needed to address technical issues with the Fitbit and environmental issues such as message timing. While integrating peer social support may be desired by some, peer support strategies should be mindful of youth's desire to foster personal motivation for behavior change. Findings from this study will inform future diabetes prevention trials of Fit24 and other digital health interventions for high-risk pediatric populations.
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Affiliation(s)
- Erica G Soltero
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Salma M Musaad
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Keith Norris
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, United States
| | - Bettina M Beech
- UH Population Health, University of Houston, Houston, TX, United States
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Raeside R, Todd A, Sim KA, Kang M, Mihrshahi S, Gardner LA, Champion KE, Skinner J, Laranjo L, Steinbeck K, Redfern J, Partridge SR. Accelerating implementation of adolescent digital health prevention programs: analysis of insights from Australian stakeholders. Front Public Health 2024; 12:1389739. [PMID: 38765492 PMCID: PMC11100413 DOI: 10.3389/fpubh.2024.1389739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 04/10/2024] [Indexed: 05/22/2024] Open
Abstract
Background Chronic disease risk factors are increasing amongst adolescents, globally. Digital health prevention programs, which provide education and information to reduce chronic disease risk factors need to be equitable and accessible for all. For their success, multiple highly engaged stakeholders should be involved in development and implementation. This study aimed to evaluate stakeholders' support for, and perspectives on potential public health impact of digital health prevention programs for adolescents and potential pathways for future implementation. Methods Qualitative semi-structured online interviews with stakeholders. Stakeholder mapping identified key individuals, groups and organizations across Australia that may influence the implementation of digital health prevention programs for adolescents. Recorded and transcribed interviews were analyzed within the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) Framework, using deductive content analysis. Findings Nineteen interviews were conducted in 2023 with stakeholders from government, health, non-government organizations, youth services, education, community settings and others. Four overarching themes were identified: (i) existing digital health initiatives are not fit for purpose; (ii) the co-creation of digital health prevention programs is critical for successful implementation; (iii) digital health prevention programs must address equity and the unique challenges raised by technology and; (iv) system level factors must be addressed. Interpretation Stakeholders broadly supported digital health prevention programs, yet raised unique insights to ensure that future programs create public health impact by improving chronic disease risk factors among adolescents. These insights can be applied in future development of digital health prevention programs for adolescents to strengthen widespread implementation.
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Affiliation(s)
- Rebecca Raeside
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Allyson Todd
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kyra A. Sim
- Metabolism & Obesity Service, Sydney Local Health District, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Melissa Kang
- General Practice Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Seema Mihrshahi
- Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Lauren A. Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - Katrina E. Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, NSW, Australia
| | - John Skinner
- Djurali Centre for Aboriginal and Torres Strait Islander Health Research, Heart Research Institute, Sydney, NSW, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Katharine Steinbeck
- Specialty of Child and Adolescent Health, Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, Australia
| | - Julie Redfern
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie R. Partridge
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
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Warraitch A, Wacker C, Biju S, Lee M, Bruce D, Curran P, Khraisha Q, Hadfield K. Positive Impacts of Adolescent Involvement in Health Research: An Umbrella Review. J Adolesc Health 2024:S1054-139X(24)00121-6. [PMID: 38597838 DOI: 10.1016/j.jadohealth.2024.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/11/2024]
Abstract
Despite an increased recognition of the right of adolescents to be involved in decisions that affect them, young people continue to be under-involved in health research. One of the reasons is a lack of awareness among researchers on the current evidence base around the benefits of involving adolescents. To address this, we conducted an umbrella review to synthesize the evidence on the positive impacts of adolescent involvement in health research. This umbrella review was preregistered with PROSPERO (CRD42021287467). We searched 11 databases, Google Scholar, PROSPERO, reference lists, 10 journals, websites of 472 organizations, and sought input from experts. Ultimately, we included 99 review articles. We found that adolescent involvement has many positive impacts on young people, including increased knowledge and skills; personal development; financial benefits; career and academic growth; enhanced relationships; and valuing their experience. The positive impacts of adolescent involvement on the research itself include increased relevance of the study to adolescents, improved recruitment, development of more adolescent-friendly materials, enhanced data collection and analysis, and more effective dissemination. Researchers also benefited from adolescents' involvement through increased knowledge, skills, and a shift in their attitudes. The evidence supporting the positive impacts of adolescent involvement in research is substantial but limited by a lack of rigorous evaluation, inconsistent reporting, and unclear evaluation methods.
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Affiliation(s)
- Azza Warraitch
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland; Department of Psychology, Trinity College Dublin, Dublin, Ireland.
| | - Ciara Wacker
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland; Department of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Sanjana Biju
- Department of Social Work and Social Policy, Trinity College Dublin, Dublin, Ireland
| | - Maria Lee
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland; Department of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Delali Bruce
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland; Department of Engineering, Stanford University, Stanford, California
| | - Paul Curran
- Department of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Qusai Khraisha
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland; Department of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Kristin Hadfield
- Trinity Centre for Global Health, Trinity College Dublin, Dublin, Ireland; Department of Psychology, Trinity College Dublin, Dublin, Ireland
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Moore R, Al-Tamimi AK, Freeman E. Investigating the Potential of a Conversational Agent (Phyllis) to Support Adolescent Health and Overcome Barriers to Physical Activity: Co-Design Study. JMIR Form Res 2024; 8:e51571. [PMID: 38294857 PMCID: PMC10867744 DOI: 10.2196/51571] [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: 08/03/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Conversational agents (CAs) are a promising solution to support people in improving physical activity (PA) behaviors. However, there is a lack of CAs targeted at adolescents that aim to provide support to overcome barriers to PA. This study reports the results of the co-design, development, and evaluation of a prototype CA called "Phyllis" to support adolescents in overcoming barriers to PA with the aim of improving PA behaviors. The study presents one of the first theory-driven CAs that use existing research, a theoretical framework, and a behavior change model. OBJECTIVE The aim of the study is to use a mixed methods approach to investigate the potential of a CA to support adolescents in overcoming barriers to PA and enhance their confidence and motivation to engage in PA. METHODS The methodology involved co-designing with 8 adolescents to create a relational and persuasive CA with a suitable persona and dialogue. The CA was evaluated to determine its acceptability, usability, and effectiveness, with 46 adolescents participating in the study via a web-based survey. RESULTS The co-design participants were students aged 11 to 13 years, with a sex distribution of 56% (5/9) female and 44% (4/9) male, representing diverse ethnic backgrounds. Participants reported 37 specific barriers to PA, and the most common barriers included a "lack of confidence," "fear of failure," and a "lack of motivation." The CA's persona, named "Phyllis," was co-designed with input from the students, reflecting their preferences for a friendly, understanding, and intelligent personality. Users engaged in 61 conversations with Phyllis and reported a positive user experience, and 73% of them expressed a definite intention to use the fully functional CA in the future, with a net promoter score indicating a high likelihood of recommendation. Phyllis also performed well, being able to recognize a range of different barriers to PA. The CA's persuasive capacity was evaluated in modules focusing on confidence and motivation, with a significant increase in students' agreement in feeling confident and motivated to engage in PA after interacting with Phyllis. Adolescents also expect to have a personalized experience and be able to personalize all aspects of the CA. CONCLUSIONS The results showed high acceptability and a positive user experience, indicating the CA's potential. Promising outcomes were observed, with increasing confidence and motivation for PA. Further research and development are needed to create further interventions to address other barriers to PA and assess long-term behavior change. Addressing concerns regarding bias and privacy is crucial for achieving acceptability in the future. The CA's potential extends to health care systems and multimodal support, providing valuable insights for designing digital health interventions including tackling global inactivity issues among adolescents.
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Affiliation(s)
- Richard Moore
- Sheffield Hallam University, Sport and Physical Activity Research Centre / Advanced Wellbeing Research Centre, Sheffield, United Kingdom
| | | | - Elizabeth Freeman
- Department of Psychology, Sociology & Politics, Sheffield Hallam University, Sheffield, United Kingdom
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Mansfield D, Sagan D, O'Donnell AJ, Takgbajouah M, Loiacono B, Clark Withington MH, Cory M, Buscemi J. High School Student and Caregiver Preferred Communication Method Regarding School Meals: A Qualitative Approach. THE JOURNAL OF SCHOOL HEALTH 2024; 94:47-56. [PMID: 37905453 DOI: 10.1111/josh.13407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 09/14/2023] [Accepted: 09/25/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND This study examined student and caregiver preference for school communication and explored the feasibility and acceptability of a digital tool to assist with communication about school meal program between schools and families. METHODS The study used qualitative methodology through youth focus groups and caregiver semi-structured phone interviews. The study was conducted in 4 high schools in a large, urban city. The phenomenon of interest included the exploration of preferences regarding communication around school meal programs and feasibility and acceptability of a digital tool for communication and promoting the ordering of healthful foods in the school environment. Interviews were transcribed, coded, and analyzed through NVivo qualitative software using thematic analysis approach to examine themes. RESULTS Forty-seven students (ages 14-21, grades 9-12) participated in 7 focus groups and 24 caregivers participated in semi-structured phone interviews. Three themes emerged around (1) communication preferences, (2) accessibility, and (3) extrinsic motivational factors for engagement in healthy eating behaviors. CONCLUSION Results indicated that communication methods could potentially influence motivation and engagement in youth school meal participation.
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Affiliation(s)
- Dana Mansfield
- DePaul University, 2219 N. Kenmore Ave, Chicago, IL, 60614
| | - Dylan Sagan
- DePaul University, 2219 N. Kenmore Ave, Chicago, IL, 60614
| | | | | | | | | | - Molly Cory
- DePaul University, 2219 N. Kenmore Ave, Chicago, IL, 60614
| | - Joanna Buscemi
- DePaul University, 2219 N. Kenmore Ave, Chicago, IL, 60614
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Soltero E, Lopez C, Mihail S, Hernandez A, Musaad SM, O'Connor TM, Thompson D. An SMS Text Message-Based Type 2 Diabetes Prevention Program for Hispanic Adolescents With Obesity: Qualitative Co-Design Process. JMIR Form Res 2023; 7:e46606. [PMID: 37531191 PMCID: PMC10433019 DOI: 10.2196/46606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/23/2023] [Accepted: 06/09/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND SMS text message-based interventions are a promising approach for reaching and engaging high-risk youths, such as Hispanic adolescents with obesity, in health promotion and disease prevention opportunities. This is particularly relevant, given that SMS text messaging is widely accessible and available and that adolescents are frequent texters. Including youths in the development of SMS text message content can lead to more acceptable and relevant messaging; however, few studies include this group as cocollaborators. OBJECTIVE This study aimed to use a co-design process to inform the development of SMS text messages that promote healthy physical activity (PA) and sleep behaviors among Hispanic adolescents with obesity. METHODS The co-design framework uses multiple methods across several phases. Self-determination theory and a literature review of SMS text message-based interventions guided the background and research phases. In the co-design phase, Hispanic adolescents (n=20) completed in-depth interviews to identify barriers and facilitators of PA and sleep, preferences for ways to emphasize key self-determination theory constructs (autonomy, competence, and relatedness), and suggestions for making SMS text message content engaging. In the design and content phase, interview findings were used to develop initial SMS text messages, which were then evaluated in the early evaluation phase by experts (n=6) and adolescents (n=6). Feedback from these panels was integrated into the SMS text message content during refinement. RESULTS The background phase revealed that few SMS text message-based interventions have included Hispanic adolescents. Common barriers and facilitators of activity and sleep as well as preferences for ways in which SMS text messages could provide autonomy, competence, and relatedness support were identified in the co-design phase. The youths also wanted feedback about goal attainment. Suggestions to make SMS text messages more engaging included using emojis, GIFs, and media. This information informed an initial bank of SMS text messages (N=116). Expert review indicated that all (116/116, 100%) SMS text messages were age and culturally appropriate; however, some (21/116, 18.1%) did not adequately address youth-identified barriers and facilitators of PA and sleep, whereas others (30/116, 25.9%) were not theoretically adherent. Adolescents reported that SMS text messages were easy to understand (116/116, 100%), provided the support needed for behavior change (103/116, 88.8%), and used mostly acceptable language (84/116, 72.4%). Feedback was used to refine and develop the final bank of 125 unique text messages. CONCLUSIONS Using a co-design process, a theoretically grounded, appealing, and relevant bank of SMS text messages promoting healthy PA and sleep behaviors to adolescents was developed. The SMS text messages will be further evaluated in a pilot study to assess feasibility, acceptability, and preliminary efficacy. The co-design process used in this study provides a framework for future studies aimed at developing SMS text message-based strategies among high-risk adolescents. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1016/j.cct.2023.107117.
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Affiliation(s)
- Erica Soltero
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Callie Lopez
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Sandra Mihail
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Ayleen Hernandez
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Salma M Musaad
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Teresia M O'Connor
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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Li X, Zhang M. How digital health technologies promote healthy life in the Post-COVID-19 Era: evidences from national survey on Chinese adolescents and youngsters. Front Public Health 2023; 11:1135313. [PMID: 37228730 PMCID: PMC10203178 DOI: 10.3389/fpubh.2023.1135313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/17/2023] [Indexed: 05/27/2023] Open
Abstract
The rapid development of intelligent technologies coupled with the stay-at-home trends in the Post-COVID-19 Era has significantly changed youth's health behavior as well as reshaped their lifestyles. Digital health technologies (DHTs) have been more and more used for health management among youngsters. However, little was known about the use of DHTs among youths and its consequences on their health, especially in developing countries like China. Inspired by behavior intervention technology (BIT) model, this study examined the underlying mechanisms of use and social interactions of DHTs on Chinese adolescents' and youngsters' healthy lifestyles and mental health, using a representatively national survey among high school and freshman students in China (N = 2,297). It found that use of DHTs had a significantly positive effect on Chinese youths' healthy lifestyles and mental health, with behavioral regulation as a mediator. However, social interactions of DHTs were negatively associated with their mental health. The findings contribute to a better guidance on health promotion, as well as the enhanced design of DHTs' products.
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Han R, Todd A, Wardak S, Partridge SR, Raeside R. Feasibility and Acceptability of Chatbots for Nutrition and Physical Activity Health Promotion Among Adolescents: Systematic Scoping Review With Adolescent Consultation. JMIR Hum Factors 2023; 10:e43227. [PMID: 37145858 PMCID: PMC10199392 DOI: 10.2196/43227] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/15/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Reducing lifestyle risk behaviors among adolescents depends on access to age-appropriate health promotion information. Chatbots-computer programs designed to simulate conversations with human users-have the potential to deliver health information to adolescents to improve their lifestyle behaviors and support behavior change, but research on the feasibility and acceptability of chatbots in the adolescent population is unknown. OBJECTIVE This systematic scoping review aims to evaluate the feasibility and acceptability of chatbots in nutrition and physical activity interventions among adolescents. A secondary aim is to consult adolescents to identify features of chatbots that are acceptable and feasible. METHODS We searched 6 electronic databases from March to April 2022 (MEDLINE, Embase, Joanna Briggs Institute, the Cumulative Index to Nursing and Allied Health, the Association for Computing Machinery library, and the IT database Institute of Electrical and Electronics Engineers). Peer-reviewed studies were included that were conducted in the adolescent population (10-19 years old) without any chronic disease, except obesity or type 2 diabetes, and assessed chatbots used nutrition or physical activity interventions or both that encouraged individuals to meet dietary or physical activity guidelines and support positive behavior change. Studies were screened by 2 independent reviewers, with any queries resolved by a third reviewer. Data were extracted into tables and collated in a narrative summary. Gray literature searches were also undertaken. Results of the scoping review were presented to a diverse youth advisory group (N=16, 13-18 years old) to gain insights into this topic beyond what is published in the literature. RESULTS The search identified 5558 papers, with 5 (0.1%) studies describing 5 chatbots meeting the inclusion criteria. The 5 chatbots were supported by mobile apps using a combination of the following features: personalized feedback, conversational agents, gamification, and monitoring of behavior change. Of the 5 studies, 2 (40.0%) studies focused on nutrition, 2 (40.0%) studies focused on physical activity, and 1 (20.0%) focused on both nutrition and physical activity. Feasibility and acceptability varied across the 5 studies, with usage rates above 50% in 3 (60.0%) studies. In addition, 3 (60.0%) studies reported health-related outcomes, with only 1 (20.0%) study showing promising effects of the intervention. Adolescents presented novel concerns around the use of chatbots in nutrition and physical activity interventions, including ethical concerns and the use of false or misleading information. CONCLUSIONS Limited research is available on chatbots in adolescent nutrition and physical activity interventions, finding insufficient evidence on the acceptability and feasibility of chatbots in the adolescent population. Similarly, adolescent consultation identified issues in the design features that have not been mentioned in the published literature. Therefore, chatbot codesign with adolescents may help ensure that such technology is feasible and acceptable to an adolescent population.
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Affiliation(s)
- Rui Han
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Allyson Todd
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Sara Wardak
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Stephanie R Partridge
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
| | - Rebecca Raeside
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Westmead, Australia
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10
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Sweeney AM, Wilson DK, Resnicow K, Van Horn ML, Kitzman H. Engagement With Tailored Physical Activity Content: Secondary Findings From the Families Improving Together for Weight Loss Randomized Controlled Trial. J Med Internet Res 2023; 25:e42581. [PMID: 37043271 PMCID: PMC10134014 DOI: 10.2196/42581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/29/2023] [Accepted: 02/24/2023] [Indexed: 04/13/2023] Open
Abstract
BACKGROUND Web-based tailored interventions offer rich opportunities for improved access to and personalization of behavioral interventions. However, despite the promise of this approach, the engagement and underrepresentation of minority groups remain major issues. OBJECTIVE This study evaluated whether engagement (log-in status and log-in duration) with different types of tailored behavioral content from the Families Improving Together for weight loss web-based intervention was associated with changes in moderate to vigorous physical activity (MVPA) among African American families with overweight or obesity. METHODS Parent-adolescent dyads were randomized to a web-based tailored intervention or web-based health education comparison program. The web-based intervention (N=119) was completed by parents and targeted 6 weight-related behaviors to support their adolescent children's weight loss goals (session contents included energy balance, fast food, fruits and vegetables, physical activity [PA], sedentary behavior, and sweetened beverages). MVPA was measured using accelerometers at baseline and after the intervention. RESULTS Using a hierarchical approach, the log-in status and duration for each web-based session were used to evaluate the additive effects of engagement with different types of tailored behavioral content on MVPA after the web-based intervention. Among parents, logging in to the PA session was not associated with greater MVPA (B=-12.561, 95% CI -18.759 to -6.367), but MVPA increased with greater log-in duration for the PA (B=0.008, 95% CI 0.004-0.012) and sedentary behavior (B= 0.008, 95% CI 0.004-0.012) sessions. These results suggest that parents who logged in to the PA session had lower MVPA, but MVPA increased with greater log-in duration for the PA and sedentary behavior sessions. These associations remained even after accounting for engagement with other content sessions. However, these engagement effects did not translate to the adolescents. CONCLUSIONS The results of this study highlight the need to disentangle the impact of engagement with different tailored content to improve the efficacy of tailored web-based interventions, especially for promoting PA in African American families. TRIAL REGISTRATION ClinicalTrials.gov NCT01796067; https://clinicaltrials.gov/ct2/show/NCT01796067.
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Affiliation(s)
- Allison M Sweeney
- Department of Biobehavioral Health & Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, United States
| | - Dawn K Wilson
- Department of Psychology, University of South Carolina, Columbia, SC, United States
| | - Kenneth Resnicow
- Department of Health Behavior & Health Education, University of Michigan, Ann Arbor, MI, United States
| | - M Lee Van Horn
- Department of Individual, Family, and Community Education, University of New Mexico, Albuquerque, NM, United States
| | - Heather Kitzman
- Baylor Scott and White Health, Baylor Scott & White Health and Wellness Center, Dallas, TX, United States
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11
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Kim EH, Jenness JL, Miller AB, Halabi R, de Zambotti M, Bagot KS, Baker FC, Pratap A. Association of Demographic and Socioeconomic Indicators With the Use of Wearable Devices Among Children. JAMA Netw Open 2023; 6:e235681. [PMID: 36995714 PMCID: PMC10064258 DOI: 10.1001/jamanetworkopen.2023.5681] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/14/2023] [Indexed: 03/31/2023] Open
Abstract
Importance The use of consumer-grade wearable devices for collecting data for biomedical research may be associated with social determinants of health (SDoHs) linked to people's understanding of and willingness to join and remain engaged in remote health studies. Objective To examine whether demographic and socioeconomic indicators are associated with willingness to join a wearable device study and adherence to wearable data collection in children. Design, Setting, and Participants This cohort study used wearable device usage data collected from 10 414 participants (aged 11-13 years) at the year-2 follow-up (2018-2020) of the ongoing Adolescent Brain and Cognitive Development (ABCD) Study, performed at 21 sites across the United States. Data were analyzed from November 2021 to July 2022. Main Outcomes and Measures The 2 primary outcomes were (1) participant retention in the wearable device substudy and (2) total device wear time during the 21-day observation period. Associations between the primary end points and sociodemographic and economic indicators were examined. Results The mean (SD) age of the 10 414 participants was 12.00 (0.72) years, with 5444 (52.3%) male participants. Overall, 1424 participants (13.7%) were Black; 2048 (19.7%), Hispanic; and 5615 (53.9%) White. Substantial differences were observed between the cohort that participated and shared wearable device data (wearable device cohort [WDC]; 7424 participants [71.3%]) compared with those who did not participate or share data (no wearable device cohort [NWDC]; 2900 participants [28.7%]). Black children were significantly underrepresented (-59%) in the WDC (847 [11.4%]) compared with the NWDC (577 [19.3%]; P < .001). In contrast, White children were overrepresented (+132%) in the WDC (4301 [57.9%]) vs the NWDC (1314 [43.9%]; P < .001). Children from low-income households (<$24 999) were significantly underrepresented in WDC (638 [8.6%]) compared with NWDC (492 [16.5%]; P < .001). Overall, Black children were retained for a substantially shorter duration (16 days; 95% CI, 14-17 days) compared with White children (21 days; 95% CI, 21-21 days; P < .001) in the wearable device substudy. In addition, total device wear time during the observation was notably different between Black vs White children (β = -43.00 hours; 95% CI, -55.11 to -30.88 hours; P < .001). Conclusions and Relevance In this cohort study, large-scale wearable device data collected from children showed considerable differences between White and Black children in terms of enrollment and daily wear time. While wearable devices provide an opportunity for real-time, high-frequency contextual monitoring of individuals' health, future studies should account for and address considerable representational bias in wearable data collection associated with demographic and SDoH factors.
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Affiliation(s)
- Ethan H. Kim
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jessica L. Jenness
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Adam Bryant Miller
- RTI International, Research Triangle Park, North Carolina
- University of North Carolina at Chapel Hill
| | - Ramzi Halabi
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Kara S. Bagot
- Addiction Institute, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fiona C. Baker
- Center for Health Sciences, SRI International, Menlo Park, California
| | - Abhishek Pratap
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
- King’s College London, London, United Kingdom
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle
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12
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Soltero EG, Lopez C, Hernandez E, O'Connor TM, Thompson D. Technology-Based Obesity Prevention Interventions Among Hispanic Adolescents in the United States: Scoping Review. JMIR Pediatr Parent 2022; 5:e39261. [PMID: 36331547 PMCID: PMC9675012 DOI: 10.2196/39261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/05/2022] [Accepted: 08/24/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Given that today's adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions. OBJECTIVE The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths. METHODS A comprehensive search of Embase and PubMed identified 7 studies that met the inclusion criteria. Data were extracted by 2 independent reviewers. RESULTS Of the 7 included studies, half (n=4, 57%) used a randomized control trial design, with equal implementation in school (n=3, 43%) and clinic (n=4, 57%) settings. Studies commonly targeted improvements in diet (n=4, 57%) and physical activity (n=7, 100%), with only 1 (14%) study focused on sedentary behaviors. Just 2 (29%) studies reported the use of behavioral theories or models. Studies focused primarily on youths in early (n=5, 71%) or middle (n=6, 86%) adolescence, and there was limited information reported on socioeconomic status. Only 3 (43%) study conducted formative work, and few (n=3, 43%) reported on acceptability. Only 1 (14%) study reported that materials were available in Spanish and English, and only 1 (14%) study used culturally tailored content. Additionally, 3 (43%) studies used strategies that considered social determinants of health. CONCLUSIONS To increase our understanding of the feasibility and effectiveness of technology-based obesity prevention strategies among Hispanic adolescents, there is a need for more feasibility studies that are theoretically grounded and comprehensively report on feasibility-related outcomes. Future studies should also leverage technology to simultaneously address multiple health behaviors beyond diet and physical activity. The result of this review can be used to guide the development of future technology-based obesity prevention strategies among Hispanic adolescents. TRIAL REGISTRATION CliniclaTrials.gov NCT04953442; https://clinicaltrials.gov/ct2/show/NCT04953442.
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Affiliation(s)
- Erica G Soltero
- United States Department of Agriculture/Agricultural Research Services Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Callie Lopez
- United States Department of Agriculture/Agricultural Research Services Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Edith Hernandez
- United States Department of Agriculture/Agricultural Research Services Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Teresia M O'Connor
- United States Department of Agriculture/Agricultural Research Services Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Debbe Thompson
- United States Department of Agriculture/Agricultural Research Services Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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13
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Duffy A, Christie GJ, Moreno S. The Challenges Toward Real-world Implementation of Digital Health Design Approaches: Narrative Review. JMIR Hum Factors 2022; 9:e35693. [PMID: 36083628 PMCID: PMC9508664 DOI: 10.2196/35693] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 05/19/2022] [Accepted: 07/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Digital health represents an important strategy in the future of health care delivery. Over the past decade, mobile health has accelerated the agency of health care users. Despite prevailing excitement about the potential of digital health, questions remain on efficacy, uptake, usability, and patient outcome. This challenge is confounded by 2 industries, digital and health, which have vastly different approaches to research, design, testing, and implementation. In this regard, there is a need to examine prevailing design approaches, weigh their benefits and challenges toward implementation, and recommend a path forward that synthesizes the needs of this complex stakeholder group. OBJECTIVE In this review, we aimed to study prominent digital health intervention design approaches that mediate the digital health space. In doing so, we sought to examine the origins, perceived benefits, contrasting nuances, challenges, and typical use-case scenarios of each methodology. METHODS A narrative review of digital health design approaches was performed between September 2020 and April 2021 by referencing keywords such as "digital health design," "mHealth design," "e-Health design," "agile health," and "agile healthcare." The studies selected after screening were those that discussed the design and implementation of digital health design approaches. A total of 120 studies were selected for full-text review, of which 62 (51.6%) were selected for inclusion in this review. RESULTS A review identifying the 5 overarching digital health design approaches was compiled: user-centered design, person-based design, human-centered design, patient-centered design, and patient-led design. The findings were synthesized in a narrative structure discussing the origins, advantages, disadvantages, challenges, and potential use-case scenarios. CONCLUSIONS Digital health is experiencing the growing pains of rapid expansion. Currently, numerous design approaches are being implemented to harmonize the needs of a complex stakeholder group. Whether the end user is positioned as a person, patient, or user, the challenge to synthesize the constraints and affordances of both digital design and health care, built equally around user satisfaction and clinical efficacy, remains paramount. Further research that works toward a transdisciplinarity in digital health may help break down friction in this field. Until digital health is viewed as a hybridized industry with unique requirements rather than one with competing interests, the nuances that each design approach posits will be difficult to realize in a real-world context. We encourage the collaboration of digital and health experts within hybrid design teams, through all stages of intervention design, to create a better digital health culture and design ethos.
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Affiliation(s)
- Anthony Duffy
- School of Interactive Arts & Technology, Simon Fraser University, Surrey, BC, Canada
| | | | - Sylvain Moreno
- School of Interactive Arts & Technology, Simon Fraser University, Surrey, BC, Canada
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14
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Treneman-Evans G, Ali B, Denison-Day J, Clegg T, Yardley L, Denford S, Essery R. The Rapid Adaptation and Optimisation of a Digital Behaviour-Change Intervention to Reduce the Spread of COVID-19 in Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6731. [PMID: 35682312 PMCID: PMC9180389 DOI: 10.3390/ijerph19116731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 02/04/2023]
Abstract
The rapid transmission of COVID-19 in school communities has been a major concern. To ensure that mitigation systems were in place and support was available, a digital intervention to encourage and facilitate infection-control behaviours was rapidly adapted and optimised for implementation as a whole-school intervention. Using the person-based approach, 'Germ Defence' was iteratively adapted, guided by relevant literature, co-production with Patient and Public Involvement representatives, and think-aloud interviews with forty-five school students, staff, and parents. Suggested infection-control behaviours deemed feasible and acceptable by the majority of participants included handwashing/hand-sanitising and wearing a face covering in certain contexts, such as crowded public spaces. Promoting a sense of collective responsibility was reported to increase motivation for the adoption of these behaviours. However, acceptability and willingness to implement recommended behaviours seemed to be influenced by participants' perceptions of risk. Barriers to the implementation of recommended behaviours in school and at home primarily related to childcare needs and physical space. We conclude that it was possible to rapidly adapt Germ Defence to provide an acceptable resource to help mitigate against infection transmission within and from school settings. Adapted content was considered acceptable, persuasive, and accessible.
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Affiliation(s)
- Georgia Treneman-Evans
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
| | - Becky Ali
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
| | - James Denison-Day
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
| | - Tara Clegg
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
| | - Lucy Yardley
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
| | - Sarah Denford
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
| | - Rosie Essery
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
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15
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Daniore P, Nittas V, von Wyl V. Enrollment and retention of participants in remote digital health studies: a scoping review and framework proposal (Preprint). J Med Internet Res 2022; 24:e39910. [PMID: 36083626 PMCID: PMC9508669 DOI: 10.2196/39910] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/12/2022] [Accepted: 07/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Paola Daniore
- Institute for Implementation Science in Healthcare, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
| | - Vasileios Nittas
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Viktor von Wyl
- Institute for Implementation Science in Healthcare, University of Zurich, Zurich, Switzerland
- Digital Society Initiative, University of Zurich, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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16
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Co-Produce, Co-Design, Co-Create, or Co-Construct—Who Does It and How Is It Done in Chronic Disease Prevention? A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10040647. [PMID: 35455826 PMCID: PMC9029027 DOI: 10.3390/healthcare10040647] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/17/2022] [Accepted: 03/28/2022] [Indexed: 01/18/2023] Open
Abstract
Co-production in health literature has increased in recent years. Despite mounting interest, numerous terms are used to describe co-production. There is confusion regarding its use in health promotion and little evidence and guidance for using co-produced chronic disease prevention interventions in the general population. We conducted a scoping review to examine the research literature using co-production to develop and evaluate chronic disease prevention programs. We searched four electronic databases for articles using co-production for health behaviour change in smoking, physical activity, diet, and/or weight management. In 71 articles that reported using co-production, co-design, co-create, co-develop, and co-construct, these terms were used interchangeably to refer to a participatory process involving researchers, stakeholders, and end users of interventions. Overall, studies used co-production as a formative research process, including focus groups and interviews. Co-produced health promotion interventions were generally not well described or robustly evaluated, and the literature did not show whether co-produced interventions achieved better outcomes than those that were not. Uniform agreement on the meanings of these words would avoid confusion about their use, facilitating the development of a co-production framework for health promotion interventions. Doing so would allow practitioners and researchers to develop a shared understanding of the co-production process and how best to evaluate co-produced interventions.
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17
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Willmott TJ, Mathew A, Luck E, Rundle-Thiele S, Carins J, Vincze L, Williams L, Ball L. Participatory design application in obesity prevention targeting young adults and adolescents: a mixed-methods systematic scoping review protocol. Syst Rev 2022; 11:51. [PMID: 35317866 PMCID: PMC8939071 DOI: 10.1186/s13643-022-01900-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 02/07/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prevention of obesity is economically and sociologically preferable to treatment, with early intervention key to preventing excess weight gain and obesity. The transition from adolescence to young adulthood is a critical intervention period. An expert-led, top-down model has dominated obesity prevention research and practice with limited success. Participatory design (PD) offers potential in transforming obesity prevention research and practice by delivering bottom-up solutions that young people value and may therefore voluntarily engage with over time. An evidence synthesis of PD application in obesity prevention targeting adolescents and young adults is currently lacking. OBJECTIVES Report the protocol for a mixed-methods systematic scoping review which aims to integrate and synthesise available evidence on PD application in obesity prevention targeting adolescents and young adults. Specifically, the review will address three research questions: RQ1: How is PD defined in obesity prevention interventions targeting adolescents and young adults? RQ2: To what extent is PD applied in obesity preventions interventions targeting adolescents and young adults? RQ3a: How is the utility of PD evaluated in obesity preventions interventions targeting adolescents and young adults? RQ3b: What is the utility of PD application in obesity prevention interventions targeting adolescents and young adults? METHODS This mixed-methods systematic scoping review protocol adheres to the PRISMA-P guidelines and is informed by the PRISMA extension for scoping reviews (PRISMA-ScR). The search strategy and eligibility criteria are informed by the sample, phenomenon of interest, design, evaluation, and research type tool. Eligible studies will be peer-reviewed literature published in English, reporting on PD application in obesity prevention interventions (including intervention development, implementation, and/or evaluation) targeting adolescents and young adults (aged 10-35 years). Study designs will include qualitative, quantitative, and mixed methods. The review will comprise a systematic literature search, eligibility screening, data extraction, quality assessment using the Mixed-Methods Appraisal Tool (MMAT), and data analysis using an iterative narrative evidence synthesis approach. Evidence on PD application will be thematically integrated in terms of who was involved, when they were involved, and how and why they were involved. Further thematic analyses will be conducted according to the MATE taxonomy and the United Kingdom Medical Research Council (UK MRC's) key functions of process evaluations. The MATE taxonomy classifies PD application in terms of methodology, agent of change, training, and engagement. The MRC describes three functions of process evaluations: implementation, mechanisms of impact, and context. Applying both in the evidence synthesis is intended to provide a more complete picture of PD application. Exploratory analyses will be conducted to assess any potential associations between PD application and effectiveness across key outcomes (weight, physical activity, sedentary time, nutrition and dietary habit, mental health, and sleep) reported within intervention evaluations. CONCLUSIONS Elucidating PD application is a prerequisite to establishing its utility. Through the location and synthesis of available evidence on PD application in obesity prevention targeting adolescents and young adults, this review will categorise and describe different methods of PD application and explore the utility of PD application including whether any differences may be observed between PD method applied and the effectiveness of obesity prevention interventions. Implications will be delineated from the narrative evidence synthesis to inform future research and advance practice in this context. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021268240.
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Affiliation(s)
- Taylor Jade Willmott
- Adelaide Business School, The University of Adelaide, 10 Pulteney Street, Adelaide, South Australia, 5005, Australia.
| | - Alieena Mathew
- Social Marketing @ Griffith, Griffith Business School, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
| | - Eve Luck
- Social Marketing @ Griffith, Griffith Business School, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
| | - Sharyn Rundle-Thiele
- Social Marketing @ Griffith, Griffith Business School, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
| | - Julia Carins
- Social Marketing @ Griffith, Griffith Business School, Griffith University, 170 Kessels Road, Nathan, QLD, 4111, Australia
| | - Lisa Vincze
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, 1 Parklands Dr, Southport, QLD, 4215, Australia
| | - Lauren Williams
- Nutrition and Dietetics, School of Health Sciences and Social Work, Griffith University, 1 Parklands Dr, Southport, QLD, 4215, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, School of Health Sciences and Social Work, Griffith University, Southport, Australia
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18
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Kouvari M, Karipidou M, Tsiampalis T, Mamalaki E, Poulimeneas D, Bathrellou E, Panagiotakos D, Yannakoulia M. Digital Health Interventions for Weight Management in Children and Adolescents: Systematic Review and Meta-analysis. J Med Internet Res 2022; 24:e30675. [PMID: 35156934 PMCID: PMC8887634 DOI: 10.2196/30675] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/10/2021] [Accepted: 09/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background Recent meta-analyses suggest the use of technology-based interventions as a treatment option for obesity in adulthood. Similar meta-analytic approaches for children are scarce. Objective The aim of this meta-analysis is to examine the effect of technology-based interventions on overweight and obesity treatment in children and adolescents. Methods A systematic literature search was performed using MEDLINE (PubMed), Scopus, and Cochrane Library for randomized clinical trials to identify interventional studies published between January 2000 and February 2021. Results In total, 9 manuscripts from 8 clinical trials of 582 children or adolescents were considered eligible. BMI, BMI z-score, and other BMI-related baseline metrics during and after intervention were considered as primary outcomes. In 7 of 8 studies, a technology-based intervention was applied in addition to conventional care. Of the 8 studies, 6 studies were conducted in the United States, 1 in Australia, and 1 in northwestern Europe. In total, 5 studies included adolescents, whereas the rest addressed children aged 9 to 12 years. Intervention duration ranged from 3 to 24 months. Significant differences between groups in BMI metric changes were reported by 5 of the 8 studies. Pooled analysis revealed an overall significant decrease in BMI metrics in the intervention group (standardized mean difference –0.61, 95% CI –1.10 to –0.13; P=.01). Subgroup analysis revealed that significance was lost in case of no parental involvement (standardized mean difference –0.36, 95% CI –0.83 to 0.11; P=.14). The small number of clinical trials found, the varying study quality, and the study heterogeneity are some limitations of this review. Conclusions The studies reported herein describe functional and acceptable technology-based approaches, in addition to conventional treatments, to enhance weight loss in young populations.
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Affiliation(s)
- Matina Kouvari
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Melina Karipidou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Thomas Tsiampalis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eirini Mamalaki
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Eirini Bathrellou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.,Faculty of Health, University of Canberra, Canberra, Australia
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
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19
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Ab Mumin N, Yusof ZYM, Marhazlinda J, Obaidellah U. Adolescents’ opinions on the use of a smartphone application as an oral health education tool: A qualitative study. Digit Health 2022; 8:20552076221114190. [PMID: 35898290 PMCID: PMC9309770 DOI: 10.1177/20552076221114190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Developing health-related smartphone applications for oral health education
should consider the end-user's perspectives to ensure they will be usable. This
study aimed to explore the opinions of secondary school students in Selangor,
Malaysia regarding the use of a smartphone application for oral health education
and to identify the features for an oral health education smartphone application
from the perspectives of adolescents. Focus group discussions were conducted
among Form Two (14-year-old) and Form Four (16-year-old) students from selected
government secondary schools in Selangor utilising a semi-structured topic guide
until data saturation was achieved. Data were analysed using framework analysis.
Ten focus group discussions were conducted involving 77 participants. Mixed
opinions were recorded on the use of health-related smartphone applications for
oral health education. The preferred features in a health-related smartphone
application are disease detection, have games and rewards, educational and fun,
access to a dentist, reminders, and user-friendliness. Adolescents are aware of
the positive aspect of using health-related smartphone applications for oral
health education; however, they are wary of the need to install one.
Nevertheless, identifying adolescents’ preferred features of an oral health
education app is the first step in developing an application tailored to their
needs. Smartphone application could be a timely strategy to improve oral health
education delivery and behaviour improvement for this age group.
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Affiliation(s)
- Nazirah Ab Mumin
- Department of Periodontology and Community Oral Health, Faculty of Dentistry, Universiti Sains Islam Malaysia (USIM), Kuala Lumpur, Malaysia
| | - Zamros Yuzadi Mohd Yusof
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya (UM), Kuala Lumpur, Malaysia
| | - Jamaludin Marhazlinda
- Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry, Universiti Malaya (UM), Kuala Lumpur, Malaysia
| | - Unaizah Obaidellah
- Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, Universiti Malaya (UM), Kuala Lumpur, Malaysia
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20
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Soltero EG, O'Connor TM, Thompson D, Shaibi GQ. Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents. Curr Obes Rep 2021; 10:332-341. [PMID: 34263434 PMCID: PMC9116051 DOI: 10.1007/s13679-021-00445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity. RECENT FINDINGS Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.
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Affiliation(s)
- Erica G Soltero
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA.
| | - Teresia M O'Connor
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Deborah Thompson
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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21
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Muange EN, Ngigi MW. Dietary quality and overnutrition among adults in Kenya: what role does ICT play? Food Secur 2021. [DOI: 10.1007/s12571-021-01174-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Ruan S, Raeside R, Singleton A, Redfern J, Partridge SR. Limited Engaging and Interactive Online Health Information for Adolescents: A Systematic Review of Australian Websites. HEALTH COMMUNICATION 2021; 36:764-773. [PMID: 31964190 DOI: 10.1080/10410236.2020.1712522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Adolescents need access to interactive and high-quality online health information about strategies to reduce their risk for non-communicable diseases (NCDs). This study aimed to evaluate the quality, readability and interactivity of webpages with adolescent-specific information on NCD risk factors. Included web pages were: (i) Australian-based; (ii) authored by government bodies or public health organizations; (iii) contained information relevant to NCD risk factors; and (iv) contained adolescent-specific information. In total, 69 web pages were included for evaluation (smoking, n = 6; nutrition, n = 22; alcohol, n = 15; physical activity n = 11; mental health, n = 6; health and obesity, n = 9). Content quality score (modified DISCERN tool) ±standard deviation ranged from fair (49.6 ± 13.6 for nutrition) to good quality (58.4 ± 11.0 for alcohol). Mean readability score (Flesch-Kincaid tool) found most webpages were difficult to read (49.6 ± 14.9, University student level). Adolescent-directed websites were written in plain English (62 ± 7.5, understood by 13-15-year-olds). Mean interactivity score indicated web pages were fairly interactive (13 ± 2.0). The study found very few webpages were written specifically for adolescents and no webpages were of excellent quality, highly interactive and written in plain English. Given the plethora of online health information from non-credible sources, we recommend public health organizations invest in co-designing excellent-quality and interactive online health information with adolescents.
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Affiliation(s)
- Stella Ruan
- Nutrition and Dietetics Group, School of Life and Environmental Science, The University of Sydney
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
| | - Rebecca Raeside
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
| | - Anna Singleton
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
| | - Julie Redfern
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
- The George Institute for Global Health, University of New South Wales
| | - Stephanie R Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney
- Prevention Research Collaboration, Sydney School of Public Health, The University of Sydney
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Thornton L, Gardner LA, Osman B, Green O, Champion KE, Bryant Z, Teesson M, Kay-Lambkin F, Chapman C. A Multiple Health Behavior Change, Self-Monitoring Mobile App for Adolescents: Development and Usability Study of the Health4Life App. JMIR Form Res 2021; 5:e25513. [PMID: 33843590 PMCID: PMC8076990 DOI: 10.2196/25513] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/08/2021] [Accepted: 03/14/2021] [Indexed: 02/06/2023] Open
Abstract
Background The link between chronic diseases and the Big 6 lifestyle risk behaviors (ie, poor diet, physical inactivity, smoking, alcohol use, sedentary recreational screen time, and poor sleep) is well established. It is critical to target these lifestyle risk behaviors, as they often co-occur and emerge in adolescence. Smartphones have become an integral part of everyday life, and many adolescents already use mobile apps to monitor their lifestyle behaviors and improve their health. Smartphones may be a valuable platform for engaging adolescents with interventions to prevent key chronic disease risk behaviors. Objective The aim of this paper is to describe the development, usability, and acceptability of the Health4Life app, a self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Methods The development of the Health4Life app was an iterative process conducted in collaboration with adolescents and experts. The development process consisted of three stages: scoping the literature; end user consultations, which included a web-based survey (N=815; mean age 13.89, SD 0.89 years) and a focus group (N=12) among adolescents; and app development and beta testing. Following this development work, 232 adolescents were asked to rate the usability and acceptability of the app. Results The process resulted in a self-monitoring smartphone app that allows adolescent users to track and set goals for the Big 6 health behaviors, using in-app rewards and notifications to enhance engagement. The overall adolescent feedback was positive in terms of user-friendly design, content, relevance, and helpfulness. Commonly identified areas for improvement were to increase interactive features and display recorded health behaviors differently to improve interpretability. Conclusions The Health4Life app is a co-designed, self-monitoring smartphone app for adolescents that concurrently targets the Big 6 lifestyle behaviors. Adolescents rated the app as highly acceptable and usable. The app has the potential to efficiently and effectively modify important risk factors for chronic disease among young people and is currently being evaluated in a world-first trial of 6640 secondary school students in 71 schools across Australia.
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Affiliation(s)
- Louise Thornton
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia.,Priority Research Centre for Brain and Mental Health, The University of Newcastle, Newcastle, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Lauren Anne Gardner
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Bridie Osman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Olivia Green
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Katrina Elizabeth Champion
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Zachary Bryant
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Maree Teesson
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
| | - Frances Kay-Lambkin
- Priority Research Centre for Brain and Mental Health, The University of Newcastle, Newcastle, Australia
| | - Cath Chapman
- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia
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- The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Sydney, Australia.,Priority Research Centre for Brain and Mental Health, The University of Newcastle, Newcastle, Australia.,Department of Exercise Physiology, School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Sydney, Australia.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,National Drug Research Institute, Curtin University, Perth, Australia.,School of Psychology, Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Australia
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Hayes AJ, Carrello JP, Kelly PJ, Killedar A, Baur LA. Looking backwards and forwards: tracking and persistence of weight status between early childhood and adolescence. Int J Obes (Lond) 2021; 45:870-878. [PMID: 33558641 DOI: 10.1038/s41366-021-00751-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 11/19/2020] [Accepted: 01/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVE Many studies have shown that child BMI or weight status tracks over time, but the demographic predictors of high tracking have not been investigated. Our objective was to identify demographic predictors of persistence (duration) of healthy weight and overweight/obesity throughout childhood, and to examine whether tracking was age dependent. METHODS We conducted secondary data analysis of 4606 children from the Birth cohort and 4983 children from the Kindergarten cohort of the Longitudinal Study of Australian Children with follow-up to age 12/13 and 16/17 years, respectively. Retrospective and prospective tracking were examined descriptively. Time-to-event analysis determined demographic predictors of persistence of healthy weight and overweight/obesity beyond age 4-5 years, after controlling for child BMI z-score. Weight status was determined using WHO methods. RESULTS Tracking of healthy weight was consistently higher than that of overweight/obesity, and incident overweight was equally likely throughout childhood and adolescence. Tracking of overweight was lower for children under 7 years than in middle childhood and adolescence (2-year probability 65%, compared with 80%; 2-year resolution of overweight 35 and 20%). Children of lower socioeconomic position, those from culturally and linguistically diverse backgrounds, and girls were more likely to move into overweight (hazard ratios [95%CI] for incident overweight: 1.39 [1.26-1.52], 1.16 [1.02-1.31] and 1.12 [1.02-1.23], respectively) and less likely to resolve their overweight (hazard ratios for resolution of overweight/obesity: 0.77 [0.69-0.85], 0.8 [0.69-0.92] and 0.79 [0.71-0.81], respectively) during childhood. However, persistence of weight status was not significantly affected by rurality or Indigenous status (P > 0.05). CONCLUSIONS Lowest tracking and highest natural resolution of overweight in children under 7 years suggests this may be an opportune time for interventions to reduce overweight. Primary and secondary prevention programmes during the school years should be designed with special consideration for lower socioeconomic communities, for culturally and linguistically diverse populations and for girls.
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Affiliation(s)
- Alison J Hayes
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Joseph P Carrello
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Patrick J Kelly
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Anagha Killedar
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Louise A Baur
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW, Australia.,Speciality of Child and Adolescent Health, Clinical School, University of Sydney, Sydney, NSW, Australia.,The Children's Hospital at Westmead, Sydney, NSW, Australia
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25
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Ren H, Liu TC, Lu Y, Zhang K, Xu Y, Zhou P, Tang X. A comparison study of the influence of milk protein versus whey protein in high-protein diets on adiposity in rats. Food Funct 2021; 12:1008-1019. [PMID: 33502407 DOI: 10.1039/d0fo01960g] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
High-protein diets are known to reduce weight and fat deposition. However, there have been only a few studies on the efficacy of different types of high-protein diets in preventing obesity. Therefore, the emphasis of this study lies in comparing the efficacy of two high-protein diets (milk protein and whey protein) in preventing obesity and exploring specific mechanisms. Eighty Sprague Dawley rats were divided into two groups and fed with milk protein concentrate (MPC) and whey protein concentrate (WPC) for 12 weeks. Each group was divided into four levels: two low-fat regimens with either low or high protein content (L-14%, L-40%) and two high-fat regimens with either low or high protein content (H-14%, H-40%). The studies we have performed showed that rats treated with MPC at the 40% protein level had significantly reduced body weight, fat weight and fat ratio gain induced by a high-fat diet, while the protein level in the WPC group had no effect on body weight or body fat in rats fed with a high-fat diet. What is more, rats fed with MPC at the H-40% energy level showed a significant decrease in plasma triglyceride, total cholesterol and low-density lipoprotein cholesterol levels and a significant increase in plasma high-density lipoprotein cholesterol levels compared with the H-14% energy level group. In contrast, in the WPC groups, increasing the protein content in high-fat diets had no significant influence on plasma lipid levels. The results of the amino acid composition of the two proteins and plasma showed that the MPC diet of 40% protein level increased the transsulfuration pathway in rats, thereby increasing the level of H2S. This research work has shown that not all types of high-protein diets can effectively prevent obesity induced by high-fat diets, as effectiveness depends on the amino acid composition of the protein.
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Affiliation(s)
- Haoyi Ren
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi 214122, Jiangsu, China.
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Strömmer S, Barrett M, Woods-Townsend K, Baird J, Farrell D, Lord J, Morrison L, Shaw S, Vogel C, Lawrence W, Lovelock D, Bagust L, Varkonyi-Sepp J, Coakley P, Campbell L, Anderson R, Horsfall T, Kalita N, Onyimadu O, Clarke J, Cooper C, Chase D, Lambrick D, Little P, Hanson M, Godfrey K, Inskip H, Barker M. Engaging adolescents in changing behaviour (EACH-B): a study protocol for a cluster randomised controlled trial to improve dietary quality and physical activity. Trials 2020; 21:859. [PMID: 33059762 PMCID: PMC7557314 DOI: 10.1186/s13063-020-04761-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Poor diet and lack of physical activity are strongly linked to non-communicable disease risk, but modifying them is challenging. There is increasing recognition that adolescence is an important time to intervene; habits formed during this period tend to last, and physical and psychological changes during adolescence make it an important time to help individuals form healthier habits. Improving adolescents' health behaviours is important not only for their own health now and in adulthood, but also for the health of any future children. Building on LifeLab-an existing, purpose-built educational facility at the University of Southampton-we have developed a multi-component intervention for secondary school students called Engaging Adolescents in Changing Behaviour (EACH-B) that aims to motivate and support adolescents to eat better and be more physically active. METHODS A cluster randomised controlled trial is being conducted to evaluate the effectiveness of the EACH-B intervention. The primary outcomes of the intervention are self-reported dietary quality and objectively measured physical activity (PA) levels, both assessed at baseline and at 12-month follow-up. The EACH-B intervention consists of three linked elements: professional development for teachers including training in communication skills to support health behaviour change; the LifeLab educational module comprising in-school teaching of nine science lessons linked to the English National Curriculum and a practical day visit to the LifeLab facility; and a personalised digital intervention that involves social support and game features that promote eating better and being more active. Both the taught module and the LifeLab day are designed with a focus on the science behind the messages about positive health behaviours, such as diet and PA, for the adolescents now, in adulthood and their future offspring, with the aim of promoting personal plans for change. The EACH-B research trial aims to recruit approximately 2300 secondary school students aged 12-13 years from 50 schools (the clusters) from Hampshire and neighbouring counties. Participating schools will be randomised to either the control or intervention arm. The intervention will be run during two academic years, with continual recruitment of schools throughout the school year until the sample size is reached. The schools allocated to the control arm will receive normal schooling but will be offered the intervention after data collection for the trial is complete. An economic model will be developed to assess the cost-effectiveness of the EACH-B intervention compared with usual schooling. DISCUSSION Adolescents' health needs are often ignored and they can be difficult to engage in behaviour change. Building a cheap, sustainable way of engaging them in making healthier choices will benefit their long-term health and that of their future children. TRIAL REGISTRATION ISRCTN 74109264 . Registered on 30 August 2019. EACH-B is a cluster randomised controlled trial, funded by the National Institute for Health Research (RP-PG-0216-20004).
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Affiliation(s)
- Sofia Strömmer
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Millie Barrett
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Kathryn Woods-Townsend
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Janis Baird
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - David Farrell
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Joanne Lord
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK
- Hampshire County Council, Winchester, UK
| | - Sarah Shaw
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Christina Vogel
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Wendy Lawrence
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Donna Lovelock
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Lisa Bagust
- Southampton Education School, Faculty of Social Sciences, University of Southampton, Southampton, UK
| | - Judit Varkonyi-Sepp
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Patsy Coakley
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Lyall Campbell
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Ross Anderson
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Glasgow, UK
| | - Tina Horsfall
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Neelam Kalita
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | - Olu Onyimadu
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, UK
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | | | - Danielle Lambrick
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Paul Little
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Mark Hanson
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Keith Godfrey
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Mary Barker
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton, NHS Foundation Trust, Southampton, UK.
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Koorts H, Salmon J, Timperio A, Ball K, Macfarlane S, Lai SK, Brown H, Chappel SE, Lewis M, Ridgers ND. Translatability of a Wearable Technology Intervention to Increase Adolescent Physical Activity: Mixed Methods Implementation Evaluation. J Med Internet Res 2020; 22:e13573. [PMID: 32763872 PMCID: PMC7442941 DOI: 10.2196/13573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 08/30/2019] [Accepted: 04/15/2020] [Indexed: 01/04/2023] Open
Abstract
Background Wearable technology interventions combined with digital behavior change resources provide opportunities to increase physical activity in adolescents. The implementation of such interventions in real-world settings is unknown. The Raising Awareness of Physical Activity (RAW-PA) study was a 12-week cluster randomized controlled trial targeting inactive adolescents attending schools in socioeconomically disadvantaged areas of Melbourne, Australia. The aim was to increase moderate- to vigorous-intensity physical activity using (1) a wrist-worn Fitbit Flex and app, (2) weekly challenges, (3) digital behavior change resources, and (4) email or text message alerts. Objective This paper presents adolescents’ and teachers’ perceptions of RAW-PA in relation to program acceptability, feasibility and perceived impact, adolescent engagement and adherence, and the potential for future scale-up. Methods A mixed methods evaluation of the RAW-PA study assessed acceptability, engagement, feasibility, adherence, and perceived impact. A total of 9 intervention schools and 144 intervention adolescents were recruited. Only adolescents and teachers (n=17) in the intervention group were included in the analysis. Adolescents completed web-based surveys at baseline and surveys and focus groups postintervention. Teachers participated in interviews postintervention. Facebook data tracked engagement with web-based resources. Descriptive statistics were reported by sex. Qualitative data were analyzed thematically. Results Survey data were collected from 142 adolescents at baseline (mean age 13.7 years, SD 0.4 years; 51% males) and 132 adolescents postintervention. A total of 15 focus groups (n=124) and 9 interviews (n=17) were conducted. RAW-PA had good acceptability among adolescents and teachers. Adolescents perceived the intervention content as easy to understand (100/120, 83.3%) and the Fitbit easy to use (112/120; 93.3%). Half of the adolescents perceived the text messages to be useful (61/120; 50.8%), whereas 47.5% (57/120) liked the weekly challenges and 38.3% (46/120) liked the Facebook videos. Facebook engagement declined over time; only 18.6% (22/118) of adolescents self-reported wearing the Fitbit Flex daily postintervention. Adolescents perceived the Fitbit Flex to increase their physical activity motivation (85/120, 70.8%) and awareness (93/119, 78.2%). The web-based delivery facilitated implementation of the intervention, although school-level policies restricting phone use were perceived as potential inhibitors to program roll-out. Conclusions RAW-PA showed good acceptability among adolescents attending schools in socioeconomically disadvantaged areas and their teachers. Low levels of teacher burden enhanced their perceptions concerning the feasibility of intervention delivery. Although adolescents perceived that RAW-PA had short-term positive effects on their motivation to be physically active, adolescent adherence and engagement were low. Future research exploring the feasibility of different strategies to engage adolescents with wearable technology interventions and ways of maximizing system-level embeddedness of interventions in practice would greatly advance the field.
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Affiliation(s)
- Harriet Koorts
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Jo Salmon
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Anna Timperio
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Kylie Ball
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | | | - Samuel K Lai
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Helen Brown
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Stephanie E Chappel
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
| | - Marina Lewis
- School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia
| | - Nicola D Ridgers
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia
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Langlet B, Maramis C, Diou C, Maglaveras N, Fagerberg P, Heimeier R, Lekka I, Delopoulos A, Ioakimidis I. Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study. JMIR Mhealth Uhealth 2020; 8:e14778. [PMID: 32706684 PMCID: PMC7404017 DOI: 10.2196/14778] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/14/2019] [Accepted: 05/14/2020] [Indexed: 01/12/2023] Open
Abstract
Background Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients. Objective This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity. Methods We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the “mHealth evidence reporting and assessment checklist,” and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100% compliance. Results Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a ‘Good’ grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70% the first week to 76% the second week. Participants reported that 40% of the registered meals were home-prepared, while 34% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected. Conclusions From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk.
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Affiliation(s)
- Billy Langlet
- The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Christos Maramis
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Diou
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Maglaveras
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petter Fagerberg
- The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | | | - Irini Lekka
- Lab of Computing, Medical Informatics and Biomedical Imaging Technologies, Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anastasios Delopoulos
- Department of Electrical and Computer Engineering, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Ioakimidis
- The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
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Milne-Ives M, Lam C, Van Velthoven MH, Meinert E. Mobile Apps for Health Behavior Change: Protocol for a Systematic Review. JMIR Res Protoc 2020; 9:e16931. [PMID: 32012109 PMCID: PMC7055785 DOI: 10.2196/16931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 01/13/2023] Open
Abstract
Background The popularity and ubiquity of mobile apps have rapidly expanded in the past decade. With a growing focus on patient interaction with health management, mobile apps are increasingly used to monitor health and deliver behavioral interventions. The considerable variation in these mobile health apps, from their target patient group to their health behavior, and their behavioral change strategy, has resulted in a large but incohesive body of literature. Objective The purpose of this protocol is to provide an overview of the current landscape, theories behind, and effectiveness of mobile apps for health behavior change. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols will be used to structure this protocol. The focus of the systematic review is guided by a population, intervention, comparator, and outcome framework. A systematic search of Medline, EMBASE, CINAHL, and Web of Science will be conducted. Two authors will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. One reviewer will extract data into a standardized form, which will be validated by a second reviewer. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool, and a descriptive analysis will summarize the effectiveness of all the apps. Results As of November 2019, the systematic review has been completed and is in peer review for publication. Conclusions This systematic review will summarize the current mobile app technologies and their effectiveness, usability, and coherence with behavior change theory. It will identify areas of improvement (where there is no evidence of efficacy) and help inform the development of more useful and engaging mobile health apps. Trial Registration PROSPERO CRD42019155604; https://tinyurl.com/sno4lcu International Registered Report Identifier (IRRID) PRR1-10.2196/16931
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Affiliation(s)
- Madison Milne-Ives
- Department of Paediatrics, Digitally Enabled Preventative Health Research Group, University of Oxford, Oxford, United Kingdom
| | - Ching Lam
- Department of Paediatrics, Digitally Enabled Preventative Health Research Group, University of Oxford, Oxford, United Kingdom
| | - Michelle Helena Van Velthoven
- Department of Paediatrics, Digitally Enabled Preventative Health Research Group, University of Oxford, Oxford, United Kingdom
| | - Edward Meinert
- Department of Paediatrics, Digitally Enabled Preventative Health Research Group, University of Oxford, Oxford, United Kingdom.,Department of Primary Care and Public Health, Imperial College London, London, United Kingdom
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Validation of Health Education Material for Youth: A Step to Ensure Implementation Fidelity in Community-Based Interventions. Healthcare (Basel) 2019; 8:healthcare8010008. [PMID: 31892153 PMCID: PMC7151179 DOI: 10.3390/healthcare8010008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/15/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022] Open
Abstract
Health education materials such as flipbooks enhance learning and deliver key messages in a captivating mode. Validation of such materials is crucial to ensuring implementation fidelity. We conducted a study to achieve two objectives: (a) to develop two flipbooks, one each for adolescents and young married women (YMW); (b) to validate the flipbooks using five parameters, namely, content validity, construct validity, concurrent validity, relevance, and face validity. The study was a part of a community-based peer-led intervention on health, nutrition, and hygiene. The content validity and relevance were assessed by interviewing outreach workers (ORWs, n = 42) using self-administered five-point Likert scale-based tools. A pre- and post-intervention assessment of knowledge among adolescents (n = 100) and YMW (n = 50) across six out of 13 intervention sites was done to evaluate the construct validity. The two flipbooks contained 12 structured sessions with five key messages per session, in addition to illustrations, discussion points, and theme-based stories at the end of each session. The content and relevancy indices were ranked above 80% by ORW. There was a statistically significant increase in the knowledge scores of adolescents (p < 0.001) and YMW (p < 0.001) post intervention. The validation process helps in assessing the relevance and appropriateness of the education content for greater acceptance and responsiveness by the users.
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Partridge SR, Raeside R, Latham Z, Singleton AC, Hyun K, Grunseit A, Steinbeck K, Redfern J. 'Not to Be Harsh but Try Less to Relate to 'the Teens' and You'll Relate to Them More': Co-Designing Obesity Prevention Text Messages with Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4887. [PMID: 31817167 PMCID: PMC6950483 DOI: 10.3390/ijerph16244887] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 02/07/2023]
Abstract
Text messages remain a preferred way for adolescents to communicate, and recent evidence suggests adolescents would like access to digital healthcare options. However, there is limited evidence for text messages to engage adolescent populations in obesity prevention behaviors. We aimed to co-design a bank of text messages that are evidence-based, acceptable, and engaging for adolescents. An established iterative mixed methods process, consisting of three phases, was used to develop the text message program. The first bank of 145 text messages was drafted based on current evidence, behavior change techniques, and input from researchers and health professionals. A survey was then administered to adolescents and professionals for review of text message content, usefulness, understanding, and age-appropriateness. An adolescent research assistant collaborated with the research team on all three phases. Forty participants (25 adolescents and 15 professionals) reviewed the initial bank of 145 text messages. On average, all reviewers agreed the text messages were easy to understand (13.6/15) and useful (13.1/15). In total, 107 text messages were included in the final text message bank to support behavior change and prevent obesity. This study may guide other researchers or health professionals who are seeking to engage adolescents in the co-design of health promotion or intervention content. Effectiveness of the text message program will be tested in a randomized controlled trial.
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Affiliation(s)
- Stephanie R. Partridge
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; (R.R.); (Z.L.); (A.C.S.); (K.H.); (J.R.)
- Prevention Research Collaboration, Charles Perkins Centre, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Rebecca Raeside
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; (R.R.); (Z.L.); (A.C.S.); (K.H.); (J.R.)
| | - Zoe Latham
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; (R.R.); (Z.L.); (A.C.S.); (K.H.); (J.R.)
| | - Anna C. Singleton
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; (R.R.); (Z.L.); (A.C.S.); (K.H.); (J.R.)
| | - Karice Hyun
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; (R.R.); (Z.L.); (A.C.S.); (K.H.); (J.R.)
| | - Alicia Grunseit
- Department of Weight Management, The Children’s Hospital Westmead, Westmead, NSW 2145, Australia;
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, Faculty of Medicine, University of Sydney, Westmead, NSW 2145, Australia;
| | - Julie Redfern
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia; (R.R.); (Z.L.); (A.C.S.); (K.H.); (J.R.)
- The George Institute for Global Health, The University of New South Wales, Camperdown, NSW 2006, Australia
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Firth J, Siddiqi N, Koyanagi A, Siskind D, Rosenbaum S, Galletly C, Allan S, Caneo C, Carney R, Carvalho AF, Chatterton ML, Correll CU, Curtis J, Gaughran F, Heald A, Hoare E, Jackson SE, Kisely S, Lovell K, Maj M, McGorry PD, Mihalopoulos C, Myles H, O'Donoghue B, Pillinger T, Sarris J, Schuch FB, Shiers D, Smith L, Solmi M, Suetani S, Taylor J, Teasdale SB, Thornicroft G, Torous J, Usherwood T, Vancampfort D, Veronese N, Ward PB, Yung AR, Killackey E, Stubbs B. The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness. Lancet Psychiatry 2019; 6:675-712. [PMID: 31324560 DOI: 10.1016/s2215-0366(19)30132-4] [Citation(s) in RCA: 708] [Impact Index Per Article: 141.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Joseph Firth
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Najma Siddiqi
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK; Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain; Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Dan Siskind
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Simon Rosenbaum
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Cherrie Galletly
- Ramsay Health Care Mental Health, Adelaide, SA, Australia; Northern Adelaide Local Health Network, Adelaide, SA, Australia; Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Stephanie Allan
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Constanza Caneo
- Departamento de Psiquiatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rebekah Carney
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Andre F Carvalho
- Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mary Lou Chatterton
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Christoph U Correll
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA; Department of Psychiatry, Zucker Hillside Hospital, Glen Oaks, NY, USA; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Jackie Curtis
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Fiona Gaughran
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adrian Heald
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, University of Manchester, Manchester, UK; Department of Diabetes and Endocrinology, Salford Royal Hospital, Salford, UK
| | - Erin Hoare
- Food and Mood Centre, Deakin University, Melbourne, VIC, Australia
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Steve Kisely
- School of Medicine, University of Queensland, Brisbane, QLD, Australia; Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Patrick D McGorry
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Institute for Health Transformation, Faculty of Health, Deakin University, Melbourne, VIC, Australia
| | - Hannah Myles
- Discipline of Psychiatry, University of Adelaide, Adelaide, SA, Australia
| | - Brian O'Donoghue
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Toby Pillinger
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Medical Research Council London Institute of Medical Sciences, London, UK; Institute of Clinical Sciences, Faculty of Medicine, Imperial College London, London, UK
| | - Jerome Sarris
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia; Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia; The Melbourne Clinic, Melbourne, VIC, Australia
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
| | - David Shiers
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Lee Smith
- Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Marco Solmi
- Neurosciences Department and Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Shuichi Suetani
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia; Queensland Brain Institute, University of Queensland, Brisbane, QLD, Australia; Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, QLD, Australia
| | - Johanna Taylor
- Department of Health Sciences, University of York, Hull York Medical School, Bradford, UK
| | - Scott B Teasdale
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Keeping the Body in Mind Program, South Eastern Sydney Local Health District, Sydney, NSW, Australia
| | - Graham Thornicroft
- Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; Department of General Practice, Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium; University Psychiatric Centre, Katholieke Universiteit Leuven, Kortenberg, Belgium
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | - Philip B Ward
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia; Schizophrenia Research Unit, Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Alison R Yung
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Brendon Stubbs
- South London and Maudsley NHS Foundation Trust, London, UK; Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Aschbrenner KA, Naslund JA, Tomlinson EF, Kinney A, Pratt SI, Brunette MF. Adolescents' Use of Digital Technologies and Preferences for Mobile Health Coaching in Public Mental Health Settings. Front Public Health 2019; 7:178. [PMID: 31312629 PMCID: PMC6614191 DOI: 10.3389/fpubh.2019.00178] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/13/2019] [Indexed: 11/21/2022] Open
Abstract
Objective: Youth with mental illnesses often engage in unhealthy behaviors associated with early mortality from physical diseases in adulthood, but interventions to support positive health behaviors are rarely offered as part of routine mental health care for this group. Digital health technology that is desirable, accessible, and affordable has the potential to address health behaviors in public mental health settings where many adolescents with severe mental health problems receive care. The aims of this study were to examine how adolescents receiving public mental health services use digital technology and social media and to explore their preferences using technology to support health and wellness. Methods: Using a convergent parallel mixed methods design, we surveyed adolescents ages 13–18 from four community mental health centers in one state and conducted focus group interviews to explore their perspectives on using digital technology and social media to receive health coaching and connect with peers to support healthy behaviors. The survey and focus group data were merged to inform the future development of a digital health intervention for adolescents receiving public mental health services. Results: Of 121 survey respondents (mean age 15.2, SD = 1.5), 92% had a cell phone, 79% had a smartphone, 90% used text messaging, and 98% used social media. Focus group interviews revealed that adolescents were interested in receiving strengths-based mobile health coaching, and they preferred structured online peer-to-peer interactions in which a professional moderator promotes positive connections and adherence to privacy guidelines. Conclusions: Adolescents receiving public mental health services in this study had access to smartphones and were frequent social media users. These data suggest that digital health interventions to promote health and wellness among adolescents may be scalable in community mental health settings. Adolescent participants suggested that digital health interventions for this group should focus on strengths and online peer support for health promotion should include a professional moderator to foster and manage peer-to-peer interactions.
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Affiliation(s)
- Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Dartmouth-Hitchcock Clinic, Merrimack, NH, United States
| | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | | | - Allison Kinney
- Dartmouth-Hitchcock Clinic, Merrimack, NH, United States
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Dartmouth-Hitchcock Clinic, Merrimack, NH, United States
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,Dartmouth-Hitchcock Clinic, Merrimack, NH, United States
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Cardiovascular Disease Prevention in Adolescents: eHealth, Co-Creation, and Advocacy. Med Sci (Basel) 2019; 7:medsci7020034. [PMID: 30813490 PMCID: PMC6410225 DOI: 10.3390/medsci7020034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death globally. Early atherosclerotic changes can begin to occur early in life and though adolescence. The prevalence of modifiable CVD risk factors, namely, smoking, poor diet quality, excessive alcohol intake, physical inactivity, and overweight and obesity can exacerbate the early onset of atherosclerosis. There is a need to improve modifiable risk factors during adolescence to prevent progression to CVD in later life. Electronic health (eHealth) behaviour change interventions are a potential solution for adolescents to improve CVD risk factors, given adolescents are digital frontrunners and digital technology is wide-reaching. The process of co-creating eHealth behaviour change interventions with adolescents is a promising strategy to improve intervention effectiveness and engagement. Additionally, effective youth advocacy is an emerging strategy for CVD prevention in adolescents. This narrative review evaluates published eHealth behaviour change interventions targeting cardiovascular disease risk factors in adolescents, which utilize a co-creation process, describe the emerging role of advocacy in CVD prevention for adolescents and provide recommendations for future interventions.
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McPherson AC, Oake M, Stinson J. "Don't sweat it buddy, it's OK": an exploration of the needs of adolescents with disabilities when designing a mobile application for weight management and healthy lifestyles. Disabil Rehabil 2019; 42:1569-1577. [PMID: 30689451 DOI: 10.1080/09638288.2018.1530804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: Adolescents with disabilities often demonstrate higher sedentary behaviours, lower physical activity levels, poorer quality diets, and higher rates of overweight and obesity than typically developing youth. This study had two objectives: 1) To understand the needs and priorities of adolescents with disabilities, parents, and the healthcare professionals who work with them around healthy lifestyles and weight management; and 2) To explore whether and how a mobile application could address these needs.Methods: Multiple perspectives were gathered through separate qualitative focus groups with adolescents with disabilities (12-17 years), parents, and rehabilitation healthcare professionals. Data were analysed using descriptive thematic analysis.Results: Parents (n = 6) and healthcare professionals (n = 9) described the complex needs of adolescents with disabilities around weight management and healthy lifestyles, including balancing differing priorities and a lack of appropriate resources. Adolescents (n = 7) endorsed the potential for technology to enhance their health through empowerment and having a virtual support system. All stakeholder groups endorsed taking a holistic, wellness approach.Conclusions: Adolescents with disabilities have a complex lifestyle and weight management needs, but mobile applications have the potential to provide individualized support. It is critical that anyone developing mobile applications engage a range of stakeholders as co-designers.Implications for rehabilitationAdolescents with disabilities have complex support needs and priorities around weight management and healthy lifestyles.Existing resources do not take into account the wide-ranging abilities of adolescents with disabilities.Mobile applications have the potential to empower adolescents and provide tailored support around healthy lifestyles.Including user input when designing technologies is critical.
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Affiliation(s)
- Amy C McPherson
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Michelle Oake
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Jennifer Stinson
- The Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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