Intervention INC: An interactive family-centered mHealth tool to reduce obesity risk in urban minority preadolescents

摘要 在美国，儿童肥胖症仍然是一个严重的公共卫生问题，不成比例 在低收入、少数族裔儿童中的比率。有效而又引人入胜的干预措施需要设计成 吸引生活在多媒体环境中的儿童及其父母/照顾者的注意。我们的工作 以漫画的形式展示了多通道叙事的新颖性、感染力和效果，传达了 以图形和最少的语言发送信息，作为向年轻人传递健康信息的格式 人口。此外，在基于网络的/移动健康平台上提供的干预措施可能会很吸引人 可扩展以支持家庭健康行为的改变，并增强和扩展诊所就诊的影响 通过提供在线资源，加强医疗保健提供者面对面传递的健康信息。在……里面 与我们的社区合作伙伴儿童援助(美国历史最悠久、规模最大的儿童福利机构之一 组织)，一项由AHRQ资助的R21研究支持干预公司的开发和试点测试，a 以家庭为中心的、互动的、基于网络的健康促进工具，侧重于降低儿童肥胖风险。这个 工具是为满足低收入、黑人/非裔美国人(AA)和拉丁裔的需求和偏好而量身定做的 9至12岁的儿童及其父母/照顾者。试验性可行性研究的结果非常有希望，因为 该工具不仅交付可行，并为我们的儿童和家长群体所接受，而且儿童接受 漫画工具在蔬菜、水和糖的摄入量方面表现出更大的改善(p&lt；0.05)。 对照组，从干预前到干预后。然而，关于工具有效性和 现实世界环境中的实现仍然存在。为了填补这些空白，我们提出了一项具有以下目标的研究。 在目标1中，将与保健从业者/管理人员和儿童家长一起进行形成性研究 确定与在诊所实施这种工具相关的组织(诊所)和家庭特征的二元组 设置，而在目标2中，将对工具进行调整(基于目标1的调查结果)，并对其进行可用性测试 指挥。在目标3中，将在儿童援助社区诊所进行全面的随机对照试验，以测试 经过调整和扩展的工具，将包括12周的漫画干预和6个月的维护 干预，对儿童BMI z评分。在目标4中，诊所、提供者和家庭层面的背景因素 本课程将探讨影响工具的实施。我们相信这个以家庭为中心的基于网络的工具是独一无二的 鉴于其重点是创新的通信方法和移动健康平台，以增强可访问性和 与往往很难接触到的多样化人口打交道。它也有很强的

ABSTRACT Childhood obesity continues to be a serious public health issue in the United States (US), with disproportionate rates among low-income, minority children. Effective, yet engaging interventions need to be designed to capture the attention of children and their parents/caregivers living in a multi-media environment. Our work demonstrates the novelty, appeal, and effect of multi-modal narratives in the form of comics, which convey messages in graphics and minimal language, as a format to deliver health messages to the younger populations. Additionally, interventions delivered on web-based/mHealth platforms can be engaging and scalable to support health behavior change in families and also enhance and extend the impact of clinic visits by providing online resources that reinforce health messages delivered in-person by healthcare providers. In collaboration with our community partner, Children’s Aid (one of the oldest and largest US child welfare organizations), an AHRQ-funded R21 study supported development and pilot testing of Intervention INC, a family-centered, interactive, web-based health promotion tool focused on reducing childhood obesity risk. The tool is tailored to meet the needs and preferences of low-income, black/African-American (AA) and Latino children ages 9 to 12 and their parents/caregivers. Results of a pilot feasibility study were highly promising as not only was the tool feasible to deliver and acceptable to our child and parent populations, children receiving the comic tool demonstrated greater improvements (p<0.05) in vegetable, water, and sugar intake compared to the control group, from pre- to post-intervention. However, knowledge gaps regarding tool effectiveness and implementation in real world settings still exist. To fill these gaps, we propose a study with the following aims. In Aim 1, formative research will be conducted with healthcare practitioners/administrators and child-parent dyads to identify organizational (clinic) and family characteristics relevant to implementing such a tool in a clinic setting, while in Aim 2, the tool will be adapted (based on Aim 1 findings) and usability testing of it will be conducted. In Aim 3, a full-scale RCT will be conducted in Children’s Aid community clinics, to test the effect of the adapted and extended tool, which will comprise a 12-week comic intervention and a 6-month maintenance intervention, on child BMI z-score. In Aim 4, contextual factors at the clinic-, provider-, and family-level that influence tool implementation will be explored. We believe that this family-centered web-based tool is unique given its focus on innovative communication approaches and mHealth platform to enhance accessibility and engagement with an often hard to reach, diverse population. It also has strong