Reducing Childhood Obesity Using Ecological Momentary Intervention (EMI) and Video Feedback atFamily Meals

摘要 到目前为止，儿童肥胖干预的低到中等成功和持续的肥胖差异 跨种族/民族和社会经济地位表明有必要以一种新的和 创新的方式。在过去30年关于儿童肥胖症的研究的基础上， 建议的研究是利用最先进的干预方法，包括生态瞬时干预 (EMI)、视频反馈和与初级保健诊所和社区合作的家访方法 卫生工作者(CHW)研究是否提高家庭膳食的质量(即饮食质量， 家庭用餐的数量(即用餐频率)可以减少儿童肥胖症。 许多研究表明，家庭用餐频率与儿童体重和 与体重相关的行为(例如，更好的饮食质量，较低的体重状况)。研究还表明， 家庭用餐的质量，包括家庭用餐提供的食物的饮食质量和人际关系 家庭用餐期间的氛围与儿童肥胖风险的降低有关。此外，之前的 干预研究表明，对健康行为的即时反馈(例如，EMI、视频反馈) 增加了行为改变的可能性。因此，提出的个体随机控制有效性 试验，基于我们的初步研究，测试上述因素的组合(即，EMI、家访、视频反馈) 跨三个研究分支：(1)EMI；(2)EMI+家访(HV)；(3)EMI+HV+视频反馈。所有的武器都会 接收通过智能手机发送的为期16周的EMI家庭用餐提示消息。臂2和臂3将另外 接受家访(8次上门访问；8次“亲自尝试”活动)，重点是家庭用餐质量和 与EMI的16周同时由CHW提供的数量和家庭用餐准备活动。臂3 还将收到为期八周的关于家庭用餐行为的视频反馈(S)/提供的模式 在八次家访中被CHW。所有武器将接受为期8周的维护阶段，允许 逐渐减少对家庭的支持，这样他们就可以增加自我效能和行为改变的可持续性。 这项干预将对超重/肥胖(即体重指数≥85%ILE)的儿童进行6个月 5-8岁(n=510)，来自低收入和不同家庭(即非裔美国人、西班牙裔、土著 美国人、白人)和他们的家人。符合条件的儿童将通过初级保健诊所招募。在上面绘制 家庭系统理论认为，这种干预旨在改变个人和家庭层面的行为。具体地说， 干预措施将提供给家庭单位，主要结果将包括儿童体重(即BMI%)。 和饮食质量(即健康饮食指数)。次要结果将包括父母和其他家庭成员 体重和体重相关行为。这项研究将通过创建一种新的模型来改变临床实践 初级保健中使用CHW作为干预者的儿童肥胖症治疗和移动卫生技术 实时干预父母的压力和家庭的饮食环境，以减少儿童肥胖。

Abstract The low to moderate success with childhood obesity interventions to date and the persistent obesity disparities across race/ethnicity and socioeconomic status indicate the need to approach childhood obesity in a new and innovative way. Building on the last three decades of research on childhood obesity, the main objective of the proposed study is to utilize state-of-the-art intervention methods including ecological momentary intervention (EMI), video feedback, and home visiting methods in partnership with primary care clinics and Community Health Workers (CHWs) to examine whether increasing the quality of family meals (i.e., dietary quality, interpersonal atmosphere) and quantity of family meals (i.e., frequency of meals) reduces childhood obesity. Numerous studies have shown significant associations between family meal frequency and child weight and weight-related behaviors (e.g., better diet quality, lower weight status). Research has also shown that the quality of family meals, including dietary quality of the food served at family meals and the interpersonal atmosphere during family meals, is associated with decreased childhood obesity risk. In addition, prior intervention research has shown that immediate feedback on health behaviors (e.g., EMI, video feedback) increases the likelihood of behavior change. Thus, the proposed individual randomized controlled effectiveness trial, based on our pilot study, tests combinations of the above factors (i.e., EMI, home visiting, video feedback) across three study arms: (1) EMI; (2) EMI+Home Visiting (HV); and (3) EMI+HV+Video Feedback. All arms will receive 16 weeks of EMI family meal tip messages delivered via smartphones. Arms 2 and 3 will additionally receive home visiting (eight in-home visits; eight “Try it Yourself” activities) focused on family meal quality and quantity and a family meal prep activity delivered by a CHW simultaneously with the 16 weeks of EMI. Arm 3 will additionally receive eight weeks of video feedback focused on family meal behavior(s)/patterns delivered by a CHW during the eight in-home visits. All arms will receive an 8-week maintenance phase allowing for progressively less support of families so they can increase self-efficacy and sustainability of behavior change. The intervention will be carried out for 6 months with children with overweight/obesity (i.e., BMI ≥85%ile) who are ages 5-8 years (n=510), from low income and diverse households (i.e., African American, Hispanic, Native American, White), and their families. Eligible children will be recruited through primary care clinics. Drawing on Family Systems Theory, the intervention aims to change individual and family-level behaviors. Specifically, the intervention will be delivered to the family unit and primary outcomes will include child weight (i.e., BMI %ile) and diet quality (i.e., Healthy Eating Index). Secondary outcomes will include parent and other family member’s weight and weight-related behaviors. This study will change clinical practice by creating a new model for childhood obesity treatment in primary care using CHWs as interventionists and mobile health technology to intervene in real-time on parental stress and the home food environment to reduce childhood obesity.