Parents' recalled experiences of the child centred health dialogue in children with overweight: a qualitative study

BACKGROUND

Because overweight and obesity are still increasing and prevention of childhood obesity is more likely to be effective when initiated in preschool children, the Child Health Service in the south of Sweden developed a structured child-centred health dialogue model targeting all 4-year-old children and their families. The aim of this study was to describe parents' recalled experiences of this health dialogue in children with overweight.

METHODS

A qualitative inductive approach with purposeful sampling was used. Thirteen individual interviews with parents (including 11 mothers and 3 fathers) were conducted and analysed with qualitative content analysis.

RESULTS

The analysis resulted in two categories: 'A valuable visit with a subtle individual impact' that described parents' recalled experiences of the health dialogue and 'There is a complex interaction between weight and lifestyle' that reflected the parents' perceptions of the relationship between their children's weight and lifestyle.

CONCLUSIONS

Parents recalled the child-centred health dialogue as important and described discussing a healthy lifestyle as one of the obligations of the Child Health Service. Parents wanted confirmation that their family lifestyle was healthy; however, they did not want to discuss the relationship between their family lifestyle and their children's weight. Parents expressed that when their child followed the child's growth curve, then this indicated healthy growth. This study supports using the child-centred health dialogue as a model to provide structure for discussing a healthy lifestyle and growth but highlights the difficulties of discussing body mass index and overweight, especially in the presence of children.

Feasibility of using activity trackers and apps to increase physical activity in whole families: The Step it Up Family intervention

Objective

This study examined the feasibility of an activity tracker and app intervention to increase physical activity in whole families.

Methods

This was a single-arm feasibility study with pre-post-intervention measures. Between 2017 and 2018, 40 families (58 children aged 6-10 years, 39 mothers, 33 fathers) participated in the 6-week Step it Up Family programme in Queensland, Australia. It was delivered using Garmin activity trackers and apps, weekly motivational text messages and an introductory session. Online surveys and semi-structured interviews conducted with parents assessed intervention usage, acceptability, usability, perceived usefulness, use of physical activity self-management strategies and programme influence. Analyses included descriptive statistics, Wilcoxon signed-rank test and qualitative content analysis.

Results

Overall, 38 families completed the post-intervention survey (95% family retention; 90% children, 95% mothers, 88% fathers). Garmin activity tracker usage was high (i.e. nearly 24/7 during the 6 weeks intervention). Families also used the Garmin apps regularly (i.e. mostly 2-6 times per week). Further, 80% of mothers and 52% of fathers read the motivational mobile text messages. Usability and perceived usefulness of the Garmin activity trackers and apps were rated high. Both parents significantly increased their use of physical activity self-management strategies from pre to post-intervention. Parents expressed that the intervention had increased awareness of physical (in)activity in the family, encouraged to be active and promoted outdoor family activities.

Conclusions

Using activity trackers and apps to increase physical activity in the whole family was well received by children and parents which suggests that this intervention approach is feasible. However, further testing is needed amongst more diverse family populations. These early findings support the implementation of a randomised controlled trial to examine intervention efficacy.

Predictors of Engagement and Attendance of a Family-Based Prevention Program for Underage Drinking in Mexico

Underage drinking represents a major global health problem. Given the crisis that underage drinking represents, Tomando Buenas Decisiones, a family-based prevention program, was adapted and piloted in Mexico based on the existing Guiding Good Choices program. Although family-based interventions in the USA are promising for preventing underage drinking, little is known about how adapted versions of these interventions may work in low-middle income countries, such as in Latin America. The present study examined whether baseline individual, familial, and cultural factors predict participants' engagement and attendance in an adapted program for preventing underage drinking in Zacatecas, Mexico. The study was conducted with a sample of 178 parents who participated in the adapted program and were employed at local private companies. Latent growth curve modeling was used to analyze (a) change in engagement, (b) predictors of engagement, and (c) predictors of attendance. Results indicated that perceived engagement evidenced a significant linear increase throughout the intervention. Participants' familism values, such as perceived family as referents and family support, at baseline predicted both initial levels of and change in engagement. Perceived familial obligation also predicted change in engagement. Attendance was negatively predicted by male gender, by perceived stress, and by perceived familial obligations among women only. Poor family management, and perceived familial obligations among men, positively predicted attendance. Our findings have important implications for the conceptualization of engagement and attendance in family-based preventive interventions for underage drinking among Hispanics. Researchers interested in implementing interventions in Latin America can use these findings to better comprehend how and for whom adapted family-based preventive interventions work.

'eatNplay' - a rurally-tailored, family-based, telehealth intervention for childhood obesity: Protocol for a mixed-methods randomized newsletter controlled pilot study

BACKGROUND

Childhood obesity disproportionately affects rural communities where access to pediatric weight control services is limited. Telehealth may facilitate access to these services.

OBJECTIVE

This paper describes the rationale, curriculum, and methodology for conducting a randomized controlled pilot trial of a rural, family-based, telehealth intervention that aims to improve weight-related behaviors among children, compared to monthly newsletters.

METHODS

A mixed-methods randomized design will randomly assign 44 rural families with one or more children aged 5 to 11 years identified as overweight or obese to an intervention or newsletter control group. The intervention group will attend 'eatNplay' group videoconferencing telehealth sessions, conducted weekly by a registered nurse and a motivational interviewing expert, to discuss diet, exercise, sleep, and peer group influences. The control group will receive newsletters covering these topics. Outcome measures at baseline, 12, and 26 weeks will assess 1) participant engagement and satisfaction with 'eatNplay'; 2) child's BMI, dietary behavior, physical activity, and sleep behavior; and 3) parent/guardians' self-reported beliefs, behaviors, attitudes, perceived stress, and perceived quality of life. Analyses will employ 1) thematic analysis of semi-structured parent/guardian interviews after follow-up to help refine the intervention (e.g., curriculum), and 2) linear mixed models to compare outcomes between groups pre- and post-intervention and reduce bias from unobserved variables. Results of this pilot study could refine methodology for conducting telehealth studies, acceptability of healthcare provider-involved recruitment, interdisciplinary team approach, and addressing childhood obesity in rural communities through telehealth.

Preventing the Onset of Anxiety Disorders in Offspring of Anxious Parents: A Six-Year Follow-up

This study examined the effects of a family-based intervention Coping and Promoting Strength (CAPS) relative to a control condition, information-monitoring (IM), to prevent the onset of anxiety disorders in offspring of anxious parents six years after their initial assessment. One hundred thirty six families participated in the original randomized trial; 113 (83%) completed the one time follow-up assessment. Presence of anxiety disorders and severity of symptoms in offspring were assessed by masked evaluators using the Anxiety Disorders Interview Schedule; parents and offspring also completed questionnaires assessing offspring anxiety. Using the intention to treat sample from the original trial, Cox regression models showed significant intervention main effects in the rate of onset of anxiety disorders from baseline to follow-up (anxiety disorder: hazard ratio (HR) = 2.55, 95% CI: 1.54, 4.21) but growth curves suggest effects occurred within the first year after program completion. No group differences were found in the cumulative incidence of anxiety disorders at the six-year follow-up. Additional intervention appears needed to maintain the initial positive effects long-term to reduce the risk for downstream disability.Clinical Trials Registration: NCT00847561.

Family-based nutrition interventions for obesity prevention among school-aged children: a systematic review

Effective evidence-informed family-based nutrition interventions for childhood obesity management are needed. (a) To assess the number and quality of published randomized controlled trials incorporating family-based nutrition interventions for childhood obesity (ages 5-18 years) management and (b) to identify intervention attributes (e.g., contact time, nutrition curricula, and behavior change strategies) used in successful interventions. Studies that met eligibility criteria were randomized controlled trials and family-based childhood obesity management interventions for children and adolescents ages 5-18 years old that included a healthy eating component and measured child dietary behaviors and/or parent dietary feeding practices. Six databases were searched: CINAHL complete, Cochrane Central Register of Controlled Trials, Health Source: Nursing/Academic Edition, MEDLINE with full text (PubMed), PsycINFO, SPORTDiscus, and ERIC (EBSCO Host). The validated Quality Assessment Tool for Quantitative Studies was used to assess study quality. Eight studies met eligibility criteria. Study quality analysis showed that blinding of the research teams (e.g., analysts, and those focused on data collection) and the use of age appropriate, valid, and reliable instruments were areas of concern. Successful nutrition interventions targeting children 5-18 years old, appear to include setting family-based goals, modifying home food environment, hands-on approaches to teaching nutrition (games, group-based activities), and fruit and vegetable vouchers. This review highlighted a limited amount of moderate to high quality evidence to suggest that family-based nutrition interventions can be successful in improving dietary behaviors and that interventions with positive outcomes had some components of nutrition curricula and strategies in common.

Rationale and protocol for translating basic habituation research into family-based childhood obesity treatment: Families becoming healthy together study

This publication describes the rationale and protocol, including design, aims, intervention, and measures, of Families Becoming Healthy Together, a randomized clinical trial examining the effect of a limited RED (non-nutrient-dense, energy-dense) food variety prescription delivered within an 18-month family-based behavioral obesity treatment (FBT) on body mass index (BMI) and habituation rate to RED foods. One hundred fifty-six children (ages: 8-12 y; BMI: ≥ 85th percentile-for-age) and a caregiver (BMI: ≥ 25 kg/m2), both with overweight or obesity, will be randomized to one of two, interventions: FBT or FBT + Variety. All participants will receive 29 sessions of FBT and be prescribed the Traffic Light Diet (1000-1500 kcal/day, ≤ 2 RED food servings/day), and a physical activity goal (≥ 60 min/day [child] or 150 min/week [adult] of moderate-vigorous physical activity (MVPA)). FBT + Variety will also identify two RED foods, a dinner entrée and snack food, and develop meal plans that reduce variety of RED foods by regularly consuming these foods and limiting consumption of other RED foods. Measures of anthropometrics, dietary intake, habituation of salivary response to food cues, and physical activity will be assessed at 0, 6, 12, and 18-months. This study translates a line of basic behavioral research examining how dietary variety influences habituation into a dietary prescription that will be tested within an efficacy trial. It is hypothesized that a novel, limited dietary variety prescription within FBT should promote a faster food habituation rate, reducing energy intake and amplifying long-term weight loss in children.

Limited access to family-based addiction prevention services for socio-economically deprived families in Switzerland: a grounded theory study

Background

Families living in poor socio-economic circumstances, already confronted with social and health inequalities, are often not reached by family-based addiction prevention services. Besides quantitative models and health literacy approaches, qualitative research is lacking that could shed light on the exact circumstances and processes that lead to hindered addiction prevention service uptake by these families. Drawing on the concept of candidacy, we therefore reconstructed how socio-economically deprived parents and their (pre) adolescent children in the German-speaking part of Switzerland (non-)identified their candidacy for family-based addiction prevention services.

Methods

Following grounded theory, we collected and analysed data in an iterative-cyclical manner using theoretical sampling and theoretical coding techniques. Sixteen families with children aged 10–14 years were interviewed in depth (parent/s and child separately). All but one family lived below the at-risk-of-poverty threshold.

Results

Socio-economically deprived families’ modes of recognizing and handling problems in everyday life were found to be core phenomena that structure the process towards (non) identification of candidacy for family-based addiction prevention services. Four modes anchored within socio-demographic resources were found: Families with mode A perceived their current life situation as existentially threatening and focused daily coping on the main pressing problem. Others (mode B) perceived prevalent multiple problems as normal (now); problems were normalized, often not recognized as such. In mode C families, problems were pragmatically recognized at a low threshold and pragmatically dealt with, mostly within the family. In mode D families, problems were constantly produced and dealt with early by the worried and anxious parents monitoring their child. From modes D to A, vulnerability increased concerning non-identification of candidacy for family-based addiction prevention services. Further, thematic relevance of addiction prevention, past experience with offers, integration in systems of assistance, strategies to protect the family, and families’ search for information influenced whether identification of candidacy took place.

Conclusions

Socio-economically deprived families differ in modes of problem construction and handling in everyday life; this differently opens up or closes routes to family-based addiction prevention. Addiction prevention practice should build on a bundle of diverse strategies for outreach to these families, stressing especially interventions on the structural and environmental level.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-020-01305-1.

A family-based multimedia intervention to enhance the uptake of colorectal cancer screening among older South Asian adults in Hong Kong: a study protocol for a cluster randomized controlled trial

BACKGROUND

Colorectal cancer (CRC) screening, such as fecal occult blood test (FOBT), is an effective way to prevent CRC, one of the most common cancers worldwide. However, studies found that South Asian ethnic minorities tend not to utilize CRC screening, whose importance on CRC prevention shall be educated among those from ethnic minorities, especially older adults. The purpose of this study is to develop and implement a family-based, multimedia intervention to augment the knowledge of CRC prevention among older South Asian adults in Hong Kong and enhance their motivation for undergoing FOBT. The acceptability and effectiveness of the intervention will be assessed using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

METHODS

A cluster randomized controlled trial will be carried out. Three hundred and twenty South Asian dyads, comprising an older adult aged between 50 and 75 and a younger family member aged between 18 and 49, will be recruited in ten districts in Hong Kong through community organizations that provide support services for South Asians in local communities. Dyads will be randomly allocated to either the intervention or wait-list control group. Intervention dyads will receive intervention, whose contents are based on the health belief model, via multiple forms of media including PowerPoint presentation, video clip and health information booklet. Control dyads will receive intervention after post-intervention data are collected. For dyads in both groups, an appointment with a family doctor will be arranged for those willing to undergo FOBT. Outcomes will be assessed at baseline and post-intervention. Data will be analysed using the Generalised Linear Models Procedure in an intention-to-treat manner.

DISCUSSION

Findings of this study will provide evidence of the benefits of utilizing multimedia and family-based approaches in intervention development to enhance the effectiveness of health promotion interventions for ethnic minorities. Further, the findings would provide reference to the potential incorporation of the intervention in the existing support services for South Asian ethnic minorities in local communities.

TRIAL REGISTRATION

This trial is registered at the ISRCTN Registry ( ISRCTN72829325 ) on 19th July 2018.

Project SHINE: effects of a randomized family-based health promotion program on the physical activity of African American parents

This study examined the effects of a family-based health promotion intervention on the moderate-to-vigorous physical activity (MVPA), light physical activity, sedentary behavior, and fruit and vegetable intake of African American parents. Eighty-nine African American parents (41.5 ± 8.5 years; 92% females; 74% obese; 64% < $40 K income) and adolescents (12.5 ± 1.4 years; 61% girls; 48% obese) were randomized to a 6-week behavioral skills plus positive parenting and peer monitoring intervention grounded in social cognitive, self-determination, and family systems theories or a general health comparison program. Parents wore accelerometers for 7 days and completed three 24-h dietary recalls at baseline and post-intervention. Multilevel regression models (controlling for baseline variables) demonstrated a significantly greater increase in parent MVPA for those in the intervention versus comparison condition (b = 9.44, SE = 4.26, p < 0.05). There were no other significant effects. Family-based approaches that include African American parents and youth may increase parent MVPA and hold promise for preventing chronic diseases.

A randomized controlled study of brief family-based intervention in obsessive compulsive disorder

BACKGROUND

Cognitive behaviour therapy (CBT) for Obsessive Compulsive Disorder (OCD) is therapist-intensive and prolonged making it less accessible to patients, particularly in resource-constrained situations. We examined the efficacy of a brief psychotherapeutic intervention as an adjunct to serotonin reuptake inhibitors (SRIs) in OCD.

METHOD

We randomized 64 adult OCD patients stabilized on SRIs to either the 6-session brief family-based intervention (BFBI; n = 30) that included psychoeducation, exposure and response prevention and family intervention or to a control arm of relaxation exercises (RE). Assessments were conducted at baseline and at 1- and 3- months post-intervention. Primary outcome measure was response to treatment defined as ≥ 35% reduction in the Yale-Brown Obsessive Compulsive Scale total score relative to baseline score plus a Clinical Global Impression- Improvement rating of very much improved or much improved. Family accommodation and expressed emotions were also assessed.

RESULTS

At 3- month follow-up, the BFBI group responded better than the RE group (53% vs. 12%, p < 0.001). Illness severity, family accommodation and expressed emotion declined significantly over time in the BFBI group compared to the RE group. The BFBI (OR = 13.17, p < 0.001) and baseline illness severity (OR = 0.746, p < 0.011) predicted treatment response.

LIMITATIONS

Sample size was small and follow-up duration was short. Control group had less time with the therapist although number of sessions was identical in both the groups.

CONCLUSION

Briefer intervention is effective in treating OCD. Briefer and inclusive format of intervention has important implications for clinical practice in resource-constrained circumstances.

How effective are family-based and institutional nutrition interventions in improving children's diet and health? A systematic review

BACKGROUND

Effective strategies to improve dietary intake in young children are a priority to reduce the high prevalence of chronic non-communicable diseases in adulthood. This study aimed to assess the impact of family-based and school/preschool nutrition programs on the health of children aged 12 or younger, including the sustainability of these impacts and the relevance to socio-economic inequalities.

METHODS

A systematic review of literature published from 1980 to December 2014 was undertaken. Randomised controlled trials involving families with children aged up to 12 years in high income countries were included. The primary outcomes were dietary intake and health status. Results were presented in a narrative synthesis due to the heterogeneity of the interventions and outcomes.

RESULTS

The systematic search and assessment identified 39 eligible studies. 82% of these studies were set in school/preschools. Only one school study assessed the impact of involving parents systematically. The family-based programs which provided simple positive dietary advice to parents and regular follow-up reduced fat intake significantly. School and family-based studies, if designed and implemented well, increased F&V intake, particularly fruit. Effective school-based programs have incorporated role-models including peers, teachers and heroic figures, rewards and increased access to healthy foods. School nutrition programs in disadvantaged communities were as effective as programs in other communities.

CONCLUSIONS

Family and school nutrition programs can improve dietary intake, however evidence of the long-term sustainability of these impacts is limited. The modest overall impact of even these successful programs suggest complementary nutrition interventions are needed to build a supportive environment for healthy eating generally.

Family-based childhood obesity prevention interventions: a systematic review and quantitative content analysis

BACKGROUND

A wide range of interventions has been implemented and tested to prevent obesity in children. Given parents' influence and control over children's energy-balance behaviors, including diet, physical activity, media use, and sleep, family interventions are a key strategy in this effort. The objective of this study was to profile the field of recent family-based childhood obesity prevention interventions by employing systematic review and quantitative content analysis methods to identify gaps in the knowledge base.

METHODS

Using a comprehensive search strategy, we searched the PubMed, PsycIFO, and CINAHL databases to identify eligible interventions aimed at preventing childhood obesity with an active family component published between 2008 and 2015. Characteristics of study design, behavioral domains targeted, and sample demographics were extracted from eligible articles using a comprehensive codebook.

RESULTS

More than 90% of the 119 eligible interventions were based in the United States, Europe, or Australia. Most interventions targeted children 2-5 years of age (43%) or 6-10 years of age (35%), with few studies targeting the prenatal period (8%) or children 14-17 years of age (7%). The home (28%), primary health care (27%), and community (33%) were the most common intervention settings. Diet (90%) and physical activity (82%) were more frequently targeted in interventions than media use (55%) and sleep (20%). Only 16% of interventions targeted all four behavioral domains. In addition to studies in developing countries, racial minorities and non-traditional families were also underrepresented. Hispanic/Latino and families of low socioeconomic status were highly represented.

CONCLUSIONS

The limited number of interventions targeting diverse populations and obesity risk behaviors beyond diet and physical activity inhibit the development of comprehensive, tailored interventions. To ensure a broad evidence base, more interventions implemented in developing countries and targeting racial minorities, children at both ends of the age spectrum, and media and sleep behaviors would be beneficial. This study can help inform future decision-making around the design and funding of family-based interventions to prevent childhood obesity.

Themes arising in clinical consultation for therapists implementing family-based treatment for adolescents with anorexia nervosa: a qualitative study

BACKGROUND

Our study aims to explore and describe themes arising in sessions of clinical consultation with therapists implementing Family-Based Treatment (FBT) for adolescents with Anorexia Nervosa (AN). There is currently no literature describing the content of clinical consultation for FBT. Thus, this knowledge will add to the evidence-base on what therapists need from consultants in ongoing clinical consultation.

METHODS

Eight therapists at four sites participated in this study, which spanned a two-year period. Following a two-day training workshop, each therapist treated at least one adolescent patient presenting with a restrictive eating disorder with FBT, focusing on adherence to the treatment manual. Clinical consultation sessions occurred monthly and were led by an external FBT expert. Thirty-five (average per site = 9) audio recorded group clinical consultation sessions were transcribed verbatim and coded for themes. Twenty percent of the transcripts were double-coded to ensure consistency. Fundamental qualitative description guided the sampling and data collection.

RESULTS

Thematic content analysis revealed ten common themes relating to the provision of clinical consultation to therapists implementing FBT in clinical practice: encouraging parental meal time supervision,discussing the role of mothers, how to align parents, ensuring parental buy-in, when to transition to Phase 2, weighing the patient and the patients' knowledge of their weight, the role of siblings in FBT sessions, how best to manage patient co-morbidities, the role of the father in FBT and how best to manage the family meal.

CONCLUSIONS

In conclusion, clinical consultation themes aligned with many of the central tenets of FBT, including how to help parents align their supportive approach during the refeeding process, and how to help parents assume control of eating disordered behaviours. This knowledge helps to guide consultants to anticipate common issues brought forward by therapists attempting to implement FBT.

Pedigree based DNA sequencing pipeline for germline genomes of cancer families

BACKGROUND

In the course of our whole-genome sequencing efforts, we have developed a pipeline for analyzing germline genomes from Mendelian types of cancer pedigrees (familial cancer variant prioritization pipeline, FCVPP).

RESULTS

The variant calling step distinguishes two types of genomic variants: single nucleotide variants (SNVs) and indels, which undergo technical quality control. Mendelian types of variants are assumed to be rare and variants with frequencies higher that 0.1 % are screened out using human 1000 Genomes (Phase 3) and non-TCGA ExAC population data. Segregation in the pedigree allows variants to be present in affected family members and not in old, unaffected ones. The effectiveness of variant segregation depends on the number and relatedness of the family members: if over 5 third-degree (or more distant) relatives are available, the experience has shown that the number of likely variants is reduced from many hundreds to a few tens. These are then subjected to bioinformatics analysis, starting with the combined annotation dependent depletion (CADD) tool, which predicts the likelihood of the variant being deleterious. Different sets of individual tools are used for further evaluation of the deleteriousness of coding variants, 5' and 3' untranslated regions (UTRs), and intergenic variants.

CONLUSIONS

The likelihood of success of the present genomic pipeline in finding novel high- or medium-penetrant genes depends on many steps but first and foremost, the pedigree needs to be reasonably large and the assignments and diagnoses among the members need to be correct.

The feasibility and acceptability of a preventive intervention programme for children with depressed parents: study protocol for a randomised controlled trial

Background

One of the most important risk factors for childhood depression is being the child of a depressed parent. These at-risk children have two to four times the probability of having an affective episode compared with their peers. Preventive interventions such as Beardslee’s Preventive Intervention Program (PIP) that are targeted at children of depressed parents have proven effective in many countries. The PIP is a family-based approach that works by promoting resilience in children and increasing positive interactions within the family. In this pilot randomised controlled trial (RCT), we will determine the acceptability and feasibility of an adapted version of this intervention in Chile.

Methods/design

We are conducting a pilot RCT with a manualized intervention. The intervention will be delivered in seven weekly sessions at the family home. It is targeted mostly at parents but will also measure outcomes among the children. Control subjects will follow their treatment as usual. Feasibility and acceptability will be assessed by recruitment, adherence, dropout and level of missing data, as well as the burden of scales and measurement tools. Families will be followed for 11 months.

Discussion

Given the negative lifelong consequences of depression and the burden they represent, preventive programmes are not only feasible but necessary. Despite the successful implementation of this intervention in different countries, an adaptation to the Chilean reality will be prerequisite. The results of this pilot study will inform a definitive trial that will make the case for its national implementation.

Trial registration

Clinicaltrials.gov trial identifier: NCT02593266. Registration date: 30 Octo 2015.

Heart failure family-based education: a systematic review

OBJECTIVE

To systematically review evidence for the efficacy of family-based education for heart failure (HF) patients and carers.

METHOD

A systematic review was conducted. Databases CINAHL, MEDLINE Complete, Cochrane, PubMed, Web of Science, EMBASE, PsycINFO, and Scopus were searched between 1 January 2005 and 1 May 2015. Randomised controlled trials included HF patient and carer dyads or carers alone. The primary outcome was HF knowledge. Secondary outcomes included self-care behaviour, dietary and treatment adherence, quality of life, depression, perceived control, hospital readmissions, and carer burden.

RESULT

Six trials reported in nine papers were included. Wide variation in the quality of the studies was found. Two studies only examined HF knowledge; a significant improvement among patients and carers was reported. Other significant findings were enhanced patient self-care, boosted dietary and treatment adherence, enriched patient quality of life, improved perceived control among patients but not carers, and reduced carer burden

CONCLUSION

Modest evidence was found for family-based education among HF patients and carers. Methodological shortcomings of trials signify the need for empirically sound future research.

PRACTICE IMPLICATION

Family-based HF education needs to include strategies that are tailored to the HF patient and carer, and sustainable in nature.

A web-based, health promotion program for adolescent girls and their mothers who reside in public housing

This study tested a brief web-based, family-involvement health promotion program aimed at drug use, physical activity, and nutrition for adolescent girls, aged 10 to 12 years, who reside in public housing. Separately, girls (n=67) and their mothers (n=67) completed baseline measures online. Following baseline, 36 randomly assigned mother-daughter dyads jointly completed a 3-session, health promotion program online. Subsequently, all girls and mothers separately completed posttest and 5-month follow-up measures. Attrition at posttest and 5-month follow-up measures was 3% and 9%, respectively. At posttest, intervention-arm girls, relative to control-arm girls, reported greater mother-daughter communication and parental monitoring. Intervention-arm mothers reported greater mother-daughter communication and closeness as well as increased vegetable intake and physical activity. At 5-month follow-up, intervention-arm girls and mothers, relative to those in the control arm, reported greater levels of parental monitoring. Intervention-arm girls also reported greater mother-daughter communication and closeness, reduced stress, greater refusal skills, and increased fruit intake. Findings indicate the potential of a brief, web-based program to improve the health of low-income girls and their mothers.