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

摘要 迄今为止，儿童肥胖干预的低至中等成功率和持续的肥胖差异 在种族/民族和社会经济地位之间的差异表明，需要以一种新的、 创新的方式。在过去三十年儿童肥胖研究的基础上， 拟议的研究是利用最先进的干预方法，包括生态瞬时干预 (EMI)、视频反馈以及与初级保健诊所和社区合作的家访方法 卫生工作者（CHW）检查是否提高家庭膳食的质量（即，饮食质量， 人际氛围）和家庭膳食的数量（即，饮食频率）减少儿童肥胖。 许多研究表明，家庭用餐频率和儿童体重之间存在显着联系， 与体重相关的行为（例如，更好的饮食质量，更低的体重状态）。研究还表明， 家庭膳食的质量，包括家庭膳食中提供的食物的饮食质量和人际关系， 家庭用餐时的气氛，与降低儿童肥胖风险有关。此外，事先 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，拟定的个体随机对照有效性 基于我们的试点研究的试验测试了上述因素的组合（即，EMI、家访、视频反馈） 三个研究组：（1）EMI;（2）EMI+家庭访视（HV）;和（3）EMI+HV+视频反馈。所有武器将 通过智能手机接收为期16周的EMI家庭用餐提示信息。第2组和第3组还将 接受家访（八次家访;八次“自己尝试”活动），重点是家庭膳食质量， 量和家庭膳食准备活动提供的CHW同时与16周的EMI。臂3 此外，还将收到为期八周的视频反馈，重点关注家庭用餐行为/模式 在八次家访中，所有组将接受为期8周的维持期， 逐渐减少对家庭的支持，以便他们能够提高自我效能和行为改变的可持续性。 干预将对超重/肥胖儿童进行6个月（即，BMI ≥85%ile） 年龄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，白色）和他们的家人。合格的儿童将通过初级保健诊所招募。借鉴 家庭系统理论，干预的目的是改变个人和家庭层面的行为。具体而言是 干预将被传递到家庭单元并且主要结果将包括儿童体重（即，BMI %ile） 和饮食质量（即，健康饮食指数）。次要结局将包括父母和其他家庭成员的 体重和体重相关的行为。这项研究将通过创建一个新的模型来改变临床实践， 在初级保健中使用社区卫生工作者作为干预者和移动的卫生技术治疗儿童肥胖症， 实时干预父母压力和家庭食物环境，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.