La fattibilità e l'efficacia preliminare dell'intervento familiare consapevole e sano con le famiglie rurali (MHFproject)

Intervention group parents will receive 9 intervention sessions every other week by trained staff via 9 online sessions via Zoom or phone calls. Each intervention session will last 30-40 minutes. Intervention group parents will receive 3 text messages per week. No in-person contacts will be conducted without MSU department permission. All assessments will be delivered remotely with guided phone calls or zoom conference. The assessment of dyads' BMI, %BF, and WC will be obtained remotely from the parents using the scale and measuring tape delivered to their home.

9 remote mindful-based MI sessions will be delivered to promote participating parents' mindful eating, mindful movements, and mindful family interactions. Parents will be encouraged to act as changing agents for their families.

Control group parents will receive a total of 9 emailed packets of educational materials (without information related to the mindfulness-based motivational interviewing [MM-based-MI]). The pre and post assessments will be collected the same way as the participants at intervention group.

9 health education emails will be sent to participating parents in the control group

The Healthy Eating Index (HEI) score derived from ASA24 reflects how closely an individual's reported food and beverage intake aligns with the Dietary Guidelines for Americans, summarizing overall diet quality on a scale from 1 to 100, with higher scores indicating healthier eating patterns.

The International Physical Activity Questionnaire (IPAQ) total score is expressed in MET-minutes per week, with higher scores indicating greater levels of physical activity. Scores can range from 0 (no reported physical activity) to several thousand MET-minutes per week, depending on the frequency, duration, and intensity of activities performed.

Health literacy (parent only) was assessed using the Newest Vital Sign (NVS), a validated screening tool that evaluates an individual's ability to read and apply health-related information. The NVS is based on interpretation of a nutrition label and yields a score ranging from 0 to 6, with higher scores indicating greater health literacy. Scores of 0-1 suggest a high likelihood of limited literacy, 2-3 indicate the possibility of limited literacy, and 4-6 reflect adequate health literacy.

Total daily energy intake (parent report) was estimated using the Block Dietary Screener, a validated food frequency questionnaire that assesses usual dietary intake over a specified period. Responses are used to estimate average daily energy intake (kilocalories per day) based on standardized nutrient databases and scoring algorithms. Higher values indicate greater total energy intake.

Child physical activity (parent report) was assessed by the number of days in the past week that the child engaged adequately in physical activity. Parents reported the frequency of activity over the previous 7 days, yielding a score ranging from 0 to 7 days, with higher values indicating more frequent physical activity.

Exercise self-efficacy was assessed using a 9-item self-reported measure evaluating confidence in the ability to engage in physical activity. Each item is scored on a scale from 0 ("Not confident") to 10 ("Very confident"). Item scores are summed to produce a total score ranging from 0 to 90, with higher scores indicating greater exercise self-efficacy.

Collective family efficacy was assessed using a 20-item self-reported scale. Each item is rated on a 7-point Likert scale, and item scores are summed to yield a total score ranging from 20 to 140. Higher scores indicate greater levels of collective family efficacy.

Parental depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CES-D 10). Each item is rated on a 4-point scale ranging from "Rarely or none of the time" to "All of the time." Item scores are summed to yield a total score ranging from 0 to 30, with higher scores indicating greater depressive symptoms.

Perceived stress (parent report) was assessed using the 10-item Perceived Stress Scale (PSS-10), which evaluates the degree to which situations in one's life are appraised as stressful. Items are rated on a 5-point Likert scale ranging from 0 ("Never") to 4 ("Very Often"). Four positively worded items (items 4, 5, 7, and 8) are reverse-scored prior to summation. Total scores range from 0 to 40, with higher scores indicating greater perceived stress.

Family functioning was assessed using a 5-item self-reported scale evaluating Adaptability, Partnership, Growth, Affection, and Resolve. Each item is scored on a 3-point scale (0 = "Hardly ever," 1 = "Some of the time," 2 = "Almost always"). Item scores are summed to yield a total score ranging from 0 to 10, with higher scores indicating greater satisfaction with family functioning across the five domains.

Mindful eating (parent report) was assessed using a 28-item self-reported scale evaluating mindful eating attitudes across multiple domains (e.g., awareness, distraction, disinhibition, emotional, and external eating). Each item is rated on a 4-point scale. Domain scores are calculated by summing items within each domain and dividing by the number of items in that domain, yielding mean domain scores. A total summed score ranges from 28 to 112, with higher scores indicating greater levels of mindful eating.

Parent body mass index (BMI) was calculated as weight in kilograms divided by height in meters squared (kg/m²). Higher BMI values indicate greater body weight relative to height.

Hair cortisol concentration was measured as a biomarker of chronic physiological stress. A small sample of hair was collected and analyzed to estimate cumulative cortisol exposure over time. Results are expressed as cortisol concentration (e.g., pg/mg of hair), with higher values indicating greater chronic stress levels.