The following research questions guided this review: (1) What approaches were used to develop technology-based obesity prevention interventions among Hispanic adolescents? (2) What are the intervention and sample characteristics of technology-based prevention interventions implemented among Hispanic adolescents? and (3) Were outcomes regarding the feasibility of technology-based obesity prevention interventions among Hispanic youths reported in a feasibility or pilot study or earlier in the development of a fully powered trial? Given that few technology-based interventions have been developed for Hispanic youths, studies that have applied technology-based strategies among this population are primarily still in the pre-efficacy phase, and the feasibility of intervention components has yet to be confirmed [30]. To address this gap in the literature, we reviewed the current studies or previously published studies by the research team to evaluate outcomes related to the acceptability of the intervention, formative work conducted in the development phase, technical issues or barriers experienced, and any other factors that impacted the development or implementation of the intervention among this population [31].

Studies identified as relevant to this scoping review were defined as empirical, peer-reviewed articles that described a technology-based obesity prevention intervention among Hispanic adolescents with obesity. A literature search of PubMed was conducted using a combination of the following Medical Subject Headings terms: obesity, adolescent, Hispanic, and intervention. The search strategy and combination of terms that were used are provided in Multimedia Appendix 1. This same search strategy was then applied to the Embase database. We reviewed the references for eligible articles; however, no other sources or search strategies were used to identify articles.

Studies were selected using the following eligibility criteria: (1) included adolescents aged 13-18 years; (2) focused on obesity prevention or included a lifestyle intervention focused on reducing obesity outcomes (eg, weight, body mass index, and body fat) and cardiometabolic disease risk factors (eg, insulin, glucose, and cortisol); (3) written in English, (4) used a technology-based component; (5) conducted within the United States, given that Hispanic adolescents in this country have a unique sociocultural and environmental context; and (6) included a sample of at least 50% of participants who self-identify as Hispanic/Latino. This criterion has been used in previous reviews to ensure that studies are focused on Hispanic adolescents and that study findings are applicable to this population [32-34]. We did not have any criteria or limitations on publication date. Relevant studies were identified during the search and were screened first by the study title and then by the abstract using Endnote (Clarivate) referencing software. For the articles that met eligibility criteria based on title and abstract, the full article was assessed by 2 independent reviewers to confirm eligibility. Disagreements about study eligibility were discussed between the 2 reviewers and brought to a third party, when necessary, until a consensus was reached. There were no requirements for sample size, adolescent weight status, or study location. Articles were excluded if they (1) did not involve a technology-based component; (2) were protocol studies or nonintervention studies (eg, cross-sectional studies, qualitative studies, and review articles); or (3) were duplicates or had overlap with another study.

Once relevant articles were selected, information from all studies was extracted using a narrative review approach [35]. We developed an extraction framework that included 32 categories focused on information from the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and our research questions. In all, 2 reviewers independently extracted information from each article across each data extraction category and met to compare the extracted information. Discrepancies were discussed between the 2 reviewers and a third party, when necessary, until a consensus was reached. The presence of available information across extraction categories is presented in Multimedia Appendix 2 [36-42].

Descriptive statistics (ie, frequencies) were calculated for intervention and sample characteristics as well as feasibility-related components. A content analysis approach was used to summarize patterns found in the information extracted across data extraction categories [29]. Data synthesis and summation was focused on answering the research questions.

The search yielded a total of 20,160 results, with 10,512 remaining after duplicates were removed. The Consolidated Standards of Reporting Trials (CONSORT) diagram in Figure 1 summarizes the review process. A total of 10,382 papers were eliminated by the blind screening of titles and abstracts. After reading the full article, 123 papers were eliminated for the following reasons: being a conference abstract, not being an adolescent obesity prevention intervention, adolescents were out of the age range, conducted outside of the United States, included fewer than 50% Hispanic/Latino participants, no use of technology in prevention intervention, and not being a peer-reviewed paper. The search yielded a total of 7 papers published between 2010-2021 that were included in this scoping review.

Table 1 provides a summary of intervention characteristics. Of the 7 included papers, half (n=4, 57%) of all studies were randomized control trials, with the other half (n=3, 43%) representing quasi-experimental study designs including pre-post feasibility and pilot studies. There were about equal numbers of interventions that were implemented in the school (n=3, 43%) and clinic (n=4, 57%) settings. Additionally, 2 interventions implemented in the school setting and 2 interventions implemented in the clinic setting also had a home-based component. Most (n=5, 71%) interventions were fewer than or equal to 12 weeks in duration, with a few (n=2, 29%) lasting from 11-52 weeks, and no study lasting longer than 1 year. Regarding obesity-related health behaviors, all (n=7, 100%) interventions targeted physical activity and most (n=4, 57%) focused on dietary habits. Most (n=5, 71%) studies did not report the use of a theoretical framework. For the studies that did, they reported the use of multiple theories including the following: Transtheoretical Model of Change, Mindset Theory, Achievement Motivation Theory, and Behavioral Determinants Model. Web-based sessions were the most (n=4, 57%) commonly used technology-based approach sessions, typically lasted 30-45 minutes. All (n=7, 100%) the studies reviewed described the use of at least one behavior change techniques, with many studies using more than one. Enhancing social support (n=5, 71%) and self-efficacy (n=6, 86%) were the most commonly used techniques, followed by the use of didactic health education sessions (n=5, 71%). Regarding primary outcomes, all (n=7, 100%) studies assessed physical activity with over half of the studies also assessing diet (n=4, 57%), anthropometrics or cardiometabolic outcomes (n=6, 86%), and a psychosocial outcome (n=5, 71%). We found 4 (57%) studies that reported significant improvements in health behaviors, 3 (43%) studies that reported improvements in obesity or cardiometabolic disease outcomes, and 3 (43%) studies that reported improvements to psychosocial outcomes.

Participant characteristics are presented in Table 2. Almost all interventions included an overlapping population of youths in early and middle adolescence aged 10-13 years (n=5, 71%) and 14-17 years (n=6, 86%), respectively, with just 1 (14%) study including older adolescents aged 18-21 years. Sample sizes varied, with most (n=6, 86%) studies having 200 participants or fewer, and just 1 (14%) study having over 300 participants. Most (n=5, 71%) studies did not present data on family socioeconomic status. Among studies that did (n=2, 29%), they focused on youths from lower socioeconomic backgrounds. Most (n=6, 86%) interventions were designed to engage adolescents only; however, 1 (14%) study focused on both the parent and adolescent.

Feasibility-related characteristics are presented in Table 3. Only 3 (43%) studies conducted formative work. Formative work included pilot-testing intervention strategies [36], usability testing [37], and qualitative focus groups to guide intervention development [38]. The formative work conducted yielded information on the technical issues, level of participant engagement, and age-appropriateness of technology-based components [36-38]. Additionally, 1 (14%) study was delivered simultaneously in Spanish and English [36]. No other study specified the language used (n=6, 86%). There was also no study that reported the use of culturally tailored content in their intervention. Regarding SDoH, only a few (n=3, 43%) studies addressed or considered SDoH that were barriers in their development or implementation phase of the intervention. These strategies included identifying perceived self-reported barriers to physical activity [39], delivering the intervention on the web to overcome barriers such as transportation [40], and collaborating with community clinics and conducting provider trainings to focus on high-risk patients [36]. Only a few (n=3, 43%) studies included a measure of acceptability [38-40]. These studies used qualitative interviews, focus groups, and a postintervention satisfaction survey to measure acceptability. Flynn et al [39] reported 90% enjoyment among participants; Weigensberg et al [38] rated enjoyment on a scale from 1 to 10, and all participants reported scores of 9-10; whereas Jones et al [40] reported high satisfaction; however, only survey findings were presented. Only 2 (29%) studies reported on technical issues, which included device malfunctioning [41] and technical issues with computers in the school setting [40]. Finally, a few (n=3, 42%) studies reported retention rates above 80%, with a few (n=2, 29%) studies reporting retention rates below 80%, including Bowen-Jallow et al [41] (54.2%) and Patrick et al [36] (63%).

Technology-based interventions are a promising, age-appropriate, and accessible approach for engaging high-risk youths in disease prevention efforts; however, few such interventions have been developed and tested specifically for Hispanic youths. This scoping review used rigorous methods to review technology-based obesity prevention interventions among Hispanic adolescents. This review examined intervention and sample characteristics. Strengths in intervention and sample characteristics include the use of a rigorous randomized controlled trial study designs among half of all studies, although only 2 reported that they were fully powered. Most studies assessed physical activity, diet, anthropometrics, cardiometabolic biomarkers, and a psychosocial outcome. Although the focus of a scoping review is not on study outcomes, it is worth noting that studies that reported significant improvements to anthropometric or cardiometabolic outcomes used a hybrid approach of in-person and remote technology strategies and reported high acceptability and retention (≥80%) [38,40,42]. Although it is not clear what the most effective behavior change techniques are for Hispanic youths given the broad range of techniques used, all studies reported the use of 1 or more behavior change technique, which is a noteworthy strength [43,44].

This review also focused on the reporting of feasibility-related outcomes in each study. Only a few studies reported on technical issues, and it is not clear if this is because few technical issues were experienced or if the investigators did not publish this information. Of the studies that did publish on acceptability, they reported very high levels of satisfaction and enjoyment. Attrition, another indicator of engagement and feasibility, was mixed, with some studies reporting high levels of attrition. Taken together, reporting on feasibility criteria across studies in this review are limited, and although the technology-based strategies used in these interventions are promising, there is a greater need for the testing and publishing of feasibility-related criteria. To increase the feasibility, reach, and begin to move toward efficacy, there are substantial gaps that future technology-based prevention strategies should address.

This study focused on a high-risk population that is traditionally underrepresented in research. This review will contribute to the limited body of research describing technology-based obesity prevention interventions among Hispanic youths with obesity. Additional strengths included a rigorous, comprehensive search strategy across numerous databases and a systematic, in-depth data extraction process that was performed in duplicate to ensure reliability. Some studies may have had information missing across data extraction categories (ie, examined theoretical mediators) given that they were feasibility and pilot studies. We did not assess intervention effectiveness or quality, which may be seen as a limitation; however, a more rigorous assessment of outcomes is more in line with a systematic review and not a scoping review. Lastly, the results of this study may be influenced by the search terms that were used, the use of US-based search engines, the number of databases searched, the focus on English-language articles, and the selection of databases used in the search. As a result, this review may be subject to publication bias.

The literature on technology-based obesity prevention efforts among Hispanic adolescents is limited, making it difficult to determine the feasibility of this promising approach among this population. In addition to greater testing and reporting on feasibility-related outcomes, this review highlights 3 key gaps that should be addressed in future studies. There is a need for technology-based obesity prevention interventions that are theoretically grounded and that evaluate theoretical constructs to identify the underlying mechanism by which these strategies impact obesity-related outcomes and health behaviors among high-risk youths. There is a need for interventions that are tailored to the context of Hispanic youths and a need for increased evaluation and reporting of feasibility-related outcomes of these interventions to determine the acceptability and appropriateness of technology-based strategies for Hispanic youths. Furthermore, given known disparities in screen time and sleep among Hispanic youths, intervention strategies among this population should leverage technology to address a broader range of health behaviors, including sedentary behaviors and sleep, to increase program effectiveness. Addressing these gaps in future work will guide the development and implementation of technology-based obesity prevention efforts that aim to reduce obesity disparities and promote health equity among Hispanic adolescents.