Working With Parents to Prevent Childhood Obesity: Protocol for a Primary Care-Based eHealth Study

Jillian Ls Avis, Andrew L Cave, Stephanie Donaldson, Carol Ellendt, Nicholas L Holt, Susan Jelinski, Patricia Martz, Katerina Maximova, Raj Padwal, T Cameron Wild, Geoff Dc Ball, Jillian Ls Avis, Andrew L Cave, Stephanie Donaldson, Carol Ellendt, Nicholas L Holt, Susan Jelinski, Patricia Martz, Katerina Maximova, Raj Padwal, T Cameron Wild, Geoff Dc Ball

Abstract

Background: Parents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents' motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention.

Objective: (1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents' concern for, and motivation to, support children's healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial.

Methods: This is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III). Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company. Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT. Phase III: Parents (n=200) of children-boys and girls, 5 to 17 years old-will be recruited from a primary care pediatric clinic while they await their children's clinical appointment. Parents will be randomly assigned to one of five groups-four intervention groups and one control group-as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children's dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome).

Results: This research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016.

Conclusions: The proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children's healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or "nudge" individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings.

Trial registration: ClinicalTrials.gov NCT02330588; https://ichgcp.net/clinical-trials-registry/NCT02330588 (Archived by WebCite at http://www.webcitation.org/6WyUOeRlr).

Keywords: Canada; Internet; body weight; child; childhood obesity; parents; prevention; primary health care.

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram of predicted progress through RCT phases (enrollment, allocation, follow-up, and analysis).

References

    1. Roberts KC, Shields M, de Groh M, Aziz A, Gilbert JA. Overweight and obesity in children and adolescents: results from the 2009 to 2011 Canadian Health Measures Survey. Health Rep. 2012 Sep;23(3):37–41.
    1. Shields M. Overweight and obesity among children and youth. Health Rep. 2006 Aug;17(3):27–42.
    1. Oude LH, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP, Summerbell CD. Interventions for treating obesity in children. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001872. doi: 10.1002/14651858.CD001872.pub2.
    1. Faith S, Van HL, Appel LJ, Burke LE, Carson JA, Franch HA, Jakicic JM, Kral TV, Odoms-Young A, Wansink B, Wylie-Rosett J, American Heart Association Nutrition and Obesity Committees of the Council on Nutrition, Physical Activity and Metabolism. Council on Clinical Cardiology. Council on Cardiovascular Disease in the Young. Council on Cardiovascular Nursing. Council on Epidemiology and Prevention. Council on the Kidney in Cardiovascular Disease Evaluating parents and adult caregivers as "agents of change" for treating obese children: evidence for parent behavior change strategies and research gaps: a scientific statement from the American Heart Association. Circulation. 2012 Mar 6;125(9):1186–1207. doi: 10.1161/CIR.0b013e31824607ee.
    1. Golan M, Crow S. Parents are key players in the prevention and treatment of weight-related problems. Nutr Rev. 2004 Jan;62(1):39–50.
    1. Zehle K, Wen LM, Orr N, Rissel C. "It's not an issue at the moment": a qualitative study of mothers about childhood obesity. MCN Am J Matern Child Nurs. 2007;32(1):36–41.
    1. Eckstein KC, Mikhail LM, Ariza AJ, Thomson JS, Millard SC, Binns HJ, Pediatric Practice Research Group Parents' perceptions of their child's weight and health. Pediatrics. 2006 Mar;117(3):681–690. doi: 10.1542/peds.2005-0910.
    1. Neumark-Sztainer D, Wall M, Story M, van den Berg P. Accurate parental classification of overweight adolescents' weight status: does it matter? Pediatrics. 2008 Jun;121(6):e1495–e1502. doi: 10.1542/peds.2007-2642.
    1. Whiteley JA, Bailey BW, McInnis KJ. State of the art reviews: Using the Internet to promote physical activity and healthy eating in youth. Am J Life Med. 2008;2(2):159–177.
    1. Tate DF. Application of innovative technologies in the prevention and treatment of overweight in children and adolescents. In: Jelalian E, Steele RG, editors. Handbook of Childhood and Adolescent Obesity. Issues in Clinical Child Psychology. New York, NY: Springer; 2008. pp. 387–404.
    1. An JY, Hayman LL, Park YS, Dusaj TK, Ayres CG. Web-based weight management programs for children and adolescents: a systematic review of randomized controlled trial studies. ANS Adv Nurs Sci. 2009;32(3):222–240. doi: 10.1097/ANS.0b013e3181b0d6ef.
    1. Ball GDC, Ambler KA, Chanoine JP. Pediatric weight management programs in Canada: where, what and how? Int J Pediatr Obes. 2011 Jun;6(2-2):e58–e61. doi: 10.3109/17477166.2010.512390.
    1. He M, Piché L, Clarson CL, Callaghan C, Harris SB. Childhood overweight and obesity management: A national perspective of primary health care providers' views, practices, perceived barriers and needs. Paediatr Child Health. 2010 Sep;15(7):419–426.
    1. Perrin EM, Flower KB, Garrett J, Ammerman AS. Preventing and treating obesity: pediatricians' self-efficacy, barriers, resources, and advocacy. Ambul Pediatr. 2005;5(3):150–156. doi: 10.1367/A04-104R.1.
    1. Nguyen B, Kornman KP, Baur LA. A review of electronic interventions for prevention and treatment of overweight and obesity in young people. Obes Rev. 2011 May;12(5):e298–e314. doi: 10.1111/j.1467-789X.2010.00830.x.
    1. Manzoni GM, Pagnini F, Corti S, Molinari E, Castelnuovo G. Internet-based behavioral interventions for obesity: an updated systematic review. Clin Pract Epidemiol Ment Health. 2011;7:19–28. doi: 10.2174/1745017901107010019.
    1. Davies CA, Spence JC, Vandelanotte C, Caperchione CM, Mummery WK. Meta-analysis of Internet-delivered interventions to increase physical activity levels. Int J Behav Nutr Phy. 2012;9(52):1–13.
    1. Hamel LM, Robbins LB. Computer- and web-based interventions to promote healthy eating among children and adolescents: a systematic review. J Adv Nurs. 2013 Jan;69(1):16–30. doi: 10.1111/j.1365-2648.2012.06086.x.
    1. Estabrooks PA, Fisher EB, Hayman LL. What is needed to reverse the trends in childhood obesity? A call to action. Ann Behav Med. 2008 Dec;36(3):209–216. doi: 10.1007/s12160-008-9070-7.
    1. Rao G, Burke LE, Spring BJ, Ewing LJ, Turk M, Lichtenstein AH, Cornier MA, Spence JD, Coons M, American Heart Association Obesity Committee of the Council on Nutrition‚ Physical Activity and Metabolism. Council on Clinical Cardiology. Council on Cardiovascular Nursing. Council on the Kidney in Cardiovascular Disease. Stroke Council New and emerging weight management strategies for busy ambulatory settings: a scientific statement from the American Heart Association endorsed by the Society of Behavioral Medicine. Circulation. 2011 Sep 6;124(10):1182–1203. doi: 10.1161/CIR.0b013e31822b9543.
    1. Miller WR, Rollnick S. Motivational Interviewing: Preparing People for Change. 2nd edition. New York, NY: The Guilford Press; 2002.
    1. Papadakis S, McDonald P, Mullen KA, Reid R, Skulsky K, Pipe A. Strategies to increase the delivery of smoking cessation treatments in primary care settings: a systematic review and meta-analysis. Prev Med. 2010;51(3-4):199–213. doi: 10.1016/j.ypmed.2010.06.007.
    1. Kaner EF, Dickinson HO, Beyer F, Pienaar E, Schlesinger C, Campbell F, Saunders JB, Burnand B, Heather N. The effectiveness of brief alcohol interventions in primary care settings: a systematic review. Drug Alcohol Rev. 2009 May;28(3):301–323. doi: 10.1111/j.1465-3362.2009.00071.x.
    1. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83(3):457–502. doi: 10.1111/j.1468-0009.2005.00409.x.
    1. Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010;10:1. doi: 10.1186/1471-2288-10-1.
    1. Kubik MY, Story M, Davey C, Dudovitz B, Zuehlke EU. Providing obesity prevention counseling to children during a primary care clinic visit: results from a pilot study. J Am Diet Assoc. 2008 Nov;108(11):1902–1906. doi: 10.1016/j.jada.2008.08.017.
    1. Evolution Health. Toronto, ON: Evolution Health Systems; 2015. [2015-01-25].
    1. Slater A, Bowen J, Corsini N, Gardner C, Golley R, Noakes M. Understanding parent concerns about children's diet, activity and weight status: an important step towards effective obesity prevention interventions. Public Health Nutr. 2010 Aug;13(8):1221–1228. doi: 10.1017/S1368980009992096.
    1. Steinbeck KS. The importance of physical activity in the prevention of overweight and obesity in childhood: a review and an opinion. Obes Rev. 2001 May;2(2):117–130.
    1. Schwartz SH. Normative influences on altruism. In: Berkowtiz L, editor. Advances in Experimental Social Psychology. Volume 10. New York, NY: Academic Press; 1977. pp. 221–279.
    1. Rosenstock IM. The health belief model and preventive health behavior. Health Educ Behav. 1974 Dec 21;2(4):354–386. doi: 10.1177/109019817400200405.
    1. Garriguet D. Canadians' eating habits. Health Rep. 2007 May;18(2):17–32.
    1. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physical activity of Canadian children and youth: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011 Mar;22(1):15–23.
    1. Health Canada and the Canadian Society for Exercise Physiology . Canada’s Physical Activity Guide for Children. Ottawa, ON: Minister of Public Works and Government Services Canada; 2002. [2015-03-18]. .
    1. Cunningham JA, van MT. The check your cannabis screener: a new online personalized feedback tool. Open Med Inform J. 2009;3:27–31. doi: 10.2174/1874431100903010027.
    1. Cunningham JA, Humphreys K, Kypri K, van MT. Formative evaluation and three-month follow-up of an online personalized assessment feedback intervention for problem drinkers. J Med Internet Res. 2006;8(2):e5. doi: 10.2196/jmir.8.2.e5.
    1. Cloutier MM, Lucuara-Revelo P, Wakefield DB, Gorin AA. My Weight Ruler: a simple and effective tool to enhance parental understanding of child weight status. Prev Med. 2013 Nov;57(5):550–554. doi: 10.1016/j.ypmed.2013.07.014.
    1. Campbell M, Benton JM, Werk LN. Parent perceptions to promote a healthier lifestyle for their obese child. Soc Work Health Care. 2011;50(10):787–800. doi: 10.1080/00981389.2011.597316.
    1. Kidd PS, Parshall MB. Getting the focus and the group: Enhancing analytical rigor in focus group research. Qual Health Res. 2000;10(3):298–308.
    1. Smithson J. Using and analyzing focus groups: Limitations and possibilities. Int J Soc Res Method. 2000;3(2):103–119.
    1. Sandelowski M. Sample size in qualitative research. Res Nurs Health. 1995 Apr;18(2):179–183.
    1. Farnesi BC, Newton AS, Holt NL, Sharma AM, Ball GDC. Exploring collaboration between clinicians and parents to optimize pediatric weight management. Patient Educ Couns. 2012 Apr;87(1):10–17. doi: 10.1016/j.pec.2011.08.011.
    1. Holt NL, Moylan BA, Spence JC, Lenk JM, Sehn ZL, Ball GDC. Treatment preferences of overweight youth and their parents in Western Canada. Qual Health Res. 2008 Sep;18(9):1206–1219. doi: 10.1177/1049732308321740.
    1. Scott SD, Sharpe H, O'Leary K, Dehaeck U, Hindmarsh K, Moore JG, Osmond MH. Court reporters: a viable solution for the challenges of focus group data collection? Qual Health Res. 2009 Jan;19(1):140–146. doi: 10.1177/1049732308327883.
    1. Morse JM, Field PA. Qualitative Research Methods for Health Professionals. 2nd edition. Thousand Oaks, CA: Sage Publications, Incorporated; 1995.
    1. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health. 2000 Aug;23(4):334–340.
    1. Leon AC, Davis LL, Kraemer HC. The role and interpretation of pilot studies in clinical research. J Psychiatr Res. 2011 May;45(5):626–629. doi: 10.1016/j.jpsychires.2010.10.008.
    1. . 2014. Dec, [2015-03-14]. The Resource Information Program for Parents on Lifestyle and Education (RIPPLE) .
    1. Moher D, Schulz KF, Altman DG, CONSORT The CONSORT statement: revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol. 2001;1:2.
    1. Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group. Cochrane Statistical Methods Group The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011 Oct 18;343:d5928.
    1. Yarnall KS, Pollak KI, Østbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. 2003 Apr;93(4):635–641.
    1. Freeborn DK, Polen MR, Hollis JF, Senft RA. Screening and brief intervention for hazardous drinking in an HMO: effects on medical care utilization. J Behav Health Serv Res. 2000 Nov;27(4):446–453.
    1. Dhaliwal J, Nosworthy NM, Holt NL, Zwaigenbaum L, Avis JLS, Rasquinha A, Ball GD. Attrition and the management of pediatric obesity: an integrative review. Child Obes. 2014 Dec;10(6):461–473. doi: 10.1089/chi.2014.0060.
    1. Sullivan LM, Dukes KA, Losina E. Tutorial in biostatistics. An introduction to hierarchical linear modelling. Stat Med. 1999 Apr 15;18(7):855–888.
    1. Spivack JG, Swietlik M, Alessandrini E, Faith MS. Primary care providers' knowledge, practices, and perceived barriers to the treatment and prevention of childhood obesity. Obesity (Silver Spring) 2010 Jul;18(7):1341–1347. doi: 10.1038/oby.2009.410.
    1. Smith AJ, Skow Á, Bodurtha J, Kinra S. Health information technology in screening and treatment of child obesity: a systematic review. Pediatrics. 2013 Mar;131(3):e894–e902. doi: 10.1542/peds.2012-2011.
    1. Delamater AM, Pulgaron ER, Rarback S, Hernandez J, Carrillo A, Christiansen S, Severson HH. Web-based family intervention for overweight children: a pilot study. Child Obes. 2013 Feb;9(1):57–63. doi: 10.1089/chi.2011.0126.
    1. Laws R, Counterweight Project Team A new evidence-based model for weight management in primary care: the Counterweight Programme. J Hum Nutr Diet. 2004 Jun;17(3):191–208. doi: 10.1111/j.1365-277X.2004.00517.x.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera