Enhancing Childhood Obesity Interventions Through Digital Media Tools

An Experimental Study on Enhancing Childhood Obesity Interventions Through Digital Media Tools: A Case Study of Taipei City Hospital

This study evaluated the effectiveness of a LINE Official Account (a mobile messaging platform) as a digital health education tool to enhance parental engagement with childhood obesity-related health literacy content.

Parents of school-aged children (grades 1, 4, and 7) identified as obese through school health screenings in Taipei, Taiwan, who declined face-to-face clinic participation, were invited to join the LINE Official Account platform.

Participants were allocated to either an immediate push notification group (receiving automated educational messages for 24 weeks from enrollment) or a delayed push notification group (receiving no push notifications for the first 12 weeks, followed by 12 weeks of push notifications).

The study compared parental engagement behaviors between the two groups, including the proportion of users clicking interactive educational content and the click frequency per user, to determine whether the timing of push notification initiation affects parental engagement with digital health education content related to childhood obesity.

Study Overview

• Status: Completed
• Conditions: Pediatric Obesity; Health Literacy
• Intervention / Treatment: Behavioral: Immediate Automated Push Notifications; Behavioral: Delayed Automated Push Notifications

Detailed Description

Background: Childhood obesity is a growing public health concern in Taiwan. A hospital-based childhood obesity intervention program in Taipei faced consistently low parental participation rates (6-10%), despite school-based screening identifying eligible children. To address this gap, a digital health education platform was developed using the LINE Official Account messaging application to deliver health literacy content to parents who declined face-to-face clinic visits.

Intervention: The LINE Official Account platform incorporated six functional modules: Understanding Obesity, Dietary Guidance, Exercise Guidance, Family Lifestyle Habits, Course Resources, and Healthy Weight Clinic Introduction. Educational content was designed based on the Health Belief Model (addressing perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy) and Nudge theory (employing reminders, imagery, simplification, rewards, defaults, and social norms).

Study Design: This was a quasi-randomized trial using systematic allocation. Parents were allocated to two groups based on the sequential order of consent form returns during telephone contact. Since the team could not predict which parents would decline clinic participation during phone calls, this systematic alternating allocation achieved a quasi-random distribution. The experimental group (Channel 1) received automated push notifications from week 1 through week 24. The control group (Channel 2) received no push notifications during weeks 1-12, with notifications beginning at week 13 through week 24. Both groups had identical educational content available on the platform at all times; the intervention variable was the timing of automated push notification delivery.

Outcomes: Daily user activity data were collected from the LINE Official Account backend system over the 24-week study period. Primary outcome measures included the daily proportion of users clicking interactive educational messages and the daily click rate per user. Secondary outcomes included page view rates, system operation rates, and click differences across educational topic categories.

Statistical Analysis: Descriptive statistics, Mann-Whitney U tests, Chi-square tests, Spearman correlation analysis, and hierarchical regression analysis were employed. Significance level was set at p<0.05. All analyses were performed using IBM SPSS.

• Study Type: Interventional
• Enrollment (Actual): 567
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taiwas
    • Taipei, Taiwas, Taiwan, 100
      • Taipei City Hospital, Heping Fuyou Branch, Department of Pediatrics

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Parents or legal guardians of primary school (grades 1 and 4) or junior high school (grade 7) students in Zhongzheng and Wanhua districts, Taipei City
• Their child was identified as obese (BMI above the age- and sex-specific 95th percentile based on Taiwan national standards) through school health screenings conducted by Taipei City Hospital
• Parents provided consent for the public health program to calculate their child's BMI classification and to be contacted
• Parents declined the invitation to participate in the face-to-face Healthy Weight Clinic program during telephone contact
• Parents were able to use the LINE messaging application on a smartphone

Exclusion Criteria:

• Parents who accepted the face-to-face Healthy Weight Clinic invitation during initial telephone contact
• Parents whose child participated in another research study within the preceding month
• Parents unable to access the LINE messaging application

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Immediate Push Notification Group; Parents joined LINE Official Account Channel 1 and received automated push notifications containing health education content from week 1 through week 24 (total 24 weeks of push notifications). Push notifications included weekly messages covering BMI education, dietary guidance, exercise guidance, obesity comorbidities, and clinic introduction, designed based on the Health Belief Model and Nudge theory.	Behavioral: Immediate Automated Push Notifications; Automated weekly push notifications delivered via LINE Official Account from week 1 through week 24. Each week's push notification included health education content covering topics such as BMI measurement reminders, dietary guidance, exercise guidance, obesity comorbidity awareness, and healthy weight clinic introduction. Content was designed based on the Health Belief Model constructs (perceived susceptibility, severity, benefits, barriers, cues to action, self-efficacy) and Nudge theory strategies (reminders, imagery, simplification, rewards, defaults, social norms). The 12-week content cycle repeated in weeks 13-24.
Active Comparator: Delayed Push Notification Group; Parents joined LINE Official Account Channel 2 and received no automated push notifications during weeks 1-12. Starting from week 13, they received the same automated push notification content as the experimental group through week 24 (total 12 weeks of push notifications). The same educational content was available for self-directed browsing on the platform throughout the entire 24-week period.	Behavioral: Delayed Automated Push Notifications; No automated push notifications during weeks 1-12. Starting from week 13, participants received the same automated weekly push notifications as the experimental group through week 24 (identical content and delivery schedule). During weeks 1-12, the platform content was available for self-directed access but no proactive notifications were sent.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of Children Re-enrolling in the Face-to-face Healthy Weight Clinic Program	The proportion of children whose parents, after joining the LINE Official Account, subsequently chose to re-enroll in the face-to-face Healthy Weight Clinic intervention program at the hospital. This was compared between the push notification period and the non-push notification period as an odds ratio. Note: Due to a very low event rate (n=2 in the immediate push notification group, n=0 in the delayed push notification group), this outcome could not be adequately analyzed statistically. Pre-specified secondary outcomes (digital engagement metrics) were therefore used as the primary analytical focus in the final publication.	24 weeks from enrollment

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Daily Proportion of Users Clicking Interactive Educational Messages	The number of unique users who clicked on interactive educational content on a given day divided by the cumulative total number of users in the LINE Official Account channel on that day. This measure captures the daily proportion of active users engaging with the educational content.	24 weeks from enrollment
Daily Click Rate Per User for Interactive Educational Messages	The total number of clicks on interactive educational content on a given day divided by the cumulative total number of users in the LINE Official Account channel on that day. This measure captures the daily click frequency per user for educational content engagement.	24 weeks from enrollment
Daily Page View Rate Per User	The number of page views of the LINE Official Account profile page on a given day divided by the cumulative total number of users on that day.	24 weeks from enrollment'
Daily System Operation Rate Per User	The number of system operations (menu interactions) within the LINE Official Account on a given day divided by the cumulative total number of users on that day.	24 weeks from enrollment
Average Clicks Per Person on Interactive Educational Content	The total number of clicks on interactive educational messages per person accumulated over the entire study period, compared between the immediate and delayed push notification groups.	24 weeks from enrollment
Click Distribution Across Educational Topic Categories	The number of clicks on interactive educational content categorized by seven topic areas (Understanding Body Weight, Dietary Guidance, Exercise Guidance, Family and Lifestyle Habits, Obesity and Comorbidities, Healthy Weight Clinic Introduction, and Course Resources), compared between the two groups.	24 weeks from enrollment
Enrollment Rate (Joining Rate)	The proportion of invited parents who actually joined the LINE Official Account channel, calculated as the number of parents who joined divided by the total number of parents who received the invitation SMS, compared between groups.	At enrollment

Collaborators and Investigators

• Sponsor: Taipei City Hospital
• Collaborators: National Taiwan University, College of Public Health

Study record dates

Study Major Dates

• Study Start (Actual): February 3, 2024
• Primary Completion (Actual): July 19, 2024
• Study Completion (Actual): September 30, 2024

Study Registration Dates

• First Submitted: March 24, 2026
• First Submitted That Met QC Criteria: March 24, 2026
• First Posted (Actual): March 30, 2026

Study Record Updates

• Last Update Posted (Actual): March 30, 2026
• Last Update Submitted That Met QC Criteria: March 24, 2026
• Last Verified: March 1, 2026

More Information

Terms related to this study

• Keywords: Childhood Obesity; Health Literacy; mHealth; Digital Health; Health Belief Model; LINE Official Account; Push Notification; Nudge Theory; Parental Engagement
• Additional Relevant MeSH Terms: Nutrition Disorders; Overnutrition; Body Weight; Overweight; Obesity; Pathological Conditions, Signs and Symptoms; Nutritional and Metabolic Diseases; Signs and Symptoms; Pediatric Obesity
• Other Study ID Numbers: TCHIRB-11210004-E

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared due to privacy regulations and the nature of the data collected from the LINE Official Account backend system, which contains platform usage metrics only.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No