%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69425 %T Effectiveness of a Mobile Phone-Delivered Multiple Health Behavior Change Intervention (LIFE4YOUth) in Adolescents: Randomized Controlled Trial %A Seiterö,Anna %A Henriksson,Pontus %A Thomas,Kristin %A Henriksson,Hanna %A Löf,Marie %A Bendtsen,Marcus %A Müssener,Ulrika %+ Department of Health, Medicine and Caring Sciences, Linköping University, Campus US, Linköping, SE-58183, Sweden, 46 700895376, anna.seitero@liu.se %K mHealth %K multiple behavior %K high school students %K digital behavior change intervention %K public health %K telemedicine %K randomized controlled trial %D 2025 %7 22.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors. Objective: This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition. Methods: A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ≥4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models. Results: In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI –0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only. Conclusions: Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence. Trial Registration: ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623 %M 40262133 %R 10.2196/69425 %U https://www.jmir.org/2025/1/e69425 %U https://doi.org/10.2196/69425 %U http://www.ncbi.nlm.nih.gov/pubmed/40262133 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69242 %T Evaluation of a Curriculum-Based Nutrition Education Intervention Protocol in Elementary Schools: Nonrandomized Feasibility Study %A Brown,Jacqueline Marie %A Rita,Nicholas %A Franco-Arellano,Beatriz %A LeSage,Ann %A Arcand,Joanne %K nutrition education %K serious games %K children %K food literacy %K school nutrition intervention %K feasibility %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: Improving children’s food literacy through school-based interventions can support developing healthy eating habits. However, teachers lack appropriate resources, time, and training to provide nutrition education in schools. Serious games, which are games designed for a purpose other than entertainment, have been demonstrated to improve children’s food literacy and dietary intake and can address the barriers teachers face in providing nutrition education. Foodbot Factory (Arcand Lab) is a nutrition education intervention that is aligned with curricula and uses a serious game to provide nutrition education to students. Further evidence is needed to understand how serious games, including Foodbot Factory, can be researched in schools to support nutrition education. Objective: The objective of this study was to evaluate the feasibility of a research study protocol that implements the curriculum-based nutrition education intervention Foodbot Factory into a real-world classroom setting. The evaluation of the protocol included study processes, resources, and management feasibility outcomes, as well as a preliminary assessment of scientific outcomes relevant to the intervention. Methods: A nonrandomized study determined the feasibility of intervention implementation. Grade 4 and 4/5 classrooms were assigned to have nutrition education lessons for 5 days with either the Foodbot Factory or a control intervention. Outcomes were assessed in 4 feasibility domains of study processes (eg, recruitment and attrition rates), resources (eg, time taken to deliver the intervention), and management (eg, challenges with intervention delivery), and a preliminary assessment of scientific outcomes pertaining to the acceptability and impacts of the interventions. These outcomes were captured in semistructured field notes completed by study staff and a Nutrition Attitudes and Knowledge questionnaire and acceptability questionnaire completed by participants. Data were analyzed descriptively and using a paired t test to assess within-group changes in nutrition knowledge. Results: In total, 4 classrooms participated in the feasibility study, with varying recruitment rates for schools (3/20, 15%), classrooms (4/4, 100%), parents (54/102, 53%), and children (49/54, 91%). The time required to implement the research protocol, including data collection and lesson plans, was sufficient and management of the intervention implementation was overall successful. Some challenges were experienced with classroom management during data collection, specifically with electronic data collection. After the intervention, participants reported a positive affective experience (26/41, 63%) and learning something new about healthy eating (31/41, 76%). Participants in both study groups improved their nutrition knowledge, but the changes were not statistically significant. The Foodbot Factory group had a statistically significant improvement in their knowledge of vegetables and fruit (P=.04) and protein foods (P=.03). Conclusions: These findings indicate that the study protocol is feasible to implement and evaluate Foodbot Factory in a representative sample with select modifications to improve recruitment and data collection procedures. %R 10.2196/69242 %U https://formative.jmir.org/2025/1/e69242 %U https://doi.org/10.2196/69242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60092 %T Effectiveness of an mHealth- and School-Based Health Education Program for Salt Reduction (EduSaltS) in China: Cluster Randomized Controlled Trial Within Scale-Up %A Wang,Naibo %A Wang,Chen %A Zhang,Puhong %A Li,Yinghua %A He,Feng J %A Li,Li %A Li,Yuan %A Luo,Rong %A Wan,Dezhi %A Xu,Lewei %A Deng,Lifang %A Wu,Lei %+ School of Public Health, Jiangxi Provincial Key Laboratory of Disease Prevention and Public Health, Jiangxi Medical College, Nanchang University, No. 461 Ba Yi Avenue, Donghu District, Jiangxi Province, Nanchang, 330006, China, 86 18970813850, leiwu@ncu.edu.cn %K school-based health education %K EduSaltS %K mobile health %K salt reduction %K cluster randomized trial %D 2025 %7 27.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, cardiovascular diseases are leading causes of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure are among the most cost-effective health promotion strategies. While mobile health (mHealth)– and school-based salt reduction interventions have proven effective in trials, their impact when scaled up in real-world contexts remains uncertain. Objective: We evaluated the effectiveness of the real-world implementation of an mHealth- and school-based health education scale-up program to reduce salt intake (EduSaltS [mHealth and school-based education program to reduce salt intake scaling up in China]). Methods: A parallel cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in 2 districts and 2 counties within Ganzhou City, Jiangxi Province, China. Schools were randomized 1:1 to intervention or control groups within each district or county. One third-grade class per school and 26 students per class were randomly sampled. One parent, or alternative family member (aged 18-75 years, residing with the student), of each student was invited to join. The EduSaltS intervention, spanning over 1 academic year, incorporated both app-based health education courses and offline salt reduction activities, with participation monitored through the backend management system. The intervention’s effectiveness was assessed by comparing changes in salt intake and blood pressure between groups from baseline to 1-year follow-up using surveys, physical examination, and 24-hour urine tests. Results: Of 524 children (boys: n=288, 54.96%; age: mean 9.16, SD 0.35 years) and 524 adults (men: n=194, 37.02%; age: mean 40.99, SD 11.04 years) who completed the baseline assessments in 10 intervention and 10 control schools, 13 (2.48%) children and 47 (8.97%) adults were lost to follow-up. All schools and participants showed satisfactory intervention adherence. Measured differences in schoolchildren’s salt intake, systolic blood pressure, and diastolic blood pressure, between the intervention and control schools, were –0.24 g/day (95% CI –0.82 to 0.33), –0.68 mm Hg (95% CI –2.32 to 0.95), and –1.37 mm Hg (95% CI –2.79 to 0.06), respectively. For adults, the intervention group’s salt intake decreased from 9.0 (SE 0.2) g/day to 8.3 (SE 0.2) g/day post intervention. Adjusted changes in the intervention (vs control) group in salt intake, systolic blood pressure, and diastolic blood pressure were –1.06 g/day (95% CI –1.81 to –0.30), –2.26 mm Hg (95% CI –4.26 to –0.26), and –2.33 mm Hg (95% CI –3.84 to –0.82), respectively. Conclusions: The EduSaltS program, delivered through primary schools with a child-to-parent approach, was effective in reducing salt intake and controlling blood pressure in adults, but its effects on children were not significant. While promising for nationwide scaling, further improvements are needed to ensure its effectiveness in reducing salt intake among schoolchildren. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400079893; https://tinyurl.com/4maz7dyv (retrospectively registered); Chinese Clinical Trial Registry ChiCTR2000039767; https://tinyurl.com/5n6hc4s2 %M 40017342 %R 10.2196/60092 %U https://www.jmir.org/2025/1/e60092 %U https://doi.org/10.2196/60092 %U http://www.ncbi.nlm.nih.gov/pubmed/40017342 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e58586 %T A Noninvasive Approach to Assess the Prevalence of and Factors Associated With Anemia Risk in Malaysian Children Under Three Years of Age: Cross-Sectional Study %A Jalaludin,Muhammad Yazid %A Kiau,Ho Bee %A Hasim,Suriati %A Lee,Wai Khew %A Low,Angie %A Kazim,Nik Harlina Nik %A Hoi,Jia Tse %A Taher,Sri Wahyu %K anemia %K iron deficiency %K children %K Masimo Rad-67 %K noninvasive assessment %K Malaysia %D 2025 %7 24.3.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Anemia remains a significant public health concern with adverse effects among children. Noninvasive screening assessments enable the early detection and prompt treatment of anemia. However, there is limited literature on the use of such screening assessments. Objective: The study aimed to assess the prevalence of and factors associated with being at risk of anemia among Malaysian children aged ≥6 months to ≤36 months by using a noninvasive hemoglobin assessment. Methods: This was a cross-sectional study (from July to December 2022) of outpatient Malaysian children, aged ≥6 months to ≤36 months, who were selected from five maternal-and-child health clinics by convenience sampling. At risk of anemia was defined as a total hemoglobin level of <12 g/dL, measured using the Masimo Rad-67, a noninvasive screening device for total hemoglobin levels. The χ2 and multiple logistic regression analyses were used to assess the prevalence and factors associated with being at risk of anemia, using R-Studio (version 4.0.0). Results: The study included 1201 participants, of whom 30% (95% CI 28‐33) were at risk of anemia. Children aged 6‐12 months (210/364, 57.7%, P<.001), those of Asian Malay race (238/364, 65.4%, P<.05), those residing in the Klang district (123/371, 33.9%, P<.05), those born via a normal vaginal delivery (275/364, 75.5%, P<.05), those without a family history of thalassemia (284/364, 78.0%, P<.05), and those with lower weight-for-age Z scores (P<.05) were associated with being at risk of anemia. Children aged 6‐12 months (adjusted odds ratio=1.73; 95% CI 1.34‐2.24) had higher odds of being at risk of anemia compared to children aged >12‐36 months. However, weight-for-age (adjusted odds ratio=0.88; 95% CI 0.80‐0.98) was associated with lower odds of being at risk of anemia. Conclusions: The current study revealed a substantial prevalence of Malaysian children being at risk of developing anemia. The study results therefore imply a need for more community education and awareness on anemia, including nutrition education, as well as targeted community screening to enable the early detection and prompt treatment of anemia cases. Anemia reduction strategies in Malaysia should consider the highlighted factors indicative of higher risk of anemia. Trial Registration: Clinicaltrials.gov NCT05181436, https://clinicaltrials.gov/study/NCT05181436 %R 10.2196/58586 %U https://pediatrics.jmir.org/2025/1/e58586 %U https://doi.org/10.2196/58586 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60891 %T How TikTok Influencers Disclose Food and Beverage Brand Partnerships: Descriptive Study %A Dupuis,Roxanne %A Musicus,Aviva A %A Edghill,Brittany %A Keteku,Emma %A Bragg,Marie A %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 646 470 4505, roxanne.dupuis@nyulangone.org %K social media %K social media marketing %K social media influencer %K food and beverage marketing %K adolescent health %D 2025 %7 28.2.2025 %9 Short Paper %J J Med Internet Res %G English %X Background: Food and beverage marketing is an important influence on the health and diets of adolescents. Food and beverage companies spend billions of dollars annually on advertisements to promote their products and are increasingly focusing on social media influencers. Influencer product endorsements blur the line between entertainment and marketing. Objective: This study aimed to quantify how often TikTok influencers promote products from food and beverage brands and document the range of ways they disclose brand relationships in their content. Methods: We collected up to 100 videos posted on or before July 1, 2022, from each of the top 100 influencers on TikTok in the United States and recorded information about the influencer (eg, number of followers) and video (eg, number of views and likes). For each video that contained food or beverage products, we identified the main product featured. A team of research assistants then coded each video for how the product was featured (ie, in the video, audio, or caption) and, for branded products, whether the video was accompanied by any disclosures of brand relationships. Average pairwise percentage agreement among coders was 92%, and average pairwise Cohen κ was 0.82. Results: Among the 8871 videos from 97 influencers that made up the final analytical sample, we identified 1360 videos (15.3%) that featured at least one food or beverage product. These 1360 videos were viewed >9 million times and received >1 million likes each. Nearly half (n=648, 47.6%) of the videos featured a branded product. Most videos featuring a branded product did not contain a brand relationship disclosure (n=449, 69.3%). Among videos that disclosed a brand relationship, influencers used 10 different types of disclosures. Tagging a brand in the video’s caption was the most common disclosure method (n=182, 28.1%). Six types of caption hashtags were used to disclose brand relationships, including #[brandname] (n=63, 9.7%) and #ad (n=30, 4.6%). Only 1 video (0.2%) made use of TikTok’s official disclosure label and only 1 video (0.2%) verbally mentioned a contractual agreement with a brand. Conclusions: Among the food and beverage videos with disclosures we identified, the most frequently used mechanism—tagging the brand—did not clearly differentiate between sponsored content and the influencer trying to attract a brand or followers who may like that brand. Social media users, particularly adolescents, need clearer, more robust disclosures from influencers to protect against the undue influence of food marketing. These findings may also inform calls for the Children’s Food and Beverage Advertising Initiative—the largest self-regulatory pledge to reduce unhealthy food marketing—to include older adolescents, who are heavily targeted by food and beverage companies on social media. %M 40053812 %R 10.2196/60891 %U https://www.jmir.org/2025/1/e60891 %U https://doi.org/10.2196/60891 %U http://www.ncbi.nlm.nih.gov/pubmed/40053812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66807 %T Capturing Everyday Parental Feeding Practices and Eating Behaviors of 3- to 5-Year-Old Children With Avid Eating Behavior: Ecological Momentary Assessment Feasibility and Acceptability Study %A Pickard,Abigail %A Edwards,Katie %A Farrow,Claire %A Haycraft,Emma %A Blissett,Jacqueline %K pediatric %K paediatric %K child %K child eating %K parent feeding %K parent %K ecological momentary assessment %K mHealth %K mobile health %K mobile app %K application %K smartphone %K digital %K digital health %K digital technology %K digital intervention %D 2025 %7 27.2.2025 %9 %J JMIR Form Res %G English %X Background: The wide use of smartphones offers large-scale opportunities for real-time data collection methods such as ecological momentary assessment (EMA) to assess how fluctuations in contextual and psychosocial factors influence parents’ feeding practices and feeding goals, particularly when feeding children with high food approaches. Objective: The main objectives of this study were to (1) assess parents/caregivers’ compliance with EMA procedures administered through a smartphone app and (2) estimate the criterion validity of the EMA to capture children’s eating occasions and parents’ feeding practices. Participant adherence, technological challenges, and data quality were used to provide an overview of the real-time dynamics of parental mood, feeding goals, and contextual factors during eating occasions. Methods: Parents in the United Kingdom with a child aged 3 to 5 years who exhibit avid eating behavior were invited to participate in a 10-day EMA study using a smartphone app. Of the 312 invited participants, 122 (39%) parents initiated the EMA study, of which 118 (96.7%) completed the full EMA period and the follow-up feasibility and acceptability survey. Results: Of those parents who completed the EMA study, 104 (87.4%) parents provided at least 7 “full” days of data (2 signal surveys and 1 event survey), despite 51 parents (43.2%) experiencing technical difficulties. The parents received notifications for morning surveys (69.9% response rate), 3 daily mood surveys (78.7% response rate), and an end-of-day survey (84.6% response rate) on each of the 10 days. Over the EMA period, a total of 2524 child eating/food request surveys were self-initiated by the participants on their smartphones, an average of 2.1 times per day per parent (SD 0.18; min=1.7, max=2.3). The majority of parents felt that the surveys made them more aware of their feelings (105/118, 89%) and activities (93/118, 79%). The frequency of daily food requests estimated by parents at baseline was significantly correlated with the frequency of food requests reported daily during the EMA period (r=0.483, P<.001). However, the number of daily food requests per day estimated at baseline (mean 4.5, SD 1.5) was significantly higher than the number of food requests reported per day during the EMA period (mean 3.7, SD 1.1), (t116=18.8, P<.001). Conclusions: This paper demonstrates the feasibility of employing EMA to investigate the intricate interplay between parental mood, feeding goals, contextual factors, and feeding practices with children exhibiting an avid eating behavior profile. However, the use of EMA needs to be carefully developed and tested with parents’ involvement to ensure successful data collection. International Registered Report Identifier (IRRID): RR2-10.2196/55193 %R 10.2196/66807 %U https://formative.jmir.org/2025/1/e66807 %U https://doi.org/10.2196/66807 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65451 %T Parental Perceptions of Priorities and Features for a Mobile App to Promote Healthy Lifestyle Behaviors in Preschool Children: Mixed Methods Evaluation %A Thompson,Jessica R %A Weber,Summer J %A Mulvaney,Shelagh A %A Goggans,Susanna %A Brown,Madeline %A Faiola,Anthony %A Maamari,Lynn %A Hull,Pamela C %+ , Department of Health Policy and Administration, The Pennsylvania State University, 601E Ford Building, University Park, PA, 16802-1503, United States, 1 8148638129, jrthompson@psu.edu %K mHealth %K childhood obesity %K mixed methods %K pediatric %K healthy lifestyle behaviors %K preschool children %K mobile application %K diet %K physical activity %K exercise %K media use %K sleep %K development %K semi-structured interviews %K healthy eating %K parents %K caregivers %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents of preschool-aged children are a key focus for interventions to shape healthy lifestyle behaviors and support risk reduction for obesity from an early age. In light of limited existing evidence on the use of mobile technology to promote healthy lifestyle behaviors among young children, we sought to gather parental priorities regarding a mobile app focused on guided goal setting across the domains of diet, physical activity, media use, and sleep. Objective: The purpose of this study was to explore the priorities and needs of parents of 2- to 5-year-old children to guide developing the content and features of a mobile app aimed at promoting healthy lifestyle behaviors using a novel convergent mixed methods approach. Methods: From November to December 2021, we invited parents or guardians in Kentucky to complete a series of web-based concept mapping activities and semistructured interviews (total N=30). Using 2 lists of items focused on (1) parental priorities (content areas) and (2) application features, we asked participants to conduct concept mapping procedures for each list: a web-based sorting activity, where participants grouped items together into thematic piles that made sense to them, and a rating activity, where participants rated each item on a 5-point Likert-type scale. The qualitative interviews were transcribed verbatim, coded, and then analyzed by constant comparative analysis to identify themes. We used the quantitative findings from the concept mapping process to triangulate the resulting themes from the qualitative interviews and generate possible app content areas and features. Results: The concept mapping results resulted in two 3-cluster concept maps. For parental priorities, participants identified the clusters Creating Healthy Eating Habits, Forming Boundaries, and Building Good Relationships; for app features, participant clusters included Eating Healthy, Using the App, and Setting Goals. The interview themes also represented those 2 domains. Overall, the participants indicated that the top priorities were general health and wellbeing, routine and setting boundaries, and food and healthy eating when it comes to building healthy behaviors among their preschool-aged children. Parents indicated that quick, easy, and child-friendly recipes, goal tracking, and the use of tips and notifications were the features they valued most. Conclusions: This study contributes to the understanding of what parents or caregivers of young children want from mobile apps, in both content and features, to support building healthy behaviors and routines. The findings can inform future research on the development and evaluation of existing or new mobile apps. Specific app features identified to meet family needs should be designed closely with a diverse set of families and tested using rigorous designs to identify the mechanisms of action that mobile apps may use for efficacious healthy parenting outcomes. %M 39970437 %R 10.2196/65451 %U https://pediatrics.jmir.org/2025/1/e65451 %U https://doi.org/10.2196/65451 %U http://www.ncbi.nlm.nih.gov/pubmed/39970437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60495 %T mHealth App to Promote Healthy Lifestyles for Diverse Families Living in Rural Areas: Usability Study %A Perez Ramirez,Alejandra %A Ortega,Adrian %A Stephenson,Natalie %A Muñoz Osorio,Angel %A Kazak,Anne %A Phan,Thao-Ly %+ Center For Healthcare Delivery Science, Nemours Children's Health, 1600 Rockland Road, Wilmington, DE, 19803, United States, 1 302 358 5968, alejandra.perezramirez@nemours.org %K obesity %K user testing %K mHealth %K mobile health %K Spanish %K child %K rural population %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile Integrated Care for Childhood Obesity is a multicomponent intervention for caregivers of young children with obesity from rural communities that was developed in collaboration with community, parent, and health care partners. It includes community programming to promote healthy lifestyles and address social needs and health care visits with an interdisciplinary team. A digital mobile health platform—the Healthy Lifestyle (Nemours Children’s Health) dashboard—was designed as a self-management tool for caregivers to use as part of Mobile Integrated Care for Childhood Obesity. Objective: This study aimed to improve the usability of the English and Spanish language versions of the Healthy Lifestyle dashboard. Methods: During a 3-phased approach, usability testing was conducted with a diverse group of parents. In total, 7 mothers of children with obesity from rural communities (average age 39, SD 4.9 years; 4 Spanish-speaking and 3 English-speaking) provided feedback on a prototype of the dashboard. Participants verbalized their thoughts while using the prototype to complete 4 tasks. Preferences on the dashboard icon and resource page layout were also collected. Testing was done until feedback reached saturation and no additional substantive changes were suggested. Qualitative and quantitative data regarding usability, acceptability, and understandability were analyzed. Results: The dashboard was noted to be acceptable by 100% (N=7) of the participants. Overall, participants found the dashboard easy to navigate and found the resources, notifications, and ability to communicate with the health care team to be especially helpful. However, all (N=4) of the Spanish-speaking participants identified challenges related to numeracy (eg, difficulty interpreting the growth chart) and literacy (eg, features not fully available in Spanish), which informed iterative refinements to make the dashboard clearer and more literacy-sensitive. All 7 participants (100%) selected the same dashboard icon and 71% (5/7) preferred the final resource page layout. Conclusions: Conducting usability testing with key demographic populations, especially Spanish-speaking populations, was important to developing a mobile health intervention that is user-friendly, culturally relevant, and literacy-sensitive. %M 39932772 %R 10.2196/60495 %U https://formative.jmir.org/2025/1/e60495 %U https://doi.org/10.2196/60495 %U http://www.ncbi.nlm.nih.gov/pubmed/39932772 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58434 %T Assessing the Uses, Benefits, and Limitations of Digital Technologies Used by Health Professionals in Supporting Obesity and Mental Health Communication: Scoping Review %A Kearns,Amanda %A Moorhead,Anne %A Mulvenna,Maurice %A Bond,Raymond %+ Life and Health Sciences, Institute for Nursing and Health Research, Ulster University, 2-24 York Street, Belfast, BT15 1AP, United Kingdom, 44 7706848477, kearns-a7@ulster.ac.uk %K digital communication %K digital technology %K digital transformation %K health professional %K mental health %K obesity %K complex needs %K artificial intelligence %K AI %K PRISMA %D 2025 %7 10.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Obesity and mental health issues present interconnected public health challenges that impair physical, social, and mental well-being. Digital technologies offer potential for enhancing health care communication between health professionals (HPs) and individuals living with obesity and mental health issues, but their effectiveness is not fully understood. Objective: This scoping review aims to identify and understand the different types of technologies used by HPs in supporting obesity and mental health communication. Methods: A comprehensive scoping review, which followed a validated methodology, analyzed studies published between 2013 and 2023 across 8 databases. The data extraction focused on HPs’ use of communication technologies, intervention types, biopsychosocial considerations, and perceptions of technology use. The review was guided by the following research question: “What are the uses, benefits, and limitations of digital technologies in supporting communication between HPs and persons living with obesity and mental health issues?” Results: In total, 8 studies—featuring web-based platforms, social media, synchronous video calls, telephone calls, automated SMS text messaging, and email—met the inclusion criteria. Technologies such as virtual learning collaborative dashboards and videoconferencing, supported by automated SMS text messaging and social media (Facebook and WhatsApp groups), were commonly used. Psychologists, dietitians, social workers, and health coaches used digital tools to facilitate virtual appointments, diet and mental health monitoring, and motivational and educational support through group therapy, 1-on-1 sessions, and hybrid models. Benefits included enhanced access to care and engagement, personalized digital cognitive behavioral therapy, perceived stigma reduction, privacy, and improved physical health outcomes in weight reduction. However, improvements in mental health outcomes were not statistically significant in studies reporting P values (P≥.05). The limitations included engagement difficulties due to conflicting personal family and work commitments; variable communication mode preferences, with some preferring in-person sessions; and misinterpretations of SMS text messaging prompts. Conflicts arose from cultural and individual differences, weight stigma, and confusion over HP roles in obesity and mental health care. Conclusions: Digital technologies have diversified the approaches HPs can take in delivering education, counseling, and motivation to individuals with obesity and mental health issues, facilitating private, stigma-reduced environments for personalized care. While the interventions were effective in obesity management, the review revealed a shortfall in addressing mental health needs. This highlights an urgent need for digital tools to serve as media for a deeper engagement with individuals’ complex biopsychosocial needs. The integration of data science and technological advancements offers promising avenues for tailored digital solutions. The findings advocate the importance of continued innovation and adaptation in digital health care communication strategies, with clearer HP roles and an interdisciplinary, empathetic approach focused on individual needs. %M 39928923 %R 10.2196/58434 %U https://www.jmir.org/2025/1/e58434 %U https://doi.org/10.2196/58434 %U http://www.ncbi.nlm.nih.gov/pubmed/39928923 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64749 %T Relationship Among Macronutrients, Dietary Components, and Objective Sleep Variables Measured by Smartphone Apps: Real-World Cross-Sectional Study %A Seol,Jaehoon %A Iwagami,Masao %A Kayamare,Megane Christiane Tawylum %A Yanagisawa,Masashi %+ International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan, 81 29 853 5857, yanagisawa.masa.fu@u.tsukuba.ac.jp %K sleep quality %K dietary health %K unsaturated fatty acids %K dietary fiber intake %K sodium-to-potassium ratio %K compositional data analysis %K sleep %K smartphone %K application %D 2025 %7 30.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Few studies have explored the relationship between macronutrient intake and sleep outcomes using daily data from mobile apps. Objective: This cross-sectional study aimed to examine the associations between macronutrients, dietary components, and sleep parameters, considering their interdependencies. Methods: We analyzed data from 4825 users of the Pokémon Sleep and Asken smartphone apps, each used for at least 7 days to record objective sleep parameters and dietary components, respectively. Multivariable regression explored the associations between quartiles of macronutrients (protein; carbohydrate; and total fat, including saturated, monounsaturated, and polyunsaturated fats), dietary components (sodium, potassium, dietary fiber, and sodium-to-potassium ratio), and sleep variables (total sleep time [TST], sleep latency [SL], and percentage of wakefulness after sleep onset [%WASO]). The lowest intake group was the reference. Compositional data analysis accounted for macronutrient interdependencies. Models were adjusted for age, sex, and BMI. Results: Greater protein intake was associated with longer TST in the third (+0.17, 95% CI 0.09-0.26 h) and fourth (+0.18, 95% CI 0.09-0.27 h) quartiles. In contrast, greater fat intake was linked to shorter TST in the third (–0.11, 95% CI –0.20 to –0.27 h) and fourth (–0.16, 95% CI –0.25 to –0.07 h) quartiles. Greater carbohydrate intake was associated with shorter %WASO in the third (–0.82%, 95% CI –1.37% to –0.26%) and fourth (–0.57%, 95% CI –1.13% to –0.01%) quartiles, while greater fat intake was linked to longer %WASO in the fourth quartile (+0.62%, 95% CI 0.06%-1.18%). Dietary fiber intake correlated with longer TST and shorter SL. A greater sodium-to-potassium ratio was associated with shorter TST in the third (–0.11, 95% CI –0.20 to –0.02 h) and fourth (–0.19, 95% CI –0.28 to –0.10 h) quartiles; longer SL in the second (+1.03, 95% CI 0.08-1.98 min) and fourth (+1.50, 95% CI 0.53-2.47 min) quartiles; and longer %WASO in the fourth quartile (0.71%, 95% CI 0.15%-1.28%). Compositional data analysis, involving 6% changes in macronutrient proportions, showed that greater protein intake was associated with an elevated TST (+0.27, 95% CI 0.18-0.35 h), while greater monounsaturated fat intake was associated with a longer SL (+4.6, 95% CI 1.93-7.34 min) and a larger %WASO (+2.2%, 95% CI 0.63%-3.78%). In contrast, greater polyunsaturated fat intake was associated with a reduced TST (–0.22, 95% CI –0.39 to –0.05 h), a shorter SL (–4.7, 95% CI to 6.58 to –2.86 min), and a shorter %WASO (+2.0%, 95% CI –3.08% to –0.92%). Conclusions: Greater protein and fiber intake were associated with longer TST, while greater fat intake and sodium-to-potassium ratios were linked to shorter TST and longer WASO. Increasing protein intake in place of other nutrients was associated with longer TST, while higher polyunsaturated fat intake improved SL and reduced WASO. %M 39883933 %R 10.2196/64749 %U https://www.jmir.org/2025/1/e64749 %U https://doi.org/10.2196/64749 %U http://www.ncbi.nlm.nih.gov/pubmed/39883933 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67213 %T Body Fat and Obesity Rates, Cardiovascular Fitness, and the Feasibility of a Low-Intensity Non–Weight-Centric Educational Intervention Among Late Adolescents: Quasi-Experimental Study %A Zuair,Areeg %A Alhowaymel,Fahad M %A Jalloun,Rola A %A Alzahrani,Naif S %A Almasoud,Khalid H %A Alharbi,Majdi H %A Alnawwar,Rayan K %A Alluhaibi,Mohammed N %A Alharbi,Rawan S %A Aljohan,Fatima M %A Alhumaidi,Bandar N %A Alahmadi,Mohammad A %K adolescent obesity %K macronutrient education %K cardiovascular fitness %K body composition %K health literacy %K body image %K macronutrient %K educational %K obesity %K weight %K overweight %K fitness %K nutrition %K diet %K patient education %K student %K school %K youth %K adolescent %K teenager %K metabolic %K eating %K physical activity %K exercise %D 2025 %7 24.1.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Obesity rates among Saudi adolescents are increasing, with regional variations highlighting the need for tailored interventions. School-based health programs in Saudi Arabia are limited and often emphasize weight and body size, potentially exacerbating body image dissatisfaction. There is limited knowledge on the feasibility of non–weight-centric educational programs in Saudi Arabia and their effects on health behaviors and body image. Objectives: This study aimed to (1) assess the prevalence of obesity using BMI-for-age z score (BAZ) and fat percentage among Saudi adolescents; (2) evaluate key health behaviors, cardiovascular fitness, and health literacy; and (3) assess the feasibility and impact of a low-intensity, non–weight-centric educational intervention designed to improve knowledge of macronutrients and metabolic diseases, while examining its safety on body image discrepancies. Methods: A quasi-experimental, pre-post trial with a parallel, nonequivalent control group design was conducted among 95 adolescents (58 boys and 37 girls; mean age 16.18, SD 0.53 years) from 2 public high schools in Medina City, Saudi Arabia. Participants were randomly assigned to either the weight-neutral Macronutrient + Non-Communicable Diseases Health Education group or the weight-neutral Macronutrient Health Education group. Anthropometry (BAZ and fat percentage), cardiovascular fitness, physical activity, and eating behaviors were measured at baseline. Independent t tests and χ² tests were conducted to compare group differences, and a 2-way mixed ANOVA was used to evaluate the effect of the intervention on macronutrient knowledge and body image discrepancies. A total of 69 participants completed the postintervention assessments. Results: The prevalence of overweight and obesity based on BAZ was 37.9% (36/95), while 50.5% (48/95) of participants were classified as overfat or obese based on fat percentage. Students with normal weight status were significantly more likely to have had prior exposure to health education related to metabolic diseases than students with higher weight status (P=.02). The intervention significantly improved macronutrient-metabolic knowledge (F1,64=23.452; P<.001), with a large effect size (partial η²=0.268). There was no significant change in students’ body image from pre- to postintervention (P=.70), supporting the safety of these weight-neutral programs. The intervention demonstrated strong feasibility, with a recruitment rate of 82.6% and a retention rate of 72.6%. Conclusions: This study reveals a high prevalence of obesity among Saudi adolescents, particularly when measured using fat percentage. The significant improvement in knowledge and the nonimpact on body image suggest that a non–weight-centric intervention can foster better health outcomes without exacerbating body image dissatisfaction. Region-specific strategies that prioritize metabolic health and macronutrient education over weight-centric messaging should be considered to address both obesity and body image concerns in adolescents. %R 10.2196/67213 %U https://pediatrics.jmir.org/2025/1/e67213 %U https://doi.org/10.2196/67213 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e68372 %T Assessing and Enhancing Nutrition and Physical Activity Environments in Early Childhood Education and Care Centers: Scoping Review of eHealth Tools %A Hayek,Joyce %A Dickson,Kelsi %A Lafave,Lynne M Z %+ Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada, 1 403 440 5967, llafave@mtroyal.ca %K eHealth %K early childhood educators %K ECE %K early childhood education and care %K ECEC %K knowledge synthesis %K digital technology %K health technology %K digital public health %K eating %K diet %D 2025 %7 22.1.2025 %9 Review %J JMIR Pediatr Parent %G English %X Background: Early childhood is a critical period for shaping lifelong health behaviors, making early childhood education and care (ECEC) environments ideal for implementing nutrition and physical activity interventions. eHealth tools are increasingly utilized in ECEC settings due to their accessibility, scalability, and cost-effectiveness, demonstrating promise in enhancing educators’ practices. Despite the potential effectiveness of these eHealth approaches, a comprehensive collection of available evidence on eHealth tools designed to assess or support best practices for nutrition or physical activity in ECECs is currently lacking. Objective: The primary objective of this scoping review is to map the range of available eHealth tools designed to assess or deliver interventions aimed at improving nutrition or physical activity in ECEC settings, while evaluating their components, theoretical foundations, and effectiveness. Methods: This scoping review adhered to the Joanna Briggs Institute methodology, in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist. The objectives, inclusion criteria, and methods for this review were predefined and specified. Eligibility criteria were (1) early childhood educators (population); (2) eHealth (digital) technologies, such as websites, smartphone apps, emails, and social media; and (3) tools designed to assess or deliver interventions aimed at improving best practices for nutrition, physical activity, or both within ECEC settings (context). A search was conducted across 5 electronic databases (PubMed, Scopus, CINAHL Plus, ERIC, and Embase) to identify white literature, and 3 electronic databases (ProQuest, Google Scholar, and targeted Google search), along with hand-searching of reference lists, were used to identify gray literature. All literature was reported in English or French, with the search extending until May 2024. Separate data charting tools were used for white and gray literature. Results: The search strategy identified 3064 results for white literature, yielding 2653 unique citations after duplicates were removed. Full texts for 65 citations were retrieved and screened for inclusion, resulting in 30 studies eligible for data extraction and analysis. The most common study design was a randomized controlled trial, comprising 16 studies (53%). The largest proportion of studies were conducted in the United States (11 studies, 37%). In total, 19 eHealth tools were identified, targeting nutrition (8 tools, 42%), physical activity (5 tools, 26%), or both nutrition and physical activity (6 tools, 32%). All tools were web based (19 tools, 100%). The gray literature search yielded 1054 results, of which 17 were moved to full-text screening, and 7 met the eligibility criteria for data extraction and analysis. The tools identified in the gray literature originated in Canada (4 tools, 57%) and the United States (3 tools, 43%). The majority targeted nutrition (4 tools, 57%) and were primarily web based (6 tools, 86%), with 1 mobile app (1 tool, 14%). Conclusions: This scoping review mapped the available eHealth tools designed to improve nutrition or physical activity environments in ECEC settings, highlighting the growing emphasis on web-based tools and the need for psychometric testing. Future research should systematically evaluate the effectiveness of these tools, particularly those addressing both nutrition and physical activity, to identify the key factors that contribute to long-term behavior change. Trial Registration: Open Science Framework XTRNZ; https://osf.io/xtrnz International Registered Report Identifier (IRRID): RR2-10.2196/52252 %R 10.2196/68372 %U https://pediatrics.jmir.org/2025/1/e68372 %U https://doi.org/10.2196/68372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58460 %T Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial %A Leung,May May %A Mateo,Katrina F %A Dublin,Marlo %A Harrison,Laura %A Verdaguer,Sandra %A Wyka,Katarzyna %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Avenue, Boston, MA, 02111, United States, 1 6176363676, maymay.leung@tufts.edu %K childhood obesity %K preadolescents %K racial and ethnic minority populations %K dietary behaviors %K BMI %K digital health %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes. Objective: This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored. Methods: A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of 3 for children aged ≤5 years and >2 for children aged >5 years, using the World Health Organization growth references. The obese incidence rate (IR) × 100 person-years and the relative 95% CI were computed using infant sex, area of residence, preschool and school age, and area deprivation index, which are the covariates of interest. A mixed-effect Cox proportional hazards model was used to estimate the hazard ratio and 95% CI for the association between antibiotic exposure in early life and child obesity between 24 months and 14 years of age, considering the family pediatricians as a random factor. Several subgroup and sensitivity analyses were performed to assess the robustness of our results. Results: Among 121,540 children identified, 54,698 were prescribed at least an antibiotic within the first year of life and 26,990 were classified as obese during follow-up with an incidence rate of 4.05 cases (95% CI 4.01-4.10) × 100 person-year. The risk of obesity remained consistent across different timings of antibiotic prescriptions at 6 months, 1 year, and 2 years (fully adjusted hazard ratio [aHR] 1.07, 95% CI 1.04-1.10; aHR 1.06, 95% CI 1.03-1.09; and aHR 1.07, 95% CI 1.04-1.10, respectively). Increasing the number of antibiotic exposures increases the risk of obesity significantly (P trend<.001). The individual-specific age analysis showed that starting antibiotic therapy very early (between 0 and 5 months) had the greatest impact (aHR 1.12, 95% CI 1.08-1.17) on childhood obesity with respect to what was observed among those who were first prescribed antibiotics after the fifth month of life. These results were consistent across subgroup and sensitivity analyses. Conclusions: The results from this large population-based study support the association between early exposure to antibiotics and an increased risk of childhood obesity. This association becomes progressively stronger with both increasing numbers of antibiotic prescriptions and younger age at the time of the first prescription. %M 38820573 %R 10.2196/51734 %U https://publichealth.jmir.org/2024/1/e51734 %U https://doi.org/10.2196/51734 %U http://www.ncbi.nlm.nih.gov/pubmed/38820573 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e57849 %T Designing Child Nutrition Interventions to Engage Fathers: Qualitative Analysis of Interviews and Co-Design Workshops %A So,Jeffrey Tsz Hei %A Nambiar,Smita %A Byrne,Rebecca %A Gallegos,Danielle %A Baxter,Kimberley A %+ Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, 62 Graham Street, South Brisbane, Brisbane, 4101, Australia, 61 73069 7308, jeffrey.so@hdr.qut.edu.au %K co-design %K fathers %K child nutrition %K child feeding %K intervention design %K digital delivery %K parenting %K participatory %K videoconference %K communication technology %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Fathers play a pivotal role in parenting and child feeding, but they remain underrepresented in intervention studies, especially those focused on disadvantaged populations. A better understanding of fathers’ experiences and needs regarding support access and child nutrition information in the context of disadvantage can inform future interventions engaging fathers. Objective: This study aims to explore fathers’ experiences; perceived enablers; and barriers to accessing support and information related to parenting, child feeding, and nutrition and to co-design principles for tailoring child nutrition interventions to engage fathers. Methods: Australian fathers of children aged 6 months to 5 years with lived experience of disadvantage participated in semistructured interviews and co-design workshops, primarily conducted via videoconference. Creative analogies were used to guide the ideation process in the workshops. Results: A total of 25 interviews and 3 workshops (n=10 participants) were conducted, with data analyzed using reflexive thematic analysis and the Capability, Opportunity, and Motivation–Behavior model. The interview data illuminated factors influencing fathers’ initiation in seeking support for parenting, child feeding, and nutrition, including their experiences. It highlighted fathers’ diverse information needs and the importance of an inclusive environment and encouragement. Enablers and barriers in accessing support related to parenting and child nutrition were identified at the individual (eg, personal goals and resource constraints), interpersonal (family support and false beliefs about men’s caregiving role), organizational (inadequate fathering support), and systemic levels (father-inclusive practice and policy). Digital data collection methods enabled Australia-wide participation, overcoming work and capacity barriers. Videoconferencing technology was effectively used to engage fathers creatively. Key principles for engaging fathers were co-designed from the workshop data. Interventions and resources need to be father specific, child centered, and culturally appropriate; promote empowerment and collaboration; and provide actionable and accessible strategies on the what and how of child feeding. Fathers preferred multiformat implementation, which harnesses technology-based design (eg, websites and mobile apps) and gamification. It should be tailored to the child’s age and targeted at fathers using comprehensive promotion strategies. Conclusions: Fathers faced barriers to accessing support and information related to parenting and feeding that may not adequately address their needs. Future interventions could integrate the co-designed principles to engage fathers effectively. These findings have implications for health service delivery and policy development, promoting father-inclusive practice. %M 38815260 %R 10.2196/57849 %U https://pediatrics.jmir.org/2024/1/e57849 %U https://doi.org/10.2196/57849 %U http://www.ncbi.nlm.nih.gov/pubmed/38815260 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e41567 %T Association of Child Growth Failure Indicators With Household Sanitation Practices in India (1998-2021): Spatiotemporal Observational Study %A Jain,Lovely %A Pradhan,Sreya %A Aggarwal,Arun %A Padhi,Bijaya Kumar %A Itumalla,Ramaiah %A Khatib,Mahalaqua Nazli %A Gaidhane,Shilpa %A Zahiruddin,Quazi Syed %A Santos,Celso Augusto Guimarães %A AL-Mugheed,Khalid %A Alrahbeni,Tahani %A Kukreti,Neelima %A Satapathy,Prakasini %A Rustagi,Sarvesh %A Heidler,Petra %A Marzo,Roy Rillera %+ Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160036, India, 91 8763766300, bkpadhi@gmail.com %K undernutrition %K malnutrition %K stunting %K wasting %K underweight %K sanitation %K WaSH %K LISA %K NFHS %K DHS %K spatial epidemiology %K epidemiology %K children %K child %K India %K intervention %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Undernutrition among children younger than 5 years is a subtle indicator of a country’s health and economic status. Despite substantial macroeconomic progress in India, undernutrition remains a significant burden with geographical variations, compounded by poor access to water, sanitation, and hygiene services. Objective: This study aimed to explore the spatial trends of child growth failure (CGF) indicators and their association with household sanitation practices in India. Methods: We used data from the Indian Demographic and Health Surveys spanning 1998-2021. District-level CGF indicators (stunting, wasting, and underweight) were cross-referenced with sanitation and sociodemographic characteristics. Global Moran I and Local Indicator of Spatial Association were used to detect spatial clustering of the indicators. Spatial regression models were used to evaluate the significant determinants of CGF indicators. Results: Our study showed a decreasing trend in stunting (44.9%-38.4%) and underweight (46.7%-35.7%) but an increasing prevalence of wasting (15.7%-21.0%) over 15 years. The positive values of Moran I between 1998 and 2021 indicate the presence of spatial autocorrelation. Geographic clustering was consistently observed in the states of Madhya Pradesh, Jharkhand, Odisha, Uttar Pradesh, Chhattisgarh, West Bengal, Rajasthan, Bihar, and Gujarat. Improved sanitation facilities, a higher wealth index, and advanced maternal education status showed a significant association in reducing stunting. Relative risk maps identified hotspots of CGF health outcomes, which could be targeted for future interventions. Conclusions: Despite numerous policies and programs, malnutrition remains a concern. Its multifaceted causes demand coordinated and sustained interventions that go above and beyond the usual. Identifying hotspot locations will aid in developing control methods for achieving objectives in target areas. %M 38787607 %R 10.2196/41567 %U https://publichealth.jmir.org/2024/1/e41567 %U https://doi.org/10.2196/41567 %U http://www.ncbi.nlm.nih.gov/pubmed/38787607 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e51429 %T Effects of Food Depictions in Entertainment Media on Children’s Unhealthy Food Preferences: Content Analysis Linked With Panel Data %A Matthes,Jörg %A Binder,Alice %A Naderer,Brigitte %A Forrai,Michaela %A Spielvogel,Ines %A Knupfer,Helena %A Saumer,Melanie %K children %K health %K unhealthy food preferences %K food depictions %K centrality %K coviewing %K longitudinal linkage study %K child %K food %K eating %K diet %K dietary %K preference %K preferences %K nutrition %K nutritional %K diet %K media %K entertainment %K panel %K foods %K pediatric %K pediatrics %K food preference %K food preferences %D 2024 %7 22.5.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Entertainment media content is often mentioned as one of the roots of children’s unhealthy food consumption. This might be due to the high quantity of unhealthy foods presented in children’s media environments. However, less is known about the role of the centrality of food placement, that is, whether foods are interacted with, consumed, verbally mentioned, or appear unobtrusively. We also lack longitudinal research measuring both children’s unhealthy and healthy food consumption behaviors as outcomes. Objective: The aim is to connect content analytical data based on children’s actual media diet with panel data in order to explain children’s food preferences. Moreover, this study not only focuses on the amount of healthy and unhealthy foods children are exposed to, but also on how these foods are presented (ie, centrally or not). Furthermore, we looked at the question of how parental coviewing can diminish (or enhance) the effects of unhealthy (or healthy) food depictions, and we measured healthy and unhealthy consumption as dependent variables. Methods: We conducted a 2-wave panel study with children and one of their parents (of 2250 parents contacted, 829 responded, for a response rate of 36.84%; 648 valid cases, ie, parent-child pairs, were used for analysis), with 6 months between the 2 panel waves. We linked the 2-wave panel data for the children and their parents to content analytical data for movies (n=113) and TV series (n=134; 3 randomly chosen episodes per TV series were used) that children were exposed to over the course of 6 months. Results: There was no significant relationship between exposure to unhealthy food presentation and unhealthy (b=0.008; P=.07) or healthy (b=−0.003; P=.57) food consumption over time. Also, healthy food presentation was unrelated to unhealthy (b=0.009; P=.18) or healthy (b=0.000; P=.99) food consumption over time. However, there was a significant, positive interaction between unhealthy food presentation and presentation centrality on unhealthy food consumption (b=0.000; P=.03), suggesting that the effects of unhealthy food presentation rise with increasing levels of centrality. There was no interaction between unhealthy food presentation and presentation centrality on the consumption of healthy foods (b=0.000; P=.10). Also, exposure to healthy food presentation interacted with centrality (b=−0.001; P=.003). That is, when a healthy product was presented at maximum centrality, it led to less unhealthy food consumption in children. Coviewing did not interact with exposure to unhealthy foods when explaining unhealthy (b=0.003; P=.08) or healthy (b=−0.001; P=.70) food consumption. Conclusions: We conclude that simply presenting more healthy foods is not sufficient to combat children’s unhealthy food preferences. Further regulations may be necessary with respect to representations of unhealthy foods in children’s media. %R 10.2196/51429 %U https://pediatrics.jmir.org/2024/1/e51429 %U https://doi.org/10.2196/51429 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55731 %T The Impact of Behavior Change Counseling Delivered via a Digital Health Tool Versus Routine Care Among Adolescents With Obesity: Pilot Randomized Feasibility Study %A Kepper,Maura %A Walsh-Bailey,Callie %A Miller,Zoe M %A Zhao,Min %A Zucker,Kianna %A Gacad,Angeline %A Herrick,Cynthia %A White,Neil H %A Brownson,Ross C %A Foraker,Randi E %+ Prevention Research Center, Brown School, Washington University in St. Louis, One Brookings Dr, St. Louis, MO, 63130, United States, 1 3149350142, kepperm@wustl.edu %K digital health %K obesity %K clinical care %K adolescents %K physical activity %K diet %K clinical trial %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth overweight and obesity is a public health crisis and increases the risk of poor cardiovascular health (CVH) and chronic disease. Health care providers play a key role in weight management, yet few tools exist to support providers in delivering tailored evidence-based behavior change interventions to patients. Objective: The goal of this pilot randomized feasibility study was to determine the feasibility of implementing the Patient-Centered Real-Time Intervention (PREVENT) tool in clinical settings, generate implementation data to inform scale-up, and gather preliminary effectiveness data. Methods: A pilot randomized clinical trial was conducted to examine the feasibility, implementation, and preliminary impact of PREVENT on patient knowledge, motivation, behaviors, and CVH outcomes. The study took place in a multidisciplinary obesity management clinic at a children’s hospital within an academic medical center. A total of 36 patients aged 12 to 18 years were randomized to use PREVENT during their routine visit (n=18, 50%) or usual care control (n=18, 50%). PREVENT is a digital health tool designed for use by providers to engage patients in behavior change education and goal setting and provides resources to support change. Patient electronic health record and self-report behavior data were collected at baseline and 3 months after the intervention. Implementation data were collected via PREVENT, direct observation, surveys, and interviews. We conducted quantitative, qualitative, and mixed methods analyses to evaluate pretest-posttest patient changes and implementation data. Results: PREVENT was feasible, acceptable, easy to understand, and helpful to patients. Although not statistically significant, only PREVENT patients increased their motivation to change their behaviors as well as their knowledge of ways to improve heart health and of resources. Compared to the control group, PREVENT patients significantly improved their overall CVH and blood pressure (P<.05). Conclusions: Digital tools can support the delivery of behavior change counseling in clinical settings to increase knowledge and motivate patients to change their behaviors. An appropriately powered trial is necessary to determine the impact of PREVENT on CVH behaviors and outcomes. Trial Registration: ClinicalTrials.gov NCT06121193; https://www.clinicaltrials.gov/study/NCT06121193 %M 38758581 %R 10.2196/55731 %U https://formative.jmir.org/2024/1/e55731 %U https://doi.org/10.2196/55731 %U http://www.ncbi.nlm.nih.gov/pubmed/38758581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49168 %T Exploring Children's Knowledge of Healthy Eating, Digital Media Use, and Caregivers’ Perspectives to Inform Design and Contextual Considerations for Game-Based Interventions in Schools for Low-Income Families in Lima, Peru: Survey Study %A Morales-Cahuancama,Bladimir %A Verdezoto,Nervo %A Gonzales-Achuy,Elena %A Quispe-Gala,Cinthia %A Bautista-Olortegui,William %A Hinojosa-Mamani,Paul %A Aparco,Juan Pablo %+ Centro Nacional de Alimentación, Nutrición y Vida Saludable, Instituto Nacional de Salud, Av Ricardo Tizón y Bueno 276, Jesús María, Lima, 15072, Peru, 51 7480000 ext 6626, bmorales@ins.gob.pe %K child %K children %K schoolchildren %K youth %K student %K students %K adolescent %K schoolchildren %K formative research %K digital media %K digital games %K serious game %K serious games %K nutrition %K obesity %K obese %K overweight %K mHealth %K caregivers’ perspectives %K perspective %K perspectives %K diet %K healthy eating %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of overweight and obesity in schoolchildren is increasing in Peru. Given the increased use of digital media, there is potential to develop effective digital health interventions to promote healthy eating practices at schools. This study investigates the needs of schoolchildren in relation to healthy eating and the potential role of digital media to inform the design of game-based nutritional interventions. Objective: This study aims to explore schoolchildren’s knowledge about healthy eating and use of and preferences for digital media to inform the future development of a serious game to promote healthy eating. Methods: A survey was conducted in 17 schools in metropolitan Lima, Peru. The information was collected virtually with specific questions for the schoolchild and their caregiver during October 2021 and November 2021 and following the COVID-19 public health restrictions. Questions on nutritional knowledge and preferences for and use of digital media were included. In the descriptive analysis, the percentages of the variables of interest were calculated. Results: We received 3937 validated responses from caregivers and schoolchildren. The schoolchildren were aged between 8 years and 15 years (2030/3937, 55.8% girls). Of the caregivers, 83% (3267/3937) were mothers, and 56.5% (2223/3937) had a secondary education. Only 5.2% (203/3937) of schoolchildren’s homes did not have internet access; such access was through WiFi (2151/3937, 54.6%) and mobile internet (1314/3937, 33.4%). In addition, 95.3% (3753/3937) of schoolchildren’s homes had a mobile phone; 31.3% (1233/3937) had computers. In relation to children’s knowledge on healthy eating, 42.2% (1663/3937) of schoolchildren did not know the recommendation to consume at least 5 servings of fruits and vegetables daily, 46.7% (1837/3937) of schoolchildren did not identify front-of-package warning labels (FOPWLs), and 63.9% (2514/3937) did not relate the presence of an FOPWL with dietary risk. Most schoolchildren (3100/3937, 78.7%) preferred to use a mobile phone. Only 38.3% (1509/3937) indicated they preferred a computer. In addition, 47.9% (1885/3937) of caregivers considered that the internet helps in the education of schoolchildren, 82.7% (3254/3937) of caregivers gave permission for schoolchildren to play games with digital devices, and 38% (1495/3937) of caregivers considered that traditional digital games for children are inadequate. Conclusions: The results suggest that knowledge about nutrition in Peruvian schoolchildren has limitations. Most schoolchildren have access to the internet, with mobile phones being the device type with the greatest availability and preference for use. Caregivers’ perspectives on games and schoolchildren, including a greater interest in using digital games, provide opportunities for the design and development of serious games to improve schoolchildren’s nutritional knowledge in Peru. Future research is needed to explore the potential of serious games that are tailored to the needs and preferences of both schoolchildren and their caregivers in Peru in order to promote healthy eating. %M 38743472 %R 10.2196/49168 %U https://formative.jmir.org/2024/1/e49168 %U https://doi.org/10.2196/49168 %U http://www.ncbi.nlm.nih.gov/pubmed/38743472 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53461 %T Accuracy of a Web-Based Time-Use Diary (MEDAL) in Assessing Children’s Meal Intakes With Food Photography by Parents as Reference: Instrument Validation Study %A Chong,Kar Mun %A Chia,Airu %A Shah Budin,Nur Syahirah %A Poh,Bee Koon %A Jamil,Nor Aini %A Koh,Denise %A Chong,Mary Foong-Fong %A Wong,Jyh Eiin %+ Center for Community Health Studies (ReaCH), Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz,, Kuala Lumpur, 50300, Malaysia, 60 3 9289 7683, wjeiin@ukm.edu.my %K children %K dietary intake %K time-use diary %K food photography %K accuracy %K mobile phone %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: My E-Diary for Activities and Lifestyle (MEDAL) is a web-based time-use diary developed to assess the diet and movement behaviors of Asian school children. Objective: This study aims to determine the accuracy of MEDAL in assessing the dietary intake of Malaysian school children, using photographs of the children’s meals taken by their parents as an objective reference. Methods: A convenience sample of 46 children aged 10 to 11 years recorded their daily meals in MEDAL for 4 days (2 weekdays and 2 weekend days). Their parents took photographs of the meals and snacks of their children before and after consumption during the 4-day period and sent them along with a brief description of food and drinks consumed via an instant SMS text messaging app. The accuracy of the children’s reports of the food they had consumed was determined by comparing their MEDAL reports to the photographs of the food sent by their parents. Results: Overall, the match, omission, and intrusion rates were 62% (IQR 46%-86%), 39% (IQR 16%-55%), and 20% (IQR 6%-44%), respectively. Carbohydrate-based items from the food categories “rice and porridge”; “breads, spreads, and cereals”; and “noodles, pasta, and potatoes” were reported most accurately (total match rates: 68%-76%). “Snack and dessert” items were omitted most often (omission rate: 54%). Furthermore, side dishes from “vegetables and mushrooms,” “eggs and tofu,” “meat and fish,” and “curry” food groups were often omitted (omission rates: 42%-46%). Items from “milk, cheese, and yogurt”; “snacks and desserts”; and “drinks” food groups intruded most often (intrusion rates: 37%-46%). Compared to the items reported by the boys, those reported by the girls had higher match rates (69% vs 53%) and lesser omission rates (31% vs 49%; P=.03, respectively). Conclusions: In conclusion, children aged 10 to 11 years can self-report all their meals in MEDAL, although some items are omitted or intruded. Therefore, MEDAL is a tool that can be used to assess the dietary intake of Malaysian school children. %M 38713499 %R 10.2196/53461 %U https://pediatrics.jmir.org/2024/1/e53461 %U https://doi.org/10.2196/53461 %U http://www.ncbi.nlm.nih.gov/pubmed/38713499 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51201 %T An mHealth Intervention Promoting Physical Activity and Healthy Eating in a Family Setting (SMARTFAMILY): Randomized Controlled Trial %A Wunsch,Kathrin %A Fiedler,Janis %A Hubenschmid,Sebastian %A Reiterer,Harald %A Renner,Britta %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 721608 ext 45431, kathrin.wunsch@kit.edu %K mobile app %K telemedicine %K behavior change %K health behavior %K family %K primary prevention %K exercise %K diet %K food and nutrition %K randomized controlled trial %K accelerometer %K wearable electronic devices %K social-cognitive determinants %K just-in-time adaptive intervention %K digital intervention %K mobile phone %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Numerous smartphone apps are targeting physical activity (PA) and healthy eating (HE), but empirical evidence on their effectiveness for the initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Social settings influence individual behavior; therefore, core settings such as the family need to be considered when designing mobile health (mHealth) apps. Objective: The purpose of this study was to evaluate the effectiveness of a theory- and evidence-based mHealth intervention (called SMARTFAMILY [SF]) targeting PA and HE in a collective family–based setting. Methods: A smartphone app based on behavior change theories and techniques was developed, implemented, and evaluated with a cluster randomized controlled trial in a collective family setting. Baseline (t0) and postintervention (t1) measurements included PA (self-reported and accelerometry) and HE measurements (self-reported fruit and vegetable intake) as primary outcomes. Secondary outcomes (self-reported) were intrinsic motivation, behavior-specific self-efficacy, and the family health climate. Between t0 and t1, families of the intervention group (IG) used the SF app individually and collaboratively for 3 consecutive weeks, whereas families in the control group (CG) received no treatment. Four weeks following t1, a follow-up assessment (t2) was completed by participants, consisting of all questionnaire items to assess the stability of the intervention effects. Multilevel analyses were implemented in R (R Foundation for Statistical Computing) to acknowledge the hierarchical structure of persons (level 1) clustered in families (level 2). Results: Overall, 48 families (CG: n=22, 46%, with 68 participants and IG: n=26, 54%, with 88 participants) were recruited for the study. Two families (CG: n=1, 2%, with 4 participants and IG: n=1, 2%, with 4 participants) chose to drop out of the study owing to personal reasons before t0. Overall, no evidence for meaningful and statistically significant increases in PA and HE levels of the intervention were observed in our physically active study participants (all P>.30). Conclusions: Despite incorporating behavior change techniques rooted in family life and psychological theories, the SF intervention did not yield significant increases in PA and HE levels among the participants. The results of the study were mainly limited by the physically active participants and the large age range of children and adolescents. Enhancing intervention effectiveness may involve incorporating health literacy, just-in-time adaptive interventions, and more advanced features in future app development. Further research is needed to better understand intervention engagement and tailor mHealth interventions to individuals for enhanced effectiveness in primary prevention efforts. Trial Registration: German Clinical Trials Register DRKS00010415; https://drks.de/search/en/trial/DRKS00010415 International Registered Report Identifier (IRRID): RR2-10.2196/20534 %M 38669071 %R 10.2196/51201 %U https://mhealth.jmir.org/2024/1/e51201 %U https://doi.org/10.2196/51201 %U http://www.ncbi.nlm.nih.gov/pubmed/38669071 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55509 %T Effectiveness and Implementation of a Text Messaging mHealth Intervention to Prevent Childhood Obesity in Mexico in the COVID-19 Context: Mixed Methods Study %A Lozada-Tequeanes,Ana Lilia %A Théodore,Florence L %A Kim-Herrera,Edith %A García-Guerra,Armando %A Quezada-Sánchez,Amado D %A Alvarado-Casas,Rocio %A Bonvecchio,Anabelle %+ National Institute of Public Health, Instituto Nacional de Salud Pública de México, Avenida Universidad 655, Cuernavaca, 62100, Mexico, 52 +527773293000, ftheodore@insp.mx %K effectiveness %K feasibility %K mHealth %K SMS text message %K mixed methods %K infant obesity %K physical activity %K healthy feeding %K children %K COVID-19 %K Mexico %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Promoting physical activity (PA) and healthy feeding (HF) is crucial to address the alarming increase in obesity rates in developing countries. Leveraging mobile phones for behavior change communication to encourage infant PA and promote HF is particularly significant within the Mexican context. Objective: This study aims to explore the effectiveness and feasibility of mHealth interventions aimed at promoting PA and HF among primary caregivers (PCs) of Mexican children under the age of 5 years. Additionally, the study aims to disseminate insights gained from intervention implementation amidst the COVID-19 pandemic and assess the potential of behavior change mHealth interventions on a broader population scale. Methods: NUTRES, an mHealth intervention, underwent an effectiveness-implementation hybrid trial. Over 36 weeks, participants in the intervention group (IG), totaling 230 individuals, received approximately 108 SMS text messages tailored to their children’s age. These messages covered topics such as PA and HF and emphasized the significance of proper child nutrition amidst the COVID-19 pandemic. NUTRES participants were recruited from both urban and rural health units across 2 states in Mexico. Given the COVID-19 context, both baseline and follow-up surveys were conducted via mobile or fixed telephone. The evaluation of effectiveness and implementation used a mixed methods approach. Qualitative analysis delved into participants’ experiences with NUTRES and various implementation indicators, including acceptance, relevance, and coverage. Grounded theory was used for coding and analysis. Furthermore, difference-in-differences regression models were used to discern disparities between groups (comparison group [CG] versus IG) concerning knowledge and practices pertaining to infant PA and HF. Results: Of the total 494 PCs enrolled in NUTRES, 334 persisted until the end of the study, accounting for 67.6% (334/494) participation across both groups. A majority of PCs (43/141, 30.5%, always; and 97/141, 68.8%, sometimes) used the SMS text message information. Satisfaction and acceptability toward NUTRES were notably high, reaching 98% (96/98), with respondents expressing that NUTRES was “good,” “useful,” and “helpful” for enhancing child nutrition. Significant differences after the intervention were observed in PA knowledge, with social interaction favored (CG: 8/135, 5.9% vs IG: 20/137, 14.6%; P=.048), as well as in HF practice knowledge. Notably, sweetened beverage consumption, associated with the development of chronic diseases, showed divergence (CG: 92/157, 58.6% vs IG: 110/145, 75.9%; P=.003). In the difference-in-differences model, a notable increase of 0.03 in knowledge regarding the benefits of PA was observed (CG: mean 0.13, SD 0.10 vs IG: mean 0.16, SD 0.11; P=.02). PCs expressed feeling accompanied and supported, particularly amidst the disruption of routine health care services during the COVID-19 pandemic. Conclusions: While NUTRES exhibited a restricted impact on targeted knowledge and behaviors, the SMS text messages functioned effectively as both a reminder and a source of new knowledge for PCs of Mexican children under 5 years of age. The key lessons learned were as follows: mHealth intervention strategies can effectively maintain communication with individuals during emergencies, such as the COVID-19 pandemic; methodological and implementation barriers can constrain the effectiveness of mHealth interventions; and using mixed methods approaches ensures the complementary nature of results. The findings contribute valuable evidence regarding the opportunities and constraints associated with using mobile phones to enhance knowledge and practices concerning PA and HF among PCs of children under 5 years old. Trial Registration: ClinicalTrials.gov NCT04250896; https://clinicaltrials.gov/ct2/show/NCT04250896 %M 38592753 %R 10.2196/55509 %U https://mhealth.jmir.org/2024/1/e55509 %U https://doi.org/10.2196/55509 %U http://www.ncbi.nlm.nih.gov/pubmed/38592753 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51581 %T Eating Habits and Lifestyle Factors Related to Childhood Obesity Among Children Aged 5-6 Years: Cluster Analysis of Panel Survey Data in Korea %A Lim,Heemoon %A Lee,Hyejung %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 222283345, hlee26@yuhs.ac %K BMI %K body mass index %K childhood obesity %K cluster analysis %K healthy eating %K healthy lifestyle %K pediatric obesity %K preschool child %K prevention %K unsupervised machine learning %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Childhood obesity has emerged as a major health issue due to the rapid growth in the prevalence of obesity among young children worldwide. Establishing healthy eating habits and lifestyles in early childhood may help children gain appropriate weight and further improve their health outcomes later in life. Objective: This study aims to classify clusters of young children according to their eating habits and identify the features of each cluster as they relate to childhood obesity. Methods: A total of 1280 children were selected from the Panel Study on Korean Children. Data on their eating habits (eating speed, mealtime regularity, consistency of food amount, and balanced eating), sleep hours per day, outdoor activity hours per day, and BMI were obtained. We performed a cluster analysis on the children’s eating habits using k-means methods. We conducted ANOVA and chi-square analyses to identify differences in the children’s BMI, sleep hours, physical activity, and the characteristics of their parents and family by cluster. Results: At both ages (ages 5 and 6 years), we identified 4 clusters based on the children’s eating habits. Cluster 1 was characterized by a fast eating speed (fast eaters); cluster 2 by a slow eating speed (slow eaters); cluster 3 by irregular eating habits (poor eaters); and cluster 4 by a balanced diet, regular mealtimes, and consistent food amounts (healthy eaters). Slow eaters tended to have the lowest BMI (P<.001), and a low proportion had overweight and obesity at the age of 5 years (P=.03) and 1 year later (P=.005). There was a significant difference in sleep time (P=.01) and mother’s education level (P=.03) at the age of 5 years. Moreover, there was a significant difference in sleep time (P=.03) and the father’s education level (P=.02) at the age of 6 years. Conclusions: Efforts to establish healthy eating habits in early childhood may contribute to the prevention of obesity in children. Specifically, providing dietary guidance on a child’s eating speed can help prevent childhood obesity. This research suggests that lifestyle modification could be a viable target to decrease the risk of childhood obesity and promote the development of healthy children. Additionally, we propose that future studies examine long-term changes in obesity resulting from lifestyle modifications in children from families with low educational levels. %M 38578687 %R 10.2196/51581 %U https://publichealth.jmir.org/2024/1/e51581 %U https://doi.org/10.2196/51581 %U http://www.ncbi.nlm.nih.gov/pubmed/38578687 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54783 %T The Effects of an Educational Intervention About Front-of-Package Labeling on Food and Beverage Selection Among Children and Their Caregivers: Protocol for a Randomized Controlled Trial %A Avila-Montiel,Diana %A Vilchis-Gil,Jenny %A Miranda-Lora,América Liliana %A Velázquez-López,Lubia %A Klünder-Klünder,Miguel %+ Epidemiological Research Unit in Endocrinology and Nutrition, Hospital Infantil de México Federico Gómez, Dr. Marquez 162, CDMX, 06720, Mexico, 52 5552289917 ext 4319, klunderk@gmail.com %K e-Health nutrition education %K ultraprocessed foods %K malnutrition %K children %K Mexico %K intervention %K obesity %K food %K food selection %K labeling %K package labeling %D 2024 %7 1.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Overweight and obesity pose a global public health challenge and have a multifactorial origin. One of these factors includes obesogenic environments, which promote ultraprocessed foods characterized by being high in calories, saturated fats, added sugars, and sodium. In Mexico, it has been estimated that 30% of the total energy consumed comes from processed foods. The Modification to the Official Mexican Standards introduces nutritional information through black octagonal seals that alert consumers about products with excessive amounts of some components for a better food selection in the population. However, the effects of warning labels on processed food selection and purchases among children remain unknown. Objective: We aimed to evaluate the impact of a digital educational intervention focusing on front-of-package warning labels on the food selection and purchasing behavior of elementary schoolchildren and their caregivers. Methods: Children from 4 elementary schools in Mexico City, 2 public and 2 private schools, will participate in a randomized controlled trial. The schools will be chosen by simple random sampling. Schools will be randomized into 2 groups: intervention and control. In the control group, the dyads (caregiver-schoolchildren) will receive general nutritional education, and in the intervention group, they will receive guidance on reading labels and raising awareness about the impact of consuming ultraprocessed products on health. The educational intervention will be conducted via a website. Baseline measurements will be taken for both groups at 3 and 6 months. All participants will have access to an online store through the website, allowing them to engage in exercises for selecting and purchasing food and beverages. In addition, other measures will include a brief 5-question exam to evaluate theoretical understanding, a 24-hour reminder, a survey on food habits and consumption, application of a food preference scale, anthropometric measurements, and recording of school lunch choices. Results: Registration and funding were authorized in 2022, and we will begin data collection in September 2024. Recruitment has not yet taken place, but the status of data analysis and expected results will be published in April 2025. Conclusions: The study is expected to contribute to evaluating whether reinforcing front-of-package warning labels with education enhances its effects and makes them more sustainable. Conducting this study will allow us to propose whether or not it is necessary to develop new intervention strategies related to front-of-package labeling for a better understanding of the population, improved food choices, and better health outcomes. Trial Registration: ClinicalTrials.gov NCT06102473; https://clinicaltrials.gov/study/NCT06102473 International Registered Report Identifier (IRRID): PRR1-10.2196/54783 %M 38557591 %R 10.2196/54783 %U https://www.researchprotocols.org/2024/1/e54783 %U https://doi.org/10.2196/54783 %U http://www.ncbi.nlm.nih.gov/pubmed/38557591 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55193 %T Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study %A Edwards,Katie %A Croker,Helen %A Farrow,Claire %A Haycraft,Emma %A Herle,Moritz %A Llewellyn,Clare %A Pickard,Abigail %A Blissett,Jacqueline %+ School of Psychology and Institute of Health and Neurodevelopment, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom, 44 121 204 3784, k.edwards4@aston.ac.uk %K ecological momentary assessment %K avid eating %K children’s eating behavior %K parental feeding practices %K feeding behaviour %K parent %K children %K eating behaviour %K obesity %K environmental factors %K observational study %K feeding %K United Kingdom %D 2024 %7 19.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents’ daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children’s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers’ daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children’s avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/55193 %M 38502178 %R 10.2196/55193 %U https://www.researchprotocols.org/2024/1/e55193 %U https://doi.org/10.2196/55193 %U http://www.ncbi.nlm.nih.gov/pubmed/38502178 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54163 %T Mobile App/Web Platform for Monitoring Food Oral Immunotherapy in Children: Longitudinal Clinical Validation Study %A Sánchez-Fernández,Sergio %A Lasa,Eva María %A Terrados,Soledad %A Sola-Martínez,Francisco Javier %A Martínez-Molina,Sara %A López de Calle,Marta %A Cabrera-Freitag,Paula %A Goikoetxea,María José %+ Allergy and Clinical Immunology Department, Clínica Universidad de Navarra, Pío XII, 36, Pamplona, 31008, Spain, 34 948255400, mjgoiko@unav.es %K adverse reactions %K egg allergy %K food oral immunotherapy %K mHealth %K milk allergy %K monitoring %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Milk and egg allergies significantly impact the quality of life, particularly in children. In this regard, food oral immunotherapy (OIT) has emerged as an effective treatment option; however, the occurrence of frequent adverse reactions poses a challenge, necessitating close monitoring during treatment. Objective: This study aims to evaluate the ability of a new mobile/web app called OITcontrol to monitor milk and egg OIT. Methods: Patients undergoing milk or egg OIT were recruited and divided into 2 groups: the active group used the OITcontrol app in conjunction with standard written monitoring methods, whereas the control group relied solely on written diaries. Investigators documented hospital doses, hospital reactions, and administered treatments on the website. Patients recorded their daily allergen home-dose intake, home reactions, and administered treatments using the app. The following variables were compared between both groups: number and severity of hospital and reported home reactions, patient’s adhesion to the OITcontrol app or written diary or both in terms of daily home-dose intake and home reactions recording, and treatment and dose adjustment compliance at home in case of reaction. Results: Sixteen patients were assigned to be monitored using the OITcontrol app along with additional written methods (active group), while 14 patients relied solely on a written paper diary (control group). A similar distribution was observed in terms of sex, age, basal characteristics, allergen treated in OIT, premedication, and sensitization profile. Active patients reported a comparable number of hospital and home reactions compared with the control group. In terms of recording system usage, 13/16 (81%) active patients used the OITcontrol app, while 10/14 (71%) control patients relied on the written diary. Among active patients, 6/16 (38%) used both methods, and 1 active patient used only written methods. However, control patients recorded home reactions more frequently than active patients (P=.009). Among active patients, the app was the preferred method for recording reactions (59/86, 69%), compared with the written diary (15/86, 17%) or both methods (12/86, 14%; P<.001). Treatment compliance in home-recorded reactions was similar between both groups (P=.15). However, treatment indications after an adverse reaction were more frequently followed (P=.04) in reactions recorded solely in the app (36/59, 61%) than in the written diary (29/71, 41%) or both systems (4/12, 33%). Moreover, compliance with dose adjustments after a moderate-severe reaction in home-recorded reactions was higher in the active group than in the control group (P<.001). Home reactions recorded only in the app (16/19, 84%) were more likely to follow dose adjustments (P<.001) than those recorded in the written diary (3/20, 15%) or using both methods (2/3, 67%). Conclusions: The OITcontrol app appears to be a valuable tool for monitoring OIT treatment in children with food allergies. It proves to be a suitable method for recording daily home dose intakes and reactions, and it seems to enhance adherence to treatment indications following an adverse reaction as well as compliance with dose adjustments in home reactions. However, additional studies are necessary to comprehensively grasp the benefits and limitations of using the OITcontrol app in the management of OIT. %M 38477961 %R 10.2196/54163 %U https://pediatrics.jmir.org/2024/1/e54163 %U https://doi.org/10.2196/54163 %U http://www.ncbi.nlm.nih.gov/pubmed/38477961 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53282 %T The Effectiveness of a Telenutrition Intervention to Improve Dietary Behavior and Physical Activity Among Adolescents With Obesity: Protocol for a Systematic Review %A Ansari,Muhammad Ridwan %A Kodriati,Nurul %A Pertiwi,Ariani Arista Putri %A Dewi,Fatwa Sari Tetra %+ Department of Health Behavior, Environment and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, IKM building 3rd Fl, Farmako Street, North Sekip, Yogyakarta, 55281, Indonesia, 62 274 551409, fatwasari@ugm.ac.id %K telehealth %K obesity %K telenutrition %K adolescent %K behavior change %K virtual counseling %K teenager %K young adult %K food intake %K dietary pattern %K intervention %D 2024 %7 5.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The global obesity pandemic among adolescents is becoming a public health issue throughout the world. Telehealth use has significantly increased during and after the COVID-19 pandemic, including its application in adolescent obesity prevention and treatment. Objective: This review aims to synthesize the evidence on the effectiveness of telenutrition in improving dietary behavior and physical activity in adolescents with obesity. Methods: The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) guideline will be used to structure this protocol. The focus of the systematic review is guided by the population, intervention, comparator, and outcome (PICO) framework. A systematic search of Science Direct, PubMed, Cochrane, Embase, JMIR, ProQuest, and Google scholar databases will be conducted. Two authors will screen the titles and abstracts of identified studies independently and select studies according to the eligibility criteria. The full-text reading will be done independently by 2 reviewers to assess final eligibility. Any discrepancies will then be discussed and resolved. The Cochrane Collaboration Risk of Bias tool was used to assess the risk of bias; a descriptive analysis will summarize the effectiveness of the telenutrition or any type of telehealth intervention used. Results: The systematic review is expected to be completed by the end of March 2024. The ongoing screening and review of the articles are currently being conducted. Conclusions: This systematic review aims to summarize the effectiveness, features, design process, usability, and coherence of a telenutrition intervention using behavior change theory to improve dietary patterns and physical activity among adolescents with obesity. It will identify areas for improvement and best practices, informing the development of more useful and engaging telenutrition interventions for adolescents. Trial Registration: PROSPERO CRD42023458336; http://tinyurl.com/cp46fjj9 International Registered Report Identifier (IRRID): DERR1-10.2196/53282 %M 38441950 %R 10.2196/53282 %U https://www.researchprotocols.org/2024/1/e53282 %U https://doi.org/10.2196/53282 %U http://www.ncbi.nlm.nih.gov/pubmed/38441950 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54446 %T Family-Based WhatsApp Intervention to Promote Healthy Eating Behaviors Among Amazonian School Children: Protocol for a Randomized Controlled Trial %A Hovadick,Ana Carolina de Andrade %A Cardoso,Marly Augusto %+ Department of Nutrition, School of Public Health, University of Sao Paulo, Dr. Arnaldo Avenue, 715 - Cerqueira César, Sao Paulo, 01246-904, Brazil, 55 11 3061 7863, marlyac@usp.br %K child health %K Amazon %K dietary intake %K mHealth %K mobile health %K multimedia messaging service %K WhatsApp %D 2024 %7 19.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stunting and micronutrient deficiencies have persistently affected children in the Brazilian Amazon for decades. However, in recent years, a notable increase in childhood overweight prevalence has been observed, particularly in the context of heightened food insecurity exacerbated by the COVID-19 pandemic. Despite the limited number of effective solutions proposed to tackle this problem, digital interventions have shown great promise worldwide in preventing obesity and promoting healthy diets. Objective: This study aims to describe the protocol of a family-based WhatsApp intervention, specifically designed to investigate the efficacy of multimedia messaging in preventing excessive weight gain and improving healthy eating practices among school-aged children in the Amazon region. Methods: This study protocol outlines a theory-driven randomized controlled trial based on the cognitive theory of multimedia learning and the social cognitive theory. A total of 240 parents or caregivers of children enrolled in the Maternal and Child Health and Nutrition Cohort Study in Acre (MINA-Brazil) will be recruited by phone and social media. The intervention group will receive persuasive multimedia messages through WhatsApp over 19 weeks, while the waitlist control group will remain in the usual care. The primary outcome is a change in children’s BMI in z score. Secondary outcomes are changes in dietary intake and biochemical indicators of the children. Outcome measures will be assessed at baseline and 5 months after randomization in comparison to usual care. The analysis will use an intent-to-treat approach and will be conducted using the statistical package Stata (version 18.0), with a significance level set at P<.05. Paired and unpaired 2-tailed t tests will be applied to compare mean changes in the outcomes. Results: Data collection started in June 2023, and final measurements are scheduled to be completed in December 2023. The results of the main analysis are expected to be available in 2024. Conclusions: This innovative multimedia message intervention holds significant potential for fostering behavioral changes among Amazonian children. Trial Registration: Brazilian Clinical Trials Registry RBR-5zdnw6t; https://ensaiosclinicos.gov.br/rg/RBR-5zdnw6t International Registered Report Identifier (IRRID): DERR1-10.2196/54446 %M 38373039 %R 10.2196/54446 %U https://www.researchprotocols.org/2024/1/e54446 %U https://doi.org/10.2196/54446 %U http://www.ncbi.nlm.nih.gov/pubmed/38373039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47850 %T User Requirements in Developing a Novel Dietary Assessment Tool for Children: Mixed Methods Study %A van der Heijden,Zoë %A de Gooijer,Femke %A Camps,Guido %A Lucassen,Desiree %A Feskens,Edith %A Lasschuijt,Marlou %A Brouwer-Brolsma,Elske %+ Division of Human Nutrition and Health, Wageningen University & Research, Stippeneng 4, Wageningen, 6700 AA, Netherlands, 31 7480 100, zoe.vanderheijden@wur.nl %K diet %K children %K dietary assessment %K recall %K technological innovation %K mobile health %K mHealth %K mobile phone %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of childhood obesity and comorbidities is rising alarmingly, and diet is an important modifiable determinant. Numerous dietary interventions in children have been developed to reduce childhood obesity and overweight rates, but their long-term effects are unsatisfactory. Stakeholders call for more personalized approaches, which require detailed dietary intake data. In the case of primary school children, caregivers are key to providing such dietary information. However, as school-aged children are not under the full supervision of one specific caregiver anymore, data are likely to be biased. Recent technological advancements provide opportunities for the role of children themselves, which would serve the overall quality of the obtained dietary data. Objective: This study aims to conduct a child-centered exploratory sequential mixed methods study to identify user requirements for a dietary assessment tool for children aged 5 to 6 years. Methods: Formative, nonsystematic narrative literature research was undertaken to delineate initial user requirements and inform prototype ideation in an expert panel workshop (n=11). This yielded 3 prototype dietary assessment tools: FoodBear (tangible piggy bank), myBear (smartphone or tablet app), and FoodCam (physical camera). All 3 prototypes were tested for usability by means of a usability task (video analyses) and user experience (This or That method) among 14 Dutch children aged 5 to 6 years (n=8, 57% boys and n=6, 43% girls). Results: Most children were able to complete FoodBear’s (11/14, 79%), myBear’s (10/14, 71%), and FoodCam’s (9/14, 64%) usability tasks, but all children required assistance (14/14, 100%) and most of the children encountered usability problems (13/14, 93%). Usability issues were related to food group categorization and recognition, frustrations owing to unsatisfactory functioning of (parts) of the prototypes, recall of food products, and the distinction between eating moments. No short-term differences in product preference between the 3 prototypes were observed, but autonomy, challenge, gaming elements, being tablet based, appearance, social elements, and time frame were identified as determinants of liking the product. Conclusions: Our results suggest that children can play a complementary role in dietary data collection to enhance the data collected by their parents. Incorporation of a training program, auditory or visual prompts, reminders and feedback, a user-friendly and intuitive interaction design, child-friendly food groups or icons, and room for children’s autonomy were identified as requirements for the future development of a novel and usable dietary assessment tool for children aged 5 to 6 years. Our findings can serve as valuable guidance for ongoing innovations in the field of children’s dietary assessment and the provision of personalized dietary support. %M 38300689 %R 10.2196/47850 %U https://formative.jmir.org/2024/1/e47850 %U https://doi.org/10.2196/47850 %U http://www.ncbi.nlm.nih.gov/pubmed/38300689 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48234 %T The Effects of Antenatal Interventions on Gestational Weight Gain in Low- and Middle-Income Countries: Protocol for a Systematic Review %A Wang,Dongqing %A Nguyen,Christine H %A Fawzi,Wafaie W %+ Department of Global and Community Health, College of Public Health, George Mason University, MS 5B7, Room 5111, 4400 University Drive, Fairfax, VA, 22030, United States, 1 703 993 3578, dwang25@gmu.edu %K low- and middle-income countries %K pregnant women %K gestational weight gain %K maternal nutrition %K interventions %K randomized controlled trials %K systematic review %K protocols %K RCT %K maternal %K pregnant %K pregnancy %K review methodology %K nutrition %K gestational %K weight %K prenatal %K LMIC %K low income %K middle income %D 2023 %7 8.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gestational weight gain (GWG) is a crucial determinant of maternal and child outcomes yet remains an underused target for antenatal interventions in low- and middle-income countries (LMICs). Objective: This systematic review aims to identify and summarize educational, behavioral, nutritional, and medical interventions on GWG from randomized controlled trials conducted in LMICs. Methods: Randomized controlled trials that documented the effects of antenatal interventions on GWG in LMICs will be included. The interventions of interest will be educational, behavioral, nutritional, or medical. A systematic literature search will be conducted using PubMed, Embase, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library from the inception of each database through October 2022 (with an updated search in January 2024). A total of 2 team members will independently perform the screening of studies and data extraction. A narrative synthesis of all the included studies will be provided. The risk of bias will be assessed using the Cochrane Risk of Bias tool. The certainty of the evidence for each homogeneous group of interventions will be assessed using the GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) approach. A narrative synthesis of the included studies will be conducted to summarize mean differences (with 95% CIs) for continuous outcomes and risk ratios, rate ratios, hazard ratios, or odds ratios (with 95% CIs) for dichotomous or categorical outcomes. Available information on the costs of interventions will also be summarized to facilitate the adoption and scale-up of effective GWG interventions. Results: The development of the research questions, search strategy, and search protocol was started on September 20, 2022. The database searches and the importation of the identified records into Covidence were performed on October 7, 2022. As of September 2023, the title and abstract screening was ongoing. The target completion time of this systematic review is April 2024. Conclusions: Without effective interventions to manage GWG, the potential to improve maternal and child health through optimal GWG remains unrealized in LMICs. This systematic review will inform the design and implementation of antenatal interventions to prevent inadequate and excessive GWG in resource-limited settings. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42022366354; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=366354 International Registered Report Identifier (IRRID): PRR1-10.2196/48234 %M 37938874 %R 10.2196/48234 %U https://www.researchprotocols.org/2023/1/e48234 %U https://doi.org/10.2196/48234 %U http://www.ncbi.nlm.nih.gov/pubmed/37938874 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50145 %T Digital Self-Monitoring Tools for the Management of Gestational Weight Gain: Protocol for a Systematic Review %A Mooney,Jan %A Dahl,Alicia A %+ Department of Public Health Sciences, College of Health and Human Services, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, United States, 1 7046875612, adahl3@charlotte.edu %K protocol %K systematic review %K gestational weight gain %K self-monitoring %K digital health %K review methods %K review methodology %K pregnant %K pregnancy %K gestational %K weight %K maternal %K mobile phone %D 2023 %7 26.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gestational weight gain (GWG) exceeding the recommendations of the Institute of Medicine (in the United States) is associated with numerous adverse maternal and infant health outcomes. While many behavioral interventions targeting nutrition and physical activity have been developed to promote GWG within the Institute of Medicine guidelines, engagement and results are variable. Technology-mediated interventions can potentially increase the feasibility, acceptability, and reach of interventions, particularly for pregnant women, for whom integration of interventions into daily life may be critical to retention and adherence. Previous reviews highlight GWG self-monitoring as a common intervention component, and emerging work has begun to integrate digital self-monitoring into technology-mediated interventions. With rapid advances in technology-mediated interventions, a focused synthesis of literature examining the role of digital self-monitoring tools in managing GWG is warranted to guide clinical practice and inform future studies. Objective: The proposed review aims to synthesize the emerging research base evaluating digital GWG self-monitoring interventions, primarily focusing on whether the intervention is effective in managing GWG. Depending on the characteristics of the included research, secondary focus areas will comprise intervention recruitment and retention, feasibility, acceptability, and differences between stand-alone and multicomponent interventions. Methods: This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines for systematic review protocols. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent empirical quantitative studies (reported in English) examining the use of digital weight self-monitoring tools in the context of technology-mediated interventions to manage GWG in pregnant US adults, with at least 2 instances of data collection. Literature eligible for inclusion will have a publication date between January 2010 and July 2020. The Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies will be used to assess the methodological quality of included studies across various domains, and results will be synthesized and summarized per the synthesis without meta-analysis guidelines. Results: The initial queries of 1150 records have been executed and papers have been screened for inclusion. Data extractions are expected to be finished by December 2023. Results are expected in 2024. The systematic review that will be generated from this protocol will offer evidence for the use of digital self-monitoring tools in the management of GWG. Conclusions: The planned, focused synthesis of relevant literature has the potential to inform the use of digital weight self-monitoring tools in the context of future technology-mediated interventions to manage GWG. In addition, the planned review has the potential to contribute as part of a broader movement in research toward empirically supporting the inclusion of specific components within more extensive, multicomponent interventions to balance parsimony and effectiveness. Trial Registration: PROSPERO CRD42020204820; https://tinyurl.com/ybzt6bvr International Registered Report Identifier (IRRID): PRR1-10.2196/50145 %M 37883145 %R 10.2196/50145 %U https://www.researchprotocols.org/2023/1/e50145 %U https://doi.org/10.2196/50145 %U http://www.ncbi.nlm.nih.gov/pubmed/37883145 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52252 %T eHealth Tools Supporting Early Childhood Education and Care Centers to Assess and Enhance Nutrition and Physical Activity Environments: Protocol for a Scoping Review %A Hayek,Joyce %A Elliott,Katharine %A Vermette,Makayla %A Lafave,Lynne MZ %+ Department of Health and Physical Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, AB, T3E 6K6, Canada, 1 403 440 5967, llafave@mtroyal.ca %K early childhood education and care %K childcare %K nutrition %K physical activity %K healthy eating environment %K eHealth %K digital technology %K health technology %K digital public health %K eating %K diet %K dietary %K exercise %K child %K children %K childhood %K pediatric %K pediatrics %K digital health %K early childhood educators %K ECEC %K knowledge synthesis %K review methods %K review methodology %K scoping %K mobile phone %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many children today are growing up in environments that predispose them to develop noncommunicable diseases. While no single preventive solution exists, evidence supports interventions in childcare settings for establishing good nutrition and physical activity behaviors as a “critical window” that could reduce the risk of developing noncommunicable diseases later in life. Emerging eHealth tools have shown potential in promoting best practices for nutrition and physical activity environments in early childhood education and care (ECEC) settings. Objective: The primary objective of this review is to map the breadth of available evidence on eHealth tools currently available to assess and support best practices for nutrition, physical activity, or both in ECEC settings and to highlight potential research directions. Methods: This scoping review will be conducted in accordance with the Joanna Briggs Institute Manual for Scoping Reviews with adherence to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist guidelines. Eligibility is based on the Population, Concept, and Context criteria as follows: (1) early childhood educators (population); (2) eHealth (digital) technology, such as websites, smartphone apps, email, and social media (concept); and (3) measurement and intervention tools to support best practices for nutrition, physical activity, or both in ECEC settings (context). The information sources for this review are the bibliographic databases PubMed, Scopus, CINAHL Plus, ERIC, and Embase in English and French with no date restrictions. Following this, a scan of gray literature will be undertaken. The electronic search strategy was developed in collaboration with two librarians. Two independent reviewers will screen the titles and abstracts of all relevant publications against inclusion criteria, followed by a full-text review using a data extraction tool developed by the reviewers. A synthesis of included papers will describe the publication, assessment, and intervention tool details. A summary of the findings will describe the types of eHealth assessment tools available, psychometric properties, eHealth intervention components, and theoretical frameworks used for development. Results: Preliminary searches of bibliographic databases to test and calibrate the search were carried out in May 2023. Study selection based on titles and abstracts was started in August 2023. The developed search strategy will guide our search for gray literature. The findings will be presented in visualized data map format, waffle chart, or tabular format accompanied by a narrative discussion. The scoping review is planned for completion in 2024. Conclusions: A structured review of the literature will provide a summary of the range and type of eHealth tools available for ECEC programs to assess and improve nutrition environments, physical activity environments, or both in order to identify gaps in the current evidence base and provide insights to guide future intervention research. Trial Registration: Open Science Framework XTRNZ; https://osf.io/xtrnz International Registered Report Identifier (IRRID): DERR1-10.2196/52252 %M 37874616 %R 10.2196/52252 %U https://www.researchprotocols.org/2023/1/e52252 %U https://doi.org/10.2196/52252 %U http://www.ncbi.nlm.nih.gov/pubmed/37874616 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e43843 %T Translating and Testing a Digital Game Promoting Vegetable Consumption in Young Children: Usability Study %A Bucher Della Torre,Sophie %A Lages,Marlene %A Dias,Sara S %A Guarino,Maria P %A Braga-Pontes,Cátia %+ Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, Rue des Caroubiers 25, Carouge, 1227, Switzerland, 41 225586604, sophie.bucher@hesge.ch %K vegetable %K food preference %K serious games %K video game %K children %K child %K pediatric %K obesity prevention %K pilot study %K gaming %K educational game %K nutrition %K diet %K healthy eating %K food consumption %K food intake %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Promoting healthy eating in children is key to preventing chronic diseases, and vegetable consumption is notably lower than recommended in this population. Among the interventions tested, gamification has shown promise in promoting familiarization, increasing knowledge, and potentially increasing vegetable intake. Objective: This pilot study aimed first to translate the digital game “Veggies4myHeart” into French and to assess its influence on young children’s preferences and willingness to taste vegetables when combined with repeated tasting and education. We also aimed to investigate the acceptability and applicability of the game in 2 classrooms. Methods: During 5 consecutive weekly sessions, children from 2 elementary classes played the digital game consisting of 5 mini games on different vegetables (lettuce, carrot, red cabbage, cucumber, and tomato) in pairs for 10-15 minutes. In addition, they discussed one of the vegetables and tasted the 5 vegetables in each session. Pretest and posttest food preferences and willingness to taste the vegetables were compared. Teachers participated in a semistructured interview. Results: A total of 45 children aged 5 to 6 years tested the French version of the digital game. The children’s declared food preferences were already high for carrot, cucumber, and tomato, with scores higher than 4 out of a maximum of 5. The scores did not change significantly after the intervention, except for red cabbage (pretest: mean 2.52, SD 1.49; posttest: mean 3.29, SD 1.67; P=.006) and a composite score (pretest: mean 3.76, SD 1.06; posttest: mean 4.05, SD 1.03; P=.001). Before the intervention, 18 (44%), 30 (73%), 16 (39%), 29 (71%), and 26 (63%) children out of 41 were willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. After the intervention, no significant statistical differences were observed, with 23 (51%), 36 (80%), 24 (53%), 33 (73%), and 29 (64%) children out of 45 willing to taste lettuce, carrot, red cabbage, cucumber, and tomato, respectively. Teachers supported this tool combined with repeated tasting and education and highlighted facilitators and barriers that should be anticipated to improve implementation in schools. Conclusions: In this study, we translated an existing digital game applicable and acceptable to both children and teachers. A larger study is warranted to confirm the effectiveness of interventions using the digital game to promote vegetable preference, willingness to taste, and intake. %M 37788064 %R 10.2196/43843 %U https://games.jmir.org/2023/1/e43843 %U https://doi.org/10.2196/43843 %U http://www.ncbi.nlm.nih.gov/pubmed/37788064 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45407 %T Exploring the Effect of the Dynamics of Behavioral Phenotypes on Health Outcomes in an mHealth Intervention for Childhood Obesity: Longitudinal Observational Study %A Woo,Sarah %A Jung,Sunho %A Lim,Hyunjung %A Kim,YoonMyung %A Park,Kyung Hee %+ Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang-si, Gyeonggi-do, 14068, Republic of Korea, 82 31 380 3805, beloved920@gmail.com %K behavioral dynamics %K behavioral phenotype %K functional data analysis %K FDA %K machine learning analysis %K mobile health %K mHealth %K obesity intervention %K pediatric obesity %K mobile phone %D 2023 %7 17.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Advancements in mobile health technologies and machine learning approaches have expanded the framework of behavioral phenotypes in obesity treatment to explore the dynamics of temporal changes. Objective: This study aimed to investigate the dynamics of behavioral changes during obesity intervention and identify behavioral phenotypes associated with weight change using a hybrid machine learning approach. Methods: In total, 88 children and adolescents (ages 8-16 years; 62/88, 71% male) with age- and sex-specific BMI ≥85th percentile participated in the study. Behavioral phenotypes were identified using a hybrid 2-stage procedure based on the temporal dynamics of adherence to the 5 behavioral goals during the intervention. Functional principal component analysis was used to determine behavioral phenotypes by extracting principal component factors from the functional data of each participant. Elastic net regression was used to investigate the association between behavioral phenotypes and weight change. Results: Functional principal component analysis identified 2 distinctive behavioral phenotypes, which were named the high or low adherence level and late or early behavior change. The first phenotype explained 47% to 69% of each factor, whereas the second phenotype explained 11% to 17% of the total behavioral dynamics. High or low adherence level was associated with weight change for adherence to screen time (β=−.0766, 95% CI −.1245 to −.0312), fruit and vegetable intake (β=.1770, 95% CI .0642-.2561), exercise (β=−.0711, 95% CI −.0892 to −.0363), drinking water (β=−.0203, 95% CI −.0218 to −.0123), and sleep duration. Late or early behavioral changes were significantly associated with weight loss for changes in screen time (β=.0440, 95% CI .0186-.0550), fruit and vegetable intake (β=−.1177, 95% CI −.1441 to −.0680), and sleep duration (β=−.0991, 95% CI −.1254 to −.0597). Conclusions: Overall level of adherence, or the high or low adherence level, and a gradual improvement or deterioration in health-related behaviors, or the late or early behavior change, were differently associated with weight loss for distinctive obesity-related lifestyle behaviors. A large proportion of health-related behaviors remained stable throughout the intervention, which indicates that health care professionals should closely monitor changes made during the early stages of the intervention. Trial Registration: Clinical Research Information Science KCT0004137; https://tinyurl.com/ytxr83ay %M 37590040 %R 10.2196/45407 %U https://www.jmir.org/2023/1/e45407 %U https://doi.org/10.2196/45407 %U http://www.ncbi.nlm.nih.gov/pubmed/37590040 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e36132 %T Social Media Interventions for Nutrition Education Among Adolescents: Scoping Review %A Kulandaivelu,Yalinie %A Hamilton,Jill %A Banerjee,Ananya %A Gruzd,Anatoliy %A Patel,Barkha %A Stinson,Jennifer %+ Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada, 1 416 813 7654 ext 327105, yalinie.kulandaivelu@mail.utoronto.ca %K adolescents %K digital health intervention %K food literacy %K health literacy %K nutrition %K peer education %K peer support %K social media %D 2023 %7 20.7.2023 %9 Review %J JMIR Pediatr Parent %G English %X Background: Adolescence is a critical period for reinforcing healthy dietary behaviors and supporting the development of cooking skills. Social media may be an avenue for supporting these behaviors, as it is popular among adolescents and can improve access to nutrition education interventions. This study sought to understand the optimal implementation of effective social media–based nutrition education interventions to inform the implementation of future social media–based nutrition education interventions. Objective: A scoping review of the characteristics, feasibility, effectiveness, and factors influencing social media–based nutrition education interventions for adolescents was conducted. Methods: We searched MEDLINE, Embase, CINAHL, Web of Science, and PsycINFO databases using a predefined search strategy. Primary research articles were independently screened and included if they involved adolescent populations (10-18 years old) and delivered nutrition education through social media. The information on intervention characteristics, feasibility, effectiveness, and factors influencing social media–based nutrition education interventions was extracted. Results: A total of 28 publications out of 20,557 met the eligibility criteria. Twenty-five nutrition interventions were examined by 28 studies. Fourteen interventions used homegrown social media platforms, 8 used Facebook, and 2 used Instagram. Feasibility outcomes were infrequently reported, and the cost of intervention delivery was not reported. Engagement with interventions was variable; high engagement was not required to elicit significant improvements in dietary behaviors. Tailoring interventions, offering practical content, meaningful peer support, and involving families and communities facilitated successful interventions. Strategies to address engagement and technical issues were varied. Conclusions: Emerging evidence demonstrates that social media interventions for adolescent nutrition are acceptable and improve nutrition outcomes. Future interventions should strengthen peer support components and tailor delivery to specific populations. Further research should examine engagement, adherence, and the impact of interventions on behavioral and physical outcomes. This review is the first to examine the use of social media as the primary medium for nutrition education for adolescent populations. The analysis used in this review argues the importance of peer support in social media–based nutrition interventions and the need for user-centered design of the interventions. %M 37471119 %R 10.2196/36132 %U https://pediatrics.jmir.org/2023/1/e36132 %U https://doi.org/10.2196/36132 %U http://www.ncbi.nlm.nih.gov/pubmed/37471119 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45983 %T Indigenous Women and Their Nutrition During Pregnancy (the Mums and Bubs Deadly Diets Project): Protocol for a Co-designed mHealth Resource Development Study %A Gilbert,Stephanie %A Irvine,Rachel %A D'or,Melissa %A Adam,Marc T P %A Collins,Clare E %A Marriott,Rhonda %A Rollo,Megan %A Walker,Roz %A Rae,Kym %+ Mater Research Institute, Aubigny Place, 1 Raymond Terrace, Brisbane, 4101, Australia, 61 0431379872, kym.rae@uq.edu.au %K co-design %K community-based participatory research %K mHealth %K Aboriginal and Torres Strait Islander %K maternal health %K pregnancy %K nutrition %K Indigenous women %K diet %K health literacy %K Indigenous %K Indigenous people %K mobile phone %D 2023 %7 6.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nutrition in pregnancy is pivotal to optimizing infant growth and maternal well-being. The factors affecting Indigenous people’s food and nutrition intake are complex with a history of colonization impacting the disproportionate effect of social determinants to this day. Literature regarding the dietary intake or dietary priorities of Indigenous women in Australia is scarce, with supportive, culturally appropriate resources developed for and with this group rare. Research suggests mobile health (mHealth) tools are effective in supporting health knowledge of Indigenous people and positive health behavior changes when designed and developed with the expertise of Indigenous communities. Objective: This study seeks to build the body of knowledge related to nutrition needs and priorities for Indigenous women in Australia during pregnancy. Further, this project team and its participants will co-design an mHealth digital tool to support these nutrition needs. Methods: The Mums and Bubs Deadly Diets study recruits Indigenous women and health care professionals who support Indigenous women during pregnancy into 2 phases. Phase 1 (predesign) uses a mixed methods convergent design using a biographical questionnaire and social or focus groups to inform phase 2 (generative). Phase 2 will use a participatory action research process during co-design workshops to iteratively develop the digital tool; the exact actions within a workshop will evolve according to the participant group decisions. Results: To date, this project has undertaken phase 1 focus groups at all Queensland sites, with New South Wales and Western Australia to begin in early to mid-2023. We have recruited 12 participants from Galangoor Duwalami, 18 participants from Carbal in Toowoomba, and 18 participants from Carbal in Warwick. We are expecting similar numbers of recruits in Western Australia and New South Wales. Participants have been both community members and health care professionals. Conclusions: This study is an iterative and adaptive research program that endeavors to develop real-world, impactful resources to support the nutrition needs and priorities of pregnant Indigenous women in Australia. This comprehensive project requires a combination of methods and methodologies to ensure Indigenous voices are heard at each stage and in all aspects of research output. The development of an mHealth resource for this cohort will provide a necessary bridge where there is often a gap in access to nutrition resources for women in pregnancy in Indigenous communities. International Registered Report Identifier (IRRID): DERR1-10.2196/45983 %M 37147188 %R 10.2196/45983 %U https://www.researchprotocols.org/2023/1/e45983 %U https://doi.org/10.2196/45983 %U http://www.ncbi.nlm.nih.gov/pubmed/37147188 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46816 %T The Effectiveness of Early Food Introduction in Preventing Childhood Allergic Diseases: Protocol for a Systematic Review and Meta-Analysis %A Abang Abdullah,Aisha Fadhilah %A Muhamad,Nor Asiah %A Ab Ghani,Rimah Melati %A Maamor,Nur Hasnah %A Leman,Fatin Norhasny %A Too,Chun Lai %A Ismail,Intan Hakimah %A Mohd Zulkefli,Nor Afiah %A Mohd Nazan,Ahmad Iqmer Nashriq %A Md Said,Salmiah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, 43400, Malaysia, 60 389472415, salmiahsaid68@gmail.com %K protocol %K systematic review %K childhood allergic disease %K weaning %K early food introduction %K food allergy %K allergy %K anaphylaxis %K randomized controlled trial %K pediatric %K infant %K childhood %D 2023 %7 26.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Allergic diseases affect around 40% of the pediatric population worldwide. The coexistence of asthma, allergic rhinitis, eczema, and food allergy renders allergy treatment and prevention challenging. Infant feeding strategies recommend avoiding allergenic foods to prevent allergy development and anaphylaxis. However, recent evidence suggests that early consumption of food allergens during weaning in infants aged 4-6 months could result in food tolerance, thus reducing the risk of developing allergies. Objective: The aim of this study is to systematically review and carry out a meta-analysis of evidence on the outcome of early food introduction for preventing childhood allergic diseases. Methods: We will conduct a systematic review of interventions through a comprehensive search of various databases including PubMed, Embase, Scopus, CENTRAL, PsycINFO, CINAHL, and Google Scholar to identify potential studies. The search will be performed for any eligible articles from the earliest published articles up to the latest available studies in 2023. We will include randomized controlled trials (RCTs), cluster RCTs, non-RCTs, and other observational studies that assess the effect of early food introduction to prevent childhood allergic diseases. Results: Primary outcomes will include measures related to the effect of childhood allergic diseases (ie, asthma, allergic rhinitis, eczema, and food allergy). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines will be followed for study selection. All data will be extracted using a standardized data extraction form and the quality of the studies will be assessed using the Cochrane Risk of Bias tool. A summary of findings table will be generated for the following outcomes: (1) total number of allergic diseases, (2) rate of sensitization, (3) total number of adverse events, (4) improvement of health-related quality of life, and (5) all-cause mortality. Descriptive and meta-analyses will be performed using a random-effects model in Review Manager (Cochrane). Heterogeneity among selected studies will be assessed using the I2 statistic and explored through meta-regression and subgroup analyses. Data collection is expected to start in June 2023. Conclusions: The results acquired from this study will contribute to the existing literature and harmonize recommendations for infant feeding with regard to the prevention of childhood allergic diseases. Trial Registration: PROSPERO CRD42021256776; https://tinyurl.com/4j272y8a International Registered Report Identifier (IRRID): PRR1-10.2196/46816 %M 37358892 %R 10.2196/46816 %U https://www.researchprotocols.org/2023/1/e46816 %U https://doi.org/10.2196/46816 %U http://www.ncbi.nlm.nih.gov/pubmed/37358892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45908 %T Pulse-Based Nutrition Education Intervention Among High School Students to Enhance Knowledge, Attitudes, and Practices: Pilot for a Formative Survey Study %A Teshome,Getenesh Berhanu %A Haileslassie,Hiwot Abebe %A Shand,Phyllis %A Lin,Yun %A Lieffers,Jessica R L %A Henry,Carol %+ Applied Human Sciences, University of Prince Edward Island, 550 University Ave, Charlottetown, PE, C1A 4P3, Canada, 1 3067153659, hhaileslassie@upei.ca %K adolescents %K food literacy %K high school %K macronutrients %K micronutrients %K pulses %K dietary pattern %K diet %K eating habits %K nutrition %K students %K school-based interventions %D 2023 %7 31.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Promoting pulse consumption in schools could improve students’ healthy food choices. Pulses, described as legumes, are rich in protein and micronutrients and are an important food choice for health and well-being. However, most Canadians consume very little pulse-based food. Objective: This pilot study sought to investigate outcomes of a teacher-led, school-based food literacy intervention focused on the Pulses Make Perfect Sense (PMPS) program in 2 high schools in Saskatoon, Saskatchewan. Methods: Both high schools were selected using a convenience sampling technique and have similar sociodemographic characteristics. The mean age of students was 16 years. The intervention comprised 7 key themes focused on pulses, which included defining pulses; health and nutritional benefits of pulses; incorporating pulses into meals; the role of pulses in reducing environmental stressors, food insecurity, and malnutrition; product development; taste testing and sensory analysis; and pulses around the world. A self-administered questionnaire was used to assess knowledge, attitudes, practices, and barriers regarding pulse consumption in students at baseline and study end. Teachers were interviewed at the end of the intervention. Descriptive statistics and the nonparametric Mann-Whitney U test were used for analysis. Results: In total, 41 and 32 students participated in the baseline and study-end assessments, respectively. At baseline, the median knowledge score was 9, attitude score was 6, and barrier score was 0. At study end, the median knowledge score was 10, attitude score was 7, and barrier score was 1. A lower score for barriers indicated fewer barriers to pulse consumption. There was a significant difference between baseline and study-end scores in knowledge (P<.05). Barriers to pulse consumption included parents not cooking or consuming pulses at home, participants not liking the taste of pulses, and participants often preferring other food choices over pulses. The teachers indicated that the pulse food-literacy teaching resources were informative, locally available, and easy to use. Conclusions: Despite the improvements in knowledge, attitude, and practice, pulse consumption did not change significantly at the end of the intervention. Future studies with larger samples are needed to determine the impact of PMPS on knowledge, attitude, and practice of high school students. %M 37256666 %R 10.2196/45908 %U https://formative.jmir.org/2023/1/e45908 %U https://doi.org/10.2196/45908 %U http://www.ncbi.nlm.nih.gov/pubmed/37256666 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44792 %T Using Human-Centered Design and Cocreation to Create the Live 5-2-1-0 Mobile App to Promote Healthy Behaviors in Children: App Design and Development %A Yau,Kiana W %A Tang,Tricia S %A Görges,Matthias %A Pinkney,Susan %A Amed,Shazhan %+ Research Institute, BC Children's Hospital, A4-196, 950 W 28th Ave, Vancouver, BC, V5Z 4H4, Canada, 1 6048753113, SAmed@cw.bc.ca %K childhood obesity %K mobile health %K health behaviors %K prevention %K mobile health app %K mHealth app %K human-centered design %K cocreation %K participatory approach %K mobile phone %D 2023 %7 17.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The prevalence of obesity among Canadian children is rising, partly because of increasingly obesogenic environments that limit opportunities for physical activity and healthy nutrition. Live 5-2-1-0 is a community-based multisectoral childhood obesity prevention initiative that engages stakeholders to promote and support the message of consuming ≥5 servings of vegetables and fruits, having <2 hours of recreational screen time, participating in ≥1 hour of active play, and consuming 0 sugary drinks every day. A Live 5-2-1-0 Toolkit for health care providers (HCPs) was previously developed and piloted in 2 pediatric clinics at British Columbia Children’s Hospital. Objective: This study aimed to co-create, in partnership with children, parents, and HCPs, a Live 5-2-1-0 mobile app that supports healthy behavior change and could be used as part of the Live 5-2-1-0 Toolkit for HCPs. Methods: Three focus groups (FGs) were conducted using human-centered design and participatory approaches. In FG 1, children (separately) and parents and HCPs (together) participated in sessions on app conceptualization and design. Researchers and app developers analyzed and interpreted qualitative data from FG 1 in an ideation session, and key themes were subsequently presented separately to parents, children, and HCPs in FG-2 (co-creation) sessions to identify desired app features. Parents and children tested a prototype in FG 3, provided feedback on usability and content, and completed questionnaires. Thematic analysis and descriptive statistics were used for the qualitative and quantitative data, respectively. Results: In total, 14 children (mean age 10.2, SD 1.3 years; 5/14, 36% male; 5/14, 36% White), 12 parents (9/12, 75% aged 40-49 years; 2/12, 17% male; 7/12, 58% White), and 18 HCPs participated; most parents and children (20/26, 77%) participated in ≥2 FGs. Parents wanted an app that empowered children to adopt healthy behaviors using internal motivation and accountability, whereas children described challenge-oriented goals and family-based activities as motivating. Parents and children identified gamification, goal setting, daily steps, family-based rewards, and daily notifications as desired features; HCPs wanted baseline behavior assessments and to track users’ behavior change progress. Following prototype testing, parents and children reported ease in completing tasks, with a median score of 7 (IQR 6-7) on a 7-point Likert scale (1=very difficult; 7=very easy). Children liked most suggested rewards (28/37, 76%) and found 79% (76/96) of suggested daily challenges (healthy behavior activities that users complete to achieve their goal) realistic to achieve. Participant suggestions included strategies to maintain users’ interest and content that further motivates healthy behavior change. Conclusions: Co-creating a mobile health app with children, parents, and HCPs was feasible. Stakeholders desired an app that facilitated shared decision-making with children as active agents in behavior change. Future research will involve clinical implementation and assessment of the usability and effectiveness of the Live 5-2-1-0 app. %M 37195754 %R 10.2196/44792 %U https://pediatrics.jmir.org/2023/1/e44792 %U https://doi.org/10.2196/44792 %U http://www.ncbi.nlm.nih.gov/pubmed/37195754 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36837 %T An App-Based Intervention for Pediatric Weight Management: Pre-Post Acceptability and Feasibility Trial %A Cox,Jennifer S %A Hinton,Elanor C %A Hamilton Shield,Julian %A Lawrence,Natalia S %+ NIHR Bristol Biomedical Research Centre Nutrition Theme, 3rd Floor, Education & Research Centre, Upper Maudlin Street, Bristol, BS2 8AE, United Kingdom, 44 07718905807, jennifer.cox@bristol.ac.uk %K obesity %K pediatric %K intervention %K eHealth %K weight management %D 2023 %7 24.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A multidisciplinary approach to weight management is offered at tier 3 pediatric weight management services in the United Kingdom. Encouraging dietary change is a major aim, with patients meeting with dieticians, endocrinologists, psychologists, nurse specialists, and social workers on average every other month. Objective: This research sought to trial an inhibitory control training smartphone app—FoodT—with the clinic population of a pediatric weight management service. FoodT has shown positive impacts on food choice in adult users, with resulting weight loss. It was hoped that when delivered as an adjunctive treatment alongside the extensive social, medical, psychological, and dietetic interventions already offered at the clinic, the introduction of inhibitory control training may offer patients another tool that supports eating choice. In this feasibility trial, recruitment, retention, and app use were the primary outcomes. An extensive battery of measures was included to test the feasibility and acceptability of these measures for future powered trials. Methods: FoodT was offered to pediatric patients and their parents during a routine clinic appointment, and patients were asked to use the app at home every day for the first week and once per week for the rest of the month. Feasibility and acceptability were measured in terms of recruitment, engagement with the app, and retention to the trial. A battery of psychometric tests was given before and after app use to assess the acceptability of collecting data on changes to food choices and experiences that would inform future trial work. Results: A total of 12 children and 10 parents consented (22/62, 35% of those approached). Further, 1 child and no parents achieved the recommended training schedule. No participants completed the posttrial measures. The reasons for not wanting to be recruited to the trial included participants not considering their weight to be connected to eating choices and not feeling that the app suited their needs. No reasons are known for noncompletion. Conclusions: It is unclear whether the intervention itself or the research processes, including the battery of measures, prevented completion. It is therefore difficult to make any decisions as to the value that the app has within this setting. Important lessons have been learned from this research that have potential broad relevance, including the importance of co-designing interventions with service users and avoiding deterring people from early-stage participation in extensive data collection. %M 37093633 %R 10.2196/36837 %U https://formative.jmir.org/2023/1/e36837 %U https://doi.org/10.2196/36837 %U http://www.ncbi.nlm.nih.gov/pubmed/37093633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37515 %T Integrating Human-Centered Design Methods Into a Health Promotion Project: Supplemental Nutrition Assistance Program Education Case Study for Intervention Design %A Chen,Elizabeth %A Bishop,Jared %A Guge Cozon,Lindsay %A Hernandez,Eduardo %A Sadeghzadeh,Claire %A Bradley,Megan %A Dearth-Wesley,Tracy %A De Marco,Molly %+ Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, United States, 1 9199669207, lizcchen@unc.edu %K human-centered design %K design thinking %K program development %K stakeholder engagement %K nutrition %K parenting %K children %K pediatrics %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Human-centered design, or design thinking, offers an extensive toolkit of methods and strategies for user-centered engagement that lends itself well to intervention development and implementation. These methods can be applied to the fields of public health and medicine to design interventions that may be more feasible and viable in real-world contexts than those developed with different methods. Objective: The design team aimed to develop approaches to building food skills among caregivers of children aged 0-5 years who are eligible for a federal food assistance program while they were in the grocery store. Methods: They applied 3 specific human-centered design methods—Extremes and Mainstreams, Journey Mapping, and Co-Creation Sessions—to collaboratively develop intervention approaches to enhance Supplemental Nutrition Assistance Program Education (SNAP-Ed) reach and impact across food retail settings. Extremes and Mainstreams is a specific kind of purposive sampling that selects individuals based on characteristics beyond demographics. Journey Mapping is a visual tool that asks individuals to identify key moments and decision points during an experience. Co-Creation Sessions are choreographed opportunities for individuals to explicitly contribute to the design of a solution alongside research or design team members. Results: Ten caregivers with diverse lived experiences were selected to participate in remote design thinking workshops and create individual journey maps to depict their grocery store experiences. Common happy points and pain points were identified. Nine stakeholders, including caregivers, SNAP-Ed staff, and grocery store dieticians, cocreated 2 potential intervention approaches informed by caregivers’ experiences and needs: a rewards program and a meal box option. Conclusions: These 3 human-centered design methods led to a meaningful co-design process where proposed interventions aligned with caregivers’ wants and needs. This case study provides other public health practitioners with specific examples of how to use these methods in program development and stakeholder engagement as well as lessons learned when adapting these methods to remote settings. %M 37083485 %R 10.2196/37515 %U https://formative.jmir.org/2023/1/e37515 %U https://doi.org/10.2196/37515 %U http://www.ncbi.nlm.nih.gov/pubmed/37083485 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42272 %T Parental Information Needs and Intervention Preferences for Preventing Multiple Lifestyle Risk Behaviors Among Adolescents: Cross-sectional Survey Among Parents %A Champion,Katrina E %A Hunter,Emily %A Gardner,Lauren A %A Thornton,Louise K %A Chapman,Cath %A McCann,Karrah %A Spring,Bonnie %A Slade,Tim %A Teesson,Maree %A Newton,Nicola C %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, Sydney, 2006, Australia, 61 8627 9006, katrina.champion@sydney.edu.au %K parents %K adolescents %K prevention %K risk behaviors %K intervention %K mobile phone %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents play an influential role in the health behaviors of their children, such as physical activity, dietary intake, sleep, screen time, and substance use. However, further research is needed to inform the development of more effective and engaging parent-based interventions targeting adolescent risk behaviors. Objective: This study aimed to assess parents’ knowledge about adolescent risk behaviors, barriers and facilitators to engaging in healthy behaviors, and preferences for a parent-based prevention intervention. Methods: An anonymous web-based survey was conducted from June 2022 to August 2022. Eligible participants were parents of children aged 11 to 18 years and were residing in Australia at the time of this study. The survey assessed the parents’ perceived and actual knowledge about Australian health guidelines for youth, parent and adolescent engagement in health behaviors, parenting style and attitudes, barriers and facilitators to engaging in healthy behaviors, and delivery and component preferences for a parent-based preventive intervention. Descriptive statistics and logistic regressions were conducted to analyze the data. Results: A total of 179 eligible participants completed the survey. The mean age of the parents was 42.22 (SD 7.03) years, and 63.1% (101/160) were female. Parent-reported sleep duration was high for both parents (mean 8.31, SD 1.00 hours) and adolescents (mean 9.18, SD 0.94 hours). However, the proportion of parents who reported that their child met the national recommendations for physical activity (5/149, 3.4%), vegetable intake (7/126, 5.6%), and weekend recreational screen time (7/130, 5.4%) was very low. Overall, parents’ perceived knowledge of health guidelines was moderate, ranging from 50.6% (80/158) for screen time to 72.8% (115/158) for sleep guidelines (for children aged 5-13 years). Actual knowledge was lowest for vegetable intake and physical activity, with only 44.2% (46/104) and 42% (31/74) of parents reporting correct guidelines for these behaviors, respectively. The key issues of concern reported by parents were excessive use of technology, mental health, e-cigarette use, and negative peer relationships. The top-rated delivery method for a parent-based intervention was via a website (53/129, 41.1%). The highest rated intervention component was opportunities for goal-setting (89/126, 70.7% rated very or extremely important), and other important program features were ease of use (89/122, 72.9%), paced learning (79/126, 62.7%), and appropriate program length (74/126, 58.8%). Conclusions: The findings suggest that such interventions should be brief and web based and should aim to increase parental knowledge of health guidelines; provide opportunities for skill-building, such as goal-setting; and include effective behavior change techniques, such as motivational interviewing and social support. This study will inform the development of future parent-based preventive interventions to prevent multiple lifestyle risk behaviors among adolescents. %M 37014696 %R 10.2196/42272 %U https://pediatrics.jmir.org/2023/1/e42272 %U https://doi.org/10.2196/42272 %U http://www.ncbi.nlm.nih.gov/pubmed/37014696 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41436 %T Parents’ and Health Care Professionals’ Perspectives on Prevention and Prediction of Food Allergies in Children: Protocol for a Qualitative Study %A Hörold,Madlen %A Apfelbacher,Christian %A Gerhardinger,Katharina %A Rohr,Magdalena %A Schimmelpfennig,Maria %A Weigt,Julia %A Brandstetter,Susanne %+ Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str 44, Magdeburg, 39120, Germany, 49 3916724348, madlen.hoerold@med.ovgu.de %K parents %K health care professionals %K content analysis %K grounded theory %K food allergy %K children %K allergic reaction %K information needs %K information seeking %K prevention %K prediction %K risk factors %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Food allergy in children is increasing in prevalence in the western world and appears to become an important health problem. Parents of children at risk of food allergy live with the fear of allergic reaction, especially when the children are very young. The paradigm shift in allergy prevention in the last decade—away from allergen avoidance toward a tolerance induction approach—challenges both parents and health care professionals, as they have to deal with changing information and new evidence that often contradicts previous assumptions. Yet, research on health information–seeking behavior and needs of parents on primary prevention of food allergy in children as well as on prediction and prevention strategies of German health care professionals is lacking. Objective: The aim of the study is to explore and understand parents’ and health care professionals’ perspectives on the prediction and prevention of food allergies. We are particularly interested in information needs, information seeking, and health care usage and place a special focus on families’ experiences when their child is at risk or diagnosed with food allergies. Furthermore, food allergy prediction and prevention strategies of health care professionals will be explored. Methods: This study is part of the NAMIBIO (food allergy biomarker) app consortium, which aims to identify early predictors for the development of food allergy in children and develop apps to guide health care professionals and parents of children with a high risk of food allergy toward prevention and timely tolerance induction. The study uses a qualitative approach with topic-guided interviews and focus groups with parents of children (0-3 years) and health care professionals. Data collection will continue until theoretical saturation is reached. The qualitative content analysis will be used according to Kuckartz to identify overarching themes toward information needs and seeking behavior as well as usage of health care and health care professionals’ predictive and preventive strategies. In addition, a constructivist grounded theory approach will be used to explore and understand parents’ experiences, interactions, and social processes in families in daily life. Results: Recruitment and data collection started in February 2022 and is still ongoing. Conclusions: The qualitative study will provide insight into parents’ information-seeking behavior and needs regarding the prevention of food allergy in children, parents’ use of pediatric primary care, and health care professionals strategies for the prediction and prevention of food allergies in children. We assume that our results will highlight the challenges associated with the paradigm shift in allergy prevention for both parents and health care professionals. The results will be used to make practical recommendations from the user’s perspective and inform the development of the NAMIBIO apps. International Registered Report Identifier (IRRID): DERR1-10.2196/41436 %M 36947117 %R 10.2196/41436 %U https://www.researchprotocols.org/2023/1/e41436 %U https://doi.org/10.2196/41436 %U http://www.ncbi.nlm.nih.gov/pubmed/36947117 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38667 %T COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study %A Brusk,John J %A Bensley,Robert J %+ School of Interdisciplinary Health Programs, Western Michigan University, 2414 CHHS Bldng, 1903 W. Michigan Ave., Kalamazoo, MI, 49008, United States, 1 2697162301, bobbensley@gmail.com %K COVID-19 %K user engagement %K infodemic %K Women, Infants, and Children %K WIC %K educational resource %K health care %K digital health %K nutrition %K web-based education %K web-based nutrition %K pediatric %K parenting %K dashboard %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site’s user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19–specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution. %M 36787232 %R 10.2196/38667 %U https://formative.jmir.org/2023/1/e38667 %U https://doi.org/10.2196/38667 %U http://www.ncbi.nlm.nih.gov/pubmed/36787232 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44329 %T Development of an Individualized Responsive Feeding Intervention—Learning Early Infant Feeding Cues: Protocol for a Nonrandomized Study %A Bahorski,Jessica %A Romano,Mollie %A McDougal,Julie May %A Kiratzis,Edie %A Pocchio,Kinsey %A Paek,Insu %+ College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, United States, 1 850 644 6013, jbahorski@fsu.edu %K responsive feeding %K infant growth %K infant nutrition %D 2023 %7 28.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Responsive infant feeding occurs when a parent recognizes the infant’s cues of hunger or satiety and responds promptly to these cues. It is known to promote healthy dietary patterns and infant weight gain and is recommended as part of the Dietary Guidelines for Americans. However, the use of responsive infant feeding can be challenging for many parents. Research is needed to assist caregivers recognize infant hunger or satiety cues and overcoming barriers to using responsive infant feeding. Objective: The Learning Early Infant Feeding Cues (LEIFc) intervention was designed to fill this gap by using a validated coaching approach, SS-OO-PP-RR (“super,” Setting the Stage, Observation and Opportunities, Problem Solving and Planning, Reflection and Review), to promote responsive infant feeding. Guided by the Obesity-Related Behavioral Intervention Trials model, this study aims to test the feasibility and fidelity of the LEIFc intervention in a group of mother-infant dyads. Methods: This pre-post quasi-experimental study with no control group will recruit mothers (N=30) in their third trimester (28 weeks and beyond) of pregnancy from community settings. Study visit 1 will occur prenatally in which written and video material on infant feeding and infant hunger and satiety cues is provided. Demographic information and plans for infant feeding are also collected prenatally via self-report surveys. The use of responsive infant feeding via subjective (survey) and objective (video) measures is recorded before (study visit 2, 1 month post partum) and after (study visit 5, 4 months post partum) intervention. Coaching on responsive infant feeding during a feeding session is provided by a trained interventionist using the SS-OO-PP-RR approach at study visits 3 (2 months post partum) and 4 (3 months post partum). Infant feeding practices are recorded via survey, and infant weight and length are measured at each postpartum study visit. Qualitative data on the LEIFc intervention are provided by the interventionist and mother. Infant feeding videos will be coded and tabulated for instances of infant cues and maternal responses. Subjective measures of responsive infant feeding will also be tabulated. The use of responsive infant feeding pre-post intervention will be analyzed using matched t tests. Qualitative data will be examined to guide intervention refinement. Results: This study initially began in spring 2020 but was halted because of the COVID-10 pandemic. With new funding, recruitment, enrollment, and data collection began in April 2022 and will continue until April 2023. Conclusions: After refinement, the LEIFc intervention will be tested in a pilot randomized controlled trial. The long-term goal is to implement LEIFc in the curricula of federally funded maternal-child home visiting programs that serve vulnerable populations—those that often have infant feeding practices that do not align with recommendations and are less likely to use responsive infant feeding. International Registered Report Identifier (IRRID): DERR1-10.2196/44329 %M 36853761 %R 10.2196/44329 %U https://www.researchprotocols.org/2023/1/e44329 %U https://doi.org/10.2196/44329 %U http://www.ncbi.nlm.nih.gov/pubmed/36853761 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43814 %T Evaluating the Effectiveness of Interventions to Improve the Follow-up Rate for Children With Visual Disabilities in an Eye Hospital in Nepal: Nonrandomized Study %A Shrestha,Manisha %A Bhandari,Gopal %A Kamalakannan,Sureshkumar %A Murthy,Gudlavalleti Venkata Satyanarayana %A Rathi,Suresh Kumar %A Gudlavalleti,Anirudh Gaurang %A Agiwal,Varun %A Pant,Hira %A Pandey,Binod %A Ghimire,Ramesh %A Ale,Daman %A Kayastha,Sajani %A Karki,Rakshya %A Chaudhary,Daya Shankar %A Byanju,Raghunandan %A , %+ Bharatpur Eye Hospital, Bypass Rd-10, Bharatpur Metropolitan City, Chitwan, 42201, Nepal, 977 9845023273, maneeshasht9845@gmail.com %K counseling %K follow-up %K intervention study %K Nepal %K ophthalmology %K pediatrics %K public health %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Monitoring ocular morbidity among pediatric patients requires regular follow-up visits. We found that the follow-up rate was poor among children in our setting. Therefore, we intended to assess the effectiveness of 2 interventions—(1) counseling and (2) SMS text messaging and phone calls—to improve the follow-up rates. Objective: This study aimed to evaluate the effectiveness of 2 interventions, counseling and SMS and phone calls group, as well as a routine standard care for improving the follow-up rate of pediatric patients. Methods: A Nonrandomized, quasiexperimental design was used. Children (aged 0-16 years) with ocular conditions requiring at least 3 follow-up visits during the study period were included. A total of 264 participants were equally allocated to the 3 intervention groups of (1) counseling, (2) SMS and phone calls, and (3) routine standard care group. A 20-minute counseling session by a trained counselor with the provision of disease-specific leaflets were given to those in the counseling group. For the second intervention group, parents of children received an SMS text 3 days before and a phone call 1 day before their scheduled follow-up visits. Participants allocated for the routine standard care group were provided with the existing services with no additional counseling and reminders. Participants attending 3 follow-ups within 2 days of the scheduled visit date were considered compliant. The difference in and among the proportion of participants completing all 3 follow-up visits in each group was assessed. Results: The demographic characteristics of the participants were similar across the study groups. Only 3% (8/264) of participants completed all 3 follow-up visits, but overall compliance with the follow-up, as defined by the investigators, was found to be only 0.76% (2/264). There was no statistically significant difference in the proportion of follow-up between the intervention groups. However, the proportion of participants attending the first and second follow-ups, as well as the overall total number of follow-ups, was more in the SMS and phone-call group followed by the counseling group. Conclusions: We did not find any evidence on the effectiveness of our interventions to improve the follow-up rate. The primary reason could be that this study was conducted during the COVID-19 pandemic. It could also be possible that the intensity of the interventions may have influenced the outcomes. A rigorously designed study during the absence of any lockdown restrictions is warranted to evaluate intervention effectiveness. The study also provides useful insights and highlights the importance of designing and systematically developing interventions for improving the follow-up rate and ensuring a continuum of care to children with visual disabilities in Nepal and similar contexts. Trial Registration: ClinicalTrials.gov NCT04837534; https://clinicaltrials.gov/ct2/show/NCT04837534 International Registered Report Identifier (IRRID): RR2-10.2196/31578 %M 36821366 %R 10.2196/43814 %U https://pediatrics.jmir.org/2023/1/e43814 %U https://doi.org/10.2196/43814 %U http://www.ncbi.nlm.nih.gov/pubmed/36821366 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44456 %T An mHealth Intervention to Reduce Gestational Obesity (mami-educ): Protocol for a Randomized Controlled Trial %A Chiarello,Delia Indira %A Pardo,Fabian %A Moya,Jessica %A Pino,Maricela %A Rodríguez,Andrea %A Araneda,María Eugenia %A Bertini,Ayleen %A Gutiérrez,Jaime %+ Cellular Signaling and Differentiation Laboratory, School of Medical Technology, Faculty of Medicine and Science, Universidad San Sebastián, Lota 2465, Santiago, 7510157, Chile, 56 (2) 22606855, delia.chiarello@uss.cl %K gestational obesity %K mHealth %K primary care %K randomized controlled trial %D 2023 %7 15.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The World Federation of Obesity warns that the main health problem of the next decade will be childhood obesity. It is known that factors such as gestational obesity produce profound effects on fetal programming and are strong predictors of overweight and obesity in children. Therefore, establishing healthy eating behaviors during pregnancy is the key to the primary prevention of the intergenerational transmission of obesity. Mobile health (mHealth) programs are potentially more effective than face-to-face interventions, especially during a public health emergency such as the COVID-19 outbreak. Objective: This study aims to evaluate the effectiveness of an mHealth intervention to reduce excessive weight gain in pregnant women who attend family health care centers. Methods: The design of the intervention corresponds to a classic randomized clinical trial. The participants are pregnant women in the first trimester of pregnancy who live in urban and semiurban areas. Before starting the intervention, a survey will be applied to identify the barriers and facilitators perceived by pregnant women to adopt healthy eating behaviors. The dietary intake will be estimated in the same way. The intervention will last for 12 weeks and consists of sending messages through a multimedia messaging service with food education, addressing the 3 domains of learning (cognitive, affective, and psychomotor). Descriptive statistics will be used to analyze the demographic, socioeconomic, and obstetric characteristics of the respondents. The analysis strategy follows the intention-to-treat principle. Logistic regression analysis will be used to compare the intervention with routine care on maternal pregnancy outcome and perinatal outcome. Results: The recruitment of study participants began in May 2022 and will end in May 2023. Results include the effectiveness of the intervention in reducing the incidence of excessive gestational weight gain. We also will examine the maternal-fetal outcome as well as the barriers and facilitators that influence the weight gain of pregnant women. Conclusions: Data from this effectiveness trial will determine whether mami-educ successfully reduces rates of excessive weight gain during pregnancy. If successful, the findings of this study will generate knowledge to design and implement personalized prevention strategies for gestational obesity that can be included in routine primary care. Trial Registration: ClinicalTrials.gov NCT05114174; https://clinicaltrials.gov/ct2/show/NCT05114174 International Registered Report Identifier (IRRID): DERR1-10.2196/44456 %M 36790846 %R 10.2196/44456 %U https://www.researchprotocols.org/2023/1/e44456 %U https://doi.org/10.2196/44456 %U http://www.ncbi.nlm.nih.gov/pubmed/36790846 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43160 %T Effects of a Smartphone App on Fruit and Vegetable Consumption Among Saudi Adolescents: Randomized Controlled Trial %A Shatwan,Israa M %A Alhefani,Rabab S %A Bukhari,Mawadah F %A Hanbazazah,Danah A %A Srour,Jumanah K %A Surendran,Shelini %A Aljefree,Najlaa M %A Almoraie,Noha M %+ Food and Nutrition Department, Human Sciences and Design Faculty, King Abdulaziz University, Abdulalah Suliman Street, 3270, Jeddah, 6269, Saudi Arabia, 966 535619144, eshatwan@kau.edu.sa %K smartphone app %K fruit and vegetable consumption %K Saudi Arabia %K adolescents %K nutrition %K health outcome %K digital health intervention %K digital health app %K pediatrics %K youth %D 2023 %7 9.2.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Dietary patterns and nutritional status during adolescence have a direct effect on future health outcomes. Objective: This study aimed to promote fruit and vegetable intake among adolescents using a smartphone app called MyPlate. Methods: This randomized intervention study was conducted in an urban area of Jeddah, Saudi Arabia. We included 104 adolescents aged 13 to 18 years, who were randomized into intervention (n=55) or control (n=49) arms. We examined the effects of MyPlate on fruit and vegetable intake over 6 weeks in the intervention group. Pre- and postintervention questionnaires were used in the intervention and control groups. Results: The control group showed a significant increase in fruit consumption scores between baseline (1.15, SD 0.68) and postintervention (1.64, SD 0.98; P=.01), but no significant difference in vegetable consumption scores was observed before (1.44, SD 0.97) and after intervention (1.55, SD 0.90; P=.54). However, there was no significant difference between scores at baseline and after 6 weeks of using the smartphone app for fruit (1.48, SD 0.99 and 1.70, SD 1.11, respectively; P=.31) or vegetables (1.50, SD 0.97 and 1.43, SD 1.03, respectively; P=.30) in the intervention group. Our findings showed no significant impact of using a smartphone app on fruit and vegetable consumption. Conclusions: These findings suggest that a smartphone app did not significantly improve fruit and vegetable intake among adolescents. Trial Registration: ClinicalTrials.gov NCT05692765; https://clinicaltrials.gov/ct2/show/NCT05692765 %M 36757770 %R 10.2196/43160 %U https://pediatrics.jmir.org/2023/1/e43160 %U https://doi.org/10.2196/43160 %U http://www.ncbi.nlm.nih.gov/pubmed/36757770 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38378 %T The Effectiveness of a Web-Based Application for a Balanced Diet and Healthy Weight Among Indonesian Pregnant Women: Randomized Controlled Trial %A Koeryaman,Mira Trisyani %A Pallikadavath,Saseendran %A Ryder,Isobel Helen %A Kandala,Ngianga %+ Maternity Nursing Department, Universitas Padjadjaran, Jl Raya Bandung Sumedang KM 21, Fakultas Keperawatan, Jatinangor, 45363, Indonesia, 62 22 7795596, mira.koeryaman@port.ac.uk %K web-based application %K nutrition %K pregnant women %K pregnancy %K mobile app %K diet %K dietary intake %K application %K Indonesia %K randomized controlled trial %K tool %K consumption %K maternal %K weight %K weight gain %K intervention %K control group %K treatment %K vitamins %K minerals %K healthy diet %K calorie %K food %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnant women have self-declared that they have difficulties in estimating nutrient intakes. The Nutrition Information System for Indonesian Pregnant Women (SISFORNUTRIMIL) application was created as a dietary assessment and calorie-counting tool to guide pregnant women to eat the right portion sizes for each meal. Objective: The study aimed to examine the effectiveness of the SISFORNUTRIMIL application in helping users achieve a balanced diet and healthy maternal weight gain in comparison to nonusers in Indonesia. Methods:  First-pregnancy women in the second trimester aged 19-30 years (N=112) participated in the randomized controlled trial. Recruited women who were eligible and consented to participate in the study were allocated into the intervention group, or application user (n=56), and the control group, or application nonuser (n=56). The intervention recommended that pregnant women consume at least 5 food groups and calculate a recommended average portion size for 12 weeks. Both groups were self-monitored and recorded their intake in food records for 3 days every week. The dietary diversity consumed, macro- and micronutrient intake, and maternal weight gain were assessed pre- and postintervention. Data were collected three times during the intervention. Diversity food consumption was measured by the Minimum Dietary Diversity for Women of reproductive age. Furthermore, the Indonesian recommended dietary allowances were used to refer to and validate appropriate energy and nutrient amounts. Independent sample t test was used to compare differences between the intervention and control groups. Results: The mean dietary diversity score for the application user group (7.79, SD 1.20) was significantly greater than for the application nonuser group (7.02, SD 1.39; adjusted mean difference 0.77, 95% CI 0.28-1.25; d=0.28; P=.005). Macro- and micronutrient intake was significantly more in accordance with the dietary recommendations for the user group compared to the control group, including an energy daily intake of 156.88 kcal (95% CI 114.52-199.23; d=–1.39; P=.002), 102.43 g of carbohydrates (95% CI –125.2 to –79.60; d=–1.68; P=.02), 14.33 g of protein (95% CI 11.40-17.25; d=1.86; P<.001), and 10.96 g of fat (95% CI –13.71 to –8.20; d=–1.49; P<.001). Furthermore, there was a significantly higher intake of daily vitamins and minerals in the intervention group than in the control group. Other results showed that maternal weight gain in the intervention group was in accordance with the parameters of healthy weight gain. Conclusions:  Recording food intake using the application was significantly effective in improving the dietary diversity consumed, improving adequate energy and nutrient intake, and producing healthy maternal weight during pregnancy. Trial Registration: ISRCTN Registry ISRCTN42690828; https://www.isrctn.com/ISRCTN42690828 %M 36716078 %R 10.2196/38378 %U https://formative.jmir.org/2023/1/e38378 %U https://doi.org/10.2196/38378 %U http://www.ncbi.nlm.nih.gov/pubmed/36716078 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40354 %T The Relationship Between Social Integration and Physical Activity, Diet, and Sleep Among Youths: Cross-sectional Survey Study %A Wray,Bridget %A Grimes,Amanda %A Eighmy,Katlyn %A Lightner,Joseph %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108-2718, United States, 1 816 235 1703, lightnerj@umkc.edu %K social integration %K youth %K nutrition %K sleep %K physical activity %K adults %K exercise %K health %K wellness %K health behavior %K school students %K diet %K children %K health behavior intervention %D 2022 %7 23.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social integration has been shown to predict physical activity (PA), diet, and sleep in adults. However, these associations have not been well-studied in youth samples. Using a life course perspective, it is imperative to study this in youths as social and health behaviors are established early in life. Objective: The purpose of this study was to understand the relationship between social integration and PA, diet, and sleep for urban, middle-school youth. Methods: Cross-sectional baseline data from middle-school youths (N=73) who participated in an afterschool health behavior intervention were included in this study. Results: Time with friends significantly predicted moderate to vigorous intensity PA (β=.33, P=.02). Time spent with family was significantly related to fruit consumption (t66=1.38, P=.005) and vegetable consumption (t72=1.96, P=.01). Conclusions: Social integration appears to be related to both PA and nutrition behaviors in youths. Future research should expand on our findings to explain how different domains of social integration may impact youths’ health behaviors. International Registered Report Identifier (IRRID): RR2-10.2196/37126 %M 36416871 %R 10.2196/40354 %U https://pediatrics.jmir.org/2022/4/e40354 %U https://doi.org/10.2196/40354 %U http://www.ncbi.nlm.nih.gov/pubmed/36416871 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e39261 %T Technology-Based Obesity Prevention Interventions Among Hispanic Adolescents in the United States: Scoping Review %A Soltero,Erica G %A Lopez,Callie %A Hernandez,Edith %A O'Connor,Teresia M %A Thompson,Debbe %+ United States Department of Agriculture/Agricultural Research Services Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, 1100 Bates, Houston, TX, 77030, United States, 1 7137987154, soltero@bcm.edu %K obesity %K technology %K adolescents %K health disparities %K prevention interventions %K prevention %K intervention %K feasibility %K effectiveness %K Hispanic %K engagement %D 2022 %7 4.11.2022 %9 Review %J JMIR Pediatr Parent %G English %X Background: Given that today’s adolescents are digital front-runners, technology-based obesity prevention strategies are age-appropriate for this population. The use of remote and wireless technologies may be suitable for extending the reach and engagement of obesity prevention efforts among high-risk Hispanic youths, as this subgroup is disproportionately affected by barriers that limit participation in traditional, in-person interventions. Objective: The purpose of this scoping review was to examine the intervention and sample characteristics of technology-based obesity prevention interventions among Hispanic adolescents. We also examined feasibility criteria to assess the acceptability and appropriateness of technology-based strategies among Hispanic youths. Methods: A comprehensive search of Embase and PubMed identified 7 studies that met the inclusion criteria. Data were extracted by 2 independent reviewers. Results: Of the 7 included studies, half (n=4, 57%) used a randomized control trial design, with equal implementation in school (n=3, 43%) and clinic (n=4, 57%) settings. Studies commonly targeted improvements in diet (n=4, 57%) and physical activity (n=7, 100%), with only 1 (14%) study focused on sedentary behaviors. Just 2 (29%) studies reported the use of behavioral theories or models. Studies focused primarily on youths in early (n=5, 71%) or middle (n=6, 86%) adolescence, and there was limited information reported on socioeconomic status. Only 3 (43%) study conducted formative work, and few (n=3, 43%) reported on acceptability. Only 1 (14%) study reported that materials were available in Spanish and English, and only 1 (14%) study used culturally tailored content. Additionally, 3 (43%) studies used strategies that considered social determinants of health. Conclusions: To increase our understanding of the feasibility and effectiveness of technology-based obesity prevention strategies among Hispanic adolescents, there is a need for more feasibility studies that are theoretically grounded and comprehensively report on feasibility-related outcomes. Future studies should also leverage technology to simultaneously address multiple health behaviors beyond diet and physical activity. The result of this review can be used to guide the development of future technology-based obesity prevention strategies among Hispanic adolescents. Trial Registration: CliniclaTrials.gov NCT04953442; https://clinicaltrials.gov/ct2/show/NCT04953442 %M 36331547 %R 10.2196/39261 %U https://pediatrics.jmir.org/2022/4/e39261 %U https://doi.org/10.2196/39261 %U http://www.ncbi.nlm.nih.gov/pubmed/36331547 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40431 %T Evaluating the Effectiveness of a Family-Based Virtual Childhood Obesity Management Program Delivered During the COVID-19 Pandemic in Canada: Prospective Study %A Nuss,Kayla %A Coulter,Rebecca %A DeSilva,Bianca %A Buenafe,Jeann %A Sheikhi,Ronak %A Naylor,Patti-Jean %A Liu,Sam %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8392, samliu@uvic.ca %K childhood obesity management %K virtual intervention %K COVID-19 pandemic %K COVID-19 %K children %K healthy lifestyle %K health promotion %K virtual health %K digital health intervention %K parenting %K obesity %K childhood obesity %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Generation Health (GH) is a 10-week family-based lifestyle program designed to promote a healthy lifestyle for families with children who are off the healthy weight trajectory in British Columbia, Canada. GH uses a blended delivery format that involves 10 weekly in-person sessions, and self-guided lessons and activities on a web portal. The blended program was adapted to be delivered virtually due to the COVID-19 pandemic. Currently, the effectiveness of the virtual GH program compared with that of the blended GH program remains unclear. Objective: We aimed to (1) compare the effectiveness of the virtual GH program delivered during the COVID-19 pandemic with that of the blended GH program delivered prior to the pandemic for changing child physical activity, sedentary and dietary behaviors, screen time, and parental support–related behaviors for child physical activity and healthy eating, and (2) explore virtual GH program engagement and satisfaction. Methods: This study used a single-arm pre-post design. The blended GH program (n=102) was delivered from January 2019 to February 2020, and the virtual GH program (n=90) was delivered during the COVID-19 pandemic from April 2020 to March 2021. Families with children aged 8-12 years and considered overweight or obese (BMI ≥85th percentile according to age and sex) were recruited. Participants completed preintervention and postintervention questionnaires to assess the children’s physical activity, dietary and sedentary behaviors, and screen time, and the parent’s support behaviors. Intervention feedback was obtained by interviews. Repeated measures ANOVA was used to evaluate the difference between the virtual and blended GH programs over time. Qualitative interviews were analyzed using thematic analyses. Results: Both the virtual and blended GH programs improved children’s moderate-to-vigorous physical activity (F1,380=18.37; P<.001; ηp2=0.07) and reduced screen time (F1,380=9.17; P=.003; ηp2=0.06). However, vegetable intake was significantly greater in the virtual GH group than in the blended GH group at the 10-week follow-up (F1,380=15.19; P<.001; ηp2=0.004). Parents in both groups showed significant improvements in support behaviors for children’s physical activity (F1,380=5.55; P=.02; ηp2=0.002) and healthy eating (F1,380=3.91; P<.001; ηp2=0.01), as well as self-regulation of parental support for children’s physical activity (F1,380=49.20; P<.001; ηp2=0.16) and healthy eating (F1,380=91.13; P<.001; ηp2=0.28). Families in both groups were satisfied with program delivery. There were no significant differences in attendance for the weekly in-person or group video chat sessions; however, portal usage was significantly greater in the virtual GH group (mean 50, SD 55.82 minutes) than in the blended GH group (mean 17, SD 15.3 minutes; P<.001). Conclusions: The study findings suggested that the virtual GH program was as effective as the blended program for improving child lifestyle behaviors and parental support–related behaviors. The virtual program has the potential to improve the flexibility and scalability of family-based childhood obesity management interventions. %M 36054663 %R 10.2196/40431 %U https://pediatrics.jmir.org/2022/4/e40431 %U https://doi.org/10.2196/40431 %U http://www.ncbi.nlm.nih.gov/pubmed/36054663 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e38908 %T Motivational Interviewing Conversational Agent for Parents as Proxies for Their Children in Healthy Eating: Development and User Testing %A Smriti,Diva %A Kao,Tsui-Sui Annie %A Rathod,Rahil %A Shin,Ji Youn %A Peng,Wei %A Williams,Jake %A Mujib,Munif Ishad %A Colosimo,Meghan %A Huh-Yoo,Jina %+ College of Computing and Informatics, Drexel University, 3675 Market Street, 10th floor, Philadelphia, PA, 19104, United States, 1 2158952474, ds3659@drexel.edu %K conversational agents %K voice user interface %K voice agents %K proxy %K motivational interviewing %K parents %K healthy eating %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Increased adoption of off-the-shelf conversational agents (CAs) brings opportunities to integrate therapeutic interventions. Motivational Interviewing (MI) can then be integrated with CAs for cost-effective access to it. MI can be especially beneficial for parents who often have low motivation because of limited time and resources to eat healthy together with their children. Objective: We developed a Motivational Interviewing Conversational Agent (MICA) to improve healthy eating in parents who serve as a proxy for health behavior change in their children. Proxy relationships involve a person serving as a catalyst for behavior change in another person. Parents, serving as proxies, can bring about behavior change in their children. Methods: We conducted user test sessions of the MICA prototype to understand the perceived acceptability and usefulness of the MICA prototype by parents. A total of 24 parents of young children participated in 2 user test sessions with MICA, approximately 2 weeks apart. After parents’ interaction with the MICA prototype in each user test session, we used qualitative interviews to understand parents’ perceptions and suggestions for improvements in MICA. Results: Findings showed participants’ perceived usefulness of MICAs for helping them self-reflect and motivating them to adopt healthier eating habits together with their children. Participants further suggested various ways in which MICA can help them safely manage their children’s eating behaviors and provide customized support for their proxy needs and goals. Conclusions: We have discussed how the user experience of CAs can be improved to uniquely offer support to parents who serve as proxies in changing the behavior of their children. We have concluded with implications for a larger context of designing MI-based CAs for supporting proxy relationships for health behavior change. %M 36206036 %R 10.2196/38908 %U https://humanfactors.jmir.org/2022/4/e38908 %U https://doi.org/10.2196/38908 %U http://www.ncbi.nlm.nih.gov/pubmed/36206036 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e40191 %T A Web-Based Intervention to Improve Health Literacy and Obesogenic Behaviors Among Adolescents: Protocol of a Randomized Pilot Feasibility Study for a Parallel Randomized Controlled Trial %A Fleary,Sasha A %+ Department of Community Health and Social Sciences, Graduate School of Public Health and Health Policy, City University of New York, 55 W 125th St, New York, NY, 10027, United States, 1 6463640282, sasha.fleary@sph.cuny.edu %K health literacy %K adolescent %K obesity %K prevention %K diet %K physical activity %K web-based intervention %K eHealth %D 2022 %7 16.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Predictive theoretical models suggest that health knowledge works in conjunction with motivation and behavioral skills to influence adolescents’ obesogenic behavior. However, most of the existing adolescent interventions target these variables in isolation. Furthermore, health literacy (HL), a precursor to health knowledge, is necessary for translating health knowledge into behavior and is negatively related to adolescents’ obesity status. However, HL has not been included in obesity interventions targeting adolescents. Objective: This study aims to pilot the feasibility of a 2-armed web-based obesity prevention intervention in school settings and assess the preliminary effectiveness of adding an HL module to an obesity prevention intervention for adolescents. Methods: This web-based pilot feasibility study will take place in the Northeastern United States. Participants will be adolescents (aged 13-16 years) attending school, and recruitment will be conducted through flyers to parents and adolescents in participating classes or advisory groups at the school. The intervention includes 2 arms: an experimental arm that will receive an HL module and 3 obesity prevention modules and a comparison arm that will receive a vaping module and 3 obesity prevention modules. A blinded randomized procedure will be used to allocate classrooms and advisory groups to the experimental and comparison arms. The intervention will be fully web-based. Participants will complete measures of their HL and obesogenic behavior–related health knowledge, motivation, and behaviors at 3 time points (baseline, 1 month after the intervention, and 3 months after the intervention) via web-based surveys. The primary outcomes will be the measures of study feasibility (recruitment, retention, completion, and treatment fidelity rates). Secondary outcomes will be preliminary efficacy, as measured by logistic and linear regressions and calculation of effect sizes. Descriptive statistics will be calculated for all measures at each time point. Results: This study was approved by the City University of New York Institutional Review Board in August 2020. As of June 2022, the web-based intervention design is complete and ready for use. Recruitment, data collection, and intervention implementation are scheduled to begin in September 2022. These results are expected to be published in 2023. Conclusions: This study’s feasibility findings will inform changes to the intervention content and randomized controlled trial design. The study’s efficacy findings will inform the sample size for the full-scale randomized controlled trial and the preliminary utility of the intervention. Trial Registration: ClinicalTrials.gov NCT04252677; https://clinicaltrials.gov/ct2/show/NCT04252677 International Registered Report Identifier (IRRID): PRR1-10.2196/40191 %M 35972787 %R 10.2196/40191 %U https://www.researchprotocols.org/2022/8/e40191 %U https://doi.org/10.2196/40191 %U http://www.ncbi.nlm.nih.gov/pubmed/35972787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38326 %T Associations of Maternal and Paternal Parenting Practices With Children’s Fruit and Vegetable Intake and Physical Activity: Preliminary Findings From an Ecological Momentary Study %A Lopez,Nanette Virginia %A Lai,Mark HC %A Yang,Chih-Hsiang %A Dunton,Genevieve Fridlund %A Belcher,Britni Ryan %+ Department of Health Sciences, Northern Arizona University, 1100 S Beaver St, Box 15095, Flagstaff, AZ, 86011, United States, 1 928 523 7913, nanette.lopez@nau.edu %K parenting %K ecological momentary assessment %K fruit and vegetable consumption %K physical activity %K pediatrics %K obesity %D 2022 %7 10.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood obesity prevention interventions routinely focus on changing maternal parenting practices. Failure to assess how fathers’ weight-related (ie, diet and physical activity) parenting practices contribute to children’s energy balance behaviors limits the understanding of their paternal role within the family. Examining the independent and interacting effects of fathers’ and mothers’ weight-related parenting practices on children’s diet and physical activity addresses this important research gap. Objective: This study used ecological momentary assessment (EMA) to investigate the within-subject and between-subject independent and interactive effects of maternal and paternal encouragement to eat and preparation of fruits and vegetables (F/V) and encouragement of and taking their child to be physically active on their child’s self-reported F/V intake and physical activity engagement. Methods: Participants included mother-father-child triads (n=22 triads, n=205-213 prompts/occasions) in the Mothers and Their Children’s Health Study and the University of Southern California Fathers Study. Simultaneously, mothers and fathers (agesmean 44.2 years, SD 5.6, and 45.2 years, SD 8.1, respectively), and their children (agemean 12.0 years, SD 0.7) completed up to 8 randomly prompted EMA surveys per day on separate smartphones for 7 days. At each prompt, mothers and fathers each reported whether they did the following in the past 2 hours: (1) encouraged their child to eat F/V, (2) prepared F/V for their child, (3) encouraged their child to be physically active, or (4) took their child to be physically active. Children self-reported whether they consumed F/V or were physically active in the past 2 hours. Results: Results from Bayesian multilevel logistic models (all in log-odd units) indicated that at the within-subject level, greater maternal encouragement (β=2.28, 95% CI 0.08 to 5.68) of eating F/V was associated with greater child report of eating F/V, but paternal encouragement (β=1.50, 95% CI –0.83 to 4.52) showed no effects above and beyond maternal encouragement. Additionally, greater than usual paternal encouragement (β=2.28, 95% CI 0.08 to 5.54) and maternal encouragement (β=2.94, 95% CI 0.36 to 6.69) of physical activity had significant independent effects and were associated with greater child report of physical activity. No other within-subject or between-subject associations nor interactive effects were significant. Conclusions: Findings from this study suggest that fathers play a role in supporting their children’s physical activity but not their intake of F/V. Future EMA studies should recruit larger samples to evaluate the independent and interacting roles of mothers’ and fathers’ weight-related parenting practices on child’s obesogenic behaviors. %M 35947425 %R 10.2196/38326 %U https://formative.jmir.org/2022/8/e38326 %U https://doi.org/10.2196/38326 %U http://www.ncbi.nlm.nih.gov/pubmed/35947425 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38686 %T Effectiveness of Interventions to Promote Physical, Psychological, and Socioeconomic Well-being Outcomes of Parents of Children With Neurodevelopmental Disabilities: Protocol for a Systematic Review %A Novak-Pavlic,Monika %A Rosenbaum,Peter %A Gazzi Macedo,Luciana %A Di Rezze,Briano %A Yong,Joshua %A Noori,Atefeh %A Hughes,Debra %+ School of Rehabilitation Science, McMaster University, Institute for Applied Health Sciences, 1400 Main St W, Hamilton, ON, L8S 1C7, Canada, 1 289 788 0157, monika.novak@outlook.com %K childhood disability %K developmental disability %K family %K health %K parent intervention %K pediatric %K children %K parenting %K rehabilitation %K child development %K health intervention %K peer support %K socioeconomic well-being %K parent support %K meta-analysis %K quality of life %D 2022 %7 28.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: It is well recognized that parents of children with neurodevelopmental disabilities can experience a considerable burden of care associated with their child’s disability, which can potentially impact their functioning and quality of life. Historically, the intervention efforts in pediatric rehabilitation have focused primarily on the child’s development and well-being and much less on parental and family well-being. The impact that a child’s diagnosis might have on parents remains unclear, and it is unknown how we can best support parents on their journey of childhood disability. It is, therefore, important to synthesize the published evidence on interventions for parents of children with neurodevelopmental disabilities so that clinicians can be better informed about the ways in which families they work with can be supported. Objective: This manuscript presents the protocol for a systematic review of the effectiveness of interventions aiming to improve the physical, psychological, or socioeconomic well-being of parents of children with neurodevelopmental disabilities when compared to usual care or no care. Methods: We will systematically search 4 databases (MEDLINE, Embase, PsycINFO, and CINAHL) from the year 2000 until the search date, for randomized controlled trials that evaluated the effectiveness of interventions to improve parental physical, psychological, or socioeconomic well-being. Two authors will independently screen the titles and abstracts, which will then be followed by full-text screening. After the eligibility assessment, two reviewers will independently extract data and conduct a risk of bias assessment using the Cochrane risk-of-bias tool. We will assess the quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation approach. If the data allow, we will perform a pairwise meta-analysis or network meta-analysis. We plan to evaluate the coherence of the network with a global test by using the node-splitting method. Results: As of May 30, 2022, there have been two searches of data initiated: in September 2020 for articles published since 2000 and an updated search in January 2022 for articles published since 2020. We have screened all the titles and abstracts and performed eligibility assessment. However, the final number of references is still not available due to the additional information needed for some of the potentially eligible studies. The results from this systematic review will be published in an indexed journal within a year after this protocol is published. Conclusions: This study is expected to identify a variety of programs to address the well-being needs of parents of children with neurodevelopmental disabilities and provide directions on how parents can best be supported within health care. Such interventions might help professionals and stakeholders in creating service delivery models that can enhance parental well-being and minimize the risks to their physical, psychological, and socioeconomic functioning. Trial Registration: PROSPERO CRD42021230706; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=230706 International Registered Report Identifier (IRRID): DERR1-10.2196/38686 %M 35900806 %R 10.2196/38686 %U https://www.researchprotocols.org/2022/7/e38686 %U https://doi.org/10.2196/38686 %U http://www.ncbi.nlm.nih.gov/pubmed/35900806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35553 %T Exploring the Use of a Web-Based Menu Planning Tool in Childcare Services: Qualitative Cross-sectional Survey Study %A Kempler,Jessica V %A Love,Penelope %A Bolton,Kristy A %A Rozman,Margaret %A Spence,Alison C %+ School of Exercise and Nutrition Sciences, Deakin University, 75 Pigdons Road, Geelong, 3216, Australia, 61 3 9246 8651, jkempler@deakin.edu.au %K child care %K preschool %K early childhood services %K child nutrition %K menu planning %K healthy eating %K web-based systems %K web-based tool %K internet-based intervention %K user experience %D 2022 %7 18.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early childhood is a critical period for supporting the development of healthy eating habits, which may affect lifelong health. Childcare services are important settings for promoting early childhood nutrition; however, food provision in childcare frequently does not align with dietary guidelines. Web-based menu planning tools are well suited to support healthy food provision in childcare, although little is known about their use. Research is needed to understand how web-based menu planning tools are used in the childcare setting and how they can effectively support healthy menu planning and food provision for children in childcare. Objective: We aimed to explore the use of a web-based menu planning tool called FoodChecker, which is available to childcare services in Victoria, Australia. We also aimed to gain insights and perspectives from childcare staff involved in menu planning about their use of the tool to plan healthy menus and guide healthy food provision for children. Methods: We conducted a qualitative descriptive study using a cross-sectional web-based survey completed by the staff involved in menu planning in childcare services. Thematic analysis was performed using NVivo software. Emergent themes were mapped against constructs of the Technology Acceptance Model regarding perceived usefulness, perceived ease of use, and external variables influencing perceptions and use. Results: The participants included 30 cooks and 34 directors from 53 childcare services. Participants perceived the web-based menu planning tool as useful for supporting child nutrition and health, improving organizational processes, and aiding the menu planner role. Perceptions regarding ease of use were mixed. External variables influencing perceptions and use included awareness of the tool, perceived need, time, resources, organizational support, and the food budget. Participants made recommendations to improve the tool, particularly the need to integrate functionality to make it easier and faster to use or to include more links to resources to support healthy menu planning. Conclusions: The web-based menu planning tool was perceived as useful for cooks and directors in childcare services. Areas for improvement were identified; for example, the need for integrated digital features to make the tool easier and faster to use. As the first qualitative study to explore childcare staff experiences with a web-based menu planning tool, these findings inform future research and development of such tools to aid scalable and sustainable support for healthier food provision in the childcare sector. %M 35849438 %R 10.2196/35553 %U https://formative.jmir.org/2022/7/e35553 %U https://doi.org/10.2196/35553 %U http://www.ncbi.nlm.nih.gov/pubmed/35849438 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e36770 %T Dose-Response Relationship of a Blended In-Person and Online Family-Based Childhood Obesity Management Program: Secondary Analysis of a Behavior Intervention %A Liu,Sam %A Smith,Nicholas %A Nuss,Kayla %A Perdew,Megan %A Adiputranto,Dimas %A Naylor,Patti-Jean %+ School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 2507218392, samliu@uvic.ca %K engagement %K dose response %K childhood obesity %K web-based intervention %K child %K obesity %K weight %K web based %K intervention %K family %K families %K lifestyle %K parent %K parental support %K healthy eating %K family support %K physical activity %K diet %K exercise %K fitness %K online portal %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The Early Intervention Program (EIP) was a 10-week, blended, in-person and online lifestyle intervention for families with children who were off the healthy weight trajectory. The engagement pattern and the dose response of EIP have not been examined. Objective: The aims of this paper are to examine families’ engagement patterns with the EIP and to evaluate the dose-response relationship between EIP engagement patterns and physical activity and healthy eating–related outcomes at 10 weeks. Methods: Families with children (8-12 years old) who are off the healthy weight trajectory (child BMI ≥85th percentile for age and sex) were recruited. Pre- and postintervention questionnaires assessed child lifestyle behaviors, parental support behaviors, family lifestyle habits, as well as parental physical activity and healthy-eating identity. Hierarchical cluster analysis of both in-person and online components was used to classify engagement patterns. Regression analysis assessed differences in outcomes by engagement groups. Results: Two distinct clusters of engagement groups were identified (N=66), which were in-person (IP; n=40, 61%) and in-person + online (IP+; n=26, 39%) engagement. Relative to the IP group at week 10, IP+ showed a greater child moderate-to-vigorous physical activity level (1.53, SD 0.56; P=.008), child physical activity confidence (1.04, SD 0.37; P=.007), parental support for child physical activity (5.54, SD 2.57; P=.04) and healthy eating (2.43, SD 1.16; P=.04), family habits for physical activity (3.02, SD 1.50; P=.049) and healthy eating (3.95, SD 1.84; P=.04), and parental identity for physical activity (2.82, SD 1.19; P=.02). Conclusions: The online EIP portal complemented the in-person sessions. Additional engagement with the portal was associated with greater improvements in child physical activity and parental support behaviors, habits, and identity for physical activity. %M 35787514 %R 10.2196/36770 %U https://pediatrics.jmir.org/2022/3/e36770 %U https://doi.org/10.2196/36770 %U http://www.ncbi.nlm.nih.gov/pubmed/35787514 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e36925 %T The Role of Mealtimes in Fostering Language Development and Aligning Home and School Learning: Protocol for a Multi-Method Study of Preschool Children in Rural Kenya and Zambia %A Zeidler,Henriette %A Farrow,Claire %A Jarman,Megan %A Koteng,Grace %A Simatende,Barnabas %A Matthews,Danielle %A Mooya,Haatembo %A Shapiro,Laura R %A Wadende,Pamela %+ School of Psychology, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, United Kingdom, 44 702349027, h.zeidler1@aston.ac.uk %K language development %K nutrition %K preschool education %K school %K education %K home %K environment %K academic %K children %K student %K language learning %K language %K caregiving %K responsive caregiving %K speech %K child-directed speech %K nutritional level %D 2022 %7 5.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The association between school and home is fundamental to sustainable education: parents’ understanding of the school’s priorities and teachers’ understanding of their pupils’ home environment are both vital for children to remain in school and succeed academically. The relationship between parents and teachers is closest in preschool settings, providing a valuable opportunity to build bridges between home and school. In this protocol paper, we outline our planned methods for identifying beneficial home and school behaviors. Objective: Our project aims to identify culture-specific structures and behaviors in home and school settings, which influence the quantity and quality of child-directed speech and identify positive experiences that can help improve children’s linguistic development and nutrition. Methods: Using a mixed methods approach and focusing on early language learning, nutrition, and responsive caregiving, we will video-record and analyze mealtime language and eating behaviors at home and in school, targeting 80 preschool children and their families in rural Kenya and Zambia. In addition, we will assess children’s language skills through audio recordings and use questionnaire-based interviews to collect extensive sociodemographic and dietary data. Results: Between the start of our project in January 2020 and the end of December 2021, we had collected complete sets of sociodemographic, observational, and food recall data for 40 children in Kenya and 16 children in Zambia. By the end of May 2022, we had started data collection for an additional 24 children in Zambia and transcribed and coded approximately 85% of the data. By the end of September, 2022, we plan to complete data collection, transcription, and coding for the entire sample of 80 children across both countries. From September 2022 onwards, we will focus on analyzing our language data, and we hope to have results ready for publication in early 2023. By relating children’s language outcomes and nutritional intake to the observed mealtime behaviors, we hope to identify practices that increase the quantity and quality of child-directed speech and improve children’s nutritional intake. Conclusions: Good nutrition and the promotion of language learning are key issues in early childhood development. By using a cross-cultural approach, combining a variety of methods, and working closely with stakeholders and policy makers throughout the project, we hope to find and share best practices for improving children’s linguistic outcomes and nutrition and lay the foundation for the development of practitioner networks and parent outreach programs. International Registered Report Identifier (IRRID): DERR1-10.2196/36925 %M 35788473 %R 10.2196/36925 %U https://www.researchprotocols.org/2022/7/e36925 %U https://doi.org/10.2196/36925 %U http://www.ncbi.nlm.nih.gov/pubmed/35788473 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e33137 %T The Effects of a Computer Game (Healthy Rat King) on Preschool Children’s Nutritional Knowledge and Junk Food Intake Behavior: Nonrandomized Controlled Trial %A Chang,Ing-Chau %A Yang,Cheng-Ying %A Yen,Chin-En %+ Department of Early Childhood Development and Education, Chaoyang University of Technology, 168, Jifeng East Road, Wufeng District, Taichung, 41349, Taiwan, 886 4 23323000 ext 4706, ceyen@cyut.edu.tw %K computer games %K nutrition knowledge %K junk food %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Playing computer-aided games could enhance children’s interest in learning about nutritional knowledge and eventually promote healthy dietary intake behavior. Objective: This study aims to evaluate the effectiveness of a computer game (Healthy Rat King) in improving the knowledge on nutrition and junk food intake among preschool children in Taiwan. Methods: This was a quasi-experimental study that utilized the computer game Healthy Rat King as the nutrition education tool. We recruited 104 preschool children (aged 5-6 years) from preschools in central Taiwan, who were assigned to either the experimental group (n=56) or the control group (n=48). In the experimental group, a 1-hour computer-based educational game intervention was included in the course for 4 consecutive weeks. The control group did not receive this intervention. Results: The level of nutritional knowledge for children in the experimental group was significantly higher than those in the control group after 4 weeks (P=.002). Furthermore, the frequency of consumption of chocolate, candies, and ice cream (high-calorie junk food) was reduced in the experimental group. There was also no significant difference in the consumption of candy and chocolate (P=.54), ice cream and ice pops (P=.21), cake (P=.92), biscuit (P=.98), soft drinks (P=.52), and fruit juice and sugary drinks (P=.31) between the 2 groups in the posttest. Conclusions: Teaching using a computer game could improve children’s nutritional knowledge. However, the intake frequency of junk food among children in the experimental group showed no significant difference from those in the control group. %M 35776502 %R 10.2196/33137 %U https://games.jmir.org/2022/3/e33137 %U https://doi.org/10.2196/33137 %U http://www.ncbi.nlm.nih.gov/pubmed/35776502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e35285 %T The Aim2Be mHealth Intervention for Children With Overweight or Obesity and Their Parents: Person-Centered Analyses to Uncover Digital Phenotypes %A De-Jongh González,Olivia %A Tugault-Lafleur,Claire N %A Buckler,E Jean %A Hamilton,Jill %A Ho,Josephine %A Buchholz,Annick %A Morrison,Katherine M %A Ball,Geoff DC %A Mâsse,Louise C %+ School of Population and Public Health, University of British Columbia, BC Children's Hospital Research Institute, 4480 Oak St., Vancouver, BC, V6H 3V4, Canada, 1 6048752000 ext 5563, lmasse@bcchr.ubc.ca %K mobile health %K mHealth %K childhood obesity %K digital phenotypes %K latent class analysis %D 2022 %7 22.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing number of mobile health (mHealth) interventions targeting childhood obesity, few studies have characterized user typologies derived from individuals’ patterns of interactions with specific app features (digital phenotypes). Objective: This study aims to identify digital phenotypes among 214 parent-child dyads who used the Aim2Be mHealth app as part of a randomized controlled trial conducted between 2019 and 2020, and explores whether participants’ characteristics and health outcomes differed across phenotypes. Methods: Latent class analysis was used to identify distinct parent and child phenotypes based on their use of the app’s behavioral, gamified, and social features over 3 months. Multinomial logistic regression models were used to assess whether the phenotypes differed by demographic characteristics. Covariate-adjusted mixed-effect models evaluated changes in BMI z scores (zBMI), diet, physical activity, and screen time across phenotypes. Results: Among parents, 5 digital phenotypes were identified: socially engaged (35/214, 16.3%), independently engaged (18/214, 8.4%) (socially and independently engaged parents are those who used mainly the social or the behavioral features of the app, respectively), fully engaged (26/214, 12.1%), partially engaged (32/214, 15%), and unengaged (103/214, 48.1%) users. Married parents were more likely to be fully engaged than independently engaged (P=.02) or unengaged (P=.01) users. Socially engaged parents were older than fully engaged (P=.02) and unengaged (P=.01) parents. The latent class analysis revealed 4 phenotypes among children: fully engaged (32/214, 15%), partially engaged (61/214, 28.5%), dabblers (42/214, 19.6%), and unengaged (79/214, 36.9%) users. Fully engaged children were younger than dabblers (P=.04) and unengaged (P=.003) children. Dabblers lived in higher-income households than fully and partially engaged children (P=.03 and P=.047, respectively). Fully engaged children were more likely to have fully engaged (P<.001) and partially engaged (P<.001) parents than unengaged children. Compared with unengaged children, fully and partially engaged children had decreased total sugar (P=.006 and P=.004, respectively) and energy intake (P=.03 and P=.04, respectively) after 3 months of app use. Partially engaged children also had decreased sugary beverage intake compared with unengaged children (P=.03). Similarly, children with fully engaged parents had decreased zBMI, whereas children with unengaged parents had increased zBMI over time (P=.005). Finally, children with independently engaged parents had decreased caloric intake, whereas children with unengaged parents had increased caloric intake over time (P=.02). Conclusions: Full parent-child engagement is critical for the success of mHealth interventions. Further research is needed to understand program design elements that can affect participants’ engagement in supporting behavior change. Trial Registration: ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/NCT03651284 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4080-2 %M 35731547 %R 10.2196/35285 %U https://www.jmir.org/2022/6/e35285 %U https://doi.org/10.2196/35285 %U http://www.ncbi.nlm.nih.gov/pubmed/35731547 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33929 %T A Web-Based mHealth Intervention With Telephone Support to Increase Physical Activity Among Pregnant Patients With Overweight or Obesity: Feasibility Randomized Controlled Trial %A Thomas,Tainayah %A Xu,Fei %A Sridhar,Sneha %A Sedgwick,Tali %A Nkemere,Linda %A Badon,Sylvia E %A Quesenberry,Charles %A Ferrara,Assiamira %A Mandel,Sarah %A Brown,Susan D %A Hedderson,Monique %+ Department of Epidemiology and Population Health, Stanford University School of Medicine, 1701 Page Mill Road, Palo Alto, CA, 94304, United States, 1 3107211208, tainayah@stanford.edu %K mobile health %K gestational weight gain %K obesity %K physical activity %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnant patients with overweight or obesity are at high risk for perinatal complications. Excess gestational weight gain (GWG) further exacerbates this risk. Mobile health (mHealth) lifestyle interventions that leverage technology to facilitate self-monitoring and provide just-in-time feedback may motivate behavior change to reduce excess GWG, reduce intervention costs, and increase scalability by improving access. Objective: This study aimed to test the acceptability and feasibility of a pilot mHealth lifestyle intervention for pregnant patients with overweight or obesity to promote moderate intensity physical activity (PA), encourage guideline-concordant GWG, and inform the design of a larger pragmatic cluster randomized controlled trial. Methods: We conducted a mixed methods acceptability and feasibility randomized controlled trial among pregnant patients with a prepregnancy BMI of 25 to 40 kg/m2. Patients with singletons at 8 to 15 weeks of gestation who were aged ≥21 years and had Wi-Fi access were recruited via email from 2 clinics within Kaiser Permanente Northern California and randomized to receive usual prenatal care or an mHealth lifestyle intervention. Participants in the intervention arm received wireless scales, access to an intervention website, activity trackers to receive automated feedback on weight gain and activity goals, and monthly calls from a lifestyle coach. Surveys and focus groups with intervention participants assessed intervention satisfaction and ways to improve the intervention. PA outcomes were self-assessed using the Pregnancy Physical Activity Questionnaire, and GWG was assessed using electronic health record data for both arms. Results: Overall, 33 patients were randomly assigned to the intervention arm, and 35 patients were randomly assigned to the usual care arm. All participants in the intervention arm weighed themselves at least once a week, compared with 20% (7/35) of the participants in the usual care arm. Participants in the intervention arm wore the activity tracker 6.4 days per week and weighed themselves 5.3 times per week, and 88% (29/33) of them rated the program “good to excellent.” Focus groups found that participants desired more nutrition-related support to help them manage GWG and would have preferred an app instead of a website. Participants in the intervention arm had a 23.46 metabolic equivalent of task hours greater change in total PA per week and a 247.2-minute greater change in moderate intensity PA per week in unadjusted models, but these effects were attenuated in adjusted models (change in total PA: 15.55 metabolic equivalent of task hours per week; change in moderate intensity PA: 199.6 minutes per week). We found no difference in total GWG (mean difference 1.14 kg) compared with usual care. Conclusions: The pilot mHealth lifestyle intervention was feasible, highly acceptable, and promoted self-monitoring. Refined interventions are needed to effectively affect PA and GWG among pregnant patients with overweight or obesity. Trial Registration: ClinicalTrials.gov NCT03936283; https://clinicaltrials.gov/ct2/show/NCT03936283 %M 35731565 %R 10.2196/33929 %U https://formative.jmir.org/2022/6/e33929 %U https://doi.org/10.2196/33929 %U http://www.ncbi.nlm.nih.gov/pubmed/35731565 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e33412 %T HelperFriend, a Serious Game for Promoting Healthy Lifestyle Behaviors in Children: Design and Pilot Study %A Espinosa-Curiel,Ismael Edrein %A Pozas-Bogarin,Edgar Efrén %A Hernández-Arvizu,Maryleidi %A Navarro-Jiménez,Maria Elena %A Delgado-Pérez,Edwin Emeth %A Martínez-Miranda,Juan %A Pérez-Espinosa,Humberto %+ Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Andador 10, entre calles 3 y 4, Ciudad del Conocimiento, Tepic, Nayarit, 63173, Mexico, 52 3111295930 ext 28607, ecuriel@cicese.mx %K serious game %K children %K education and behavior change %K healthy lifestyle behaviors %K physical activity %K healthy eating %K socioemotional wellness %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The use of health games is a promising strategy for educating and promoting healthy lifestyle behaviors among children. Objective: We aimed to describe the design and development of a serious game, called HelperFriend, and evaluate its feasibility, acceptability, and preliminary effects in children in a pilot study. HelperFriend is a vicarious experiential video game designed to promote 3 lifestyle behaviors among young children: physical activity, healthy eating, and socioemotional wellness. Methods: Participants aged 8 to 11 years were recruited from an elementary school and randomized to receive a healthy lifestyle behavior educational talk (control) or play six 30-minute sessions with HelperFriend (intervention). Assessments were conducted at baseline (T0) and after the intervention (ie, 4 weeks) (T1). The primary outcome was gain in knowledge. The secondary outcomes were intention to conduct healthy behaviors, dietary intake, and player satisfaction. Results: Knowledge scores of intervention group participants increased from T0 to T1 for physical activity (t14=2.01, P=.03), healthy eating (t14=3.14, P=.003), and socioemotional wellness (t14=2.75, P=.008). In addition, from T0 to T1, the intervention group improved their intention to perform physical activity (t14=2.82, P=.006), healthy eating (t14=3.44, P=.002), and socioemotional wellness (t14=2.65, P=.009); and there was a reduction in their intake of 13 unhealthy foods. HelperFriend was well received by intervention group. Conclusions: HelperFriend appears to be feasible and acceptable for young children. In addition, this game seems to be a viable tool to help improve the knowledge, the intention to conduct healthy behaviors, and the dietary intake of children; however, a well-powered randomized controlled trial is needed to prove the efficacy of HelperFriend. %M 35522474 %R 10.2196/33412 %U https://games.jmir.org/2022/2/e33412 %U https://doi.org/10.2196/33412 %U http://www.ncbi.nlm.nih.gov/pubmed/35522474 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37126 %T Physical Activity and Nutrition Intervention for Middle Schoolers (Move More, Get More): Protocol for a Quasi-Experimental Study %A Grimes,Amanda %A Lightner,Joseph S %A Eighmy,Katlyn %A Wray,Bridget D %A Valleroy,Ella %A Baughn,Maya %+ School of Nursing and Health Studies, University of Missouri, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 816 235 1737, grimesa@umkc.edu %K intervention protocol %K physical activity %K food intake %K nutrition %K healthy eating %K middle schoolers %K youth %K school %K student %K fitness %K exercise %K food consumption %K diet %K fruit consumption %K vegetable consumption %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity and nutrition behaviors are important to reducing the prevalence of childhood obesity. Previous research has identified school-based interventions as effective strategies to improve physical activity and nutrition. However, the results are often mixed, and middle schoolers are an under-studied population. Objective: Our study aims to fill this gap by developing an after-school intervention to increase physical activity and fruit and vegetable consumption that is influenced by national guidelines and formative research. Methods: This study was an after-school, quasi-experimental study spanning 9 months. Enrollment began in September 2021 and continued on a rolling basis through February 2022. Weekly, middle schoolers were offered 2-3 physical activity sessions and 1 produce kit. Physical activity was measured using accelerometers and questionnaires. Nutrition behaviors were assessed using questionnaires, and physical literacy was assessed using researcher observations. Follow-up data collection occurred in December 2021 and in April 2022. Difference scores will be calculated and analyzed for each outcome variable. Results: The intervention started in September 2021 and will conclude in May 2022. Published study results are expected in late 2022. Conclusions: An increase in physical literacy, physical activity, and fruit and vegetable consumption is expected. If successful, future studies will focus on reach and sustainability. Lastly, this study may serve as a model for improving health outcomes in middle schools. International Registered Report Identifier (IRRID): DERR1-10.2196/37126 %M 35507392 %R 10.2196/37126 %U https://www.researchprotocols.org/2022/5/e37126 %U https://doi.org/10.2196/37126 %U http://www.ncbi.nlm.nih.gov/pubmed/35507392 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e33552 %T Oral Health Status and Practices, and Anthropometric Measurements of Preschool Children: Protocol for a Multi-African Country Survey %A El Tantawi,Maha %A Folayan,Morenike O %A Bhayat,Ahmed %+ Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Champolion St., Azarita, Alexandria, 21527, Egypt, 20 01227824017, maha_tantawy@hotmail.com %K oral health %K early childhood caries %K oral hygiene %K dietary intake %K Africa %K preschool children %K dentistry %K oral disease %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Oral diseases are among the most prevalent conditions with significant impact on the growth and development of young children. Data are required to plan effectively for the management of early childhood caries (ECC) and other oral diseases in this age. There are currently very few African countries with updated and nationally representative data on ECC prevalence, and risk indicators and regional data on ECC and other oral diseases are scarce. Objective: We aim to determine the oral health status and practices, dietary intake, and anthropometric measurements of preschool children in several African countries. Methods: A cross-sectional study will be conducted in several African countries using a standardized questionnaire and clinical examination for data collection from healthy preschool children in kindergartens and primary health care facilities. The clinical examination will assess ECC using the decayed, missing due to caries, and filled teeth (dmft) index according to the World Health Organization (WHO) criteria, dental erosion (using the Basic Erosive Wear Examination Index), deciduous molar hypomineralization (using the European Association of Paediatric Dentistry criteria), dental fluorosis (using Dean’s Index), oral hygiene status (using the Oral Hygiene Index Simplified), and oral mucosal lesions. Oral hygiene habits and dental visits will be assessed using the WHO child questionnaire, and dietary intake will be assessed using the Food and Agriculture Organization method. Anthropometric measurements will be obtained following the International Society for the Advancement of Kinanthropometry standard protocol, and the children’s nutritional status will be assessed following the WHO child growth standards. To train and calibrate examiners, educational resources and electronic forms will be used to reach interexaminer and intraexaminer reliability with κ>0.6. Descriptive analysis will determine the prevalence of clinical conditions by age and sex. Bivariate analysis and multivariable regression will assess associations between the clinical conditions and sociodemographic factors, and oral health behaviors. Results: Data collection will begin after approvals and ethical clearance are obtained. The first stage will include 3 countries, namely Egypt, Nigeria, and South Africa, and collaborators from other African countries will join afterward. Conclusions: This study will lay down the foundations for using validated tools to collect data on the oral health of young children in Africa, allowing researchers from different countries across Africa to collect standardized data on ECC and other oral conditions. This will facilitate comparisons and analysis of risk factors that might be unique to the African continent. The results will provide baseline data on the prevalence of oral diseases and enable planning to address the treatment needs of young African children and design programs to prevent oral diseases in the African continent. International Registered Report Identifier (IRRID): PRR1-10.2196/33552 %M 35476047 %R 10.2196/33552 %U https://www.researchprotocols.org/2022/4/e33552 %U https://doi.org/10.2196/33552 %U http://www.ncbi.nlm.nih.gov/pubmed/35476047 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e34967 %T Effectiveness of Mobile Apps in Promoting Healthy Behavior Changes and Preventing Obesity in Children: Systematic Review %A Yau,Kiana W %A Tang,Tricia S %A Görges,Matthias %A Pinkney,Susan %A Kim,Annie D %A Kalia,Angela %A Amed,Shazhan %+ Research Institute, BC Children's Hospital, A4-196, 950 West 28 Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 604 875 3113, SAmed@cw.bc.ca %K childhood obesity %K mobile health %K health behaviors %K prevention %K study design %K systematic review %K mobile phone %D 2022 %7 28.3.2022 %9 Review %J JMIR Pediatr Parent %G English %X Background: Mobile apps have been increasingly incorporated into healthy behavior promotion interventions targeting childhood obesity. However, their effectiveness remains unclear. Objective: This paper aims to conduct a systematic review examining the effectiveness of mobile apps aimed at preventing childhood obesity by promoting health behavior changes in diet, physical activity, or sedentary behavior in children aged 8 to 12 years. Methods: MEDLINE, Embase, PsycINFO, CINAHL, and ERIC were systematically searched for peer-reviewed primary studies from January 2008 to July 2021, which included children aged 8 to 12 years; involved mobile app use; and targeted at least one obesity-related factor, including diet, physical activity, or sedentary behavior. Data extraction and risk of bias assessments were conducted by 2 authors. Results: Of the 13 studies identified, most used a quasi-experimental design (n=8, 62%). Significant improvements in physical activity (4/8, 50% studies), dietary outcomes (5/6, 83% studies), and BMI (2/6, 33% studies) were reported. All 6 multicomponent interventions and 57% (4/7) of standalone interventions reported significant outcomes in ≥1 behavioral change outcome measured (anthropometric, physical activity, dietary, and screen time outcomes). Gamification, behavioral monitoring, and goal setting were common features of the mobile apps used in these studies. Conclusions: Apps for health behavior promotion interventions have the potential to increase the adoption of healthy behaviors among children; however, their effectiveness in improving anthropometric measures remains unclear. Further investigation of studies that use more rigorous study designs, as well as mobile apps as a standalone intervention, is needed. %M 35343908 %R 10.2196/34967 %U https://pediatrics.jmir.org/2022/1/e34967 %U https://doi.org/10.2196/34967 %U http://www.ncbi.nlm.nih.gov/pubmed/35343908 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27760 %T An mHealth Intervention to Reduce the Packing of Discretionary Foods in Children’s Lunch Boxes in Early Childhood Education and Care Services: Cluster Randomized Controlled Trial %A Pearson,Nicole %A Finch,Meghan %A Sutherland,Rachel %A Kingsland,Melanie %A Wolfenden,Luke %A Wedesweiler,Taya %A Herrmann,Vanessa %A Yoong,Sze Lin %+ Hunter New England Population Health, Longworth Avenue, Wallsend, 2308, Australia, 61 02 49246031 ext 46031, Nicole.Pearson@health.nsw.gov.au %K nutrition %K mHealth %K child %K preschool %K parents %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Interventions in early childhood education and care (ECEC) services have the potential to improve children’s diet at the population level. Objective: This study aims to test the efficacy of a mobile health intervention in ECEC services to reduce parent packing of foods high in saturated fat, sugar, and sodium (discretionary foods) in children’s (aged 3-6 years) lunch boxes. Methods: A cluster randomized controlled trial was undertaken with 355 parent and child dyads recruited by phone and in person from 17 ECEC services (8 [47%] intervention and 9 [53%] control services). Parents in the intervention group received a 10-week fully automated program targeting barriers to packing healthy lunch boxes delivered via an existing service communication app. The program included weekly push notifications, within-app messages, and links to further resources, including websites and videos. The control group did not receive any intervention. The primary outcomes were kilojoules from discretionary foods and associated nutrients (saturated fat, free sugars, and sodium) packed in children’s lunch boxes. Secondary outcomes included consumption of kilojoules from discretionary foods and related nutrients and the packing and consumption of serves of discretionary foods and core food groups. Photography and weights of foods in children’s lunch boxes were recorded by trained researchers before and after the trial to assess primary and secondary outcomes. Outcome assessors were blinded to service allocation. Feasibility, appropriateness, and acceptability were assessed via an ECEC service manager survey and a parent web-based survey. Use of the app was assessed via app analytics. Results: Data on packed lunch box contents were collected for 88.8% (355/400) of consenting children at baseline and 84.3% (337/400) of children after the intervention. There was no significant difference between groups in kilojoule from discretionary foods packed (77.84 kJ, 95% CI −163.49 to 319.18; P=.53) or the other primary or secondary outcomes. The per-protocol analysis, including only data from children of parents who downloaded the app, also did not find any statistically significant change in primary (−1.98 kJ, 95% CI −343.87 to 339.90; P=.86) or secondary outcomes. Approximately 61.8% (102/165) of parents in the intervention group downloaded the app, and the mean service viewing rate of weekly within-app messages was 26% (SD 14.9). Parents who responded to the survey and participating services agreed that it was appropriate to receive lunch box information via the app (40/50, 80% and 6/8, 75%, respectively). Conclusions: The intervention was unable to demonstrate an impact on kilojoules or associated nutrients from discretionary foods packed in children’s lunch boxes. Low app downloads and program message views indicate a need to explore how to improve factors related to implementation before further testing similar mobile health interventions in this setting. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000133235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374379 %M 35297768 %R 10.2196/27760 %U https://www.jmir.org/2022/3/e27760 %U https://doi.org/10.2196/27760 %U http://www.ncbi.nlm.nih.gov/pubmed/35297768 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31537 %T The Content, Quality, and Behavior Change Techniques in Nutrition-Themed Mobile Apps for Children in Canada: App Review and Evaluation Study %A Brown,Jacqueline Marie %A Franco-Arellano,Beatriz %A Froome,Hannah %A Siddiqi,Amina %A Mahmood,Amina %A Arcand,JoAnne %+ Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe Street North, Oshawa, ON, L1H 7K4, Canada, 1 905 721 8668, joanne.arcand@ontariotechu.ca %K mHealth %K children %K app quality %K behavior change techniques %K child nutrition %K mobile apps %K Canada %K mobile phone %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Children increasingly use mobile apps. Strategies to increase child engagement with apps include the use of gamification and images that incite fun and interaction, such as food. However, the foods and beverages that children are exposed to while using apps are unknown and may vary by app type. Objective: The aim of this study is to identify the app content (ie, types of foods and beverages) included in nutrition-themed apps intended for children, to assess the use of game-like features, and to examine app characteristics such as overall quality and behavior change techniques (BCTs). Methods: This analysis used a cross-sectional database of nutrition-themed apps intended for children (≤12 years), collected between May 2018 and June 2019 from the Apple App Store and Google Play Store (n=259). Apps were classified into four types: food games or nongames that included didactic nutrition guides, habit trackers, and other. Food and beverages were identified in apps and classified into 16 food categories, as recommended (8/16, 50%) and as not recommended (8/16, 50%) by dietary guidelines, and quantified by app type. Binomial logistic regression assessed whether game apps were associated with foods and beverages not recommended by guidelines. App quality, overall and by subscales, was determined using the Mobile App Rating Scale. The BCT Taxonomy was used to classify the different behavioral techniques that were identified in a subsample of apps (124/259, 47.9%). Results: A total of 259 apps displayed a median of 6 (IQR 3) foods and beverages. Moreover, 62.5% (162/259) of apps were classified as food games, 27.4% (71/259) as didactic nutrition guides, 6.6% (17/259) as habit trackers, and 3.5% (9/259) as other. Most apps (198/259, 76.4%) displayed at least one food or beverage that was not recommended by the dietary guidelines. Food game apps were almost 3 times more likely to display food and beverages not recommended by the guidelines compared with nongame apps (β=2.8; P<.001). The overall app quality was moderate, with a median Mobile App Rating Scale score of 3.6 (IQR 0.7). Functionality was the subscale with the highest score (median 4, IQR 0.3). Nutrition guides were more likely to be educational and contain informative content on healthy eating (score 3.7), compared with the other app types, although they also scored significantly lower in engagement (score 2.3). Most apps (105/124, 84.7%) displayed at least one BCT, with the most common BCT being information about health consequences. Conclusions: Findings suggest nutrition-themed apps intended for children displayed food and beverage content not recommended by dietary guidelines, with gaming apps more likely to display not recommended foods than their nongame counterparts. Many apps have a moderate app quality, and the use of consequences (instead of rewards) was the most common BCT. %M 35171100 %R 10.2196/31537 %U https://mhealth.jmir.org/2022/2/e31537 %U https://doi.org/10.2196/31537 %U http://www.ncbi.nlm.nih.gov/pubmed/35171100 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31475 %T The Shishu Pushti Trial–Extended Peer Counseling for Improving Feeding Practices and Reducing Undernutrition in Children Aged 0-48 Months in Urban Bangladesh: Protocol for a Cluster-Randomized Controlled Trial %A Mihrshahi,Seema %A Ara,Gulshan %A Khanam,Mansura %A Rasheed,Sabrina %A Agho,Kingsley Emwinyore %A Kabir,AKM Iqbal %A Roy,S K %A Haider,Rukhsana %A Derakhshani Hamadani,Jena %A Tofail,Fahmida %A Alam,Ashraful %A Dibley,Michael J %+ Department of Health Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, 75T Building, 75 Talavera Rd, Macquarie Park, 2109, Australia, 61 2 98502468, seema.mihrshahi@mq.edu.au %K child stunting %K prevention %K nutrition behavior change %K breastfeeding: infant and young child feeding %K peer counseling, child development %D 2022 %7 7.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The aim of this study is to assess if peer counseling of women improves breastfeeding, complementary feeding practices, and child growth, and thus reduces the prevalence of undernutrition in children up to 4 years of age. Objective: Lack of exclusive breastfeeding and inappropriate complementary feeding are critical factors in reducing child undernutrition, morbidity, and mortality. There are reported trials of peer counseling to improve breastfeeding; however, they did not examine the efficacy of peer counseling to improve complementary feeding or the long-term impacts on child growth and development. Methods: This study has used a community-based, cluster-randomized controlled trial with a superiority design and 2 parallel treatment arms. It is assessing the impact of peer counseling, starting in late pregnancy up to 1 year after delivery, on child feeding practices, growth, and development with follow-up until 48 months of age. The study site was Mirpur, a densely populated area in Dhaka. Using satellite maps and geographic information system mapping, we constructed 36 clusters with an average population of 5000 people. We recruited pregnant women in the third trimester aged 16-40 years, with no more than 3 living children. Trained peer counselors visited women at home twice before delivery, 4 times in the first month, monthly from 2 to 6 months, and again at 9 and 12 months. Trained research assistants collected anthropometric measurements. The primary outcome will be differences in child stunting and mean length for age at 6, 12, 15, and 18 months. Secondary outcomes will be differences in the percentage of women exclusively breastfeeding in the mean duration of any breastfeeding and in the percentage of children at 6 and 9 months of age who receive solid, semisolid, or soft foods; and the percentage of children consuming foods from 4 or more food groups at 9, 12, 15, and 18 months. We will assess the mean cognitive function scores from the Ages and Stages Questionnaire (9 and 18 months) and Bayley tests (24 and 36 months). Results: We identified 65,535 people in mapped residences, from which we defined 36 clusters and randomly allocated them equally to intervention or control groups stratified by cluster socioeconomic status. From July 2011 to May 2013, we identified 1056 pregnant women and 993 births in the intervention group and 994 pregnancies and 890 births in the control group. At 18 months, 692 children remained in the intervention group and 551 in the control group. From January 2015 to February 2017, we conducted the long-term follow-up of the cohort. We have now completed the data collection and processing and have started analyses. Conclusions: This study will help fill the evidence gap about the short- and long-term impact of peer counseling on improving infant feeding, preventing childhood undernutrition, and enhancing child cognitive development. Trial Registration: ClinicalTrials.gov NCT01333995; https://clinicaltrials.gov/ct2/show/NCT01333995 International Registered Report Identifier (IRRID): DERR1-10.2196/31475 %M 35129457 %R 10.2196/31475 %U https://www.researchprotocols.org/2022/2/e31475 %U https://doi.org/10.2196/31475 %U http://www.ncbi.nlm.nih.gov/pubmed/35129457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33322 %T Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19–Related Health Challenges: Formative Research Study %A Grimes,Amanda %A Lightner,Joseph S %A Pina,Kimberly %A Donis de Miranda,Evelyn S %A Meissen-Sebelius,Emily %A Shook,Robin P %A Hurley,Emily A %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 816 235 1737, grimesa@umkc.edu %K intervention %K physical activity %K nutrition %K adolescents %K formative research %K COVID-19 %K exercise %K young adult %K teenager %K focus group %K qualitative %K interview %K urban %K barrier %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19). Objective: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest. Methods: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software. Results: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day. Conclusions: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted. %M 34932499 %R 10.2196/33322 %U https://formative.jmir.org/2022/1/e33322 %U https://doi.org/10.2196/33322 %U http://www.ncbi.nlm.nih.gov/pubmed/34932499 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30352 %T A Mobile App to Increase Fruit and Vegetable Acceptance Among Finnish and Polish Preschoolers: Randomized Trial %A Vepsäläinen,Henna %A Skaffari,Essi %A Wojtkowska,Katarzyna %A Barlińska,Julia %A Kinnunen,Satu %A Makkonen,Riikka %A Heikkilä,Maria %A Lehtovirta,Mikko %A Ray,Carola %A Suhonen,Eira %A Nevalainen,Jaakko %A Sajaniemi,Nina %A Erkkola,Maijaliisa %+ Department of Food and Nutrition, University of Helsinki, PO Box 66, Helsinki, 00014, Finland, 358 443581467, henna.vepsalainen@helsinki.fi %K gamification %K intervention %K behavior change %K health game %K games for health %K smartphone app %K mobile phone %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early childhood education and care (ECEC) centers are ideal venues for food education. As smartphones and tablets are becoming increasingly popular in ECEC centers, technology can be used to deliver such pedagogical content. Evidence suggests that video games can affect fruit and vegetable (FV) consumption among 9- to 12-year-old children, but studies among preschoolers are scarce. Objective: This paper describes the development of the Mole’s Veggie Adventures app and its effectiveness in increasing FV acceptance among Finnish and Polish preschoolers aged 3 to 6 years. Methods: A multiprofessional team created an app to be used in ECEC centers in groups of 3 to 10 children. The app aimed to increase vegetable acceptance, and it was built using elements that support the development of self-regulation and social skills. Altogether, 7 Finnish and 4 Polish ECEC centers participated in the study. Before randomization, parents reported background factors and their children’s willingness to taste different FVs. The ECEC professionals in the intervention arm were instructed to use the app at least once a week during the 3- to 4-week intervention period. The main outcomes in this unblinded, cluster-randomized study were FV acceptance and relative FV acceptance. The first was calculated as a sum variable describing the children’s willingness to taste 25 different FVs, the second as FV acceptance divided by the number of FVs served. We used analysis of covariance to compare the FV acceptance and relative FV acceptance scores between the intervention and control groups at follow-up. Results: A total of 221 children were included in the analysis. At follow-up, the intervention group (115/221, 52%) had higher FV acceptance scores (baseline adjusted difference of mean 7.22; 95% CI 1.41-13.03) than the control group (106/221, 48%). The intervention effect was parallel for relative FV acceptance scores (baseline adjusted difference of mean 0.28; 95% CI 0.05-0.52). Conclusions: The Mole’s Veggie Adventures app has the potential to increase FV acceptance among preschoolers and can be a valuable tool in supporting food education in ECEC centers. Furthermore, the app can be feasibly incorporated into preschool routines in countries with different educational environments. Trial Registration: ClinicalTrials.gov NCT05173311; https://tinyurl.com/4vfbh283 %M 34982718 %R 10.2196/30352 %U https://mhealth.jmir.org/2022/1/e30352 %U https://doi.org/10.2196/30352 %U http://www.ncbi.nlm.nih.gov/pubmed/34982718 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25902 %T Feasibility of a Web-Based Implementation Intervention to Improve Child Dietary Intake in Early Childhood Education and Care: Pilot Randomized Controlled Trial %A Barnes,Courtney %A Yoong,Sze Lin %A Nathan,Nicole %A Wolfenden,Luke %A Wedesweiler,Taya %A Kerr,Jayde %A Ward,Dianne S %A Grady,Alice %+ Hunter New England Population Health, Locked Bag 10, Wallsend, Newcastle, 2287, Australia, 61 0249246678, courtney.barnes@health.nsw.gov.au %K childcare center %K web-based %K nutrition %K healthy eating %K randomized controlled trial %K intervention %K implementation %D 2021 %7 15.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internationally, the implementation of evidence-based healthy eating policies and practices within early childhood education and care (ECEC) settings that encourage children’s healthy diet is recommended. Despite the existence of evidence-based healthy eating practices, research indicates that current implementation rates are inadequate. Web-based approaches provide a potentially effective and less costly approach to support ECEC staff with implementing nutrition policies and practices. Objective: The broad aim of this pilot randomized controlled trial is to assess the feasibility of assessing the impact of a web-based program together with health promotion officer (HPO) support on ECEC center implementation of healthy eating policies and practices. Specifically, we seek to describe the completion rate of study evaluation processes (participant consent and data collection rates); examine ECEC center uptake, acceptability, and appropriateness of the intervention and implementation strategies; understand the potential cost of delivering and receiving implementation support strategies; and describe the potential impact of the web-based intervention on the implementation of targeted healthy eating practices among centers in the intervention group. Methods: A 6-month pilot implementation trial using a cluster-randomized controlled trial design was conducted in 22 ECEC centers within the Hunter New England region of New South Wales, Australia. Potentially eligible centers were distributed a recruitment package and telephoned by the research team to assess eligibility and obtain consent. Centers randomly allocated to the intervention group received access to a web-based program, together with HPO support (eg, educational outreach visit and local technical assistance) to implement 5 healthy eating practices. The web-based program incorporated audit with feedback, development of formal implementation blueprints, and educational materials to facilitate improvement in implementation. The centers allocated to the control group received the usual care. Results: Of the 57 centers approached for the study, 22 (47%) provided consent to participate. Data collection components were completed by 100% (22/22) of the centers. High uptake for implementation strategies provided by HPOs (10/11, 91% to 11/11, 100%) and the web-based program (11/11, 100%) was observed. At follow-up, intervention centers had logged on to the program at an average of 5.18 (SD 2.52) times. The web-based program and implementation support strategies were highly acceptable (10/11, 91% to 11/11, 100%). Implementation of 4 healthy eating practices improved in the intervention group, ranging from 19% (2/11) to 64% (7/11). Conclusions: This study provides promising pilot data to warrant the conduct of a fully powered implementation trial to assess the impact of the program on ECEC healthy eating practice implementation. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001158156; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378099 International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00707-w %M 34914617 %R 10.2196/25902 %U https://www.jmir.org/2021/12/e25902 %U https://doi.org/10.2196/25902 %U http://www.ncbi.nlm.nih.gov/pubmed/34914617 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32441 %T Using Interactive Text Messaging to Improve Diet Quality and Increase Redemption of Foods Approved by the Special Supplemental Nutrition Program for Women, Infants, and Children: Protocol for a Cohort Feasibility Study %A Kay,Melissa C %A Hammad,Nour M %A Herring,Sharon J %A Bennett,Gary G %+ Duke University, 310 Trent Dr., Durham, NC, 27708, United States, 1 7812493062, melissa.kay@duke.edu %K WIC %K diet quality %K digital health %K text messaging %K mothers %K postpartum %K child obesity %K mobile phone %D 2021 %7 15.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children in the United States eat too few fruits, vegetables, and whole grains and too many energy-dense foods; these dietary behaviors are associated with increased risk of obesity. Maternal diet plays a key role in shaping children's diets; however, many mothers have poor diet quality, especially those living in low-income households. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federal nutrition assistance program that provides mothers and children with nutrient-dense foods, and those who participate have better diet quality. However, many mothers do not redeem all their WIC-approved foods. Thus, there is a need to create effective interventions to improve diet quality, especially among low-income children and families. Objective: This paper aims to describe the development and protocol for a study to evaluate the feasibility, satisfaction, and preliminary efficacy of a fully automated text messaging intervention as a strategy to improve maternal diet quality and the redemption of WIC-approved foods. Methods: We describe the use of the framework developed for the description of nonrandomized feasibility studies. Using an observational, prospective cohort study design, we will recruit mothers enrolled in WIC with a child aged ≤2 years. Participants will receive automated SMS text messages aimed at improving the redemption of WIC-approved foods to improve the participants’ diet quality for 12 weeks. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this study began in March 2021. We expect the study results to be available within 9 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated text messages as a behavior change strategy for mothers enrolled in WIC. Conclusions: The results of this pilot study will explore whether this digital behavioral intervention, which will deliver nutrition guidance in accordance with the Dietary Guidelines for Americans using interactive self-monitoring and feedback, is feasible and acceptable. This will lay the foundation for a larger evaluation to determine efficacy for improving diet quality in those most at risk for obesity. Trial Registration: ClinicalTrials.gov NCT04098016; https://clinicaltrials.gov/ct2/show/NCT04098016 International Registered Report Identifier (IRRID): DERR1-10.2196/32441 %M 34914616 %R 10.2196/32441 %U https://www.researchprotocols.org/2021/12/e32441 %U https://doi.org/10.2196/32441 %U http://www.ncbi.nlm.nih.gov/pubmed/34914616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e31734 %T Long-term Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Online Lunch Orders: 18-Month Follow-up of the Click & Crunch Cluster Randomized Controlled Trial %A Wyse,Rebecca %A Delaney,Tessa %A Stacey,Fiona %A Lecathelinais,Christophe %A Ball,Kylie %A Zoetemeyer,Rachel %A Lamont,Hannah %A Sutherland,Rachel %A Nathan,Nicole %A Wiggers,John H %A Wolfenden,Luke %+ Hunter New England Population Health, Locked Bag 10, Wallsend, 2287, Australia, 61 2 404 20272, r.wyse@newcastle.edu.au %K child diet %K consumer behavior %K intervention %K RCT %K public health nutrition %K obesity %K school %K school canteen %K long-term follow-up %K choice architecture %K public health %K nutrition %K children %K diet %K eHealth %K school lunch %D 2021 %7 29.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: School food services, including cafeterias and canteens, are an ideal setting in which to improve child nutrition. Online canteen ordering systems are increasingly common and provide unique opportunities to deliver choice architecture strategies to nudge users to select healthier items. Despite evidence of short-term effectiveness, there is little evidence regarding the long-term effectiveness of choice architecture interventions, particularly those delivered online. Objective: This study determined the long-term effectiveness of a multistrategy behavioral intervention (Click & Crunch) embedded within an existing online school lunch-ordering system on the energy, saturated fat, sugar, and sodium content of primary school students’ lunch orders 18 months after baseline. Methods: This cluster randomized controlled trial (RCT) involved a cohort of 2207 students (aged 5-12 years) from 17 schools in New South Wales, Australia. Schools were randomized to receive either a multistrategy behavioral intervention or the control (usual online ordering only). The intervention strategies ran continuously for 14-16.5 months until the end of follow-up data collection. Trial primary outcomes (ie, mean total energy, saturated fat, sugar and sodium content of student online lunch orders) and secondary outcomes (ie, the proportion of online lunch order items that were categorized as everyday, occasional, and caution) were assessed over an 8-week period at baseline and 18-month follow-up. Results: In all, 16 schools (94%) participated in the 18-month follow-up. Over time, from baseline to follow-up, relative to control orders, intervention orders had significantly lower energy (–74.1 kJ; 95% CI [–124.7, –23.4]; P=.006) and saturated fat (–0.4 g; 95% CI [–0.7, –0.1]; P=.003) but no significant differences in sugar or sodium content. Relative to control schools, the odds of purchasing everyday items increased significantly (odds ratio [OR] 1.2; 95% CI [1.1, 1.4]; P=.009, corresponding to a +3.8% change) and the odds of purchasing caution items significantly decreased among intervention schools (OR 0.7, 95% CI [0.6, 0.9]; P=.002, corresponding to a –2.6% change). There was no between-group difference over time in canteen revenue. Conclusions: This is the first study to investigate the sustained effect of a choice architecture intervention delivered via an online canteen ordering systems in schools. The findings suggest that there are intervention effects up to 18-months postbaseline in terms of decreased energy and saturated fat content and changes in the relative proportions of healthy and unhealthy food purchased for student lunches. As such, this intervention approach may hold promise as a population health behavior change strategy within schools and may have implications for the use of online food-ordering systems more generally; however, more research is required. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075 %M 34847063 %R 10.2196/31734 %U https://www.jmir.org/2021/11/e31734 %U https://doi.org/10.2196/31734 %U http://www.ncbi.nlm.nih.gov/pubmed/34847063 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30160 %T Digital Interventions to Promote Healthy Eating in Children: Umbrella Review %A Prowse,Rachel %A Carsley,Sarah %+ Division of Community Health and Humanities, Faculty of Medicine, Memorial University of Newfoundland, 300 Prince Philip Drive, St. John's, NL, A1B 3V6, Canada, 1 709 864 6622, rprowse@mun.ca %K children %K healthy eating %K eHealth %K nutrition intervention %K nutrition education %K food literacy %K digital health %K virtual delivery %K digital interventions %K nutrition interventions %K best practices %K education %K mobile phone %D 2021 %7 25.11.2021 %9 Review %J JMIR Pediatr Parent %G English %X Background: eHealth and web-based service delivery have become increasingly common during the COVID-19 pandemic. Digital interventions may be highly appealing to young people; however, their effectiveness compared with that of the usual face-to-face interventions is unknown. As nutrition interventions merge with the digital world, there is a need to determine the best practices for digital interventions for children. Objective: The aim of this study is to examine the effectiveness of digital nutrition interventions for children on dietary outcomes compared with status quo interventions (eg, conventional face-to-face programming or nondigital support). Methods: We conducted an umbrella review of systematic reviews of studies assessing primary research on digital interventions aimed at improving food and nutrition outcomes for children aged <18 years compared with conventional nutrition education were eligible for inclusion. Results: In total, 11 systematic reviews published since 2015 were included (7/11, 64%, were of moderate quality). Digital interventions ranged from internet, computer, or mobile interventions to websites, programs, apps, email, videos, CD-ROMs, games, telehealth, SMS text messages, and social media, or a combination thereof. The dose and duration of the interventions varied widely (single to multiple exposures; 1-60 minutes). Many studies have been informed by theory or used behavior change techniques (eg, feedback, goal-setting, and tailoring). The effect of digital nutrition interventions for children on dietary outcomes is small and inconsistent. Digital interventions seemed to be the most promising for improving fruit and vegetable intake compared with other nutrition outcomes; however, reviews have found mixed results. Conclusions: Owing to the heterogeneity and duration of digital interventions, follow-up evaluations, comparison groups, and outcomes measured, the effectiveness of these interventions remains unclear. High-quality evidence with common definitions for digital intervention types evaluated with validated measures is needed to improve the state of evidence, to inform policy and program decisions for health promotion in children. Now is the time for critical, robust evaluation of the adopted digital interventions during and after the COVID-19 pandemic to establish best practices for nutrition interventions for children. %M 34842561 %R 10.2196/30160 %U https://pediatrics.jmir.org/2021/4/e30160 %U https://doi.org/10.2196/30160 %U http://www.ncbi.nlm.nih.gov/pubmed/34842561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29003 %T Effectiveness of Information and Communication Technology on Obesity in Childhood and Adolescence: Systematic Review and Meta-analysis %A Park,Jihyun %A Park,Mi-Jeong %A Seo,Young-Gyun %+ Department of Family Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang, 14068, Republic of Korea, 82 31 380 3805, yg035@daum.net %K ICT %K eHealth %K mHealth %K weight loss %K obesity %K BMI %K meta-analysis %K randomized controlled trial %K children %K adolescents %K mobile phone %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Internet or mobile device use as a form of information and communication technology (ICT) can be more effective in weight loss and weight maintenance than traditional obesity interventions. Objective: The study aims to assess the effectiveness of child-centered ICT interventions on obesity-related outcomes. Methods: Articles were retrieved from the Cochrane Central Register of Controlled Trials, Embase, and PubMed web-based databases. We selected randomized controlled trials in which the participants were aged <18 years. The primary outcomes were BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Results: In total, 10 of the initial 14,867 studies identified in the databases were selected according to the inclusion criteria. A total of 640 participants were included in the intervention group and 619 in the comparator group. Meta-analyses were conducted considering various subgroups (intervention type, comparator type, target participants, mean age, sex, BMI status, and follow-up period). Overall, ICT interventions demonstrated no significant effect on BMI, body weight, BMI z-score, waist circumference, and percentage body fat. Subgroup analyses revealed that the effect of the intervention was statistically significant for the following: web intervention (weighted mean difference [WMD]=−1.26 kg/m2, 95% CI −2.24 to −0.28), lifestyle modification comparator (WMD=−1.75, 95% CI −2.76 to −0.74), intervention involving both boys and girls (WMD=−1.30, 95% CI −2.14 to −0.46), and intervention involving obesity only (WMD=−1.92, 95% CI −3.75 to −0.09). Conclusions: The meta-analysis results for children with obesity who used the web intervention program confirmed significant effects on BMI reduction compared with lifestyle modification. Evidence from the meta-analysis identified internet technology as a useful tool for weight loss in children with obesity. %M 34787572 %R 10.2196/29003 %U https://www.jmir.org/2021/11/e29003 %U https://doi.org/10.2196/29003 %U http://www.ncbi.nlm.nih.gov/pubmed/34787572 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e31611 %T The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial %A Nuruddin,Rozina %A Vadsaria,Khadija %A Mohammed,Nuruddin %A Sayani,Saleem %+ Department of Community Health Sciences, Medical College, The Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 21 3486 ext 4833, rozina.nuruddin@aku.edu %K coaching %K compliance %K diet %K maternal health %K mobile health %K offspring health %K physical activity %K pregnancy %K supplement use %K usability %D 2021 %7 16.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration. Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program’s effect on maternal and offspring health outcomes and assessment of its compliance and usability. Methods: A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit. Results: The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We expect the results to be published by the end of 2023. Conclusions: This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446 International Registered Report Identifier (IRRID): DERR1-10.2196/31611 %M 34783675 %R 10.2196/31611 %U https://www.researchprotocols.org/2021/11/e31611 %U https://doi.org/10.2196/31611 %U http://www.ncbi.nlm.nih.gov/pubmed/34783675 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e28608 %T Consumption of Ultraprocessed Foods in a Sample of Adolescents With Obesity and Its Association With the Food Educational Style of Their Parent: Observational Study %A Borloz,Sylvie %A Bucher Della Torre,Sophie %A Collet,Tinh-Hai %A Jotterand Chaparro,Corinne %+ Pediatric Service, Department Woman-Mother-Child, Lausanne University Hospital (CHUV), Montetan 14, Lausanne, 1004, Switzerland, 41 795568409, sylvie.borloz@chuv.ch %K adolescent %K obesity %K ultraprocessed foods %K qualitative food intake %K food educational style %K smartphone application %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Both parental education and the food environment influence dietary intake and may therefore contribute to childhood obesity. Objective: We aimed to assess the consumption of ultraprocessed foods (UPFs) in a convenience sample of adolescents with obesity and to determine its association with the food educational style of their parent. Methods: This observational study included 24 participants, 12 adolescents (8 boys and 4 girls) aged from 12 to 14 years and their 12 parents, who were followed in a specialized pediatric obesity clinic in the French-speaking part of Switzerland. The adolescents were asked to take a photograph with a smartphone application of all meals and beverages consumed in their daily routine over 14 consecutive days. They evaluated their parent’s food educational style using the Kids’ Child Feeding Questionnaire. The parent who was present at the study visits also completed the Feeding Style Questionnaire. A dietitian analyzed the pictures to extract food group portions and to identify UPFs using the NOVA classification. A nonparametric statistical test was used to investigate associations between UPF intake and food educational style. Results: Overall, the adolescents had unbalanced dietary habits compared to national recommendations. They consumed an insufficient quantity of vegetables, fruits, dairy products, and starchy foods and an excessive amount of meat portions and sugary and fatty products compared to the current Swiss recommendations. Their consumption of UPFs accounted for 20% of their food intake. All adolescents defined their parent as being restrictive in terms of diet, with a mean parental restriction score of 3.3±SD 0.4 (norm median=2.1). No parent reported a permissive food educational style. A higher intake of UPFs was associated with a lower parental restriction score (P=.04). Conclusions: Despite being followed in a specialized pediatric obesity clinic, this small group of adolescents had an unbalanced diet, which included 20% UPFs. The intake of UPFs was lower in participants whose parent was more restrictive, suggesting the importance of parents as role models and to provide adequate food at home. Trial Registration: ClinicalTrials.gov NCT03241121; https://clinicaltrials.gov/ct2/show/NCT03241121 %M 34779776 %R 10.2196/28608 %U https://pediatrics.jmir.org/2021/4/e28608 %U https://doi.org/10.2196/28608 %U http://www.ncbi.nlm.nih.gov/pubmed/34779776 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e20520 %T Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study %A Chew,Chu Shan Elaine %A Davis,Courtney %A Lim,Jie Kai Ethel %A Lim,Chee Meng Micheal %A Tan,Yi Zhen Henny %A Oh,Jean Yin %A Rajasegaran,Kumudhini %A Chia,Yong Hwa Michael %A Finkelstein,Eric Andrew %+ KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore, 65 62255554, elaine.chew.c.s@singhealth.com.sg %K pediatric obesity %K mobile health %K apps %K health behavior %K mHealth %K obesity %K adolescent %K lifestyle %K well-being %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective: This study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods: This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results: Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions: The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake. %M 34581672 %R 10.2196/20520 %U https://www.jmir.org/2021/9/e20520 %U https://doi.org/10.2196/20520 %U http://www.ncbi.nlm.nih.gov/pubmed/34581672 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30899 %T The Good Food for Learning Universal Curriculum-Integrated Healthy School Lunch Intervention: Protocol for a Two-Year Matched Control Pre-Post and Case Study %A Engler-Stringer,Rachel %A Black,Jennifer %A Muhajarine,Nazeem %A Martin,Wanda %A Gilliland,Jason %A McVittie,Janet %A Kirk,Sara %A Wittman,Hannah %A Mousavi,Amin %A Elliott,Sinikka %A Tu,Sylvana %A Hills,Brent %A Androsoff,Gordon %A Field,Debbie %A Macdonald,Brit %A Belt,Chelsea %A Vatanparast,Hassan %+ Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N5E5, Canada, 1 3069667839, rachel.engler-stringer@usask.ca %K school food programs %K Canada %K nutrition %K intervention research %K mHealth %D 2021 %7 21.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Good nutrition affects children’s health, well-being, and learning, and schools offer an important setting to promote healthy behaviors that can last a lifetime. Once children reach school age, they spend more of their waking hours in school than in any other environment. Children’s eating habits may be easier to influence than those of adults. In Canada, households with children are more likely to experience food insecurity, and school food programs that are universally available to all children can support the development of healthy eating patterns across groups of varying socioeconomic status. There is a significant gap in the rigorous community-engaged academic research on the impact of school meal programs, especially universal ones. Objective: The aim of this population health intervention research is to study the impact of a 2-year universal, curriculum-integrated healthy school lunch program in elementary schools in Saskatoon, Saskatchewan, Canada, on food consumption, dietary quality and food and nutrition-related knowledge, attitudes, and practices. Methods: This population health intervention study will be conducted in 2 intervention elementary schools matched with 2 control schools. We will collect preintervention data, including objective measurements of food eaten at school and food-related knowledge, attitudes, and behaviors. This will be followed by the intervention itself, along with qualitative case studies of the intervention process in the 2 intervention schools. Then, we will collect postintervention data similar to the preintervention data. Finally, we will finish the data analysis and complete the ongoing sharing of learning from the project. Results: This study was funded in April 2020 but because of the COVID-19 pandemic, data collection did not begin until May 2021. The intervention will begin in September 2021 and end in June 2023, with end point data collection occurring in May and June 2023. The case study research will begin in September 2021 and will be ongoing for the duration of the intervention. Conclusions: The opportunity we have to systematically and comprehensively study a curriculum-integrated school lunch program, as well as the promising practices for school food programs across Canada, is without precedent. International Registered Report Identifier (IRRID): DERR1-10.2196/30899 %M 34546171 %R 10.2196/30899 %U https://www.researchprotocols.org/2021/9/e30899 %U https://doi.org/10.2196/30899 %U http://www.ncbi.nlm.nih.gov/pubmed/34546171 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 9 %P e31621 %T Pediatric Weight Management Through mHealth Compared to Face-to-Face Care: Cost Analysis of a Randomized Control Trial %A Tully,Louise %A Sorensen,Jan %A O'Malley,Grace %+ Obesity Research and Care Group, Division of Population Health Sciences, School of Physiotherapy, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Beaux Lane House, Level -1, Mercer St, Dublin, D02 DH60, Ireland, 353 014022100, louisetully@rcsi.com %K childhood obesity %K pediatric weight management %K economic evaluation %K digital health %K telemedicine %K mHealth %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) may improve pediatric weight management capacity and the geographical reach of services, and overcome barriers to attending physical appointments using ubiquitous devices such as smartphones and tablets. This field remains an emerging research area with some evidence of its effectiveness; however, there is a scarcity of literature describing economic evaluations of mHealth interventions. Objective: We aimed to assess the economic viability of using an mHealth approach as an alternative to standard multidisciplinary care by evaluating the direct costs incurred within treatment arms during a noninferiority randomized controlled trial (RCT). Methods: A digitally delivered (via a smartphone app) maintenance phase of a pediatric weight management program was developed iteratively with patients and families using evidence-based approaches. We undertook a microcosting exercise and budget impact analysis to assess the costs of delivery from the perspective of the publicly funded health care system. Resource use was analyzed alongside the RCT, and we estimated the costs associated with the staff time and resources for service delivery per participant. Results: In total, 109 adolescents participated in the trial, and 84 participants completed the trial (25 withdrew from the trial). We estimated the mean direct cost per adolescent attending usual care at €142 (SD 23.7), whereas the cost per adolescent in the mHealth group was €722 (SD 221.1), with variations depending on the number of weeks of treatment completion. The conversion rate for the reference year 2013 was $1=€0.7525. The costs incurred for those who withdrew from the study ranged from €35 to €681, depending on the point of dropout and study arm. The main driver of the costs in the mHealth arm was the need for health professional monitoring and support for patients on a weekly basis. The budget impact for offering the mHealth intervention to all newly referred patients in a 1-year period was estimated at €59,046 using the assessed approach. Conclusions: This mHealth approach was substantially more expensive than usual care, although modifications to the intervention may offer opportunities to reduce the mHealth costs. The need for monitoring and support from health care professionals (HCPs) was not eliminated using this delivery model. Further research is needed to explore the cost-effectiveness and economic impact on families and from a wider societal perspective. Trial Registration: ClinicalTrials.gov NCT01804855; https://clinicaltrials.gov/ct2/show/NCT01804855 %M 34519665 %R 10.2196/31621 %U https://mhealth.jmir.org/2021/9/e31621 %U https://doi.org/10.2196/31621 %U http://www.ncbi.nlm.nih.gov/pubmed/34519665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24515 %T Unique Features of a Web-Based Nutrition Website for Childhood Cancer Populations: Descriptive Study %A Wartenberg,Lisa %A Raber,Margaret %A Chandra,Joya %+ Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 853, Houston, TX, 77030-4000, United States, 1 17135635405, jchandra@mdanderson.org %K pediatric oncology %K web-based resources %K oncology nutrition %K culinary education %K oncology %K children %K pediatric %K nutrition %K culinary %K education %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Children with cancer experience a myriad of nutritional challenges that impact their nutrition status during treatment and into survivorship. Growing evidence suggests that weight at diagnosis impacts cancer outcomes, but provider guidance on nutrition and diet during treatment varies. Nutrition literacy and culinary resources may help mitigate some common nutritional problems; however, many patients may face barriers to accessing in-person classes. Along with dietitian-led clinical interventions, web-based resources such as the newly updated electronic cookbook (e-cookbook) created by The University of Texas MD Anderson Cancer Center, @TheTable, may facilitate access to nutrition and culinary education during treatment and into survivorship. Objective: We sought to define and describe the features and content of the @TheTable e-cookbook and compare it with analogous resources for a lay audience of patients with childhood cancer and childhood cancer survivors as well as their families. Methods: We evaluated freely available web-based resources via a popular online search engine (ie, Google). These searches yielded three web-based resources analogous to @TheTable: the American Institute for Cancer Research’s Healthy Recipes, The Children’s Hospital of San Antonio’s Culinary Health Education for Families Recipe for Life, and Ann Ogden Gaffney and Fred Hutchinson Cancer Research Center’s Cook for Your Life. These sites were analyzed for the following: number of recipes, search functionality, child or family focus, cancer focus, specific dietary guidance, videos or other media, and miscellaneous unique features. Results: Cook for Your Life and Culinary Health Education for Families Recipe for Life were the most comparable to @TheTable with respect to cancer focus and family focus, respectively. Healthy Recipes is the least user-friendly, with few search options and no didactic videos. Conclusions: The @TheTable e-cookbook is unique in its offering of child- and family-focused content centered on the cancer and survivorship experience. %M 34515643 %R 10.2196/24515 %U https://www.jmir.org/2021/9/e24515 %U https://doi.org/10.2196/24515 %U http://www.ncbi.nlm.nih.gov/pubmed/34515643 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26054 %T Effectiveness of a Multistrategy Behavioral Intervention to Increase the Nutritional Quality of Primary School Students’ Web-Based Canteen Lunch Orders (Click & Crunch): Cluster Randomized Controlled Trial %A Wyse,Rebecca %A Delaney,Tessa %A Stacey,Fiona %A Zoetemeyer,Rachel %A Lecathelinais,Christophe %A Lamont,Hannah %A Ball,Kylie %A Campbell,Karen %A Rissel,Chris %A Attia,John %A Wiggers,John %A Yoong,Sze Lin %A Oldmeadow,Christopher %A Sutherland,Rachel %A Nathan,Nicole %A Reilly,Kathryn %A Wolfenden,Luke %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia, 61 49246310, rebecca.wyse@health.nsw.gov.au %K nudge %K choice architecture %K intervention %K online canteen %K online ordering systems %K digital interventions %K school children %K school food service %K canteens %K menu labeling %D 2021 %7 7.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: School food outlets represent a key setting for public health nutrition intervention. The recent proliferation of web-based food ordering systems provides a unique opportunity to support healthy purchasing from schools. Embedding evidence-based choice architecture strategies within these routinely used systems provides the opportunity to impact the purchasing decisions of many users simultaneously and warrants investigation. Objective: This study aims to assess the effectiveness of a multistrategy behavioral intervention implemented via a web-based school canteen lunch ordering system in reducing the energy, saturated fat, sugar, and sodium content of primary students’ web-based lunch orders. Methods: The study used a parallel-group, cohort, cluster randomized controlled trial design with 2207 students from 17 Australian primary schools. Schools with a web-based canteen lunch ordering system were randomly assigned to receive either a multistrategy behavioral intervention that included choice architecture strategies embedded in the web-based system (n=9 schools) or the standard web-based ordering system only (n=8 control schools). Automatically collected student purchasing data at baseline (term 2, 2018) and 12 months later (term 2, 2019) were used to assess trial outcomes. Primary trial outcomes included the mean energy (kJ), saturated fat (g), sugar (g), and sodium (mg) content of student lunch orders. Secondary outcomes included the proportion of all web-based lunch order items classified as everyday, occasional, and caution (based on the New South Wales Healthy School Canteen Strategy) and canteen revenue. Results: From baseline to follow-up, the intervention lunch orders had significantly lower energy content (−69.4 kJ, 95% CI −119.6 to −19.1; P=.01) and saturated fat content (−0.6 g, 95% CI −0.9 to −0.4; P<.001) than the control lunch orders, but they did not have significantly lower sugar or sodium content. There was also a small significant between-group difference in the percentage of energy from saturated fat (−0.9%, 95% CI −1.4% to −0.5%; P<.001) but not in the percentage of energy from sugar (+1.1%, 95% CI 0.2% to 1.9%; P=.02). Relative to control schools, intervention schools had significantly greater odds of having everyday items purchased (odds ratio [OR] 1.7, 95% CI 1.5-2.0; P<.001), corresponding to a 9.8% increase in everyday items, and lower odds of having occasional items purchased (OR 0.7, 95% CI 0.6-0.8; P<.001), corresponding to a 7.7% decrease in occasional items); however, there was no change in the odds of having caution (least healthy) items purchased (OR 0.8, 95% CI 0.7-1.0; P=.05). Furthermore, there was no change in schools’ revenue between groups. Conclusions: Given the evidence of small statistically significant improvements in the energy and saturated fat content, acceptability, and wide reach, this intervention has the potential to influence dietary choices at a population level, and further research is warranted to determine its impact when implemented at scale. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000855224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375075. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-030538 %M 34491207 %R 10.2196/26054 %U https://www.jmir.org/2021/9/e26054 %U https://doi.org/10.2196/26054 %U http://www.ncbi.nlm.nih.gov/pubmed/34491207 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e23050 %T The Effect of a Serious Health Game on Children’s Eating Behavior: Cluster-Randomized Controlled Trial %A Folkvord,Frans %A Haga,Gosse %A Theben,Alexandra %+ Tilburg School of Humanities and Digital Sciences, Warrandelaan 2, Tilburg, 5000 LE, Netherlands, 31 +31610948122, fransfolkvord@Gmail.com %K children %K eating behavior %K food-cues %K serious health game %K health intervention %D 2021 %7 2.9.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Currently, children’s dietary intake patterns do not meet prescribed dietary guidelines. Consequently, childhood obesity is one of the most serious health concerns. Therefore, innovative methods need to be developed and tested in order to effectively improve the dietary intake of children. Teaching children how to cope with the overwhelming number of unhealthy food cues could be conducted effectively by serious health games. Objective: The main aim of this study was to examine the effect of a serious health computer game on young children’s eating behavior and attitudes toward healthy and unhealthy foods. Methods: A cluster-randomized controlled trial with a between-group design was conducted (n=157; 8-12 years), wherein children played a game that promoted a healthy lifestyle or attended regular classes and did not play a game (control). The game was designed in collaboration with researchers and pilot-tested among a group of children repeatedly before conducting the experiment. After 1 week of playing, attitudes toward food snacks and actual intake (children could eat ad libitum from fruits or energy-dense snacks) was assessed. Results: The results showed that playing a serious health game did not have an effect on attitude toward fruits or energy-dense snacks or on the intake of fruits or less energy-dense snacks. Additional Bayesian analyses supported these findings. Conclusions: Serious health games are increasingly considered to be a potential effective intervention when it comes to behavior change. The results of the current study stress the importance of tailoring serious health games in order to be effective, because no effect was found on attitude or eating behavior. Trial Registration: ClinicalTrials.gov NCT05025995; https://tinyurl.com/mdd7wrjd %M 34473061 %R 10.2196/23050 %U https://games.jmir.org/2021/3/e23050 %U https://doi.org/10.2196/23050 %U http://www.ncbi.nlm.nih.gov/pubmed/34473061 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e28148 %T Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial %A Swain,Dharitri %A Begum,Jasmina %A Parida,Swayam Prangnan %+ College of Nursing, All India Institute of Medical Sciences, Sijua, Dumduma, Bhubaneswar, 751019, India, 91 94 38884272, dhari79@yahoo.co.in %K preconception care %K maternal nutritional status %K birth outcome %K paternal preconception health %K childbirth %K birth outcomes %K maternal and child health %K maternal health %K maternal and child nutrition %K health education %K pediatrics %D 2021 %7 16.8.2021 %9 Proposal %J JMIR Res Protoc %G English %X Background: The provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures. Objective: The goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India’s low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications. Methods: A nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed. Results: The proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024. Conclusions: Through preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes. Trial Registration: Clinical Trials Registry–India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836 International Registered Report Identifier (IRRID): PRR1-10.2196/28148 %M 34398798 %R 10.2196/28148 %U https://www.researchprotocols.org/2021/8/e28148 %U https://doi.org/10.2196/28148 %U http://www.ncbi.nlm.nih.gov/pubmed/34398798 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e28156 %T Effect of Community-Based Kangaroo Mother Care Package on Neonatal Mortality Among Preterm and Low Birthweight Infants in Rural Pakistan: Protocol for a Cluster Randomized Controlled Trial %A Ariff,Shabina %A Habib,Atif %A Memon,Zahid %A Arshad,Tayyaba %A Samejo,Tariq %A Maznani,Ikram %A Umer,Muhammad %A Hussain,Amjad %A Rizvi,Arjumand %A Ahmed,Imran %A Soofi,Sajid Bashir %A Bhutta,Zulfiqar A %+ Center of Excellence in Women & Child Health, Aga Khan University, Stadium Road, P.O. Box 350​0, Karachi, 7480​0, Pakistan, 92 2134864798, zulfiqar.bhutta@aku.edu %K community kangaroo mother care %K low birth weight %K KMC champions %K neonatal mortality %K RCT protocol %K Pakistan %D 2021 %7 10.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neonatal mortality due to preterm birth and low birthweight remains a significant challenge in Pakistan. Kangaroo mother care (KMC) is a unique, low-cost intervention proven to reduce neonatal mortality and morbidity and increase exclusive breastfeeding rates. However, KMC has not been attempted in community settings in Pakistan. We aim to implement and evaluate the effectiveness of a community-based KMC package to reduce neonatal morbidity and mortality among preterm and low birthweight (LBW) infants, which will provide evidence for policy development and the large-scale implementation of KMC across the country. Objective: The primary objective of this trial is to reduce neonatal mortality among preterm and LBW infants. The secondary objectives are growth (measured as weight gain), reduced incidence of possible serious bacterial infection, and increased exclusive breastfeeding and continued breastfeeding practices. Methods: We designed a community-based cluster randomized controlled trial in one rural district of Pakistan. Stable, LBW babies (weighing 1200 grams to 2500 grams) are included in the study. The community KMC package, consisting of the KMC kit, information and counseling material, and community mobilization through KMC champions (village volunteers), was designed after preliminary research in the same geographical location and implemented in intervention clusters. The standard essential newborn care is offered in the control clusters. Infants are recruited and followed up by independent teams of data collectors. Data are collected on the duration of skin-to-skin contact, growth, breastfeeding practices, morbidities, neonatal mortality, and neurodevelopment status. Data analysis will be conducted based on the intention to treat principle. The Cox regression model will be used to assess the primary outcome of neonatal mortality. The secondary outcomes will be evaluated using linear or logistic regression. Results: The Ethics Review Committee of Aga Khan University, Pakistan, approved the study protocol in February 2017. Data collection began in August 2019 and will be completed in December 2021. Data analyses are yet to be completed. Conclusions: This intervention may be effective in preventing sepsis and subsequently improve survival in LBW newborns in Pakistan and other low-income and middle-income countries worldwide. Trial Registration: clinicaltrials.gov NCT03545204; https://clinicaltrials.gov/ct2/show/NCT03545204 International Registered Report Identifier (IRRID): DERR1-10.2196/28156 %M 34170839 %R 10.2196/28156 %U https://www.researchprotocols.org/2021/8/e28156 %U https://doi.org/10.2196/28156 %U http://www.ncbi.nlm.nih.gov/pubmed/34170839 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e30450 %T Prioritization of Features for Mobile Apps for Families in a Federal Nutrition Program for Low-Income Women, Infants, and Children: User-Centered Design Approach %A Weber,Summer J %A Shearer,Elyse %A Mulvaney,Shelagh A %A Schmidt,Douglas %A Thompson,Chris %A Jones,Jessica %A Ahmad,Haseeb %A Coe,Martina %A Hull,Pamela C %+ Markey Cancer Center, University of Kentucky, 2365 Harrodsburg Rd, Suite A230, Lexington, KY, 40504-3381, United States, 1 859 323 9965, Pam.Hull@uky.edu %K WIC %K mobile technology %K maternal-child health %K childhood obesity %K nutrition %K government programs %K mobile app %K user-centered design %K low income %K women %K infant %K child %K formative %K development %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) is a federal nutrition program that provides nutritious food, education, and health care referrals to low-income women, infants, and children up to the age of 5 years. Although WIC is associated with positive health outcomes for each participant category, modernization and efficiency are needed at the clinic and shopping levels to increase program satisfaction and participation rates. New technologies, such as electronic benefits transfer (EBT), online nutrition education, and mobile apps, can provide opportunities to improve the WIC experience for participants. Objective: This formative study applies user-centered design principles to inform the layout and prioritization of features in mobile apps for low-income families participating in the WIC program. Methods: To identify and prioritize desirable app features, caregivers (N=22) of the children enrolled in WIC participated in individual semistructured interviews with a card sorting activity. Interviews were transcribed verbatim and analyzed using constant comparative analysis for themes. App features were ranked and placed into natural groupings by each participant. The sum and average of the rankings were calculated to understand which features were prioritized by the users. Natural groupings of features were labeled according to participant descriptions. Results: Natural groupings focused on the following categories: clinics/appointments, shopping/stores, education/assessments, location, and recipes/food. Themes from the interviews triangulated the results from the ranking activity. The priority app features were balance checking, an item scanner, and appointment scheduling. Other app features discussed and ranked included appointment reminders, nutrition training and quizzes, shopping lists, clinic and store locators, recipe gallery, produce calculator, and dietary preferences/allergies. Conclusions: This study demonstrates how a user-centered design process can aid the development of an app for low-income families participating in WIC to inform the effective design of the app features and user interface. %M 34328432 %R 10.2196/30450 %U https://formative.jmir.org/2021/7/e30450 %U https://doi.org/10.2196/30450 %U http://www.ncbi.nlm.nih.gov/pubmed/34328432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e29858 %T Design, Implementation, and Examination of a Remote Patient Monitoring System for Pediatric Obesity: Protocol for an Open Trial Pilot Study %A Lim,Crystal %A Rutledge,Laura %A Sandridge,Shanda %A King,Krista %A Jefferson,Darryl %A Tucker,Tanya %+ Department of Psychiatry & Human Behavior, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, United States, 1 601 815 1021, cstacklim@umc.edu %K digital health %K eHealth %K obesity %K pediatric obesity %K pediatrics %K remote patient monitoring %K telemedicine %K weight management %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. Objective: This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. Methods: Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. Results: We hypothesize high feasibility and satisfaction, with rates over 75%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. Conclusions: This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. Trial Registration: ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597 International Registered Report Identifier (IRRID): DERR1-10.2196/29858 %M 34319245 %R 10.2196/29858 %U https://www.researchprotocols.org/2021/7/e29858 %U https://doi.org/10.2196/29858 %U http://www.ncbi.nlm.nih.gov/pubmed/34319245 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e17780 %T Measuring the Healthiness of Ready-to-Eat Child-Targeted Cereals: Evaluation of the FoodSwitch Platform in Sweden %A Mottas,Antoine %A Lappi,Veli-Matti %A Sundström,Johan %A Neal,Bruce %A Mhurchu,Cliona Ni %A Löf,Marie %A Rådholm,Karin %+ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, SE-58183, Sweden, 46 13 281756, karin.radholm@liu.se %K breakfast cereals %K child-targeted cereals %K front-of-pack labels %K Keyhole symbol %K Health Star Rating %K FoodSwitch %K diet %K food intake %D 2021 %7 22.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Childhood obesity is a major public health issue. The increase in the consumption of foods with poor nutritional value, such as processed foods, contributes to this. Breakfast cereals are often advertised as a healthy way to start the day, but the healthiness of these products varies greatly. Objective: Our main objective was to gather information about the nutritional characteristics of ready-to-eat breakfast cereals in Sweden and to investigate the healthiness of products targeted at children compared to other cereals by use of the FoodSwitch platform. A secondary objective was to evaluate the alignment between the Keyhole symbol and the Health Star Rating. Methods: The FoodSwitch app is a mobile health (mHealth) tool used to present nutrition data and healthier alternative products to consumers. Ready-to-eat breakfast cereals from the largest Swedish grocery retailers were collected using the FoodSwitch platform. Products were defined as targeting children if they presented features addressing children on the package. Results: Overall, information on 261 ready-to-eat cereals was examined. Of this total, 8% (n=21) were targeted at children. Child-targeted cereals were higher in sugar (22.3 g/100 g vs 12.8 g/100 g, P<.001) and lower in fiber (6.2 g/100 g vs 9.8 g/100 g, P<.001) and protein (8.1 g/100 g vs 10.5 g/100 g, P<.001). Total fat (3 g/100 g vs 10.5 g/100 g, P<.001) and saturated fat (0.8 g/100 g vs 2.6 g/100 g, P<.001) were also lower. No difference was found in salt content (P=.61). Fewer child-targeted breakfast cereals displayed an on-pack Keyhole label (n=1, 5% vs n=53, 22%; P=.06), and the mean Health Star Rating value was 3.5 for child-targeted cereals compared to others (mean 3.8, P=.07). A correlation was found between the Keyhole symbol and the Health Star Rating. Conclusions: Ready-to-eat breakfast cereals targeted at children were less healthy in terms of sugar and fiber content compared to products not targeted at children. There is a need to improve the nutritional quality of child-targeted cereals. %M 34292165 %R 10.2196/17780 %U https://mhealth.jmir.org/2021/7/e17780 %U https://doi.org/10.2196/17780 %U http://www.ncbi.nlm.nih.gov/pubmed/34292165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e28144 %T Australian Children's Exposure to, and Engagement With, Web-Based Marketing of Food and Drink Brands: Cross-sectional Observational Study %A Kelly,Bridget %A Bosward,Rebecca %A Freeman,Becky %+ Early Start, School of Health & Society, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 2 4221 3893, bkelly@uow.edu.au %K food %K beverage %K marketing %K online %K digital %D 2021 %7 12.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Food is one of the most frequently promoted commodities, and promoted foods are overwhelmingly unhealthy. Marketing normalizes unhealthy foods, creates a positive brand image, and encourages overconsumption. Limited research is available to describe the extent of food marketing to children on web-based media, and measuring actual exposure is challenging. Objective: This study aims to monitor the extent of children’s exposure to web-based media food marketing as an essential step in increasing the accountability of industry and governments to protect children. Methods: Children aged 13-17 years were recruited from October 2018 to March 2019. Children recorded their mobile device screen for 2 weekdays and 1 weekend day any time they visited relevant web-based platforms. After each day, the participants uploaded the video files to a secure server. Promoted products were defined using the World Health Organization European Region nutrient profile model. Results: The sample of 95 children uploaded 267.8 hours of video data. Children saw a median of 17.4 food promotions each hour on the internet. Considering the usual time spent on the internet on mobile devices, children would be exposed to a median of 168.4 food promotions on the web on mobile devices per week, 99.5 of which would not be permitted to be marketed based on nutrient profiling criteria. Most promotions (2613/4446, 58.77%) were peer endorsed and derived from third-party sources. Conclusions: Exposure to brand content that is seemingly endorsed by peers or web-based communities likely heightens the effects of marketing on children. Regulations to protect children from this marketing must extend beyond paid advertising to paid content in posts generated through web-based communities and influencers. %M 34255675 %R 10.2196/28144 %U https://www.jmir.org/2021/7/e28144 %U https://doi.org/10.2196/28144 %U http://www.ncbi.nlm.nih.gov/pubmed/34255675 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25256 %T A Multicomponent mHealth-Based Intervention (SWAP IT) to Decrease the Consumption of Discretionary Foods Packed in School Lunchboxes: Type I Effectiveness–Implementation Hybrid Cluster Randomized Controlled Trial %A Sutherland,Rachel %A Brown,Alison %A Nathan,Nicole %A Yoong,Serene %A Janssen,Lisa %A Chooi,Amelia %A Hudson,Nayerra %A Wiggers,John %A Kerr,Nicola %A Evans,Nicole %A Gillham,Karen %A Oldmeadow,Christopher %A Searles,Andrew %A Reeves,Penny %A Davies,Marc %A Reilly,Kathryn %A Cohen,Brad %A Wolfenden,Luke %+ Hunter New England Population Health, Booth Building, Longworth Avenue, Wallsend, Australia, 61 2 4924 6499, rachel.sutherland@health.nsw.gov.au %K childhood obesity %K lunchboxes %K children %K child nutrition %K mHealth %K schools %K hybrid %K randomized controlled trial %K technology %D 2021 %7 24.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is significant opportunity to improve the nutritional quality of foods packed in children’s school lunchboxes. Interventions that are effective and scalable targeting the school and home environment are therefore warranted. Objective: This study aimed to assess the effectiveness of a multicomponent, mobile health–based intervention, SWAP IT, in reducing the energy contribution of discretionary (ie, less healthy) foods and drinks packed for children to consume at school. Methods: A type I effectiveness–implementation hybrid cluster randomized controlled trial was conducted in 32 primary schools located across 3 local health districts in New South Wales, Australia, to compare the effects of a 6-month intervention targeting foods packed in children’s lunchboxes with those of a usual care control. Primary schools were eligible if they were not participating in other nutrition studies and used the required school communication app. The Behaviour Change Wheel was used to co-design the multicomponent SWAP IT intervention, which consisted of the following: school lunchbox nutrition guidelines, curriculum lessons, information pushed to parents digitally via an existing school communication app, and additional parent resources to address common barriers to packing healthy lunchboxes. The primary outcome, mean energy (kilojoules) content of discretionary lunchbox foods and drinks packed in lunchboxes, was measured via observation using a validated school food checklist at baseline (May 2019) and at 6-month follow-up (October 2019). Additional secondary outcomes included mean lunchbox energy from discretionary foods consumed, mean total lunchbox energy packed and consumed, mean energy content of core lunchbox foods packed and consumed, and percentage of lunchbox energy from discretionary and core foods, all of which were also measured via observation using a validated school food checklist. Measures of school engagement, consumption of discretionary foods outside of school hours, and lunchbox cost were also collected at baseline and at 6-month follow-up. Data were analyzed via hierarchical linear regression models, with controlling for clustering, socioeconomic status, and remoteness. Results: A total of 3022 (3022/7212, 41.90%) students consented to participate in the evaluation (mean age 7.8 years; 1487/3022, 49.22% girls). There were significant reductions between the intervention and control groups in the primary trial outcome, mean energy (kilojoules) content of discretionary foods packed in lunchboxes (–117.26 kJ; 95% CI –195.59 to –39.83; P=.003). Relative to the control, the intervention also significantly reduced secondary outcomes regarding the mean total lunchbox energy (kilojoules) packed (–88.38 kJ; 95% CI –172.84 to –3.92; P=.04) and consumed (–117.17 kJ; 95% CI –233.72 to –0.62; P=.05). There was no significant difference between groups in measures of student engagement, consumption of discretionary foods outside of school hours, or cost of foods packed in children’s lunchboxes. Conclusions: The SWAP IT intervention was effective in reducing the energy content of foods packed for and consumed by primary school–aged children at school. Dissemination of the SWAP IT program at a population level has the potential to influence a significant proportion of primary school–aged children, impacting weight status and associated health care costs. Trial Registration: Australian Clinical Trials Registry ACTRN12618001731280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376191&isReview=true International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7725-x %M 34185013 %R 10.2196/25256 %U https://www.jmir.org/2021/6/e25256/ %U https://doi.org/10.2196/25256 %U http://www.ncbi.nlm.nih.gov/pubmed/34185013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27807 %T Development of a Positive Body Image Chatbot (KIT) With Young People and Parents/Carers: Qualitative Focus Group Study %A Beilharz,Francesca %A Sukunesan,Suku %A Rossell,Susan L %A Kulkarni,Jayashri %A Sharp,Gemma %+ Monash Alfred Psychiatry Research Centre, Monash University, 4/607 St Kilda Road, Melbourne, 3004, Australia, 61 390765167, gemma.sharp@monash.edu %K body image %K eating disorder %K chatbot %K conversational agent %K artificial intelligence %K mental health %K digital health %K design %D 2021 %7 16.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Body image and eating disorders represent a significant public health concern; however, many affected individuals never access appropriate treatment. Conversational agents or chatbots reflect a unique opportunity to target those affected online by providing psychoeducation and coping skills, thus filling the gap in service provision. Objective: A world-first body image chatbot called “KIT” was designed. The aim of this study was to assess preliminary acceptability and feasibility via the collection of qualitative feedback from young people and parents/carers regarding the content, structure, and design of the chatbot, in accordance with an agile methodology strategy. The chatbot was developed in collaboration with Australia’s national eating disorder support organization, the Butterfly Foundation. Methods: A conversation decision tree was designed that offered psychoeducational information on body image and eating disorders, as well as evidence-based coping strategies. A version of KIT was built as a research prototype to deliver these conversations. Six focus groups were conducted using online semistructured interviews to seek feedback on the KIT prototype. This included four groups of people seeking help for themselves (n=17; age 13-18 years) and two groups of parents/carers (n=8; age 46-57 years). Participants provided feedback on the cartoon chatbot character design, as well as the content, structure, and design of the chatbot webchat. Results: Thematic analyses identified the following three main themes from the six focus groups: (1) chatbot character and design, (2) content presentation, and (3) flow. Overall, the participants provided positive feedback regarding KIT, with both young people and parents/carers generally providing similar reflections. The participants approved of KIT’s character and engagement. Specific suggestions were made regarding the brevity and tone to increase KIT’s interactivity. Conclusions: Focus groups provided overall positive qualitative feedback regarding the content, structure, and design of the body image chatbot. Incorporating the feedback of lived experience from both individuals and parents/carers allowed the refinement of KIT in the development phase as per an iterative agile methodology. Further research is required to evaluate KIT’s efficacy. %M 34132644 %R 10.2196/27807 %U https://www.jmir.org/2021/6/e27807 %U https://doi.org/10.2196/27807 %U http://www.ncbi.nlm.nih.gov/pubmed/34132644 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25794 %T A Web-Based Time-Use Application to Assess Diet and Movement Behavior in Asian Schoolchildren: Development and Usability Study of My E-Diary for Activities and Lifestyle (MEDAL) %A Chia,Airu %A Chew,Muhammad Naeem Jia Sheng %A Tan,Sarah Yi Xuan %A Chan,Mei Jun %A T Colega,Marjorelee %A Toh,Jia Ying %A Natarajan,Padmapriya %A Lança,Carla %A Shek,Lynette P %A Saw,Seang-Mei %A Müller-Riemenschneider,Falk %A Chong,Mary Foong-Fong %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore, 65 6516 4969, mary_chong@nus.edu.sg %K time use %K web-based %K diet %K movement behaviors %K usability %K schoolchildren %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors. Objective: This study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)—a self-administered, web-based time-use application to assess diet and movement behavior—and to evaluate its usability in schoolchildren in Singapore. Methods: MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire. Results: The development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8% boys, and 31/201, 15.4% overweight) in the usability study, 57.8% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1%), that MEDAL was easy to use (173/203, 85.2%), that they liked the application (172/202, 85.1%), and that they preferred recording their activities on the web than on paper (167/202, 82.7%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate. Conclusions: MEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress. %M 34106084 %R 10.2196/25794 %U https://www.jmir.org/2021/6/e25794 %U https://doi.org/10.2196/25794 %U http://www.ncbi.nlm.nih.gov/pubmed/34106084 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e16145 %T Indigenous Mothers’ Use of Web- and App-Based Information Sources to Support Healthy Parenting and Infant Health in Canada: Interpretive Description %A Wright,Amy Lynn %A VanEvery,Rachel %A Miller,Vicky %+ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Suite 130, 155 College Street, Toronto, ON, M5T 1P8, Canada, 1 416 946 8183, amyl.wright@utoronto.ca %K Indigenous health %K infant health %K mothers %K parenting %K qualitative research %K health education %K health services accessibility %K mobile phone %D 2021 %7 21.5.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based sources of health information are widely used by parents to support healthy parenting and aid in decision making about their infants’ health. Although fraught with challenges such as misinformation, if used appropriately, web-based resources can improve access to health education and promote healthy choices. How Indigenous mothers use web-based information to support their parenting and infants’ health has not yet been investigated; however, web-based modalities may be important methods for mitigating the reduced access to health care and negative health care interactions that many Indigenous people are known to experience. Objective: This study aims to understand the experience of Indigenous mothers who use web-based information to support the health of their infants. Methods: This interpretive description qualitative study used semistructured interviews and a discussion group to understand how Indigenous mothers living in Hamilton, Ontario and caring for an infant aged <2 years experienced meeting the health needs of their infants. The data presented reflect their experiences of using web-based sources of health information to support their infants’ health. The Two-Eyed Seeing approach was applied to the study design, which ensured that both western and Indigenous worldviews were considered throughout. Results: A total of 19 Indigenous mothers participated in this study. The resulting 4 themes included distrusting information, staying anonymous, using visual information to support decision making, and accessing a world of experiences. Although fewer Indigenous mothers used web-based sources of information compared to mothers in the general population in other studies, tailoring web-based modalities to meet the unique needs of Indigenous mothers is an important opportunity for supporting the health and wellness of both mothers and infants. Conclusions: Web-based information sources are commonly used among parents, and ever-evolving web-based technologies make this information increasingly available and accessible. Tailoring web-based modalities to meet the unique preferences and needs of Indigenous mothers is an important method for improving their access to reliable and accurate health care information, thereby supporting healthy parenting and promoting infant health. %M 34018489 %R 10.2196/16145 %U https://pediatrics.jmir.org/2021/2/e16145 %U https://doi.org/10.2196/16145 %U http://www.ncbi.nlm.nih.gov/pubmed/34018489 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e23115 %T Impact of Nutrition Education on the Nutrition Capacity of Caregivers and Nutrition Outcomes of Indigenous Mbororo Children in the West Region of Cameroon: Protocol for a Cluster Randomized Controlled Trial %A Manjong,Florence Titu %A Verla,Vincent Siysi %A Egbe,Thomas Obinchemti %A Nsagha,Dickson Shey %+ Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, PO Box 63, Buea, 237, Cameroon, 237 677 499 429, nsaghads@hotmail.com %K nutrition education %K caregivers %K nutrition outcomes %K indigenous children %D 2021 %7 20.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Inadequate diets and life-threatening infections have profound adverse implications for child growth, development, and survival, particularly among indigenous peoples. Evidence of the effectiveness of community-based nutrition education interventions in improving child feeding and nutrition outcomes among indigenous Mbororo population in Cameroon is scarce. Objective: This study aims to investigate the impact of culturally tailored community-based nutrition education intervention on caregivers’ knowledge, attitude, and practice regarding complementary feeding and on nutrition outcomes of indigenous Mbororo children (aged 3-59 months) in the Foumban and Galim health districts of the West Region of Cameroon. Methods: A two-arm cluster randomized controlled trial will be conducted in the Foumban Health District and Galim Health District. The intervention and control arms will each comprise 5 clusters with 121 child–caregiver pairs. Participants in the intervention arm will be organized into 5 caregivers’ peer-support platforms. A total of 12 educational sessions will be assigned to the intervention group by trained female Mbororo nutrition volunteers (n=6) and community health workers (n=6). The control arm will receive routine facility-based nutrition education. Data will be collected at 3-month and 6-month follow-up. Both descriptive statistics and multivariate logistic models will be used to estimate the effect of culturally tailored community-based nutrition education intervention (independent variable) on outcome variables (caregivers’ knowledge, attitude, and practice), child growth (weight, height/length, weight for age), and morbidity status (diarrhea, cough, and fever) between both arms. Data assessors will be blinded to the group allocation. Ethical approval (reference no. 2019/1002-07/UB/SG/IRB/FHS) was obtained from the Faculty of Health Sciences Institutional Review Board at the University of Buea. Results: Baseline data were collected in September 2019. In February 2020, 10 Mbororo communities (clusters) with 242 child–caregiver pairs were selected and allocated to the experimental and control arm in a 1:1 ratio. Community nutrition volunteers (n=6) and community health workers (n=6) were selected and trained. Data collection and analysis are ongoing, and results are not available for this manuscript. Conclusions: The findings of this study will provide evidence on the impact of culturally tailored and health belief model–based nutrition education on behavior change as a complementary strategy for strengthening health facility–based approaches in the reduction of malnutrition burden among the study population International Registered Report Identifier (IRRID): DERR1-10.2196/23115 %M 34014173 %R 10.2196/23115 %U https://www.researchprotocols.org/2021/5/e23115 %U https://doi.org/10.2196/23115 %U http://www.ncbi.nlm.nih.gov/pubmed/34014173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24802 %T An App-Based Parenting Program to Promote Healthy Energy Balance–Related Parenting Practices to Prevent Childhood Obesity: Protocol Using the Intervention Mapping Framework %A Karssen,Levie T %A Vink,Jacqueline M %A de Weerth,Carolina %A Hermans,Roel C J %A de Kort,Carina P M %A Kremers,Stef PJ %A Ruiter,Emilie L M %A Larsen,Junilla K %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, 6500 HE, Netherlands, 31 0640969305, l.karssen@bsi.ru.nl %K childhood obesity %K preventive intervention %K parenting practices %K energy-balance related behavior %K socio-economic position %K mHealth %K behavior change %K mobile phone %D 2021 %7 14.5.2021 %9 Protocol %J JMIR Form Res %G English %X Background: The family environment plays an important role in the development of children’s energy balance–related behaviors. As a result, parents’ energy balance–related parenting practices are important targets of preventive childhood obesity programs. Families with a lower socioeconomic position (SEP) may benefit from participating in such programs but are generally less well reached than families with a higher SEP. Objective: This paper describes the application of the Intervention Mapping Protocol (IMP) for the development of an app-based preventive intervention program to promote healthy energy balance–related parenting practices among parents of children (aged 0-4 years) with a lower SEP. Methods: The 6 steps of the IMP were used as a theory- and evidence-based framework to guide the development of an app-based preventive intervention program. Results: In step 1, behavioral outcomes for the app-based program (ie, children have a healthy dietary intake, sufficient sleep, and restricted screen time and sufficient physical activity) and sociocognitive (ie, knowledge, attitudes, and self-efficacy) and automatic (ie, habitual behaviors) determinants of energy balance–related parenting were identified through a needs assessment. In step 2, the behavioral outcomes were translated into performance objectives. To influence these objectives, in step 3, theory-based intervention methods were selected for each of the determinants. In step 4, the knowledge derived from the previous steps allowed for the development of the app-based program Samen Happie! through a process of continuous cocreation with parents and health professionals. In step 5, community health services were identified as potential adopters for the app. Finally, in step 6, 2 randomized controlled trials were designed to evaluate the process and effects of the app among Dutch parents of infants (trial 1) and preschoolers (trial 2). These trials were completed in November 2019 (trial 1) and February 2020 (trial 2). Conclusions: The IMP allowed for the effective development of the app-based parenting program Samen Happie! to promote healthy energy balance–related parenting practices among parents of infants and preschoolers. Through the integration of theory, empirical evidence, and data from the target population, as well as the process of continued cocreation, the program specifically addresses parents with a lower SEP. This increases the potential of the program to prevent the development of obesity in early childhood among families with a lower SEP. Trial Registration: Netherlands Trial Register NL6727, https://www.trialregister.nl/trial/6727; Netherlands Trial Register NL7371, https://www.trialregister.nl/trial/7371. %M 33988510 %R 10.2196/24802 %U https://formative.jmir.org/2021/5/e24802 %U https://doi.org/10.2196/24802 %U http://www.ncbi.nlm.nih.gov/pubmed/33988510 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e17189 %T Acceptability of the Pregnancy, Exercise, and Nutrition Research Study With Smartphone App Support (PEARS) and the Use of Mobile Health in a Mixed Lifestyle Intervention by Pregnant Obese and Overweight Women: Secondary Analysis of a Randomized Controlled Trial %A Greene,Ellen M %A O'Brien,Eileen C %A Kennelly,Maria A %A O'Brien,Orna A %A Lindsay,Karen L %A McAuliffe,Fionnuala M %+ UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Dublin 2, Ireland, 353 637 3216, fionnuala.mcauliffe@ucd.ie %K pregnancy %K mHealth %K nutrition %K lifestyle %K acceptability %K app %K mobile phone %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dietary interventions can improve pregnancy outcomes among women with increased BMI. Although the interest in mobile health interventions is growing, little is known about the acceptability of smartphone apps to support lifestyle interventions in such a cohort. Objective: We aimed to assess the acceptability of the pregnancy, exercise, and nutrition research study with smartphone app support (PEARS) and the use of mobile health in a mixed lifestyle intervention delivered to overweight and obese pregnant women. Methods: PEARS was a randomized controlled trial of a low glycemic index dietary intervention with exercise prescription and a smartphone app, which was delivered to pregnant women who were overweight or obese. Acceptability questionnaires were completed by the intervention group at 28 weeks of gestation (n=149) and at postintervention (n=123). Maternal characteristics were recorded (ie, age, ethnicity, BMI, socioeconomic status). Associations between maternal characteristics and acceptability of the intervention and app were analyzed using two-tailed t tests, Mann-Whitney U tests, chi-square test, and logistic regression. One-on-one semistructured interviews were conducted with a subcohort of the intervention participants (n=28) at 34 weeks of gestation, in which the participants shared their experiences of the PEARS intervention. Results: The intervention was generally accepted, with respondents agreeing that the diet was easy to follow (98/148, 68.5%), enjoyable (106/148, 74.1%), and affordable (110/148, 76.9%). Qualitative and quantitative results were consistent with each another, both demonstrating that app acceptability was high. The participants agreed that the app was enjoyable (96/120, 80.0%) and easy to use (116/119, 97.5%). Compared to those with tertiary education, those with lower education levels were more likely to enjoy the dietary changes (P=.04). Enjoyment of the app was associated with disadvantaged neighborhood deprivation index (P=.01) and higher BMI (P=.03). Conclusions: The PEARS intervention and use of a supportive smartphone app were accepted by pregnant women, particularly by those from vulnerable subgroups of this population. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 29316280; https://www.isrctn.com/ISRCTN29316280 %M 33978597 %R 10.2196/17189 %U https://mhealth.jmir.org/2021/5/e17189 %U https://doi.org/10.2196/17189 %U http://www.ncbi.nlm.nih.gov/pubmed/33978597 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e22990 %T Commercially Available Apps to Support Healthy Family Meals: User Testing of App Utility, Acceptability, and Engagement %A Mauch,Chelsea E %A Laws,Rachel A %A Prichard,Ivanka %A Maeder,Anthony J %A Wycherley,Thomas P %A Golley,Rebecca K %+ Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 8 83038988, chelsea.mauch@csiro.au %K diet %K nutrition %K family %K mobile applications %K behavior modification %D 2021 %7 7.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents juggling caregiving and paid employment encounter a range of barriers in providing healthy food to their families. Mobile apps have the potential to help parents in planning, purchasing, and preparing healthy family food. The utility and acceptability of apps for supporting parents are unknown. User perspectives of existing technology, such as commercially available apps, can guide the development of evidence-based apps in the future. Objective: This study aims to determine the feasibility of existing commercially available apps for supporting the healthy food provision practices of working parents. Methods: Working parents (N=133) were recruited via the web and completed a 10-item Capability, Opportunity, Motivation, and Behavior (COM-B) self-evaluation survey assessing their needs in relation to the provision of healthy family meals. A total of 5 apps were selected for testing, including a meal planning app, recipe app, recipe manager app, family organizer app, and barcode scanning app. Survey items were mapped to app features, with a subsample of parents (67/133, 50.4%) allocated 2 apps each to trial simultaneously over 4 weeks. A semistructured interview exploring app utility and acceptability and a web-based survey, including the System Usability Scale and the user version of the Mobile App Rating Scale, followed app testing. The interview data were analyzed using a theoretical thematic approach. Results: Survey participants (N=133; mean age 34 years, SD 4 years) were mainly mothers (130/133, 97.7%) and partnered (122/133, 91.7%). Participants identified a need for healthy recipes (109/133, 82% agreed or strongly agreed) and time for food provision processes (107/133, 80.5%). Engagement quality was the lowest rated domain of the user version of the Mobile App Rating Scale across all 5 apps (mean score per app ranging from 3.0 to 3.7 out of a maximum of 5). The family organizer, requiring a high level of user input, was rated the lowest for usability (median 48, IQR 34-73). In the interviews, participants weighed the benefits of the apps (ie, time saving) against the effort involved in using them in determining their acceptability. Organization was a subtheme emerging from interviews, associated with the use of meal planners and shopping lists. Meal planners and shopping lists were used in time, while behavior was occurring. Conclusions: Meal planning apps and features promoting organization present feasible, time-saving solutions to support healthy food provision practices. Attention must be paid to enhancing app automation and integration, as well as recipe and nutrition content, to ensure that apps do not add to the time burden of food provision and are supportive of healthy food provision behavior in time. %M 33960951 %R 10.2196/22990 %U https://mhealth.jmir.org/2021/5/e22990 %U https://doi.org/10.2196/22990 %U http://www.ncbi.nlm.nih.gov/pubmed/33960951 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25047 %T Effectiveness of an Integrated Care Package for Refugee Mothers and Children: Protocol for a Cluster Randomized Controlled Trial %A Al Azdi,Zunayed %A Islam,Khaleda %A Khan,Muhammad Amir %A Khan,Nida %A Ejaz,Amna %A Khan,Muhammad Ahmar %A Warraitch,Azza %A Jahan,Ishrat %A Huque,Rumana %+ ARK Foundation, Suite C-4, House No. 6, Road No. 109, Gulshan-2, Dhaka, 1212, Bangladesh, 880 1711455670, azdi1627@gmail.com %K mental health %K refugee health %K early childhood development %K Rohingya %K Bangladesh %K community health care %K community health worker %D 2021 %7 4.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Thousands of Rohingya refugee mothers at the world’s largest refugee camp located in Bangladesh are at risk of poor mental health. Accordingly, their children are also vulnerable to delayed cognitive and physical development. Objective: The aim of this study is to evaluate the effectiveness of an integrated care package in reducing the prevalence of developmental delays among children aged 1 year and improving their mothers’ mental health status. Methods: This is a parallel, two-arm, single-blind, cluster randomized controlled trial (cRCT). A total of 704 mother-child dyads residing at the Kutupalong refugee camp in Cox’s Bazar, Bangladesh, will be recruited from 22 clusters with 32 mother-child dyads per cluster. In the intervention arm, an integrated early childhood development and maternal mental health package will be delivered every quarter to mothers of newborns by trained community health workers until the child is 1 year old. Our primary outcome is a reduction in the prevalence of two or more childhood developmental delays of infants aged 1 year compared to the usual treatment. The secondary outcomes include reduced stunting among children and the prevalence of maternal depression. We will also assess the cost-effectiveness of the integrated intervention, and will further explore the intervention’s acceptability and feasibility. Results: At the time of submission, the study was at the stage of endpoint assessment. The data analysis started in December 2020, and the results are expected to be published after the first quarter of 2021. Conclusions: This study will address the burden of childhood developmental delays and poor maternal mental health in a low-resource setting. If proven effective, the delivery of the intervention through community health workers will ensure the proposed intervention’s sustainability. Trial Registration: ISRCTN Registry ISRCTN10892553; https://www.isrctn.com/ISRCTN10892553 International Registered Report Identifier (IRRID): DERR1-10.2196/25047 %M 33944793 %R 10.2196/25047 %U https://www.researchprotocols.org/2021/5/e25047 %U https://doi.org/10.2196/25047 %U http://www.ncbi.nlm.nih.gov/pubmed/33944793 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e29048 %T Nutritional Implications of Baby-Led Weaning and Baby Food Pouches as Novel Methods of Infant Feeding: Protocol for an Observational Study %A Taylor,Rachael W %A Conlon,Cathryn A %A Beck,Kathryn L %A von Hurst,Pamela R %A Te Morenga,Lisa A %A Daniels,Lisa %A Haszard,Jill J %A Meldrum,Alison M %A McLean,Neve H %A Cox,Alice M %A Tukuafu,Lesieli %A Casale,Maria %A Brown,Kimberley J %A Jones,Emily A %A Katiforis,Ioanna %A Rowan,Madeleine %A McArthur,Jenny %A Fleming,Elizabeth A %A Wheeler,Ben J %A Houghton,Lisa A %A Diana,Aly %A Heath,Anne-Louise M %+ Department of Human Nutrition, University of Otago, 70 Union St West, Dunedin, 9054, New Zealand, 64 34798379, anne-louise.heath@otago.ac.nz %K infant %K diet %K complementary feeding %K food pouch %K baby-led weaning %K iron %K growth %K eating behavior %K feeding behavior %K dental health %K choking %K breast milk %D 2021 %7 21.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The complementary feeding period is a time of unparalleled dietary change for every human, during which the diet changes from one that is 100% milk to one that resembles the usual diet of the wider family in less than a year. Despite this major dietary shift, we know relatively little about food and nutrient intake in infants worldwide and virtually nothing about the impact of baby food “pouches” and “baby-led weaning” (BLW), which are infant feeding approaches that are becoming increasingly popular. Pouches are squeezable containers with a plastic spout that have great appeal for parents, as evidenced by their extraordinary market share worldwide. BLW is an alternative approach to introducing solids that promotes infant self-feeding of whole foods rather than being fed purées, and is popular and widely advocated on social media. The nutritional and health impacts of these novel methods of infant feeding have not yet been determined. Objective: The aim of the First Foods New Zealand study is to determine the iron status, growth, food and nutrient intakes, breast milk intake, eating and feeding behaviors, dental health, oral motor skills, and choking risk of New Zealand infants in general and those who are using pouches or BLW compared with those who are not. Methods: Dietary intake (two 24-hour recalls supplemented with food photographs), iron status (hemoglobin, plasma ferritin, and soluble transferrin receptor), weight status (BMI), food pouch use and extent of BLW (questionnaire), breast milk intake (deuterium oxide “dose-to-mother” technique), eating and feeding behaviors (questionnaires and video recording of an evening meal), dental health (photographs of upper and lower teeth for counting of caries and developmental defects of enamel), oral motor skills (questionnaires), and choking risk (questionnaire) will be assessed in 625 infants aged 7.0 to 9.9 months. Propensity score matching will be used to address bias caused by differences in demographics between groups so that the results more closely represent a potential causal effect. Results: This observational study has full ethical approval from the Health and Disability Ethics Committees New Zealand (19/STH/151) and was funded in May 2019 by the Health Research Council (HRC) of New Zealand (grant 19/172). Data collection commenced in July 2020, and the first results are expected to be submitted for publication in 2022. Conclusions: This large study will provide much needed data on the implications for nutritional intake and health with the use of baby food pouches and BLW in infancy. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000459921; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379436. International Registered Report Identifier (IRRID): DERR1-10.2196/29048 %M 33881411 %R 10.2196/29048 %U https://www.researchprotocols.org/2021/4/e29048 %U https://doi.org/10.2196/29048 %U http://www.ncbi.nlm.nih.gov/pubmed/33881411 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e24579 %T Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial %A Scott,Jane Anne %A Burns,Sharyn K %A Hauck,Yvonne L %A Giglia,Roslyn C %A Jorgensen,Anita M %A White,Becky Kate %A Martin,Annegret %A Robinson,Suzanne %A Dhaliwal,Satvinder S %A Binns,Colin W %A Maycock,Bruce R %+ School of Population Health, Curtin University, Kent Street, Bentley, Perth, Australia, 61 040 413 0489, jane.scott@curtin.edu.au %K breastfeeding %K fathers %K peer support %K mHealth, smartphone app %K infants %K social support %K feeding %K smartphone %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant’s father, has been identified as a crucial element for successful breastfeeding. Objective: The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. Methods: The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support. Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers. Conclusions: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695 International Registered Report Identifier (IRRID): RR2-10.1186/s12884-015-0601-5 %M 33843604 %R 10.2196/24579 %U https://pediatrics.jmir.org/2021/2/e24579 %U https://doi.org/10.2196/24579 %U http://www.ncbi.nlm.nih.gov/pubmed/33843604 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e22541 %T Days Needed to Characterize the Healthfulness of a Typical Dinner Meal in Direct Observational Research: Mixed Methods Study %A Tate,Allan %A Trofholz,Amanda %A Miner,Michael %A Berge,Jerica %+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 202 BS Miller Hall, 101 Buck Rd, Health Sciences Campus, Athens, GA, 30602, United States, 1 706 542 6317, allan.tate@uga.edu %K meal healthfulness %K direct observation %K family meals %K well-being %K diet %K food %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior research around the home meal environment has demonstrated that family meals are associated with positive health outcomes for children and adolescents. Researchers have begun using direct observational methods to understand key aspects of family meals such as meal healthfulness and family meal frequency to explain the protective nature of family meals. Direct observational research, however, can be resource intensive and also burdensome for participants. Information about the number of days needed to sufficiently characterize typical meal healthfulness using direct observational research methods is needed. Objective: The current study aimed to produce guidance about the number of meals necessary to approximate typical meal healthfulness at the family dinner meal occasion in a direct observational, mixed methods study of the home food environment. Methods: Families were recruited between 2012-2013 from primary care clinics in the Minneapolis–St Paul metropolitan area (N=120). A total of 800 meals were collected as part of the Family Meals LIVE! mixed methods study. The Healthfulness of Meal Index was used to evaluate meal dietary healthfulness of foods served at 8 family meal occasions. Participating families were provided an iPad (Apple Inc) and asked to video-record 8 consecutive days of family dinner meals with a minimum of two weekend meals. After the meal, families completed a meal screener, which is a self-reported, open-ended measure of the foods served at the meal. Results: Weekend and weekday meals differed in their measurement of meal healthfulness, indicating that at least one weekday and one weekend day are necessary to approximate meal healthfulness. Single-day measurement mischaracterized the strength of the relationship between the quality of what was served and intake by almost 50%, and 3 to 4 observation days were sufficient to characterize typical weekly meal healthfulness (r=0.94; P<.001). Conclusions: Relatively few direct observational days of family meals data appear to be needed to approximate the healthfulness of meals across 1 week. Specifically, 1 weekday and 1 weekend observation are needed, including a total of 3 to 4 days of direct observational meal data. These findings may inform future direct observational study designs to reduce both research costs and participant burden in assessing features of the meal environment. %M 33759788 %R 10.2196/22541 %U https://pediatrics.jmir.org/2021/1/e22541 %U https://doi.org/10.2196/22541 %U http://www.ncbi.nlm.nih.gov/pubmed/33759788 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e27196 %T Implementation of the Living Well During Pregnancy Telecoaching Program for Women at High Risk of Excessive Gestational Weight Gain: Protocol for an Effectiveness-Implementation Hybrid Study %A de Jersey,Susan %A Meloncelli,Nina %A Guthrie,Taylor %A Powlesland,Hilary %A Callaway,Leonie %A Chang,Angela T %A Wilkinson,Shelley %A Comans,Tracy %A Eakin,Elizabeth %+ Centre for Clinical Research and Perinatal Research Centre, Faculty of Medicine, The University of Queensland, Building 71/918, RBWH Herston, Brisbane, Australia, 61 424949217, susan.dejersey@health.qld.gov.au %K implementation study %K pregnancy %K weight %K nutrition %K lifestyle intervention %K physical activity %D 2021 %7 18.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite comprehensive guidelines for healthy gestational weight gain (GWG) and evidence for the efficacy of dietary counseling coupled with weight monitoring on reducing excessive GWG, reporting on the effectiveness of interventions translated into routine antenatal care is limited. Objective: This study aims to implement and evaluate the Living Well during Pregnancy (LWdP) program in a large Australian antenatal care setting. Specifically, the LWdP program will be incorporated into usual care and delivered to a population of pregnant women at risk of excessive GWG through a dietitian-delivered telephone coaching service. Methods: Metrics from the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework will guide the evaluation in this hybrid effectiveness-implementation study. All women aged ≥16 years without pre-exiting diabetes with a prepregnancy BMI >25 kg/m2 and gaining weight above recommendations at <20 weeks’ gestation who are referred for dietetic care during the 12-month study period will be eligible for participation. The setting is a metropolitan hospital at which approximately 6% of the national births in Australia take place each year. Eligible participants will receive up to 10 telecoaching calls during their pregnancy. Primary outcomes will be service level indicators of reach, adoption, and implementation that will be compared with a retrospective control group, and secondary effectiveness outcomes will be participant-reported anthropometric and behavioral outcomes; all outcomes will be assessed pre- and postprogram completion. Additional secondary outcomes relate to the costs associated with program implementation and pregnancy outcomes gathered through routine clinical service data. Results: Data collection of all variables was completed in December 2020, with results expected to be published by the end of 2021. Conclusions: This study will evaluate the implementation of an evidence-based intervention into routine health service delivery and will provide the practice-based evidence needed to inform decisions about its incorporation into routine antenatal care. International Registered Report Identifier (IRRID): DERR1-10.2196/27196 %M 33734093 %R 10.2196/27196 %U https://www.researchprotocols.org/2021/3/e27196 %U https://doi.org/10.2196/27196 %U http://www.ncbi.nlm.nih.gov/pubmed/33734093 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e17492 %T The Kurbo App: The Freemium Model and Developmental Behavior Concerns. Comment on “Impact of a Mobile App–Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study” %A Vitolo,Marcia Regina %+ Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre, 90050170, Brazil, 55 1138651010, marciavitolo@hotmail.com %K childhood obesity %K intervention %K app %D 2021 %7 25.2.2021 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 33629965 %R 10.2196/17492 %U https://mhealth.jmir.org/2021/2/e17492 %U https://doi.org/10.2196/17492 %U http://www.ncbi.nlm.nih.gov/pubmed/33629965 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 13 %N 1 %P e18245 %T Diabetes Prevention in Adolescents: Co-design Study Using Human-Centered Design Methodologies %A Pike,Julie M %A Moore,Courtney M %A Yazel,Lisa G %A Lynch,Dustin O %A Haberlin-Pittz,Kathryn M %A Wiehe,Sarah E %A Hannon,Tamara S %+ Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, United States, 1 317 688 5065, julpike@iu.edu %K diabetes prevention %K adolescents %K human-centered design %D 2021 %7 24.2.2021 %9 Original Paper %J J Participat Med %G English %X Background: The rise in pediatric obesity and its accompanying condition, type 2 diabetes (T2D), is a serious public health concern. T2D in adolescents is associated with poor health outcomes and decreased life expectancy. Effective diabetes prevention strategies for high-risk adolescents and their families are urgently needed. Objective: The aim of this study was to co-design a diabetes prevention program for adolescents by using human-centered design methodologies. Methods: We partnered with at-risk adolescents, parents, and professionals with expertise in diabetes prevention or those working with adolescents to conduct a series of human-centered design research sessions to co-design a diabetes prevention intervention for youth and their families. In order to do so, we needed to (1) better understand environmental factors that inhibit/promote recommended lifestyle changes to decrease T2D risk, (2) elucidate desired program characteristics, and (3) explore improved activation in diabetes prevention programs. Results: Financial resources, limited access to healthy foods, safe places for physical activity, and competing priorities pose barriers to adopting lifestyle changes. Adolescents and their parents desire interactive, hands-on learning experiences that incorporate a sense of fun, play, and community in diabetes prevention programs. Conclusions: The findings of this study highlight important insights of 3 specific stakeholder groups regarding diabetes prevention and lifestyle changes. The findings of this study demonstrate that, with appropriate methods and facilitation, adolescents, parents, and professionals can be empowered to co-design diabetes prevention programs. %M 33625364 %R 10.2196/18245 %U https://jopm.jmir.org/2021/1/e18245 %U https://doi.org/10.2196/18245 %U http://www.ncbi.nlm.nih.gov/pubmed/33625364 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e20217 %T eHealth Intervention to Improve Health Habits in the Adolescent Population: Mixed Methods Study %A Benavides,Carmen %A Benítez-Andrades,José Alberto %A Marqués-Sánchez,Pilar %A Arias,Natalia %+ SALBIS Research Group, Department of Electric, Systems and Automatics Engineering, University of León, Campus de Vegazana s/n, León, Spain, 34 987293628, jbena@unileon.es %K adolescent behaviors %K BMI %K diet %K healthy habits %K intervention %K leader %K physical activity %K social network analysis %K adolescent %K social network %K behavior %D 2021 %7 18.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology has provided a new way of life for the adolescent population. Indeed, strategies aimed at improving health-related behaviors through digital platforms can offer promising results. However, since it has been shown that peers are capable of modifying behaviors related to food and physical exercise, it is important to study whether digital interventions based on peer influence are capable of improving the weight status of adolescents. Objective: The purpose of this study was to assess the effectiveness of an eHealth app in an adolescent population in terms of improvements in their age- and sex-adjusted BMI percentiles. Other goals of the study were to examine the social relationships of adolescents pre- and postintervention, and to identify the group leaders and study their profiles, eating and physical activity habits, and use of the web app. Methods: The BMI percentiles were calculated in accordance with the reference guidelines of the World Health Organization. Participants’ diets and levels of physical activity were assessed using the Mediterranean Diet Quality Index (KIDMED) questionnaire and the Physical Activity Questionnaire for Adolescents (PAQ-A), respectively. The variables related to social networks were analyzed using the social network analysis (SNA) methodology. In this respect, peer relationships that were considered reciprocal friendships were used to compute the “degree” measure, which was used as an indicative parameter of centrality. Results: The sample population comprised 210 individuals in the intervention group (IG) and 91 individuals in the control group (CG). A participation rate of 60.1% (301/501) was obtained. After checking for homogeneity between the IG and the CG, it was found that adolescents in the IG at BMI percentiles both below and above the 50th percentile (P50) modified their BMI to approach this reference value (with a significance of P<.001 among individuals with an initial BMI below the P50 and P=.04 for those with an initial BMI above the P50). The diet was also improved in the IG compared with the CG (P<.001). After verifying that the social network had increased postintervention, it was seen that the group leaders (according to the degree SNA measure) were also leaders in physical activity performed (P=.002) and use of the app. Conclusions: The eHealth app was able to modify behaviors related to P50 compliance and exert a positive influence in relation to diet and physical exercise. Digital interventions in the adolescent population, based on the improvement in behaviors related to healthy habits and optimizing the social network, can offer promising results that help in the fight against obesity. %M 33599616 %R 10.2196/20217 %U http://mhealth.jmir.org/2021/2/e20217/ %U https://doi.org/10.2196/20217 %U http://www.ncbi.nlm.nih.gov/pubmed/33599616 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e18311 %T Effect of a Parent-Focused eHealth Intervention on Children’s Fruit, Vegetable, and Discretionary Food Intake (Food4toddlers): Randomized Controlled Trial %A Røed,Margrethe %A Medin,Anine C %A Vik,Frøydis N %A Hillesund,Elisabet R %A Van Lippevelde,Wendy %A Campbell,Karen %A Øverby,Nina C %+ Department of Nutrition and Public Health, University of Agder, Boks 422, Kristiansand, 4604, Norway, 47 91311933, margrethe.roed@uia.no %K toddler %K child %K eHealth %K intervention %K randomized controlled trial %K fruit %K vegetable %K discretionary food %D 2021 %7 16.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In Western countries, children’s diets are often low in fruits and vegetables and high in discretionary foods. Diet in early life tends to track through childhood and youth and even into adulthood. Interventions should, therefore, be delivered in periods when habitual traits are established, as in toddlerhood when children adapt to their family’s diet. Objective: In this study, we assessed the effect of the Food4toddlers eHealth intervention, which aimed to enhance toddlers’ diets by shaping their food and eating environment. Methods: The Food4toddlers randomized controlled trial was conducted in Norway in 2017-2018. Parent-child dyads were recruited through social media. In total, 298 parents completed an online questionnaire at baseline (mean child age 10.9 months, SD 1.2). Postintervention questionnaires were completed immediately after the intervention (ie, follow-up 1; mean child age 17.8 months, SD 1.3) and 6 months after the intervention (ie, follow-up 2; mean child age 24.2 months, SD 1.9). The intervention was guided by social cognitive theory, which targets the linked relationship between the person, the behavior, and the environment. The intervention group (148/298, 49.7%) got access to the Food4toddlers website for 6 months from baseline. The website included information on diet and on how to create a healthy food and eating environment as well as activities, recipes, and collaboration opportunities. To assess intervention effects on child diet from baseline to follow-up 1 and from baseline to follow-up 2, we used generalized estimating equations and a time × group interaction term. Between-group differences in changes over time for frequency and variety of fruits and vegetables and frequency of discretionary foods were assessed. Results: At follow-up 1, a significant time × group interaction was observed for the frequency of vegetable intake (P=.02). The difference between groups in the change from baseline to follow-up 1 was 0.46 vegetable items per day (95% CI 0.06-0.86) in favor of the intervention group. No other significant between-group differences in dietary changes from baseline to follow-up 1 or follow-up 2 were observed. However, there is a clear time trend showing that the intake of discretionary foods increases by time from less than 1 item per week at baseline to more than 4 items per week at 2 years of age (P<.001), regardless of group. Conclusions: A positive intervention effect was observed for the frequency of vegetable intake at follow-up 1 but not at follow-up 2. No other between-group effects on diet were observed. eHealth interventions of longer duration, including reminders after the main content of the intervention has been delivered, may be needed to obtain long-terms effects, along with tailoring in a digital or a personal form. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 92980420; https://doi.org/10.1186/ISRCTN92980420 %M 33591279 %R 10.2196/18311 %U http://www.jmir.org/2021/2/e18311/ %U https://doi.org/10.2196/18311 %U http://www.ncbi.nlm.nih.gov/pubmed/33591279 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e19430 %T App-Based Salt Reduction Intervention in School Children and Their Families (AppSalt) in China: Protocol for a Mixed Methods Process Evaluation %A Sun,Yuewen %A Luo,Rong %A Li,Yuan %A He,Feng J %A Tan,Monique %A MacGregor,Graham A %A Liu,Hueiming %A Zhang,Puhong %+ The George Institute for Global Health, Peking University Health Science Center, Room 011, Unit 2, Tayuan Diplomatic Office Building No. 14 Liangmahe Nan Lu, Beijing, 100600, China, 86 10 8280 0177, zpuhong@georgeinstitute.org.cn %K mobile health %K mobile phone %K process evaluation %K salt reduction %K health education %D 2021 %7 10.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The app-based salt reduction intervention program in school children and their families (AppSalt) is a multicomponent mobile health (mHealth) intervention program, which involves multiple stakeholders, including students, parents, teachers, school heads, and local health and education authorities. The complexity of the AppSalt program highlights the need for process evaluation to investigate how the implementation will be achieved at different sites. Objective: This paper presents a process evaluation protocol of the AppSalt program, which aims to monitor the implementation of the program, explain its causal mechanisms, and provide evidence for scaling up the program nationwide. Methods: A mixed methods approach will be used to collect data relating to five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data, including app use logs, activity logs, and routine monitoring data, will be collected alongside the intervention process to evaluate the quantity and quality of intervention activities. The quantitative data will be summarized as medians, means, and proportions as appropriate. Qualitative data will be collected through semistructured interviews of purposely selected intervention participants and key stakeholders from local health and education authorities. The thematic analysis technique will be used for analyzing the qualitative data with the support of NVivo 12. The qualitative data will be triangulated with the quantitative data during the interpretation phase to explain the 5 process evaluation dimensions. Results: The intervention activities of the AppSalt program were initiated at 27 primary schools in three cities since October 2018. We have completed the 1-year intervention of this program. The quantitative data for this study, including app use log, activity logs, and the routine monitoring data, were collected and organized during the intervention process. After completing the intervention, we conducted semistructured interviews with 32 students, 32 parents, 9 teachers, 9 school heads, and 8 stakeholders from local health and education departments. Data analysis is currently underway. Conclusions: Using mHealth technology for salt reduction among primary school students is an innovation in China. The findings of this study will help researchers understand the implementation of the AppSalt program and similar mHealth interventions in real-world settings. Furthermore, this process evaluation will be informative for other researchers and policy makers interested in replicating the AppSalt program and designing their salt reduction intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/19430 %M 33565991 %R 10.2196/19430 %U http://www.researchprotocols.org/2021/2/e19430/ %U https://doi.org/10.2196/19430 %U http://www.ncbi.nlm.nih.gov/pubmed/33565991 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e17501 %T Development and Feasibility of a Family-Based Health Behavior Intervention Using Intelligent Personal Assistants: Randomized Controlled Trial %A Carlin,Angela %A Logue,Caomhan %A Flynn,Jonathan %A Murphy,Marie H %A Gallagher,Alison M %+ Centre for Exercise Medicine, Physical Activity and Health, Sport and Exercise Sciences Research Institute, Ulster University, Shore Road, Newtownabbey, United Kingdom, 44 2871675037, a.carlin1@ulster.ac.uk %K children %K parent %K physical activity %K healthy eating %K technology %K mobile phone %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Intelligent personal assistants such as Amazon Echo and Google Home have become increasingly integrated into the home setting and, therefore, may facilitate behavior change via novel interactions or as an adjunct to conventional interventions. However, little is currently known about their potential role in this context. Objective: This feasibility study aims to develop the Intelligent Personal Assistant Project (IPAP) and assess the acceptability and feasibility of this technology for promoting and maintaining physical activity and other health-related behaviors in both parents and children. Methods: This pilot feasibility study was conducted in 2 phases. For phase 1, families who were attending a community-based weight management project were invited to participate, whereas phase 2 recruited families not currently receiving any additional intervention. Families were randomly allocated to either the intervention group (received a smart speaker for use in the family home) or the control group. The IPAP intervention aimed to promote positive health behaviors in the family setting through utilization of the functions of a smart speaker and its linked intelligent personal assistant. Data were collected on recruitment, retention, outcome measures, intervention acceptability, device interactions, and usage. Results: In total, 26 families with at least one child aged 5 to 12 years were recruited, with 23 families retained at follow-up. Across phase 1 of the intervention, families interacted with the intelligent personal assistant a total of 65 times. Although device interactions across phase 2 of the intervention were much higher (312 times), only 10.9% (34/312) of interactions were coded as relevant (related to diet, physical activity or well-being). Focus groups highlighted that the families found the devices acceptable and easy to use and felt that the prompts or reminders were useful in prompting healthier behaviors. Some further intervention refinements in relation to the timing of prompts and integrating feedback alongside the devices were suggested by families. Conclusions: Using intelligent personal assistants to deliver health-related messages and information within the home is feasible, with high levels of engagement reported by participating families. This novel feasibility study highlights important methodological considerations that should inform future trials testing the effectiveness of intelligent personal assistants in promoting positive health-related behaviors. Trial Registration: ISRCTN Registry ISRCTN16792534; http://www.isrctn.com/ISRCTN16792534 %M 33507155 %R 10.2196/17501 %U http://formative.jmir.org/2021/1/e17501/ %U https://doi.org/10.2196/17501 %U http://www.ncbi.nlm.nih.gov/pubmed/33507155 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e22680 %T Program for Healthier School Cafeterias in Rio Grande do Sul, Brazil: Protocol for a Community-Based Randomized Trial %A Balestrin,Mariana %A Brasil,Carla Cristina Bauermann %A Bellei,Ericles Andrei %A Kirsten,Vanessa Ramos %A Wagner,Mario Bernardes %+ Faculty of Medical Sciences, Federal University of Rio Grande do Sul (UFRGS), 2400 Ramiro Barcelos, Room 220, Porto Alegre, 90035-003, Brazil, 55 51 33085601, mari_dalmolin@hotmail.com %K school health services %K healthy diet %K pediatric obesity %K schools %K snacks %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: School cafeterias can promote poor eating habits, as these retail outlets have a variety of foods considered to be nonnutritive and unhealthy. However, despite the need for effective preventive strategies, there is still disagreement on the best approach due to the lack of evidence on interventions to prevent and treat obesity in the school settings. Objective: We aim to verify the efficacy of an educational intervention program to improve the hygienic conditions and the composition of the menu offered in school cafeterias in the state of Rio Grande do Sul, Brazil. Methods: We will conduct a randomized, parallel, two-arm, community-based controlled study. Elementary and high schools, both public and private, in the State of Rio Grande do Sul, Brazil, that have a cafeteria will be eligible. Schools will be recruited and randomly assigned to the intervention (n=27) or control (n=27) group. The intervention group will receive an educational intervention program based on the guidelines issued by the Ministry of Health of Brazil, consisting of a 160-hour distance-learning qualification course, for 10 weeks, and using the Moodle platform and WhatsApp app. The intervention targets the owners and people in charge of the cafeterias, food handlers, principals, vice principals, teachers, pedagogical coordinators, dietitians, representatives of students' parents, and students over 16 years old. Meanwhile, the control group will receive only a printed copy of the book containing the guidelines used. The efficacy of the intervention will be determined by the hygienic conditions of the cafeteria and the composition of the menu offered, also considering the levels of processing of food sold. All outcomes will be analyzed as intention-to-treat and per-protocol. We will use covariance analysis or a generalized linear model for continuous data and ordinal logistic regression for ordinal categorical data. The level of statistical significance considered will be P<.05 for a 95% CI. Results: This project was funded in early 2018. We administered the intervention program in 2019. All data have already been collected, and we are analyzing the data. The results are expected in 2021. Conclusions: To our knowledge, this may be the first randomized controlled study in school cafeterias held in Brazil. The results will provide evidence for the formulation of public food and nutritional security policies and for the development of effective strategies to provide safe and healthy school meals. Trial Registration: Brazilian Clinical Trials Registry RBR-9rrqhk; https://ensaiosclinicos.gov.br/rg/RBR-9rrqhk International Registered Report Identifier (IRRID): DERR1-10.2196/22680 %M 33464219 %R 10.2196/22680 %U http://www.researchprotocols.org/2021/1/e22680/ %U https://doi.org/10.2196/22680 %U http://www.ncbi.nlm.nih.gov/pubmed/33464219 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e24714 %T Digital Tools to Support Family-Based Weight Management for Children: Mixed Methods Pilot and Feasibility Study %A Staiano,Amanda E %A Shanley,Jenelle R %A Kihm,Holly %A Hawkins,Keely R %A Self-Brown,Shannon %A Höchsmann,Christoph %A Osborne,Melissa C %A LeBlanc,Monique M %A Apolzan,John W %A Martin,Corby K %+ Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA, 70808, United States, 1 2257632729, amanda.staiano@pbrc.edu %K parent training %K weight loss %K telehealth %K obesity %K SafeCare %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Family-based behavioral therapy is an efficacious approach to deliver weight management counseling to children and their parents. However, most families do not have access to in-person, evidence-based treatment. We previously developed and tested DRIVE (Developing Relationships that Include Values of Eating and Exercise), a home-based parent training program to maintain body weight among children at risk for obesity, with the intent to eventually disseminate it nationally alongside SafeCare, a parent support program that focuses on parent-child interactions. Currently the DRIVE program has only been tested independently of SafeCare. This study created the “mHealth DRIVE” program by further adapting DRIVE to incorporate digital and mobile health tools, including remotely delivered sessions, a wireless scale that enabled a child-tailored weight graph, and a pedometer. Telehealth delivery via mHealth platforms and other digital tools can improve program cost-effectiveness, deliver long-term care, and directly support both families and care providers. Objective: The objective of this study was to examine preliminary acceptability and effectiveness of the mHealth DRIVE program among children and parents who received it and among SafeCare providers who potentially could deliver it. Methods: Study 1 was a 13-week pilot study of a remotely delivered mHealth family-based weight management program. Satisfaction surveys were administered, and height and weight were measured pre- and post-study. Study 2 was a feasibility/acceptability survey administered to SafeCare providers. Results: Parental and child satisfaction (mean of 4.9/6.0 and 3.8/5.0, respectively) were high, and children’s (N=10) BMI z-scores significantly decreased (mean –0.14, SD 0.17; P=.025). Over 90% of SafeCare providers (N=74) indicated that SafeCare families would benefit from learning how to eat healthily and be more active, and 80% of providers reported that they and the families would benefit from digital tools to support child weight management. Conclusions: Pediatric mHealth weight management interventions show promise for effectiveness and acceptability by families and providers. Trial Registration: Clinicaltrials.gov NCT03297541, https://clinicaltrials.gov/ct2/show/NCT03297541. %M 33410760 %R 10.2196/24714 %U https://pediatrics.jmir.org/2021/1/e24714 %U https://doi.org/10.2196/24714 %U http://www.ncbi.nlm.nih.gov/pubmed/33410760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e21602 %T Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study %A Locher,Ione %A Waselewski,Marika %A Sonneville,Kendrin %A Resnicow,Ken %A Chang,Tammy %+ University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, United States, 1 734 730 4636, tachang@med.umich.edu %K pregnancy %K adolescent %K young adult %K female %K gestational weight gain %K diet %K food preferences %K text messaging %K feasibility studies %D 2020 %7 24.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. Objective: Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. Methods: The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US $35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants’ perspectives on grocery delivery, participants’ perspectives on dietary impact of the program, and foods consumed by participants. Results: A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5% (259/263) successful deliveries and 89.4% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. Conclusions: A grocery delivery–based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy. %M 33361055 %R 10.2196/21602 %U http://formative.jmir.org/2020/12/e21602/ %U https://doi.org/10.2196/21602 %U http://www.ncbi.nlm.nih.gov/pubmed/33361055 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e22775 %T A Nutrition Intervention to Promote the Consumption of Pulse-Based Foods in Childcare Centers: Protocol for a Multimethod Study %A Haileslassie,Hiwot Abebe %A Ramikie,Renee %A Vatanparast,Hassan %A Ramdath,D Dan %A Froehlich Chow,Amanda %A Shand,Phyllis %A Engler-Stringer,Rachel %A Lieffers,Jessica RL %A Hood-Niefer,Shannon %A Henry,Carol %+ College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK, S7N 5E5, Canada, 1 3069666327, hah483@usask.ca %K behavior change %K childcare center %K intervention mapping %K nutrition intervention %K preschool children %K pulse %D 2020 %7 24.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Plant-based foods, including pulses (dry beans, lentils, chickpeas, and peas), have gained worldwide attention owing to their health and environmental benefits. Despite high production, the consumption of pulses is low in Canada. Behavior change interventions systematically designed to promote the consumption of pulse-based foods are scarce. Objective: We describe the utilization of intervention mapping (IM) in the development of a multicomponent nutrition intervention aimed at promoting consumption of pulse-based foods among preschool children in childcare centers in Saskatchewan, Canada. Methods: The Pulse Discovery Toolkit intervention was developed following the six steps of the IM protocol. Decisions at each step were either based upon literature review, expert consultation, pretesting, or a combination of these. Following the initial phase of the study, which focused on intervention development, phases II and III of the study were concerned with pilot testing and roll-out of the intervention, respectively. In total, one, two, and four childcare centers participated in phases I, II, and III, respectively. A multimethod approach was designed to evaluate the intervention during pilot testing and roll-out. Results: The application of IM steps 1 to 3 in phase I resulted in the creation of performance objectives at different levels, including at the individual level (preschool children), and the social and environmental levels (parents, early childhood educators, and cooks). These objectives were then used to create a matrix of objectives matching the constructs of the social cognitive theory while taking Piaget cognitive development into consideration. This step was followed by defining program components, implementation, adoption, and evaluation strategies, which were utilized in phases II and III. Data have been collected from 2015 to 2018 and analyzed. The results will be reported elsewhere. Conclusions: The IM protocol provided a rigorous framework for the development of a multicomponent evidence-based intervention to promote pulse-based foods in childcare centers. International Registered Report Identifier (IRRID): RR1-10.2196/22775 %M 33361052 %R 10.2196/22775 %U http://www.researchprotocols.org/2020/12/e22775/ %U https://doi.org/10.2196/22775 %U http://www.ncbi.nlm.nih.gov/pubmed/33361052 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e22121 %T Advanced Health Information Technologies to Engage Parents, Clinicians, and Community Nutritionists in Coordinating Responsive Parenting Care: Descriptive Case Series of the Women, Infants, and Children Enhancements to Early Healthy Lifestyles for Baby (WEE Baby) Care Randomized Controlled Trial %A Kling,Samantha MR %A Harris,Holly A %A Marini,Michele %A Cook,Adam %A Hess,Lindsey B %A Lutcher,Shawnee %A Mowery,Jacob %A Bell,Scott %A Hassink,Sandra %A Hayward,Shannon B %A Johnson,Greg %A Franceschelli Hosterman,Jennifer %A Paul,Ian M %A Seiler,Christopher %A Sword,Shirley %A Savage,Jennifer S %A Bailey-Davis,Lisa %+ Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, 1265 Welch Rd x216, Stanford, CA, 94305, United States, 1 605 726 3392, skling@stanford.edu %K early obesity prevention %K responsive parenting %K health information technology %K coordination of care %K clinical care %K pragmatic intervention %K data sharing %D 2020 %7 24.11.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Socioeconomically disadvantaged newborns receive care from primary care providers (PCPs) and Women, Infants, and Children (WIC) nutritionists. However, care is not coordinated between these settings, which can result in conflicting messages. Stakeholders support an integrated approach that coordinates services between settings with care tailored to patient-centered needs. Objective: This analysis describes the usability of advanced health information technologies aiming to engage parents in self-reporting parenting practices, integrate data into electronic health records to inform and facilitate documentation of provided responsive parenting (RP) care, and share data between settings to create opportunities to coordinate care between PCPs and WIC nutritionists. Methods: Parents and newborns (dyads) who were eligible for WIC care and received pediatric care in a single health system were recruited and randomized to a RP intervention or control group. For the 6-month intervention, electronic systems were created to facilitate documentation, data sharing, and coordination of provided RP care. Prior to PCP visits, parents were prompted to respond to the Early Healthy Lifestyles (EHL) self-assessment tool to capture current RP practices. Responses were integrated into the electronic health record and shared with WIC. Documentation of RP care and an 80-character, free-text comment were shared between WIC and PCPs. A care coordination opportunity existed when the dyad attended a WIC visit and these data were available from the PCP, and vice versa. Care coordination was demonstrated when WIC or PCPs interacted with data and documented RP care provided at the visit. Results: Dyads (N=131) attended 459 PCP (3.5, SD 1.0 per dyad) and 296 WIC (2.3, SD 1.0 per dyad) visits. Parents completed the EHL tool prior to 53.2% (244/459) of PCP visits (1.9, SD 1.2 per dyad), PCPs documented provided RP care at 35.3% (162/459) of visits, and data were shared with WIC following 100% (459/459) of PCP visits. A WIC visit followed a PCP visit 50.3% (231/459) of the time; thus, there were 1.8 (SD 0.8 per dyad) PCP to WIC care coordination opportunities. WIC coordinated care by documenting RP care at 66.7% (154/231) of opportunities (1.2, SD 0.9 per dyad). WIC visits were followed by a PCP visit 58.9% (116/197) of the time; thus, there were 0.9 (SD 0.8 per dyad) WIC to PCP care coordination opportunities. PCPs coordinated care by documenting RP care at 44.0% (51/116) of opportunities (0.4, SD 0.6 per dyad). Conclusions: Results support the usability of advanced health information technology strategies to collect patient-reported data and share these data between multiple providers. Although PCPs and WIC shared data, WIC nutritionists were more likely to use data and document RP care to coordinate care than PCPs. Variability in timing, sequence, and frequency of visits underscores the need for flexibility in pragmatic studies. Trial Registration: ClinicalTrials.gov NCT03482908; https://clinicaltrials.gov/ct2/show/NCT03482908 International Registered Report Identifier (IRRID): RR2-10.1186/s12887-018-1263-z %M 33231559 %R 10.2196/22121 %U http://pediatrics.jmir.org/2020/2/e22121/ %U https://doi.org/10.2196/22121 %U http://www.ncbi.nlm.nih.gov/pubmed/33231559 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22036 %T Barriers and Enablers to Adoption of Digital Health Interventions to Support the Implementation of Dietary Guidelines in Early Childhood Education and Care: Cross-Sectional Study %A Grady,Alice %A Barnes,Courtney %A Wolfenden,Luke %A Lecathelinais,Christophe %A Yoong,Sze Lin %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 0249246310, alice.grady@health.nsw.gov.au %K early childhood education and care %K digital health technologies %K adoption %K dissemination %K guidelines %D 2020 %7 20.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Few Australian childcare centers provide foods consistent with sector dietary guidelines. Digital health technologies are a promising medium to improve the implementation of evidence-based guidelines in the setting. Despite being widely accessible, the population-level impact of such technologies has been limited due to the lack of adoption by end users. Objective: This study aimed to assess in a national sample of Australian childcare centers (1) intentions to adopt digital health interventions to support the implementation of dietary guidelines, (2) reported barriers and enablers to the adoption of digital health interventions in the setting, and (3) barriers and enablers associated with high intentions to adopt digital health interventions. Methods: A cross-sectional telephone or online survey was undertaken with 407 childcare centers randomly sampled from a publicly available national register in 2018. Center intentions to adopt new digital health interventions to support dietary guideline implementation in the sector were assessed, in addition to perceived individual, organizational, and contextual factors that may influence adoption based on seven subdomains within the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) of health and care technologies framework. A multiple-variable linear model was used to identify factors associated with high intentions to adopt digital health interventions. Results: Findings indicate that 58.9% (229/389) of childcare centers have high intentions to adopt a digital health intervention to support guideline implementation. The changes needed in team interactions subdomain scored lowest, which is indicative of a potential barrier (mean 3.52, SD 1.30), with organization’s capacity to innovate scoring highest, which is indicative of a potential enabler (mean 5.25, SD 1.00). The two NASSS subdomains of ease of the adoption decision (P<.001) and identifying work and individuals involved in implementation (P=.001) were significantly associated with high intentions to adopt digital health interventions. Conclusions: A substantial proportion of Australian childcare centers have high intentions to adopt new digital health interventions to support dietary guideline implementation. Given evidence of the effectiveness of digital health interventions, these findings suggest that such an intervention may make an important contribution to improving public health nutrition in early childhood. %M 33216005 %R 10.2196/22036 %U http://www.jmir.org/2020/11/e22036/ %U https://doi.org/10.2196/22036 %U http://www.ncbi.nlm.nih.gov/pubmed/33216005 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e15717 %T Impact of Pediatric Mobile Game Play on Healthy Eating Behavior: Randomized Controlled Trial %A Kato-Lin,Yi-Chin %A Kumar,Uttara Bharath %A Sri Prakash,Bhargav %A Prakash,Bhairavi %A Varadan,Vasini %A Agnihotri,Sanjeeta %A Subramanyam,Nrutya %A Krishnatray,Pradeep %A Padman,Rema %+ The Heinz College of Information Systems and Public Policy, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA, , United States, 1 412 268 2180, rpadman@cmu.edu %K pediatric obesity %K mobile games %K implicit learning %K healthy eating behavior evaluation %K game telemetry analysis %D 2020 %7 18.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Video and mobile games have been shown to have a positive impact on behavior change in children. However, the potential impact of game play patterns on outcomes of interest are yet to be understood, especially for games with implicit learning components. Objective: This study investigates the immediate impact of fooya!, a pediatric dietary mobile game with implicit learning components, on food choices. It also quantifies children’s heterogeneous game play patterns using game telemetry and determines the effects of these patterns on players’ food choices. Methods: We analyzed data from a randomized controlled trial (RCT) involving 104 children, aged 10 to 11 years, randomly assigned to the treatment group (played fooya!, a dietary mobile game developed by one of the authors) or the control group (played Uno, a board game without dietary education). Children played the game for 20 minutes each in two sessions. After playing the game in each session, the children were asked to choose 2 out of 6 food items (3 healthy and 3 unhealthy choices). The number of healthy choices in both sessions was used as the major outcome. We first compared the choice and identification of healthy foods between treatment and control groups using statistical tests. Next, using game telemetry, we determined the variability in game play patterns by quantifying game play measures and modeled the process of game playing at any level across all students as a Markov chain. Finally, correlation tests and regression models were used to establish the relationship between game play measures and actual food choices. Results: We saw a significant main effect of the mobile game on number of healthy foods actually chosen (treatment 2.48, control 1.10; P<.001; Cohen d=1.25) and identified (treatment 7.3, control 6.94; P=.048; Cohen d=.25). A large variation was observed in children’s game play patterns. Children played an average of 15 game levels in 2 sessions, with a range of 2 to 23 levels. The greatest variation was noted in the proportion of scoring activities that were highly rewarded, with an average of 0.17, ranging from 0.003 to 0.98. Healthy food choice was negatively associated with the number of unhealthy food facts that children read in the game (Kendall τ=–.32, P=.04), even after controlling for baseline food preference. Conclusions: A mobile video game embedded with implicit learning components showed a strong positive impact on children’s food choices immediately following the game. Game telemetry captured children’s different play patterns and was associated with behavioral outcomes. These results have implications for the design and use of mobile games as an intervention to improve health behaviors, such as the display of unhealthy food facts during game play. Longitudinal RCTs are needed to assess long-term impact. Trial Registration: ClinicalTrials.gov NCT04082195; https://clinicaltrials.gov/ct2/show/NCT04082195, registered retrospectively. %M 33206054 %R 10.2196/15717 %U http://mhealth.jmir.org/2020/11/e15717/ %U https://doi.org/10.2196/15717 %U http://www.ncbi.nlm.nih.gov/pubmed/33206054 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e20534 %T Effects of a Collective Family-Based Mobile Health Intervention Called “SMARTFAMILY” on Promoting Physical Activity and Healthy Eating: Protocol for a Randomized Controlled Trial %A Wunsch,Kathrin %A Eckert,Tobias %A Fiedler,Janis %A Cleven,Laura %A Niermann,Christina %A Reiterer,Harald %A Renner,Britta %A Woll,Alexander %+ Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, Karlsruhe, 76131, Germany, 49 72160845431, kathrin.wunsch@kit.edu %K mobile app %K telemedicine %K behavior change %K health behavior %K family %K primary prevention %K exercise %K food and nutrition %K randomized controlled trial %K accelerometer %K wearable electronic devices %K social cognitive determinants %K just-in-time adaptive intervention %K digital intervention %K mobile phone %D 2020 %7 11.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Numerous smartphone apps are targeting physical activity and healthy eating, but empirical evidence on their effectiveness for initialization and maintenance of behavior change, especially in children and adolescents, is still limited. Objective: The aim of this study was to conceptualize a theory-based and evidence-based mHealth intervention called SMARTFAMILY (SF) that targets physical activity and healthy eating in a collective family-based setting. Subsequently, the app will be refined and re-evaluated to analyze additional effects of just-in-time adaptive interventions (JITAIs) and gamification features. Methods: A smartphone app based on behavior change theories and behavior change techniques was developed and implemented and will be evaluated with family members individually and cooperatively (SF trial). Existing evidence and gained results were used to refine and will be used to re-evaluate the app (SF2.0 trial). Both trials are cluster randomized controlled trials with 3 measurement occasions. The intervention group uses the app for 3 consecutive weeks, whereas the control group receives no treatment. Baseline measurements (T0) and postintervention measurements (T1) include physical activity (ie, self-reported and accelerometry) and healthy eating measurements (ie, self-reported fruit and vegetable intake) as the primary outcomes. The secondary outcomes (ie, self-reported) are intrinsic motivation, behavior-specific self-efficacy, and the family health climate, complemented by an intentional measure in SF2.0. Four weeks following T1, a follow-up assessment (T2) is completed by the participants, consisting of all questionnaire items to assess the stability of the intervention effects. Mixed-method analysis of covariance will be used to calculate the primary intervention effects (ie, physical activity, fruit and vegetable intake) while controlling for covariates, including family health climate, behavior-specific self-efficacy, and intrinsic motivation. Results: This study is funded by the German Federal Ministry of Education and Research and ethically approved by the Karlsruhe Institute of Technology. For both trials, it is hypothesized that the apps will positively influence physical activity and healthy eating in the whole family. Furthermore, SF2.0 is expected to produce stronger effects (ie, higher effect sizes) compared to SF. SF app development and piloting are completed. Data acquisition for the SF trial is terminated and discontinued due to the COVID-19 pandemic. SF2.0 app development and piloting are completed, while data acquisition is ongoing. Participant recruitment for the SF 2.0 trial started in February 2020. The results for SF are expected to be published in mid-2021, and the results of SF2.0 are expected to be published in mid-2022. Conclusions: In this study, it is hypothesized that targeting the whole family will facilitate behavior change at the individual level and the family level, as the implemented strategies address changes in daily family life. Furthermore, subsequent app development (SF2.0) with supplementary addition of motivation-enhancing features and a JITAI approach is expected to enhance positive intervention effects. Trial Registration: German Clinical Trials Register DRKS00010415; https://tinyurl.com/yyo87yyu International Registered Report Identifier (IRRID): DERR1-10.2196/20534 %M 33174849 %R 10.2196/20534 %U http://www.researchprotocols.org/2020/11/e20534/ %U https://doi.org/10.2196/20534 %U http://www.ncbi.nlm.nih.gov/pubmed/33174849 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17999 %T Development of an Intervention Targeting Multiple Health Behaviors Among High School Students: Participatory Design Study Using Heuristic Evaluation and Usability Testing %A Müssener,Ulrika %A Thomas,Kristin %A Linderoth,Catharina %A Löf,Marie %A Åsberg,Katarina %A Henriksson,Pontus %A Bendtsen,Marcus %+ Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 1, Linköping, 58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K mHealth intervention %K health behavior %K high school students %K participatory design %K heuristic evaluation %K usability testing %K mobile phone %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile electronic platforms provide exciting possibilities for health behavior promotion. For instance, they can promote smoking cessation, moderate alcohol consumption, healthy eating, and physical activity. Young adults in Sweden are proficient in the use of technology, having been exposed to computers, smartphones, and the internet from an early age. However, with the high availability of mobile health (mHealth) interventions of varying quality, it is critical to optimize the usability of mHealth interventions to ensure long-term use of these health promotion interventions. Objective: This study aims to investigate the usability of an mHealth intervention (LIFE4YOUth) targeting health behaviors among high school students through heuristic evaluation and usability testing. Methods: A preliminary version of the LIFE4YOUth mHealth intervention, which was aimed at promoting healthy eating, physical activity, smoking cessation, and nonrisky drinking among high school students, was developed in early 2019. We completed a total of 15 heuristic evaluations and 5 usability tests to evaluate the usability of the mHealth intervention prototype to improve its functioning, content, and design. Results: Heuristic evaluation from a total of 15 experts (10 employees and 5 university students, both women and men, aged 18-25 years) revealed that the major usability problems and the worst ratings, a total of 17 problems termed usability catastrophes, concerned shortcomings in displaying easy-to-understand information to the users or technical errors. The results of the usability testing including 5 high school students (both girls and boys, aged 15-18 years) showed that the design, quality, and quantity of content in the intervention may impact the users’ level of engagement. Poor functionality was considered a major barrier to usability. Of the 5 participants, one rated the LIFE4YOUth intervention as poor, 2 rated as average, and 2 assessed it as good, according to the System Usability Scale. Conclusions: High school students have high expectations of digital products. If an mHealth intervention does not offer optimal functions, they may cease to use it. Optimizing the usability of mHealth interventions is a critical step in the development process. Heuristic evaluation and usability testing in this study provided valuable knowledge about the prototype from a user’s perspective. The findings may lead to the development of similar interventions targeting the high school population. %M 33118942 %R 10.2196/17999 %U http://mhealth.jmir.org/2020/10/e17999/ %U https://doi.org/10.2196/17999 %U http://www.ncbi.nlm.nih.gov/pubmed/33118942 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e20336 %T Understanding the Extent of Adolescents’ Willingness to Engage With Food and Beverage Companies’ Instagram Accounts: Experimental Survey Study %A Lutfeali,Samina %A Ward,Tisheya %A Greene,Tenay %A Arshonsky,Josh %A Seixas,Azizi %A Dalton,Madeline %A Bragg,Marie A %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 3rd Fl, New York, NY, 10016, United States, 1 646 501 2717, Marie.Bragg@nyulangone.org %K social media %K Instagram %K social media marketing %K food industry %K adolescents %K adolescent health %D 2020 %7 27.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media platforms have created a new advertising frontier, yet little is known about the extent to which this interactive form of advertising shapes adolescents’ online relationships with unhealthy food brands. Objective: We aimed to understand the extent to which adolescents’ preferences for Instagram food ads are shaped by the presence of comments and varying numbers of “likes.” We hypothesized that adolescents would show the highest preferences for ads with more “likes” and comments. We predicted that these differences would be greater among adolescents who were “heavy social media users” (ie, >3 hours daily) vs “light social media users” (ie, <3 hours daily). Methods: We recruited Black and non-Latinx White adolescents (aged 13-17 years; N=832) from Dynata, a firm that maintains online participant panels. Participants completed an online survey in which they were randomized to view and rate Instagram food ads that either did or did not show comments. Within each condition, adolescents were randomized to view 4 images that had high (>10,000), medium (1000-10,000), or low (<100) numbers of “likes.” Adolescents reported ad preferences and willingness to engage with the brand. Results: Adolescents rated ads with medium or high numbers of “likes” higher than ads with few “likes” (P=.001 and P=.002, respectively). Heavy social media users (>3 hours/day) were 6.366 times more willing to comment on ads compared to light users (P<.001). Conclusions: Adolescents interact with brands in ways that mimic interactions with friends on social media, which is concerning when brands promote unhealthy products. Adolescents also preferred ads with many “likes,” demonstrating the power of social norms in shaping behavior. As proposed in 2019, the Children’s Online Privacy and Protection Act should expand online advertising restrictions to include adolescents aged 12 to 16 years. %M 33107836 %R 10.2196/20336 %U https://publichealth.jmir.org/2020/4/e20336 %U https://doi.org/10.2196/20336 %U http://www.ncbi.nlm.nih.gov/pubmed/33107836 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20976 %T Repeated Psychosocial Screening of High School Students Using YouthCHAT: Cohort Study %A Thabrew,Hiran %A Kumar,Harshali %A Goldfinch,Mary %A Cavadino,Alana %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, The University of Auckland, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 21402055, h.thabrew@auckland.ac.nz %K mass screening %K mental health %K school health services %K eHealth %D 2020 %7 26.10.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Psychosocial problems are common during adolescence and can have long-lasting effects on health and on academic and social functioning. YouthCHAT, an electronic HEEADSSS (home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality and safety)-aligned instrument, has recently been demonstrated to be an acceptable and effective school-based psychosocial screener for 13-year-old (Year 9) high school students. Objective: This study aims to compare acceptability and detection rates with repeated YouthCHAT screenings of high school students when they are 13 years old (Year 9) and 14 years old (Year 10). Methods: We invited all Year-10 students to complete a YouthCHAT screening in 2018. Rates of positively identified issues were compared between the subset of students screened in both 2017 and 2018. Student acceptability toward YouthCHAT was investigated through focus group sessions. Onward clinical referral rates in 2018 were also investigated to explore the potential referral burden following screening. Data analysis for rates of positively identified issues were conducted with the McNemar test. Chi-square, Fisher exact test, and Kruskal-Wallis test were used to analyze the focus group data. Results: Of 141 eligible Year-10 students, 114 (81%) completed a YouthCHAT screening during 2018, and 97 (85%) of them completed it for a second time. Apart from depression, which increased (P=.002), and perceived life stress, which decreased (P=.04), rates of identified issues were broadly similar between 13 and 14 years of age. Repeated screenings via YouthCHAT was acceptable to students and time-efficient (mean, 6 minutes and 32 seconds) but did not reduce the overall number of individuals with identified issues. Onward clinical referrals from positive screens were mostly managed by school-based health services without the need for external referrals. Conclusions: Although further evaluation is needed, our results support the value of YouthCHAT as an acceptable and effective instrument with which to achieve routine identification of psychosocial issues and early intervention within a high school environment. %M 33104007 %R 10.2196/20976 %U http://pediatrics.jmir.org/2020/2/e20976/ %U https://doi.org/10.2196/20976 %U http://www.ncbi.nlm.nih.gov/pubmed/33104007 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 3 %P e21813 %T Relationship Between Children’s Enjoyment, User Experience Satisfaction, and Learning in a Serious Video Game for Nutrition Education: Empirical Pilot Study %A Espinosa-Curiel,Ismael Edrein %A Pozas-Bogarin,Edgar Efrén %A Martínez-Miranda,Juan %A Pérez-Espinosa,Humberto %+ Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Andador 10, entre calles 3 y 4, Ciudad del conocimiento, Tepic, Nayarit, 63173, Mexico, 52 1295930 ext 28607, ecuriel@cicese.edu.mx %K Serious video games %K children %K enjoyment %K user experience %K satisfaction %K game-based learning %K nutrition %K serious game %K pilot study %D 2020 %7 17.9.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: The design and use of serious video games for children have increased in recent years. To maximize the effects of these games, it is essential to understand the children’s experiences through playing. Previous studies identified that enjoyment and user experience satisfaction of the players are principal factors that can influence the success of serious video games and the learning of their players. However, research about the relationship between enjoyment and user experience satisfaction with learning in children 8 to 10 years old is sparse. Objective: We examined the relationship of enjoyment and user experience satisfaction with the learning of children aged 8 to 10 years while playing a serious video game for health, FoodRateMaster. This serious video game teaches children about the characteristics of healthy and unhealthy foods and how to identify them in their environment. Methods: Children aged 8 to 10 years were recruited from a primary school in Mexico. Participants completed 12 individual gaming sessions with FoodRateMaster in 6 weeks. A food knowledge questionnaire was administered before and after game play to assess the players’ food knowledge. In addition, after the gaming sessions, the children’s enjoyment and user experience satisfaction were evaluated using the EGameFlow questionnaire and the Game User Experience Satisfaction Scale (GUESS) questionnaire. Results: We found significant positive associations for children’s (n=60) posttest knowledge with enjoyment (r58=0.36, P=.005) and user experience satisfaction (r58=0.27, P=.04). The children’s posttest knowledge scores were also positively correlated with challenge (r58=0.38, P=.003), knowledge improvement (r58=0.38, P=.003), and goal clarity (r58=0.29, P=.02) EGameFlow subscales and with narrative (r58=0.35, P=.006), creative freedom (r58=0.26, P=.04), and visual esthetics (r58=0.32, P=.01) GUESS subscales. Regression analysis indicated that the EGameFlow (F7,52=2.74, P=.02, R2=0.27) and the GUESS (F8,51=2.20, P=.04, R2=0.26) ratings significantly predicted the children’s posttest knowledge scores. EGameFlow challenge (β=0.40, t52=2.17, P=.04) and knowledge improvement (β=0.29, t52=2.06, P=.04) subscales significantly contributed to predicting children’s learning. None of the GUESS subscales significantly contributed to predicting children’s learning. Conclusions: The findings of this study suggest that both enjoyment and user experience satisfaction for children aged 8 to 10 years were positively correlated with their learning and that were significant predictors of it. Challenge, knowledge improvement, narrative, creative freedom, and visual esthetics subscales correlated positively with children’s learning. In addition, challenge and knowledge improvement contributed to predicting their learning. These results are relevant to consider during the design stages of serious games developed for young children’s learning purposes. %M 32940609 %R 10.2196/21813 %U http://games.jmir.org/2020/3/e21813/ %U https://doi.org/10.2196/21813 %U http://www.ncbi.nlm.nih.gov/pubmed/32940609 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e18292 %T The Evolving Family Mealtime: Findings From Focus Group Interviews With Hispanic Mothers %A Hammons,Amber Jean %A Villegas,Elizabeth %A Olvera,Norma %A Greder,Kimberly %A Fiese,Barbara %A Teran-Garcia,Margarita %A , %+ California State University, 5241 N Maple Ave, Fresno, CA, , United States, 1 5592781158 ext 1158, ahammons@csufresno.edu %K family mealtimes %K healthy eating %K technology at the table %K parenting and mealtimes %K Hispanic culture %K obesity prevention %D 2020 %7 10.8.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Given the protective effects of shared family mealtimes and the importance of family in the Hispanic culture, this context should be explored further to determine how it can be leveraged and optimized for interventions. Objective: This study aimed to explore contextual factors associated with family mealtimes in Mexican and Puerto Rican families. Methods: A total of 63 mothers participated in 13 focus group interviews across 4 states. Thematic analysis was used to analyze transcripts. Results: Seven overarching themes were identified through the thematic analysis. Themes reflected who was present at the mealtime, what occurs during mealtime, the presence of television, the influence of technology during mealtime, and how mealtimes have changed since the mothers were children. Conclusions: Hispanic mothers may be adapting family mealtimes to fit their current situations and needs, keeping the television and other devices on during mealtimes, and making additional meals for multiple family members to appease everyone’s tastes. All of these are areas that can be incorporated into existing culturally tailored obesity prevention programs to help families lead healthier lives. %M 32576547 %R 10.2196/18292 %U http://pediatrics.jmir.org/2020/2/e18292/ %U https://doi.org/10.2196/18292 %U http://www.ncbi.nlm.nih.gov/pubmed/32576547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16924 %T Digital Behavior Change Interventions for Younger Children With Chronic Health Conditions: Systematic Review %A Brigden,Amberly %A Anderson,Emma %A Linney,Catherine %A Morris,Richard %A Parslow,Roxanne %A Serafimova,Teona %A Smith,Lucie %A Briggs,Emily %A Loades,Maria %A Crawley,Esther %+ Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road, Bristol, BS8 1NU, United Kingdom, 44 0117 42 83080, amberly.brigden@bristol.ac.uk %K mobile phone %K mHealth %K mobile health %K eHealth %K electronic health %K digital health %K behavior %K pediatrics %K chronic illness %K systematic review %D 2020 %7 31.7.2020 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of chronic health conditions in childhood is increasing, and behavioral interventions can support the management of these conditions. Compared with face-to-face treatment, the use of digital interventions may be more cost-effective, appealing, and accessible, but there has been inadequate attention to their use with younger populations (children aged 5-12 years). Objective: This systematic review aims to (1) identify effective digital interventions, (2) report the characteristics of promising interventions, and (3) describe the user’s experience of the digital intervention. Methods: A total of 4 databases were searched (Excerpta Medica Database [EMBASE], PsycINFO, Medical Literature Analysis and Retrieval System Online [MEDLINE], and the Cochrane Library) between January 2014 and January 2019. The inclusion criteria for studies were as follows: (1) children aged between 5 and 12 years, (2) interventions for behavior change, (3) randomized controlled trials, (4) digital interventions, and (5) chronic health conditions. Two researchers independently double reviewed papers to assess eligibility, extract data, and assess quality. Results: Searches run in the databases identified 2643 papers. We identified 17 eligible interventions. The most promising interventions (having a beneficial effect and low risk of bias) were 3 targeting overweight or obesity, using exergaming or social media, and 2 for anxiety, using web-based cognitive behavioral therapy (CBT). Characteristics of promising interventions included gaming features, therapist support, and parental involvement. Most were purely behavioral interventions (rather than CBT or third wave), typically using the behavior change techniques (BCTs) feedback and monitoring, shaping knowledge, repetition and substitution, and reward. Three papers included qualitative data on the user’s experience. We developed the following themes: parental involvement, connection with a health professional is important for engagement, technological affordances and barriers, and child-centered design. Conclusions: Of the 17 eligible interventions, digital interventions for anxiety and overweight or obesity had the greatest promise. Using qualitative methods during digital intervention development and evaluation may lead to more meaningful, usable, feasible, and engaging interventions, especially for this underresearched younger population. The following characteristics could be considered when developing digital interventions for younger children: involvement of parents, gaming features, additional therapist support, behavioral (rather than cognitive) approaches, and particular BCTs (feedback and monitoring, shaping knowledge, repetition and substitution, and reward). This review suggests a model for improving the conceptualization and reporting of behavioral interventions involving children and parents. %M 32735227 %R 10.2196/16924 %U http://www.jmir.org/2020/7/e16924/ %U https://doi.org/10.2196/16924 %U http://www.ncbi.nlm.nih.gov/pubmed/32735227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17031 %T Effects of the e-Motivate4Change Program on Metabolic Syndrome in Young Adults Using Health Apps and Wearable Devices: Quasi-Experimental Study %A Lee,Ji-Soo %A Kang,Min-Ah %A Lee,Soo-Kyoung %+ Keimyung University, 1095 Dalgubeol-daero, Dalseo-Gu, Daegu, 42601, Republic of Korea, 82 53 258 7665, soo1005s@gmail.com %K metabolic syndrome %K telemedicine %K mobile apps %K preventive care %K wearable electronic devices %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The health behaviors of young adults lag behind those of other age groups, and active health management is needed to improve health behaviors and prevent chronic diseases. In addition, developing good lifestyle habits earlier in life could reduce the risk of metabolic syndrome (MetS) later on. Objective: The aim of this study is to investigate the effects of the e-Motivate4Change program, for which health apps and wearable devices were selected based on user needs. The program was developed for the prevention and management of MetS in young adults. Methods: This experimental study used a nonequivalent control group. In total, 59 students from 2 universities in Daegu, Korea participated in the study (experimental group n=30; control group n=29). Data were collected over 4 months, from June 1 to September 30, 2018. The experimental group received a 12-week e-Motivate4Change program intervention, and the control group received MetS education and booklets without the e-Motivate4Change program intervention. Results: After the program, the experimental group had significantly higher scores for health-related lifestyle (t=3.86; P<.001) and self-efficacy (t=6.00; P<.001) than did the control group. Concerning BMI, there were significant effects by group (F=1.01; P<.001) and for the group × time interaction (F=4.71; P=.034). Concerning cholesterol, there were significant main effects for group (F=4.32; P=.042) and time (F=9.73; P<.001). Conclusions: The e-Motivate4Change program effectively improved participants’ health-related lifestyle scores and self-efficacy, and significantly reduced their BMI and cholesterol levels. The program can be used to identify and prevent MetS among young adults. %M 32729838 %R 10.2196/17031 %U http://www.jmir.org/2020/7/e17031/ %U https://doi.org/10.2196/17031 %U http://www.ncbi.nlm.nih.gov/pubmed/32729838 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19485 %T A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program %A Champion,Katrina Elizabeth %A Gardner,Lauren Anne %A McGowan,Cyanna %A Chapman,Cath %A Thornton,Louise %A Parmenter,Belinda %A McBride,Nyanda %A Lubans,David R %A McCann,Karrah %A Spring,Bonnie %A Teesson,Maree %A , %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, The Matilda Centre, Level 6, Jane Foss Russell Building (G02), University of Sydney, NSW, Sydney, 2006, Australia, 61 286279006, katrina.champion@sydney.edu.au %K primary prevention %K schools %K eHealth %K chronic disease %K mobile phone %K health promotion %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. %M 32720898 %R 10.2196/19485 %U http://formative.jmir.org/2020/7/e19485/ %U https://doi.org/10.2196/19485 %U http://www.ncbi.nlm.nih.gov/pubmed/32720898 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e18068 %T Acceptability and Usability of the Mobile Digital Health App NoObesity for Families and Health Care Professionals: Protocol for a Feasibility Study %A Meinert,Edward %A Rahman,Em %A Potter,Alison %A Lawrence,Wendy %A Van Velthoven,Michelle %+ Digitally Enabled PrevenTative Health (DEPTH) Research Group, Department of Paediatrics, Univeristy of Oxford, John Radcliffe Hospital, Oxford, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K mHealth %K mobile health %K digital health %K digital technology %K weight loss %K obesity %K overweight %K child health %K cell phone %K telecommunication %D 2020 %7 22.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Almost a quarter or more than a fifth of children in the United Kingdom are overweight or obese by the time they start school. The UK Department of Health and Social Care’s national policy for combating childhood obesity has critical outcomes centered on sugar and caloric consumption reduction. Health Education England has developed two digital apps for families with children up to 15 years and for their associated health care professionals to provide a digital learning resource and tool aimed at encouraging healthy lifestyles to prevent obesity. Objective: This feasibility study assesses the usability and acceptability of Health Education England’s NoObesity app for undertaking activities to improve families’ diet and physical activity. The purpose of the study is to evaluate the app’s influence on self-efficacy and goal setting and to determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. Methods: The study population will include 20 to 40 families and their linked health care professionals. Considering issues related to digital access associated with socioeconomic status and the impact on information technology use, study recruitment will be regionally focused in a low socioeconomic status area. The study will last for 9 months (3-month intervention period and 6-month follow-up). The evaluations of feasibility, acceptability, and usability will be conducted using the following scales and theoretical frameworks: (1) system usability scale; (2) Reach Effectiveness Adoption Implementation Maintenance framework; (3) Bandura model of health promotion; and (4) Nonadoption, Abandonment, and Challenges to the Scale-up, Spread, and Suitability framework. App use will be captured and quantitatively analyzed for net use patterns (eg, number of screens viewed, number of logins, cumulative minutes using the app, number of plans made, and number of times goals met) and to triangulate qualitative feedback from study participants. Results: This study was funded in March 2019 by Health Education England and received University of Oxford Medical Sciences Interdivisional Research Ethics Committee approval on January 31, 2020 (R62092/RE001). At manuscript submission, study recruitment is pending, and expected results will be published in 2021. Conclusions: This study will provide evidence on the NoObesity app’s influence on self-efficacy and goal-setting and determine what can be learnt to improve its design for future studies, if there is evidence of adoption and sustainability. International Registered Report Identifier (IRRID): PRR1-10.2196/18068 %M 32706703 %R 10.2196/18068 %U http://www.researchprotocols.org/2020/7/e18068/ %U https://doi.org/10.2196/18068 %U http://www.ncbi.nlm.nih.gov/pubmed/32706703 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e14778 %T Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study %A Langlet,Billy %A Maramis,Christos %A Diou,Christos %A Maglaveras,Nikolaos %A Fagerberg,Petter %A Heimeier,Rachel %A Lekka,Irini %A Delopoulos,Anastasios %A Ioakimidis,Ioannis %+ The Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, Blickagången 16, Huddinge, , Sweden, 46 08 524 810 95, billy.langlet@ki.se %K mHealth %K eHealth %K dietary behavior %K lifestyle behavioral monitoring %K lifestyle interventions %K obesity %K mobile phone %K smartphone %K weight management %K overweight %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients. Objective: This study aimed to evaluate the acceptability and usability and define system constraints of an mHealth system used to monitor dietary habits of adolescents in real life, as a first step in the development of a self-monitoring and lifestyle management system against adolescent obesity. Methods: We recruited 26 students from a high school in Stockholm, Sweden. After a 30-minute information meeting and 5-minute individual instruction on how to use an mHealth system (smartphone with app and two external sensors), participants used it for 2-3 weeks to objectively collect dietary habits. The app and sensors were used by the participants, without supervision, to record as many main meals and snacks as possible in real life. Feasibility was assessed following the “mHealth evidence reporting and assessment checklist,” and usability was assessed by questionnaires. Compliance was estimated based on system use, where a registration frequency of 3 main meals (breakfast, lunch, and dinner) per day for the period of the experiment, constituted 100% compliance. Results: Participants included in the analysis had a mean age of 16.8 years (SD 0.7 years) and BMI of 21.9 kg/m2 (SD 4.1 kg/m2). Due to deviations from study instructions, 2 participants were excluded from the analysis. During the study, 6 participants required additional information on system use. The system received a ‘Good’ grade (77.1 of 100 points) on the System Usability Scale, with most participants reporting that they were comfortable using the smartphone app. Participants expressed a willingness to use the app mostly at home, but also at school; most of their improvement suggestions concerned design choices for the app. Of all main meals, the registration frequency increased from 70% the first week to 76% the second week. Participants reported that 40% of the registered meals were home-prepared, while 34% of the reported drinks contained sugar. On average, breakfasts took place at 8:30 AM (from 5:00 AM to 2:00 PM), lunches took place at 12:15 PM (from 10:15 AM to 6:15 PM), and dinners took place at 7:30 PM (from 3:00 PM to 11:45 PM). When comparing meal occurrence during weekdays vs weekends, breakfasts and lunches were eaten 3 hours later during weekends, while dinner timing was unaffected. Conclusions: From an infrastructural and functional perspective, system use was feasible in the current context. The smartphone app appears to have high acceptability and usability in high school students, which are the intended end-users. The system appears promising as a relatively low-effort method to provide real-life dietary habit measurements associated with overweight and obesity risk. %M 32706684 %R 10.2196/14778 %U http://mhealth.jmir.org/2020/7/e14778/ %U https://doi.org/10.2196/14778 %U http://www.ncbi.nlm.nih.gov/pubmed/32706684 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17702 %T Effectiveness of the InCharge Prevention Program to Promote Healthier Lifestyles: Protocol for a Randomized Controlled Trial %A Mesman,Mathijs %A Onrust,Simone %A Verkerk,Renée %A Hendriks,Hanneke %A Van den Putte,Bas %+ Amsterdam School of Communication Research, University of Amsterdam, Nieuwe achtergracht 166, Amsterdam, , Netherlands, 31 0641711825, m.mesman@uva.nl %K school-based health intervention %K adolescents %K health behavior %K healthy lifestyle %K quality of life %K behavior change %D 2020 %7 8.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: InCharge is a newly developed school-based health intervention aimed at older adolescents. It aims to promote a healthier lifestyle by increasing self-regulation skills. After the InCharge program’s effectiveness was previously investigated in a pilot study, the content of the program was adapted. Objective: This study describes the protocol of a cluster randomized controlled trial that aims to investigate the effectiveness of the InCharge program. Methods: A cluster randomized controlled trial including 70 classes with older adolescents (aged 16 years or older) in the Netherlands will be conducted to test the effectiveness of the InCharge program. After schools are recruited, randomization occurs at the class level. The trial consists of the following two conditions: an experimental condition and a control condition. Participants in the experimental condition will be given the InCharge intervention, consisting of four lessons of 50 minutes, with each lesson containing three assignments of approximately 15 minutes. While participants in the experimental condition will receive InCharge, participants in the control condition will receive regular academic school courses. Surveys are administered 1 week before the intervention (baseline), 1 week after the intervention (posttest), and 12 weeks after the intervention (follow-up). Variables of interest include, but are not limited to, self-regulation; predictors of snack intake, physical activity, and alcohol use; and interpersonal communication regarding these health behaviors. In addition to surveys, observations will be conducted during the first and fourth lessons, teachers will be interviewed, and focus groups will be held with a selection of students from the intervention condition. Results: Enrollment started in September 2017. As of June 2019, a total of 1216 participants were enrolled for this trial. Findings will be published in peer-reviewed journals and presented at conferences. The trial has been approved by the Ethics Review Board of the Faculty of Social and Behavioral Sciences of the University of Amsterdam (reference no.: 2017-PC-8244). Conclusions: In this study protocol, the design of a cluster randomized controlled trial is described, which assesses how effectively the school-based intervention InCharge stimulates healthier lifestyles in late adolescents. We hypothesize that participants in the experimental condition will consume less alcohol, eat fewer unhealthy snacks, and be more physically active compared with participants in the control condition. Trial Registration: Netherlands Trial Register (NL6654); https://www.trialregister.nl/trial/6654 International Registered Report Identifier (IRRID): RR1-10.2196/17702 %M 32673278 %R 10.2196/17702 %U http://www.researchprotocols.org/2020/7/e17702/ %U https://doi.org/10.2196/17702 %U http://www.ncbi.nlm.nih.gov/pubmed/32673278 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e18171 %T Process Evaluation of an eHealth Intervention (Food4toddlers) to Improve Toddlers' Diet: Randomized Controlled Trial %A Røed,Margrethe %A Vik,Frøydis Nordgård %A Hillesund,Elisabet Rudjord %A Van Lippevelde,Wendy %A Medin,Anine Christine %A Øverby,Nina Cecilie %+ Department of Nutrition and Public Health, Faculty of Health and Sports Sciences, University of Agder, PO Box 422, Kristiansand, 4604, Norway, 47 38141324, nina.c.overby@uia.no %K toddler %K mHealth %K usability %K eHealth %K diet intervention %K digital intervention %K education difference %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Parents seek trustworthy information online to promote healthy eating for their toddlers. Such information must be perceived as relevant and easy to implement and use. Objective: The objectives of this study were to conduct a process evaluation of the electronic health (eHealth) intervention (Food4toddlers) targeting food environment, parental feeding practices, and toddlers’ diet and to examine possible differences in these areas according to education and family composition. Methods: A 2-armed randomized controlled trial, including 298 parent–toddler dyads from Norway, was conducted in 2017. In total, 148 parents in the intervention group received access to an intervention website for 6 months. Data on website usage were retrieved from the learning management platform used (NEO). Participants’ satisfaction with the intervention was asked for in a postintervention questionnaire. Chi-square and t tests were used to examine differences in usage and satisfaction between education and family composition groups. Results: Most participants were mothers (144/148, 97.2%), lived in two-adult households (148/148, 100%), and were born in Norway (132/148, 89.1%). Mean parental age was 31.5 years (SD 4.2). More than 87.8% (129/147) had a university education degree and 56.5% (83/147) had over 4 years of university education. Most (128/148, 86.5%) intervention participants entered the website at least once (mean days of access 7.4 [SD 7.1]). Most parents reported the website as appropriate to the child’s age (71/83, 86%) and self-explanatory (79/83, 95%) and appreciated the interface (52/83, 63%) and layout (46/83, 55%). In total, 61% (51/83) stated that they learned something new from the intervention. Parents with over 4 years of university education and in 1-child households used the intervention website more than those with 4 years or less of university education (8.4 vs 5.9 days in total, P=.04) and households with more than 1 child (8.3 vs 5.8 days in total, P=.04), respectively. Conclusions: The Food4toddlers intervention website was found to be relevant by most participants in the intervention group, although usage of the website differed according to educational level and family composition. For eHealth interventions to be effective, intervention materials such as websites must be used by the target group. Our results highlight the need to include users from different groups when developing interventions. Trial Registration: ISRCTN Registry ISRCTN92980420; http://www.isrctn.com/ISRCTN92980420 %M 32628612 %R 10.2196/18171 %U https://humanfactors.jmir.org/2020/3/e18171 %U https://doi.org/10.2196/18171 %U http://www.ncbi.nlm.nih.gov/pubmed/32628612 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e18391 %T Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study %A LeRouge,Cynthia M %A Hah,Hyeyoung %A Deckard,Gloria J %A Jiang,Haoqiang %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States, 1 3147090624, clerouge@fiu.edu %K consumer health technologies %K obesity care model %K chronic care model %K UTAUT %K qualitative research %K overweight %K mobile phone %K adolescent %K couse %K social support %K obesity %K social influence %K consumer health informatics %D 2020 %7 29.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. Objective: This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. Methods: This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. Results: Our qualitative analysis identified adolescents’ intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. Conclusions: Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management. %M 32597788 %R 10.2196/18391 %U http://mhealth.jmir.org/2020/6/e18391/ %U https://doi.org/10.2196/18391 %U http://www.ncbi.nlm.nih.gov/pubmed/32597788 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e15930 %T Improving the Lifestyle of Adolescents Through Peer Education and Support in Vietnam: Protocol for a Pilot Cluster Randomized Controlled Trial %A Tang,Hong K %A Nguyen,Ngoc-Minh %A Dibley,Michael J %A Nguyen,Trang H H D %A Alam,Ashraful %+ Department of Epidemiology, Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, 70000, Vietnam, 84 2838668018 ext 149, hong.tang@pnt.edu.vn %K peer education %K peer support %K peer leader %K adolescents %K dietary behaviors %K physical activity %K Vietnam %D 2020 %7 26.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Ho Chi Minh City, Vietnam, recent studies found a rapid increase in overweight and obesity in adolescents. There is a need for effective health promotion interventions to support healthy diets and encourage a physically active lifestyle. This study will help fill an evidence gap on effective interventions to prevent excess weight gain in adolescents and generate new insights about peer-led education to promote healthy lifestyles. Objective: We aim to assess the feasibility and acceptability of a combined peer-led and peer support intervention among junior high school students in Ho Chi Minh City. Additionally, the efficacy of the intervention on adolescents’ dietary practices and time spent on physical activity will also be measured in this pilot study. Methods: The Peer Education and Peer Support (PEPS) project is a pilot cluster randomized controlled trial with 2 intervention and 2 control schools. The intervention consists of 4 weekly education sessions of why and how to choose healthy food and drinks and how to be more physically active. Additionally, the intervention includes a school-based and online support system to help maintain student engagement during the intervention. We will use in-depth interviews with students, peer leaders, teachers, and parents; focus group discussions with peer educators; and direct observation of the school environment and peer leaders’ interactions with the students. Acceptability and feasibility of the intervention will be assessed. We will also quantitatively assess limited efficacy by measuring changes in student’ physical activity levels and dietary behaviors. Results: We delivered the peer education intervention at the start of each school year over 3 months for all new grade 6 adolescents in the selected schools, followed by peer support and home engagement activities over 6 months until the end of the school year. There was a baseline assessment and 2 post-intervention assessments: the first immediately after the intervention to assess the short-term impact and the second at the end of the school year to assess the sustained impact on changes in adiposity, diet, and physical activity. Conclusions: The findings of this study will be used to develop a larger-scale cluster randomized controlled trial to examine the impact of a multicomponent, school- and home-based health promotion intervention. The trial will use innovative peer education methods to reduce overweight and obesity and improve dietary choices and physical activity levels in Vietnamese adolescents. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000421134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376690&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/15930 %M 32589155 %R 10.2196/15930 %U http://www.researchprotocols.org/2020/6/e15930/ %U https://doi.org/10.2196/15930 %U http://www.ncbi.nlm.nih.gov/pubmed/32589155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16165 %T Describing the Process and Tools Adopted to Cocreate a Smartphone App for Obesity Prevention in Childhood: Mixed Method Study %A Giorgi Rossi,Paolo %A Ferrari,Francesca %A Amarri,Sergio %A Bassi,Andrea %A Bonvicini,Laura %A Dall'Aglio,Luca %A Della Giustina,Claudia %A Fabbri,Alessandra %A Ferrari,Anna Maria %A Ferrari,Elena %A Fontana,Marta %A Foracchia,Marco %A Gallelli,Teresa %A Ganugi,Giulia %A Ilari,Barbara %A Lo Scocco,Sara %A Maestri,Gianluca %A Moretti,Veronica %A Panza,Costantino %A Pinotti,Mirco %A Prandini,Riccardo %A Storani,Simone %A Street,Maria Elisabeth %A Tamelli,Marco %A Trowbridge,Hayley %A Venturelli,Francesco %A Volta,Alessandro %A Davoli,Anna Maria %A , %+ Servizio Epidemiologia, Azienda USL-IRCCS di Reggio Emilia, via Amendola 2, Reggio Emilia, Italy, 39 0522 335470, francy.ferr80@gmail.com %K childhood obesity %K health promotion %K mHealth %K cocreation %K mobile app %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Childhood obesity prevention is a public health priority in industrialized countries. The Reggio Emilia Local Health Authority has implemented a program involving primary and secondary prevention as well as the care of obese children. There are many health-promoting mobile apps, but few are targeted to children and very few are sponsored by public health agencies. Objective: The goal of the research was to describe the process and tools adopted to cocreate a mobile app sponsored by the Reggio Emilia Local Health Authority to be installed in parents’ phones aimed at promoting child health and preventing obesity. Methods: After stakeholder mapping, a consulting committee including relevant actors, stakeholders, and users was formed. Key persons for childhood obesity prevention were interviewed, focus groups with parents and pediatricians were conducted, and community reporting storytelling was collected. The results of these activities were presented to the consulting committee in order to define the functionalities and contents of the mobile app. Results: Three key trends emerged from community reporting: being active, playing, and being outdoors; time for oneself, family, and friends; and the pressures of life and work and not having time to be active and socialize. In focus groups, interviews, and labs, mothers showed a positive attitude toward using an app to manage their children's weight, while pediatricians expressed concerns that the app could increase their workload. When these findings were explored by the consulting committee, four key themes were extracted: strong relationships with peers, family members, and the community; access to safe outdoor spaces; children’s need for age-appropriate independence; and professional support should be nonjudgmental and stigma-free. It should be a dialogue that promotes family autonomy. The app functions related to these needs include the following: (1) newsletter with anticipatory guidance, recipes, and vaccination and well-child visit reminders; (2) regional map indicating where physical activity can be done; (3) information on how to manage emergencies (eg, falls, burns, fever); (4) module for reinforcing the counseling intervention conducted by pediatricians for overweight children; and (5) a function to build a balanced daily diet. Conclusions: The pilot study we conducted showed that cocreation in health promotion is feasible, with the consulting committee being the key co-governance and cocreation tool. The involvement of stakeholders in this committee made it possible to expand the number of persons and institutions actively contributing to the project. %M 32357123 %R 10.2196/16165 %U https://mhealth.jmir.org/2020/6/e16165 %U https://doi.org/10.2196/16165 %U http://www.ncbi.nlm.nih.gov/pubmed/32357123 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e18098 %T A Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors Among Adolescents: Protocol for the ImPACT Feasibility Study %A Moore,Justin B %A Dilley,Joshua R %A Singletary,Camelia R %A Skelton,Joseph A %A Miller Jr,David P %A Heboyan,Vahé %A De Leo,Gianluca %A Turner-McGrievy,Gabrielle %A McGrievy,Matthew %A Ip,Edward H %+ Department of Implementation Science, Division of Public Health Sciences, Wake Forest School of Medicine, 525 Vine St, Winston-Salem, NC, 27101, United States, 1 336 716 3702, jusmoore@wakehealth.edu %K physical activity %K obesity %K adolescence %K adult %K therapy, family %K mobile phone %D 2020 %7 5.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Severe obesity among youths (BMI for age≥120th percentile) has been steadily increasing. The home environment and parental behavioral modeling are two of the strongest predictors of child weight loss during weight loss interventions, which highlights that a family-based treatment approach is warranted. This strategy has been successful in our existing evidence-based pediatric weight management program, Brenner Families in Training (Brenner FIT). However, this program relies on face-to-face encounters, which are limited by the time constraints of the families enrolled in treatment. Objective: This study aims to refine and test a tailored suite of mobile health (mHealth) components to augment an existing evidence-based pediatric weight management program. Methods: Study outcomes will include acceptability from a patient and clinical staff perspective, feasibility, and economic costs relative to the established weight management protocol alone (ie, Brenner FIT vs Brenner FIT + mHealth [Brenner mFIT]). The Brenner mFIT intervention will consist of 6 mHealth components designed to increase patient and caregiver exposure to Brenner FIT programmatic content including the following: (1) a mobile-enabled website, (2) dietary and physical activity tracking, (3) caregiver podcasts (n=12), (4) animated videos (n=6) for adolescent patients, (5) interactive messaging, and (6) in-person tailored clinical feedback provided based on a web-based dashboard. For the study, 80 youths with obesity (aged 13-18 years) and caregiver dyads will be randomized to Brenner FIT or Brenner mFIT. All participants will complete baseline measures before randomization and at 3- and 6-month follow-up points. Results: This study was approved by the Institutional Review Board in July 2019, funded in August 2019, and will commence enrollment in April 2020. The results of the study are expected to be published in the fall/winter of 2021. Conclusions: The results of this study will be used to inform a large-scale implementation-effectiveness clinical trial. International Registered Report Identifier (IRRID): PRR1-10.2196/18098 %M 32348291 %R 10.2196/18098 %U https://www.researchprotocols.org/2020/6/e18098 %U https://doi.org/10.2196/18098 %U http://www.ncbi.nlm.nih.gov/pubmed/32348291 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e16216 %T Serious Games for Nutritional Education: Online Survey on Preferences, Motives, and Behaviors Among Young Adults at University %A Holzmann,Sophie Laura %A Schäfer,Hanna %A Plecher,David Alexander %A Stecher,Lynne %A Klinker,Gudrun Johanna %A Groh,Georg %A Hauner,Hans %A Holzapfel,Christina %+ Institute for Nutritional Medicine, Else Kröner-Fresenius-Center for Nutritional Medicine, School of Medicine, Technical University of Munich, Georg-Brauchle-Ring 62, Munich, , Germany, 49 89 289 249 23, christina.holzapfel@tum.de %K nutrition %K information sources %K serious games %K digital gameplay %K preferences %K motives %K behavior %K university students %K survey %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Data on nutritional information and digital gameplay are limited among young adults in Germany. Objective: This survey aimed to gather data on nutritional information sources and digital games for nutritional education (preferences, motives, and behaviors) among young adults at both Munich universities in Germany. Methods: An online survey was developed by an multidisciplinary research group using EvaSys, an in-house survey software. The questionnaire (47 items) covered questions about baseline characteristics (eg, housing situation and weight), nutrition (eg, nutritional information sources), and digital (nutritional) gameplay (eg, preferences, motives, and behaviors). A feedback field was also provided. This publication is based on a selection of 20 questions (7 baseline characteristics, 2 nutrition, 11 gameplay). Young adults, primarily Munich university students aged from 18 to 24 years, were invited to participate by digital and nondigital communication channels between 2016 and 2017. Statistical analyses were performed using Excel 2013 (Microsoft Corp) and R version 3.1.3 (R Foundation for Statistical Computing). Results: In total, 468 young adults (342/468, 73.1% women; 379/468, 81.0% university students) participated. Most of the participants (269/468, 57.5%) were aged 18 to 24 years with a BMI in the normal weight range (346/447, 77.4%). Mean body weight was 65.5 [SD 14.0] kg. Most participants reported getting nutritional information from the internet (372/467, 79.7%) and printed media (298/467, 63.8%), less than 1.0% (2/467, 0.4%) named digital games. Apps (100/461, 21.7%) and university/workplace (146/461, 31.7%) were the most desired sources for additional information about nutrition, while 10.0% (46/461, 10.0%) of participants stated wanting digital games. Almost two-thirds (293/468, 62.6%) of participants played digital games, while one-fifth (97/456, 21.3%) played digital games daily using smartphones or tablets. Finally, most respondents (343/468, 73.3%), mainly women, expressed interest in obtaining nutritional information during digital gameplay. However, significant gender differences were shown for nutritional acquisition behaviors and digital gameplay preferences, motives, and behaviors. Conclusions: Our survey population reported playing digital games (especially men) and wanting nutritional information during digital gameplay (especially women). Furthermore, university or workplace are named as preferred settings for nutritional information. Therefore, a digital game app might have the potential to be a tool for nutritional education among young adults within the university or workplace environment. %M 32490847 %R 10.2196/16216 %U https://games.jmir.org/2020/2/e16216 %U https://doi.org/10.2196/16216 %U http://www.ncbi.nlm.nih.gov/pubmed/32490847 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e17310 %T Dietary Intake Nutritional Status and Lifestyle of Adolescent Vegetarian and Nonvegetarian Girls in New Zealand (The SuNDiAL Project): Protocol for a Clustered, Cross-Sectional Survey %A Peddie,Meredith %A Ranasinghe,Chaya %A Scott,Tessa %A Heath,Anne-Louise %A Horwath,Caroline %A Gibson,Rosalind %A Brown,Rachel %A Houghton,Lisa %A Haszard,Jillian %+ Department of Human Nutrition, University of Otago, PO Box 56, Dunedin, 9054, New Zealand, 64 4798157, meredith.peddie@otago.ac.nz %K vegetarianism %K teenagers %K women %K iron %K zinc %K calcium %K B12 %K physical activity %K attitudes motivations, beliefs %D 2020 %7 27.5.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anecdotally, vegetarian eating patterns seem to be increasing in parallel with growing concerns about environmental sustainability. While this pattern of eating is widely believed to be associated with benefits for the planet and individual health, it may increase the risk of inadequate intakes and nutrient deficiency if not planned carefully. Adolescent girls may be particularly at risk, as they have increased requirements for nutrients such as iron, zinc, calcium, and vitamin B12 during growth and development. Objective: The objective of the SuNDiAL Project (Survey of Nutrition, Dietary Assessment, and Lifestyles) is to compare the dietary intakes and habits, nutrition status, motivations, attitudes, and physical activity of a sample of vegetarian and nonvegetarian adolescent girls in New Zealand. Methods: A clustered, cross-sectional, nationwide study of adolescents aged 15-18 years was conducted. Secondary schools were recruited throughout New Zealand, and pupils (n=290) were invited to participate in data collection in either the first (February to April) or third (August to October) school term of 2019 (New Zealand schools operate on a 4-term year). Sociodemographic and health information; vegetarian status; dietary habits; and attitudes, motivations, and beliefs regarding food choices were assessed via an online self-administered questionnaire. Dietary intakes were collected via two 24-hour diet recalls on nonconsecutive days and will be adjusted for within-person variation using the Multiple Source Method, to represent usual intakes. Nutrient adequacy will be assessed by the estimated average requirement cut-point method or probability approach as appropriate. Height and weight were measured, and blood and urine samples collected for micronutrient status assessment. Participants wore an accelerometer for 7 days to assess 24-hour activity patterns (time spent asleep, sedentary, or engagement in light-intensity or moderate-to-vigorous intensity physical activity). Results: Recruitment and data collection were conducted in 2019. Data are currently being cleaned and analyzed, with publication of the main results anticipated at the end of 2020. Conclusions: The SuNDiAL Project will provide a meaningful and timely description of diet, nutrition status, and motivational factors associated with vegetarianism and identify any risks this pattern of eating may pose for female adolescents. The results of this study will support the development of targeted recommendations and interventions aimed at enhancing the health, growth, and development of adolescent girls. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000290190; https://tinyurl.com/yaumh278 International Registered Report Identifier (IRRID): DERR1-10.2196/17310 %M 32459178 %R 10.2196/17310 %U http://www.researchprotocols.org/2020/5/e17310/ %U https://doi.org/10.2196/17310 %U http://www.ncbi.nlm.nih.gov/pubmed/32459178 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15849 %T Effectiveness of Text Message Interventions for Weight Management in Adolescents: Systematic Review %A Partridge,Stephanie Ruth %A Raeside,Rebecca %A Singleton,Anna %A Hyun,Karice %A Redfern,Julie %+ The University of Sydney, Westmead Applied Research Centre, Faculty of Medicine and Health, Department of General Practice, Acacia House, Westmead Hospital, Sydney, 2145, Australia, 61 288908187, stephanie.partridge@sydney.edu.au %K adolescent %K text message %K obesity %K overweight %K prevention %K mHealth %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The incidence of obesity among adolescents is increasing. Text messages are a primary communication form for adolescents and potentially a scalable strategy for delivering population health interventions. Objective: This study aimed to determine the effectiveness of text message interventions in reducing BMI in adolescents and describe characteristics that are common to effective interventions. Methods: This systematic review included randomized controlled trials of text message lifestyle interventions involving adolescents aged 10 to 19 years with outcomes focused on obesity prevention or management. Primary outcome was objective or self-report change in BMI. Results: In total, 4362 records were identified, and 215 full-text articles were assessed for eligibility. A total of 8 unique studies were identified, including 767 participants, mean age 14.3 (SD 0.9) years, BMI 29.7 (SD 1.6) kg/m2 and 53.1% (407/767) female (31/101, 30.7%-172/172, 100.0%). All interventions were multicomponent. The median active intervention period was 4.5 months. During the active and extended intervention phases, text messages accounted for >50% (8 studies) and >85% (3 studies) of contact points, respectively. Text messages were heterogeneous, with a median of 1.5 text messages sent per week (range: 1-21). A total of 4 studies utilized two-way text message communication with health professionals Of the 8 studies, 7 demonstrated reductions in BMI or BMI z-score in the intervention group compared with the control at the end of the final follow-up. The effect was only statistically significant in 1 study at 6 months. Over 6 months, reductions in BMI (kg/m2) ranged from 1.3% to 4.5% and BMI z-score ranged from 4.2% to 28.1%. Overall quality of the studies was low. Conclusions: Further research is required to elucidate the effectiveness and potential impact of text message interventions on weight and weight-related behaviors in adolescents. %M 32348264 %R 10.2196/15849 %U http://mhealth.jmir.org/2020/5/e15849/ %U https://doi.org/10.2196/15849 %U http://www.ncbi.nlm.nih.gov/pubmed/32348264 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14543 %T Usability of Food Size Aids in Mobile Dietary Reporting Apps for Young Adults: Randomized Controlled Trial %A Liu,Ying-Chieh %A Wu,Sheng-Tang %A Lin,Shan-Ju %A Chen,Chien-Hung %A Lin,Yu-Sheng %A Chen,Hsin-Yun %+ Department of Industrial Design, College of Management, Chang Gung University, No 259, Wen-Hwa 1st Road, Kwei-Shan, Taoyuan, 333, Taiwan, 886 3 2118800 ext 5250, ycl30@mail.cgu.edu.tw %K portion size measurement %K prototype %K user-centered design %K dietary reporting %K mobile health %K randomized controlled trial %D 2020 %7 29.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young adults are more likely to use self-managed dietary reporting apps. However, there is scant research examining the user experience of different measurement approaches for mobile dietary reporting apps when dealing with a wide variety of food shapes and container sizes. Objective: Field user experience testing was conducted under actual meal conditions to assess the accuracy, efficiency, and subjective reaction of three food portion measurement methods embedded in a developed mobile app. Key-in–based aid (KBA), commonly used in many current apps, relies on the user’s ability to key in volumes or weights. Photo-based aid (PBA) extends traditional assessment methods, allowing users to scroll, observe, and select a reduced-size image from a set of options. Gesture-based aid (GBA) is a new experimental approach in which the user makes finger movements on the screen to roughly describe food portion boundaries accompanied by a background reference. Methods: A group of 124 young adults aged 19 to 26 years was recruited for a head-to-head randomized comparison and divided into 3 groups: a KBA (n=42) control group and PBA (n=41) and GBA (n=41) experimental groups. In total, 3 meals (ie, breakfast, lunch, and dinner) were served in a university cafeteria. Participants were provided with 25 dishes and beverages for selection, with a variety of food shapes and containers that reflect everyday life conditions. The accuracy of and time spent on realistic interaction during food portion estimation and the subjective reaction of each aid were recorded and analyzed. Results: Participants in the KBA group provided the highest accuracy in terms of hash brown weight (P=.004) and outperformed PBA or GBA for many soft drinks in cups. PBA had the best results for a cylindrical hot dog (P<.001), irregularly shaped pork chop (P<.001), and green tea beverage (660 mL; P<.001). GBA outperformed PBA for most drinks, and GBA outperformed KBA for some vegetables. The GBA group spent significantly more time assessing food items than the KBA and PBA groups. For each aid, the overall subjective reaction based on the score of the System Usability Scale was not significantly different. Conclusions: Experimental results show that each aid had some distinguishing advantages. In terms of user acceptance, participants considered all 3 aids to be usable. Furthermore, users’ subjective opinions regarding measurement accuracy contradicted the empirical findings. Future work will consider the use of each aid based on food or container shape and integrate the various advantages of the 3 different aids for better results. Our findings on the use of portion size aids are based on realistic and diverse food items, providing a useful reference for future app improvement of an effective, evidence-based, and acceptable feature. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN36710750; http://www.controlled-trials.com/ISRCTN36710750. %M 32347805 %R 10.2196/14543 %U http://mhealth.jmir.org/2020/4/e14543/ %U https://doi.org/10.2196/14543 %U http://www.ncbi.nlm.nih.gov/pubmed/32347805 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15725 %T The Kids Obesity Prevention Program: Cluster Randomized Controlled Trial to Evaluate a Serious Game for the Prevention and Treatment of Childhood Obesity %A Mack,Isabelle %A Reiband,Nadine %A Etges,Carolin %A Eichhorn,Sabrina %A Schaeffeler,Norbert %A Zurstiege,Guido %A Gawrilow,Caterina %A Weimer,Katja %A Peeraully,Riyad %A Teufel,Martin %A Blumenstock,Gunnar %A Giel,Katrin Elisabeth %A Junne,Florian %A Zipfel,Stephan %+ Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Osianderstraße 5, Tübingen, 72076, Germany, 49 70712985614, isabelle.mack@uni-tuebingen.de %K children %K serious game %K nutrition %K stress %K energy density %D 2020 %7 24.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Health games provide opportunities for the treatment and prevention of childhood obesity. We developed a motion-controlled serious game for children that addresses 3 core topics of nutrition, physical activity, and stress coping. It is the first serious game that extensively targets the dietary energy density principle (DED-P) in relation to nutrition. The game is intended to provide an additional educational component for the prevention and treatment of obesity in children. Objective: The Kids Obesity Prevention study aimed to evaluate the newly developed game and to evaluate how well children are able to understand and apply the DED-P. Methods: This cluster randomized controlled trial collected data from 82 primary school children aged 9 to 12 years and their parents at baseline (T0), at 2 weeks after study commencement (T1), and at the 4-week follow-up (T2). The dropout rate was 3.6%. The intervention group (IG) played the game within 2 weeks (2 sessions with different game modules). One part of the game involves selection of food with the lower energy density when presented with a pair of foods. This allows assessment of whether the children have understood the DED-P and whether they can apply it to unknown foods under time pressure. The control group (CG) received a brochure about the food pyramid concept and physical activity. The primary outcome was the gain in knowledge (nutrition and stress coping) and measured with a pretested questionnaire. The secondary outcomes were the maintenance of knowledge, application of the DED-P, feelings during game play, game acceptance, and behavioral measures (physical activity, media consumption, and dietary intake). Results: The knowledge score ranging from 0 to 100 increased from T0 (IG: 53 [SD 10], CG: 50 [SD 11]) to T1 (IG: 69 [SD 11], CG: 52 [SD 12]) in IG versus CG (P<.001). At T2, the knowledge score of IG remained at the same level as that of T1. Game data showed that after DED-P education, the classification under time pressure of unknown versus known food pairs according to their DED category was similar (hit rate around 70%). Overall, 95% of the children liked the game very much or much. No group changes were observed at the behavioral level. Conclusions: The Kids Obesity Prevention program sustainably increased knowledge in the areas of nutrition and stress coping, and children were able to apply the DED-P. Trial Registration: ClinicalTrials.gov NCT02551978; https://clinicaltrials.gov/ct2/show/NCT02551978 %M 32329742 %R 10.2196/15725 %U https://www.jmir.org/2020/4/e15725 %U https://doi.org/10.2196/15725 %U http://www.ncbi.nlm.nih.gov/pubmed/32329742 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e15534 %T Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis %A Brown,Jacqueline Marie %A Savaglio,Robert %A Watson,Graham %A Kaplansky,Allison %A LeSage,Ann %A Hughes,Janette %A Kapralos,Bill %A Arcand,JoAnne %+ Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Science Building Rm 3016, Oshawa, ON, L1G 0C5, Canada, 1 (905) 7218668 ext 3796, joanne.arcand@uoit.ca %K mHealth %K children %K child nutrition sciences %K mobile apps %K health education %D 2020 %7 17.4.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Early nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating. Objective: This study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app. Methods: An interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained. Results: The environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71%), that the app is easy to use (12/17, 71%) and fun (14/17, 88%), and that the app goals were clearly presented (15/17, 94%). Conclusions: Foodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition. %M 32301743 %R 10.2196/15534 %U http://formative.jmir.org/2020/4/e15534/ %U https://doi.org/10.2196/15534 %U http://www.ncbi.nlm.nih.gov/pubmed/32301743 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e16431 %T Nutritional Education and Promotion of Healthy Eating Behaviors Among Mexican Children Through Video Games: Design and Pilot Test of FoodRateMaster %A Espinosa-Curiel,Ismael Edrein %A Pozas-Bogarin,Edgar Efrén %A Lozano-Salas,Jorge Luis %A Martínez-Miranda,Juan %A Delgado-Pérez,Edwin Emeth %A Estrada-Zamarron,Lizeth Stefania %+ Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Andador 10, entre calles 3 y 4, Ciudad del Conocimiento, Tepic, Nayarit, 63173, Mexico, 52 3111295930 ext 28607, ecuriel@cicese.edu.mx %K childhood obesity %K serious game %K game design %K nutritional education %K dietary intake %K healthy eating behaviors %D 2020 %7 13.4.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Childhood obesity has risen dramatically in recent decades, reaching epidemic levels. Children need guidance on and support for maintaining a healthy diet and physical activity to ensure that they grow appropriately and develop healthy eating habits. Serious video games have shown positive effects on promoting the nutritional knowledge, and eating attitudes and behaviors of children; however, research about the usefulness of such games with younger children (8-10 years old) is sparse. Objective: The objective of this study was to design and test the serious video game FoodRateMaster targeting children between 8 and 10 years old. The game includes nutritional information and behavior change techniques to help children improve their knowledge of healthy and unhealthy foods, increase their intake of healthy food, and reduce their intake of ultraprocessed food. In addition, FoodRateMaster was designed as an active game to promote physical activity. Methods: An interdisciplinary team developed FoodRateMaster following an iterative methodology based on a user-centered design. A total of 60 participants (mean age 9 years, SD 0.8; 53% male) completed 12 individual gaming sessions in 6 weeks. A food knowledge questionnaire and a food frequency questionnaire were completed before and after game play. In addition, 39 of the participants’ parents answered a parent perception questionnaire after the game play. Results: Participants showed increased food knowledge from pregame (mean 56.9, SD 10.7) to postgame play (mean 67.8, SD 10.7; P<.001). In addition, there was a greater self-reported frequency in the consumption of cauliflower and broccoli (P<.001) and corn quesadillas (P<.001). They also indicated a lower self-reported intake of 10 unhealthy foods, including french fries (P=.003), candy and chocolate (P<.001), sweet soft cakes (P=.009), and soft drinks (P=.03). Moreover, most of the parents who answered the parent perception questionnaire agreed that their children showed greater interest in explaining why they should avoid some unhealthy foods (67%, 26/39), in distinguishing between healthy and unhealthy foods (64%, 25/39), and in the intake of fruits (64%, 25/39) and vegetables (59%, 23/39). Finally, 14 parents stated that they introduced some changes in their children's diet based on the comments and suggestions they received from their children. Conclusions: In an initial evaluation, children between 8 and 10 years old indicated an increased level in nutritional knowledge and their self-reported frequency intake of two healthy foods, and a decreased level in their self-reported intake of 10 unhealthy foods after playing FoodRateMaster. Moreover, the participants’ parents agreed that FoodRateMaster positively influenced their children’s attitudes toward several healthy eating behaviors. These results support that health games such as FoodRateMaster are viable tools to help young children increase their food knowledge and improve dietary behaviors. A follow-up randomized controlled trial will be conducted to assess the medium- and long-term effects of FoodRateMaster. %M 32281539 %R 10.2196/16431 %U http://games.jmir.org/2020/2/e16431/ %U https://doi.org/10.2196/16431 %U http://www.ncbi.nlm.nih.gov/pubmed/32281539 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14118 %T A Mobile Phone Intervention to Improve Obesity-Related Health Behaviors of Adolescents Across Europe: Iterative Co-Design and Feasibility Study %A Martin,Anne %A Caon,Maurizio %A Adorni,Fulvio %A Andreoni,Giuseppe %A Ascolese,Antonio %A Atkinson,Sarah %A Bul,Kim %A Carrion,Carme %A Castell,Conxa %A Ciociola,Valentina %A Condon,Laura %A Espallargues,Mireia %A Hanley,Janet %A Jesuthasan,Nithiya %A Lafortuna,Claudio L %A Lang,Alexandra %A Prinelli,Federica %A Puidomenech Puig,Elisa %A Tabozzi,Sarah A %A McKinstry,Brian %+ UK Medical Research Council / Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Glasgow, G2 3AX, United Kingdom, 44 141353 ext 7603, Anne.Martin@glasgow.ac.uk %K health behavior %K obesity %K co-design %K mHealth %K mobile app %K mobile phone %K adolescents %K youth %K focus groups %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Promotion of physical activity, healthy eating, adequate sleep, and reduced sedentary behavior in adolescents is a major priority globally given the current increase in population health challenges of noncommunicable diseases and risk factors such as obesity. Adolescents are highly engaged with mobile technology, but the challenge is to engage them with mobile health (mHealth) technology. Recent innovations in mobile technology provide opportunities to promote a healthy lifestyle in adolescents. An increasingly utilized approach to facilitate increased engagement with mHealth technology is to involve potential users in the creation of the technology. Objective: This study aimed to describe the process of and findings from co-designing and prototyping components of the PEGASO Fit for Future (F4F) mHealth intervention for adolescents from different cultural backgrounds. Methods: A total of 74 adolescents aged 13 to 16 years from Spain, Italy, and the United Kingdom participated in the co-design of the PEGASO F4F technology. In 3 iterative cycles over 12 months, participants were involved in the co-design, refinement, and feasibility testing of a system consisting of diverse mobile apps with a variety of functions and facilities to encourage healthy weight–promoting behaviors. In the first iteration, participants attended a single workshop session and were presented with mock-ups or early-version prototypes of different apps for user requirements assessment and review. During the second iteration, prototypes of all apps were tested by participants for 1 week at home or school. In the third iteration, further developed prototypes were tested for 2 weeks. Participants’ user experience feedback and development ideas were collected through focus groups and completion of questionnaires. Results: For the PEGASO F4F technology to be motivating and engaging, participants suggested that it should (1) allow personalization of the interface, (2) have age-appropriate and easy-to-understand language (of icons, labels, instructions, and notifications), (3) provide easily accessible tutorials on how to use the app or navigate through a game, (4) present a clear purpose and end goal, (5) have an appealing and self-explanatory reward system, (6) offer variation in gamified activities within apps and the serious game, and (7) allow to seek peer support and connect with peers for competitive activities within the technology. Conclusions: Incorporating adolescents’ preferences, the PEGASO F4F technology combines the functions of a self-monitoring, entertainment, advisory, and social support tool. This was the first study demonstrating that it is possible to develop a complex mobile phone-based technological system applying the principles of co-design to mHealth technology with adolescents across 3 countries. The findings from this study informed the development of an mHealth system for healthy weight promotion to be tested in a controlled multinational pilot trial. %M 32130179 %R 10.2196/14118 %U https://mhealth.jmir.org/2020/3/e14118 %U https://doi.org/10.2196/14118 %U http://www.ncbi.nlm.nih.gov/pubmed/32130179 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 2 %P e16481 %T Text Message Behavioral Intervention for Teens on Eating, Physical Activity and Social Wellbeing (TEXTBITES): Protocol for a Randomized Controlled Trial %A Partridge,Stephanie R %A Raeside,Rebecca %A Singleton,Anna C %A Hyun,Karice %A Latham,Zoe %A Grunseit,Alicia %A Steinbeck,Katharine %A Chow,Clara %A Redfern,Julie %+ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, REN Building Westmead Hospital, Sydney, Australia, 61 88908187, stephanie.partridge@sydney.edu.au %K obesity %K adolescents %K nutrition %K physical activity %K text message %K randomized controlled trial %K mHealth %D 2020 %7 18.2.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obesity is among the most significant health challenges facing today’s adolescents. Weight gain during adolescence is related to cardiovascular disease, type 2 diabetes, and some cancers in later life. Presently, adolescents living in Australia have limited access to age-appropriate obesity prevention services. Objective: This study aims to investigate whether a two-way text message program, with optional telephone health counseling, improves body mass index (BMI) z score and lifestyle outcomes in adolescents who are overweight. Methods: This study will be a single-blind randomized controlled trial (N=150) comparing a two-way text message intervention, with optional telephone health counseling, to usual care in adolescents (13-18 years old, inclusive) who are overweight (recruited from a pediatric weight management clinic and the broader community in Sydney, Australia). The intervention group will receive a six-month text message program, which consists of two-way, semipersonalized, lifestyle-focused text messages (four messages/week) in addition to usual care. The control group will be assigned to receive usual care. The study also includes a follow-up at 12-months. The primary outcome is a change in BMI z score at six months. Secondary outcomes are changes in waist-to-height ratio, diet, physical and sedentary activity levels, sleep quality, quality of life, self-esteem, self-efficacy, social support, and eating disorder and depression symptoms. Also, we will examine acceptability, utility, and engagement with the program through a study-specific process evaluation questionnaire, semi-structured telephone interviews, and an analysis of health counselor communication logs. The analyses will be performed by the intention-to-treat principle to assess differences between intervention and control groups. Results: The study opened for recruitment in December 2019. Data collection is expected to be completed by December 2021, and the results for the primary outcome are expected to be published in early 2022. Conclusions: This study will test the effectiveness of an interactive two-way text message program compared to usual care in improving BMI z score and lifestyle outcomes in adolescents with overweight. This interactive, innovative, and scalable project also aims to inform future practice and community initiatives to promote obesity prevention behaviors for adolescents. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000389101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377158&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/16481 %M 32130194 %R 10.2196/16481 %U https://www.researchprotocols.org/2020/2/e16481 %U https://doi.org/10.2196/16481 %U http://www.ncbi.nlm.nih.gov/pubmed/32130194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e13401 %T Effectiveness of a Web-Based Menu-Planning Intervention to Improve Childcare Service Compliance With Dietary Guidelines: Randomized Controlled Trial %A Grady,Alice %A Wolfenden,Luke %A Wiggers,John %A Rissel,Chris %A Finch,Meghan %A Flood,Victoria %A Salajan,David %A O'Rourke,Ruby %A Stacey,Fiona %A Wyse,Rebecca %A Lecathelinais,Christophe %A Barnes,Courtney %A Green,Sue %A Herrmann,Vanessa %A Yoong,Sze Lin %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Australia, 61 0249246310, alice.grady@health.nsw.gov.au %K child care %K child, preschool %K online systems %K menu planning %K nutrition policy %K randomized controlled trial %K internet-based intervention %D 2020 %7 4.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Foods provided in childcare services are not consistent with dietary guideline recommendations. Web-based systems offer unique opportunities to support the implementation of such guidelines. Objective: This study aimed to assess the effectiveness of a Web-based menu planning intervention in increasing the mean number of food groups on childcare service menus that comply with dietary guidelines. Secondary aims were to assess the impact of the intervention on the proportion of service menus compliant with recommendations for (1) all food groups; (2) individual food groups; and (3) mean servings of individual food groups. Childcare service use and acceptability of the Web-based program were also assessed. Methods: A single-blind, parallel-group randomized controlled trial was undertaken with 54 childcare services in New South Wales, Australia. Services were randomized to a 12-month intervention or usual care control. Intervention services received access to a Web-based menu planning program linked to their usual childcare management software system. Childcare service compliance with dietary guidelines and servings of food groups were assessed at baseline, 3-month follow-up, and 12-month follow-up. Results: No significant differences in the mean number of food groups compliant with dietary guidelines and the proportion of service menus compliant with recommendations for all food groups, or for individual food groups, were found at 3- or 12-month follow-up between the intervention and control groups. Intervention service menus provided significantly more servings of fruit (P<.001), vegetables (P=.03), dairy (P=.03), and meat (P=.003), and reduced their servings of discretionary foods (P=.02) compared with control group at 3 months. This difference was maintained for fruit (P=.03) and discretionary foods (P=.003) at 12 months. Intervention childcare service staff logged into the Web-based program an average of 40.4 (SD 31.8) times and rated the program as highly acceptable. Conclusions: Although improvements in childcare service overall menu and individual food group compliance with dietary guidelines were not statistically significant, findings indicate that a Web-based menu planning intervention can improve the servings for some healthy food groups and reduce the provision of discretionary foods. Future research exploring the effectiveness of differing strategies in improving the implementation of dietary guidelines in childcare services is warranted. Trial Registration: Australian New Zealand Clinical Trial Registry (ANZCTR): 16000974404; http://www.anzctr.org.au/ACTRN12616000974404.aspx %M 32014843 %R 10.2196/13401 %U https://www.jmir.org/2020/2/e13401 %U https://doi.org/10.2196/13401 %U http://www.ncbi.nlm.nih.gov/pubmed/32014843 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e14458 %T Impact of a Mobile App–Based Health Coaching and Behavior Change Program on Participant Engagement and Weight Status of Overweight and Obese Children: Retrospective Cohort Study %A Cueto,Victor %A Wang,C Jason %A Sanders,Lee Michael %+ Division of General Internal Medicine, Department of Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, H-251, Newark, NJ, 07101, United States, 1 973 972 5672, vcueto@alumni.stanford.edu %K child obesity %K mHealth %K mobile apps %K health coaching %K health behavior %K self-monitoring %K behavior change %D 2019 %7 15.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective treatment of obesity in children and adolescents traditionally requires frequent in-person contact, and it is often limited by low participant engagement. Mobile health tools may offer alternative models that enhance participant engagement. Objective: The aim of this study was to assess child engagement over time, with a mobile app–based health coaching and behavior change program for weight management, and to examine the association between engagement and change in weight status. Methods: This was a retrospective cohort study of user data from Kurbo, a commercial program that provides weekly individual coaching via video chat and supports self-monitoring of health behaviors through a mobile app. Study participants included users of Kurbo between March 2015 and March 2017, who were 5 to 18 years old and who were overweight or obese (body mass index; BMI ≥ 85th percentile or ≥ 95th percentile) at baseline. The primary outcome, engagement, was defined as the total number of health coaching sessions received. The secondary outcome was change in weight status, defined as the change in BMI as a percentage of the 95th percentile (%BMIp95). Analyses of outcome measures were compared across three initial commitment period groups: 4 weeks, 12 to 16 weeks, or 24 weeks. Multivariable linear regression models were constructed to adjust outcomes for the independent variables of sex, age group (5-11 years, 12-14 years, and 15-18 years), and commitment period. A sensitivity analysis was conducted, excluding a subset of participants involuntarily assigned to the 12- to 16-week commitment period by an employer or health plan. Results: A total of 1120 participants were included in analyses. At baseline, participants had a mean age of 12 years (SD 2.5), mean BMI percentile of 96.6 (SD 3.1), mean %BMIp95 of 114.5 (SD 16.5), and they were predominantly female 68.04% (762/1120). Participant distribution across commitment periods was 26.07% (292/1120) for 4 weeks, 61.61% (690/1120) for 12-16 weeks, and 12.32% (138/1120) for 24 weeks. The median coaching sessions (interquartile range) received were 8 (3-16) for the 4-week group, 9 (5-12) for the 12- to 16-week group, and 19 (11-25) for the 24-week group (P<.001). Adjusted for sex and age group, participants in the 4- and 12-week groups participated in –8.03 (95% CI –10.19 to –5.87) and –9.34 (95% CI –11.31 to –7.39) fewer coaching sessions, compared with those in the 24-week group (P<.001). Adjusted for commitment period, sex, and age group, the overall mean change in %BMIp95 was –0.21 (95% CI –0.25 to –0.17) per additional coaching session (P<.001). Conclusions: Among overweight and obese children using a mobile app–based health coaching and behavior change program, increased engagement was associated with longer voluntary commitment periods, and increased number of coaching sessions was associated with decreased weight status. %M 31730041 %R 10.2196/14458 %U http://mhealth.jmir.org/2019/11/e14458/ %U https://doi.org/10.2196/14458 %U http://www.ncbi.nlm.nih.gov/pubmed/31730041 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e11205 %T Young People’s Attitudes and Motivations Toward Social Media and Mobile Apps for Weight Control: Mixed Methods Study %A Nikolaou,Charoula Konstantia %A Tay,Zoey %A Leu,Jodie %A Rebello,Salome Antonette %A Te Morenga,Lisa %A Van Dam,Rob M %A Lean,Michael Ernest John %+ Graduate School of Public Health, Department of Biostatistics and Bioinformatics, St Luke's International University, 3-6-2 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan, 81 08078059495, cknikolaou1@gmail.com %K weight gain %K young adults %K obesity %K public health %K focus groups %K mobile apps %K mHealth %D 2019 %7 10.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective prevention at a young enough age is critical to halt the obesity epidemic. Mobile health (mHealth) apps would potentially reach large numbers at low-cost. While there is already a profusion of lifestyle apps, they are mostly non-evidence-based and evidently ineffective against rising obesity prevalence. Objective: The aim of this study was to explore preferences and usage of lifestyle apps among young people in 6 countries. Methods: A mixed methods study was conducted among young people aged 13 to 24 years residing in the United Kingdom, Belgium, Finland, Greece, Singapore, and New Zealand. Participants were recruited from Web advertisements on Facebook, asking for volunteers interested in mobile apps in general, not specific to lifestyle or health, to complete a short survey comprising 18 questions on demographics, weight gain, and mobile app preferences and then to join English-language online focus groups, which were held during 2017, in password-protected Web rooms, moderated by an experienced researcher. Descriptive statistics were carried out for the survey, and thematic analysis was applied to transcripts. Results: A total of 2285 young people (610 adolescents aged 13-17 years and 1675 young adults aged 18-24 years) responded and completed the survey, with 72.0% (1645) reported being concerned about weight gain for themselves or friends. Later, 807 young people (376 adolescents and 431 young adults) were selected based on age and country to participate in 12 online focus groups, with 719 young people completing. Analysis revealed 4 main themes: (1) feelings toward personal weight; (2) perception of lifestyle apps and desired content for weight gain prevention; (3) social media apps, lifestyle apps, and motivation for downloading and retaining; and (4) data safety and data usage and confidentiality. Young people are interested in evidence-based advice in programs incorporating their preferences. Conclusions: Young people are commonly, and consistently across 6 countries, concerned about weight gain and obesity and would welcome evidence-based mHealth programs, provided the views of young people themselves are incorporated in the program content. %M 31603431 %R 10.2196/11205 %U https://mhealth.jmir.org/2019/10/e11205 %U https://doi.org/10.2196/11205 %U http://www.ncbi.nlm.nih.gov/pubmed/31603431 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e15153 %T Exploring an Existing Weight Management App for Use With Adolescents and Young Adults With Spina Bifida: Usability Study %A Stiles-Shields,Colleen %A Garcia,Brittney %A Villota,Kimberly %A Wartman,Elicia %A Winning,Adrien M %A Holmbeck,Grayson N %+ Population Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Chicago, IL, 60612, United States, 1 3125631579, elizabeth_stiles-shields@rush.edu %K spina bifida occulta %K mHealth %K mobile apps %K usability testing %K adolescent %K young adult %K weight reduction programs %K body weight maintenance %D 2019 %7 10.10.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescents and young adults with spina bifida (AYA-SBs) have unique user needs, given their variable and complex symptom profile. Owing to multiple barriers to prevention and intervention treatments for secondary conditions (eg, obesity), AYA-SBs may benefit from the use of behavioral intervention technologies (BITs). However, as BITs are often designed and tested with typically developing individuals, it is unclear if existing BITs may be usable for AYA-SBs. Objective: This study aimed to evaluate the usability of a high-quality, publicly available, weight management–focused mobile BIT (smartphone app) for AYA-SBs. Methods: Overall, 28 AYA-SBs attending a Young Men’s Christian Association–based summer camp completed 4 structured usability tasks using a weight management app designed for the general public called My Diet Coach (Bending Spoons). Learnability was measured by (1) time to complete task, (2) number of user errors, and (3) correct entry of data when requested by the app. Satisfaction and general usability were measured via self-reported questionnaires and qualitative feedback following interactions with the app. Results: The majority of the sample were able to complete the tasks, with increased completion rates and improved times on second attempts of the tasks (Ps<.05). Errors were common, and discrepancies emerged between quantitative and qualitative feedback such that self-reported measures indicated dissatisfaction but qualitative feedback was generally positive. Suggested improvements to the app included (1) tutorials, (2) simplifying the design, (3) more activity options for those who ambulate by wheelchair, and (4) notifications to prompt use. Conclusions: AYA-SBs were able to learn how to complete specific tasks independently on a weight management app, but design changes consistent with previously proposed user needs were recommended. Rather than designing entirely new BITs, it may be possible to adapt existing technologies to personalize BITs for specific populations such as AYA-SBs. %M 31603432 %R 10.2196/15153 %U https://pediatrics.jmir.org/2019/2/e15153 %U https://doi.org/10.2196/15153 %U http://www.ncbi.nlm.nih.gov/pubmed/31603432 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e13340 %T A Digital Intervention for Australian Adolescents Above a Healthy Weight (Health Online for Teens): Protocol for an Implementation and User Experience Study %A Moores,Carly Jane %A Maeder,Anthony %A Miller,Jacqueline %A Prichard,Ivanka %A Lewis,Lucy Kate %A Bell,Lucinda Kate %A Macoustra,Aimee %A Miller,Michelle D %+ Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 82015913, carly.moores@flinders.edu.au %K adolescent %K overweight %K diet %K exercise behavior %D 2019 %7 10.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: More than one-fourth of Australian adolescents are overweight or obese, with obesity in adolescents strongly persisting into adulthood. Recent evidence suggests that the mid-teen years present a final window of opportunity to prevent irreversible damage to the cardiovascular system. As lifestyle behaviors may change with increased autonomy during adolescence, this life stage is an ideal time to intervene and promote healthy eating and physical activity behaviors, well-being, and self-esteem. As teenagers are prolific users and innate adopters of new technologies, app-based programs may be suitable for the promotion of healthy lifestyle behaviors and goal setting training. Objective: This study aims to explore the reach, engagement, user experience, and satisfaction of the new app-based and Web-based Health Online for Teens (HOT) program in a sample of Australian adolescents above a healthy weight (ie, overweight or obese) and their parents. Methods: HOT is a 14-week program for adolescents and their parents. The program is delivered online through the Moodle app–based and website-based learning environment and aims to promote adolescents’ lifestyle behavior change in line with Australian Dietary Guidelines and Australia’s Physical Activity and Sedentary Behaviour Guidelines for Young People (aged 13-17 years). HOT aims to build parental and peer support during the program to support adolescents with healthy lifestyle behavior change. Results: Data collection for this study is ongoing. To date, 35 adolescents and their parents have participated in one of 3 groups. Conclusions: HOT is a new online-only program for Australian adolescents and their parents that aims to reduce cardiovascular disease risk factors. This protocol paper describes the HOT program in detail, along with the methods to measure reach, outcomes, engagement, user experiences, and program satisfaction. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000465257; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374771 International Registered Report Identifier (IRRID): DERR1-10.2196/13340 %M 31603435 %R 10.2196/13340 %U https://www.researchprotocols.org/2019/10/e13340 %U https://doi.org/10.2196/13340 %U http://www.ncbi.nlm.nih.gov/pubmed/31603435 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e12572 %T Use of a Web-Based Dietary Assessment Tool (RiksmatenFlex) in Swedish Adolescents: Comparison and Validation Study %A Lindroos,Anna Karin %A Petrelius Sipinen,Jessica %A Axelsson,Cecilia %A Nyberg,Gisela %A Landberg,Rikard %A Leanderson,Per %A Arnemo,Marianne %A Warensjö Lemming,Eva %+ Swedish National Food Agency, Box 622, Uppsala, 75126, Sweden, 46 18175500, annakarin.lindroos@slv.se %K dietary assessment %K 24-hour hour dietary recalls %K internet %K validity %K biomarkers %K carotenoids %K alkylresorcinols %K adolescents %D 2019 %7 4.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A Web-based dietary assessment tool—RiksmatenFlex—was developed for the national dietary survey of adolescents in Sweden. Objective: This study aimed to describe the Web-based method RiksmatenFlex and to test the validity of the reported dietary intake by comparing dietary intake with 24-hour dietary recalls (recall interviews), estimated energy expenditure, and biomarkers. Methods: Adolescents aged 11-12, 14-15, and 17-18 years were recruited through schools. In total, 78 students had complete dietary information and were included in the study. Diet was reported a few weeks apart with either RiksmatenFlexDiet (the day before and a random later day) or recall interviews (face-to-face, a random day later by phone) in a cross-over, randomized design. At a school visit, weight and height were measured and blood samples were drawn for biomarker analyses. Students wore an accelerometer for 7 days for physical activity measurements. Dietary intake captured by both dietary methods was compared, and energy intake captured by both methods was compared with the accelerometer-estimated energy expenditure (EEest). Intake of whole grain wheat and rye and fruit and vegetables by both methods was compared with alkylresorcinol and carotenoid concentrations in plasma, respectively. Results: The mean of the reported energy intake was 8.92 (SD 2.77) MJ by RiksmatenFlexDiet and 8.04 (SD 2.67) MJ by the recall interviews (P=.01). Intake of fruit and vegetables was 224 (169) g and 227 (150) g, and whole grain wheat and rye intake was 12.4 (SD 13.2) g and 12.0 (SD 13.1) g, respectively; the intakes of fruit and vegetables as well as whole grain wheat and rye did not differ between methods. Intraclass correlation coefficients ranged from 0.57 for protein and carbohydrates to 0.23 for vegetables. Energy intake by RiksmatenFlexDiet was overreported by 8% (P=.03) but not by the recall interviews (P=.53) compared with EEest. The Spearman correlation coefficient between reported energy intake and EEest was 0.34 (P=.008) for RiksmatenFlexDiet and 0.16 (P=.21) for the recall interviews. Spearman correlation coefficient between whole grain wheat and rye and plasma total alkylresorcinol homologs was 0.36 (P=.002) for RiksmatenFlexDiet and 0.29 (P=.02) for the recall interviews. Spearman correlations between intake of fruit and vegetables and plasma carotenoids were weak for both dietary tools. The strongest correlations were observed between fruit and vegetable intake and lutein/zeaxanthin for RiksmatenFlexDiet (0.46; P<.001) and for recall interviews (0.28; P=.02). Conclusions: RiksmatenFlexDiet provides information on energy, fruit, vegetables, and whole grain wheat and rye intake, which is comparable with intake obtained from recall interviews in Swedish adolescents. The results are promising for cost-effective dietary data collection in upcoming national dietary surveys and other studies in Sweden. Future research should focus on how, and if, new technological solutions could reduce dietary reporting biases. %M 31588902 %R 10.2196/12572 %U https://www.jmir.org/2019/10/e12572 %U https://doi.org/10.2196/12572 %U http://www.ncbi.nlm.nih.gov/pubmed/31588902 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e12532 %T Accuracy of Parent-Reported Child Height and Weight and Calculated Body Mass Index Compared With Objectively Measured Anthropometrics: Secondary Analysis of a Randomized Controlled Trial %A Chai,Li Kheng %A Collins,Clare E %A May,Chris %A Holder,Carl %A Burrows,Tracy L %+ School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan,, Australia, 61 249215514, tracy.burrows@newcastle.edu.au %K telemedicine %K parents %K child %K body height %K body weight %K body mass index %K self report %K dimensional measurement accuracy %D 2019 %7 16.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) interventions for children often rely on parent-reported child anthropometric measures. However, limited studies have assessed parental accuracy in reporting child height and weight via Web-based approaches. Objective: The objective of this study was to determine the accuracy of parent-reported child height and weight, as well as body mass index and weight category that we calculated from these data. We also aimed to explore whether parent report was influenced by age, sex, weight status, or exposure to participation in a 12-week brief Web-based family lifestyle intervention. Methods: This study was a secondary analysis of data from a 12-week childhood obesity pilot randomized controlled trial in families with children aged 4 to 11 years in Australia. We asked parents to report demographic information, including child height and weight, using an online survey before their child’s height and weight were objectively measured by a trained research assistant at baseline and week 12. We analyzed data using the Lin concordance correlation coefficient (ρc, ranging from 0 [poor] to ±1 [perfect] concordance), Cohen kappa coefficient, and multivariable linear regression models. Results: There were 42 families at baseline and 35 families (83%) at week 12. Overall, the accuracy of parent-reported child height was moderate (ρc=.94), accuracy of weight was substantial (ρc=.96), and accuracy of calculated body mass index was poor (ρc=.63). Parents underreported child height and weight, respectively, by 0.9 cm and 0.5 kg at baseline and by 0.2 cm and 1.6 kg after participating in a 12-week brief Web-based family lifestyle intervention. The overall interrater agreement of child body mass index category was moderate at baseline (κ=.59) and week 12 (κ=.54). The weight category calculated from 74% (n=31) and 70% (n=23) of parent-reported child height and weight was accurate at baseline and week 12, respectively. Parental age was significantly (95% CI –0.52 to –0.06; P=.01) associated with accuracy of reporting child height. Child age was significantly (95% CI –2.34 to –0.06; P=.04) associated with reporting of child weight. Conclusions: Most Australian parents were reasonably accurate in reporting child height and weight among a group of children aged 4 to 11 years. The weight category of most of the children when calculated from parent-reported data was in agreement with the objectively measured data despite the body mass index calculated from parent-reported data having poor concordance at both time points. Online parent-reported child height and weight may be a valid method of collecting child anthropometric data ahead of participation in a Web-based program. Future studies with larger sample sizes and repeated measures over time in the context of eHealth research are warranted. Future studies should consider modeling the impact of calibration equations applied to parent-reported anthropometric data on study outcomes. %M 31538954 %R 10.2196/12532 %U https://www.jmir.org/2019/9/e12532/ %U https://doi.org/10.2196/12532 %U http://www.ncbi.nlm.nih.gov/pubmed/31538954 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e11235 %T Incorporating Technology Into the iCook 4-H Program, a Cooking Intervention for Adults and Children: Randomized Controlled Trial %A Colby,Sarah %A Moret,Lauren %A Olfert,Melissa D %A Kattelmann,Kendra %A Franzen-Castle,Lisa %A Riggsbee,Kristin %A Payne,Magen %A Ellington,Ainsley %A Springer,Cary %A Allison,Chelsea %A Wiggins,Sa'Nealdra %A Butler,Rochelle %A Mathews,Douglas %A White,Adrienne A %+ Department of Nutrition, University of Tennessee, 1215 W Cumberland Ave, Jesse Harris Building Room 229, Knoxville, TN, 37996, United States, 1 865 974 6248, scolby1@utk.edu %K technology %K videos %K intervention %K cooking %K child health %D 2019 %7 29.08.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Families who cook, eat, and play together have been found to have more positive health outcomes. Interventions are needed that effectively increase these health-related behaviors. Technology is often incorporated in health-related interventions but is not always independently assessed. Objective: The objective of this study was to describe challenges and facilitators to incorporating technology into the iCook 4-H intervention program. Methods: Dyads (n=228) composed of children (mean 9.4, SD 0.7 years old) and an adult primary meal preparer (mean 39.0, SD 8 years) were randomly assigned to a control (n=77) or treatment group (n=151). All treatment group dyads participated in 6 in-person sessions designed to increase families cooking, eating, and playing together. We incorporated Web-based between-session technological components related to the curriculum content throughout the intervention. Assessments were completed by both groups at baseline and at 4, 12, and 24 months; they included measured anthropometrics for children, and online surveys about camera and website skill and use for dyads. Session leaders and participants completed open-ended process evaluations after each session about technological components. We computed chi-square analysis for sex differences in technological variables. We tested relationships between video posting frequency and outcomes of interest (cooking frequency, self-efficacy, and skills; dietary intake; and body mass index) with Spearman correlations. Process evaluations and open-ended survey responses were thematically analyzed for beneficial and inhibiting factors, including technological components in the curriculum. Results: Only 78.6% (81/103) of children and 68.3% (71/104) of adults reported always being comfortable accessing the internet postintervention. Boys reported being more comfortable than girls with technological tasks (P<.05). Children who posted more videos had a higher level of cooking skills at 4 months postintervention (r=.189, P=.05). Barriers to website usage reported most frequently by children were lack of accessibility, remembering, interactivity, motivation, time, and lack of parental encouragement. Conclusions: Incorporating technological supports, such as cameras and websites, into children’s programs may help produce improved outcomes. Identifying barriers to and patterns of technology usage need to be considered when developing future child health promotion interventions. Trial Registration: ISRCTN Registry ISRCTN54135351; https://www.isrctn.com/ISRCTN54135351 %M 31518323 %R 10.2196/11235 %U http://pediatrics.jmir.org/2019/2/e11235/ %U https://doi.org/10.2196/11235 %U http://www.ncbi.nlm.nih.gov/pubmed/31518323 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 7 %P e14097 %T Effects of a School-Based Health Intervention Program in Marginalized Communities of Port Elizabeth, South Africa (the KaziBantu Study): Protocol for a Randomized Controlled Trial %A Müller,Ivan %A Smith,Danielle %A Adams,Larissa %A Aerts,Ann %A Damons,Bruce P %A Degen,Jan %A Gall,Stefanie %A Gani,Zaahira %A Gerber,Markus %A Gresse,Annelie %A van Greunen,Darelle %A Joubert,Nandi %A Marais,Tracey %A Nqweniso,Siphesihle %A Probst-Hensch,Nicole %A du Randt,Rosa %A Seelig,Harald %A Steinmann,Peter %A Utzinger,Jürg %A Wadhwani,Christina %A Walter,Cheryl %A Pühse,Uwe %+ Department of Sport, Exercise and Health, University of Basel, Gellertstrasse 156, Basel, CH-4052, Switzerland, 41 61 207 4784, ivan.mueller@unibas.ch %K anthropometry %K cardiovascular %K cognitive function %K diabetic complications %K children’s health %K marginalization %K physical activity %K physical fitness %K schools %K South Africa %D 2019 %7 11.07.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: The burden of poverty-related infectious diseases remains high in low- and middle-income countries, while noncommunicable diseases (NCDs) are rapidly gaining importance. To address this dual disease burden, the KaziBantu project aims at improving and promoting health literacy as a means for a healthy and active lifestyle. The project implements a school-based health intervention package consisting of physical education, moving-to-music, and specific health and nutrition education lessons from the KaziKidz toolkit. It is complemented by the KaziHealth workplace health intervention program for teachers. Objectives: The aim of the KaziBantu project is to assess the effect of a school-based health intervention package on risk factors for NCDs, health behaviors, and psychosocial health in primary school children in disadvantaged communities in Port Elizabeth, South Africa. In addition, we aim to test a workplace health intervention for teachers. Methods: A randomized controlled trial (RCT) will be conducted in 8 schools. Approximately 1000 grade 4 to grade 6 school children, aged 9 to 13 years, and approximately 60 teachers will be recruited during a baseline survey in early 2019. For school children, the study is designed as a 36-week, cluster RCT (KaziKidz intervention), whereas for teachers, a 24-week intervention phase (KaziHealth intervention) is planned. The intervention program consists of 3 main components; namely, (1) KaziKidz and KaziHealth teaching material, (2) workshops, and (3) teacher coaches. After randomization, 4 of the 8 schools will receive the education program, whereas the other schools will serve as the control group. Intervention schools will be further randomized to the different combinations of 2 additional intervention components: teacher workshops and teacher coaching. Results: This study builds on previous experience and will generate new evidence on health intervention responses to NCD risk factors in school settings as a decision tool for future controlled studies that will enable comparisons among marginalized communities between South African and other African settings. Conclusions: The KaziKidz teaching material is a holistic educational and instructional tool designed for primary school teachers in low-resource settings, which is in line with South Africa’s Curriculum and Assessment Policy Statement. The ready-to-use lessons and assessments within KaziKidz should facilitate the use and implementation of the teaching material. Furthermore, the KaziHealth interventions should empower teachers to take care of their health through knowledge gains regarding disease risk factors, physical activity, fitness, psychosocial health, and nutrition indicators. Teachers as role models will be able to promote better health behaviors and encourage a healthy and active lifestyle for children at school. We conjecture that improved health and well-being increase teachers’ productivity with trickle-down effects on the children they teach and train. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 18485542; http://www.isrctn.com/ISRCTN18485542 International Registered Report Identifier (IRRID): DERR1-10.2196/14097 %M 31298224 %R 10.2196/14097 %U http://www.researchprotocols.org/2019/7/e14097/ %U https://doi.org/10.2196/14097 %U http://www.ncbi.nlm.nih.gov/pubmed/31298224 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e13549 %T Protocol for the Development of a Behavioral Family Lifestyle Intervention Supported by Mobile Health to Improve Weight Self-Management in Children With Asthma and Obesity %A Fedele,David %A Lucero,Robert %A Janicke,David %A Abu-Hasan,Mutasim %A McQuaid,Elizabeth %A Moon,Jon %A Fidler,Andrea %A Wallace-Farquharson,Tanya %A Lindberg,David %+ Department of Clinical & Health Psychology, University of Florida, 101 S Newell Dr, Rm 3151, PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 5765, dfedele@phhp.ufl.edu %K asthma %K obesity %K child %K family %K program development %D 2019 %7 24.06.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Asthma is the most common chronic childhood illness and is a leading cause of emergency department visits in the United States. Obesity increases the risk of poor health outcomes, reduced quality of life, and increased health care expenditures among youth with asthma. Weight loss is crucial for improving asthma outcomes in children with obesity. Our study team developed the Childhood Health and Asthma Management Program (CHAMP), a 16-session behavioral family lifestyle intervention (BFI) for school-age children with asthma and obesity and evaluated CHAMP in a randomized controlled trial compared with attention control. There were medium effect sizes favoring CHAMP for changes in body mass index z-scores, asthma control, and lung function among completers (ie, those who attended ≥9 of 16 sessions). Despite high rates of satisfaction reported by families, attendance and trial attrition were suboptimal, which raised concerns regarding the feasibility of CHAMP. Qualitative feedback from participants indicated 3 areas for refinement: (1) a less burdensome intervention modality, (2) a more individually tailored intervention experience, and (3) that interventionists can better answer health-related questions. Objective: We propose to improve upon our pilot intervention by developing the Mobile Childhood Health and Asthma Management Program (mCHAMP), a nurse-delivered BFI, delivered to individual families, and supported by a mobile health (mHealth) app. This study aims to (1) identify structural components of mCHAMP and (2) develop and test the usability of our mCHAMP app. Methods: Participants will be recruited from an outpatient pediatric pulmonary clinic. We will identify the structural components of mCHAMP by conducting a needs assessment with parents of children with asthma and obesity. Subsequently, we will develop and test our mCHAMP app using an iterative process that includes usability testing with target users and pediatric nurses. Results: This study was funded in 2018; 13 parents of children with asthma and obesity participated in the needs assessment. Preliminary themes from focus groups and individual meetings included barriers to engaging in health-promoting behaviors, perceived relationships between asthma and obesity, facilitators to behavior change, and intervention preferences. Participatory design sessions and usability testing are expected to conclude in late 2019. Conclusions: Outcomes from this study are expected to include an mHealth app designed with direct participation from the target audience and usability data from stakeholders as well as potential end users. International Registered Report Identifier (IRRID): DERR1-10.2196/13549 %M 31237240 %R 10.2196/13549 %U http://www.researchprotocols.org/2019/6/e13549/ %U https://doi.org/10.2196/13549 %U http://www.ncbi.nlm.nih.gov/pubmed/31237240 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14239 %T Understanding the Role of Healthy Eating and Fitness Mobile Apps in the Formation of Maladaptive Eating and Exercise Behaviors in Young People %A Honary,Mahsa %A Bell,Beth T %A Clinch,Sarah %A Wild,Sarah E %A McNaney,Roisin %+ School of Computing and Communications, Lancaster University, InfoLab21, Lancaster, LA1 4WA, United Kingdom, 44 1524 593566, m.honary@lancaster.ac.uk %K weight loss %K mobile apps %K eating disorders %K body image diet %K exercise %K mental health %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Healthy eating and fitness mobile apps are designed to promote healthier living. However, for young people, body dissatisfaction is commonplace, and these types of apps can become a source of maladaptive eating and exercise behaviors. Furthermore, such apps are designed to promote continuous engagement, potentially fostering compulsive behaviors. Objective: The aim of this study was to identify potential risks around healthy eating and fitness app use and negative experience and behavior formation among young people and to inform the understanding around how current commercial healthy eating and fitness apps on the market may, or may not, be exasperating such behaviors. Methods: Our research was conducted in 2 phases. Through a survey (n=106) and 2 workshops (n=8), we gained an understanding of young people’s perceptions of healthy eating and fitness apps and any potential harm that their use might have; we then explored these further through interviews with experts (n=3) in eating disorder and body image. Using insights drawn from this initial phase, we then explored the degree to which leading apps are preventing, or indeed contributing to, the formation of maladaptive eating and exercise behaviors. We conducted a review of the top 100 healthy eating and fitness apps on the Google Play Store to find out whether or not apps on the market have the potential to elicit maladaptive eating and exercise behaviors. Results: Participants were aged between 18 and 25 years and had current or past experience of using healthy eating and fitness apps. Almost half of our survey participants indicated that they had experienced some form of negative experiences and behaviors through their app use. Our findings indicate a wide range of concerns around the wider impact of healthy eating and fitness apps on individuals at risk of maladaptive eating and exercise behavior, including (1) guilt formation because of the nature of persuasive models, (2) social isolation as a result of personal regimens around diet and fitness goals, (3) fear of receiving negative responses when targets are not achieved, and (4) feelings of being controlled by the app. The app review identified logging functionalities available across the apps that are used to promote the sustained use of the app. However, a significant number of these functionalities were seen to have the potential to cause negative experiences and behaviors. Conclusions: In this study, we offer a set of responsibility guidelines for future researchers, designers, and developers of digital technologies aiming to support healthy eating and fitness behaviors. Our study highlights the necessity for careful considerations around the design of apps that promote weight loss or body modification through fitness training, especially when they are used by young people who are vulnerable to the development of poor body image and maladaptive eating and exercise behaviors. %M 31215514 %R 10.2196/14239 %U http://mhealth.jmir.org/2019/6/e14239/ %U https://doi.org/10.2196/14239 %U http://www.ncbi.nlm.nih.gov/pubmed/31215514 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e12792 %T Promotion of Family Routines and Positive Parent-Child Interactions for Obesity Prevention: Protocol for the 3 Pillars Study Randomized Controlled Trial %A Marsh,Samantha %A Gerritsen,Sarah %A Taylor,Rachael %A Galland,Barbara %A Parag,Varsha %A Maddison,Ralph %+ National Institute for Health Innovation, School of Population Health, University of Auckland, 261 Morrin Rd, St Johns, Auckland, 1072, New Zealand, 64 21400904, sam.marsh@auckland.ac.nz %K screen time %K family routines %K parent-child relations %K child, preschool %K randomized controlled trial %K health behavior %K pediatric obesity %K sleep %K parenting %K New Zealand %D 2019 %7 02.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Childhood obesity is a challenging public health issue, with 30% of children aged 2 to 4 years classified as being overweight or obese in New Zealand. This is concerning, given that up to 90% of obese 3-year-old children are overweight or obese by the time they reach adolescence. Interventions that target this age range often fail to demonstrate long-term effectiveness and primarily focus on traditional weight-related behaviors, including diet and physical activity. However, research suggests that targeting nontraditional weight-related behaviors, such as sleep, screen time, and family meals, may be a more effective approach in this age group, given the immense challenges in changing traditional weight-related behaviors in the long term. Objective: The aim of the proposed study was to develop and pilot the 3 Pillars Study (3PS), a 6-week program for parents of New Zealand toddlers and preschoolers aged 2 to 4 years to promote positive parent-child interactions during 3 family routines, specifically adequate sleep, regular family meals, and restricted screen time. Methods: Screen time at the end of the 6-week program is the primary endpoint. The effects of the program on screen time, frequency of family meals, parent feeding practices, diet quality, and sleep duration will be piloted using a randomized controlled trial, with outcomes compared between the active intervention group and a wait-list control group at 6 weeks (at the end of the program) and 12 weeks (at final follow-up). We aim to recruit 50 participants (25 per arm). Eligibility criteria include parents of children aged 2 to 4 years who are currently exceeding screen use recommendations (ie, greater than 1 hour of screen time per day). The 3PS program involves a half-day workshop, run by a community worker trained to deliver the program content, and 6-week access to a study website that contains in-depth information about the program. All participants will also receive a study pack, which includes resources to encourage engagement in the 3 family routines promoted by the program. Study data will be collected in REDCap. All statistical analyses will be performed using SAS version 9.4 and have been specified a priori in a statistical analysis plan prepared by the study statistician. Results: Trial recruitment opened in July 2018. Final follow-up was completed in December 2018, with trial findings expected to be available in early 2019. Conclusions: Findings from this pilot study will provide relevant data to inform the design of a larger effectiveness study of the 3PS program. Trial Registration: Australian New Zealand Clinical Trials Register ACTRN12618000823279; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=375004 (Archived by WebCite at http://www.webcitation.org/773CALeTK) International Registered Report Identifier (IRRID): DERR1-10.2196/12792 %M 30938692 %R 10.2196/12792 %U https://www.researchprotocols.org/2019/4/e12792/ %U https://doi.org/10.2196/12792 %U http://www.ncbi.nlm.nih.gov/pubmed/30938692 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e12501 %T Feasibility and Acceptability of a Culturally Tailored Website to Increase Fruit and Vegetable Intake and Physical Activity Levels in African American Mother-Child Dyads: Observational Study %A Chung,Alicia %A Wallace,Barbara %A Stanton-Koko,Monica %A Seixas,Azizi %A Jean-Louis,Girardin %+ New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 646 501 2608, alicia.chung@nyumc.org %K childhood obesity %K eHealth %K social justice %D 2019 %7 22.03.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population. Objective: This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads. Methods: Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska’s Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes. Results: A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate (P=.03), (2) meal preparation for her family (P=.01), (3) fruit and vegetable selection outside the home (P<.001), and (4) physical activity (P<.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest (P<.001). Children’s open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos. Conclusions: Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions. %M 31518320 %R 10.2196/12501 %U http://pediatrics.jmir.org/2019/1/e12501/ %U https://doi.org/10.2196/12501 %U http://www.ncbi.nlm.nih.gov/pubmed/31518320 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10284 %T Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents %A Holzmann,Sophie Laura %A Dischl,Felicitas %A Schäfer,Hanna %A Groh,Georg %A Hauner,Hans %A Holzapfel,Christina %+ Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital “Klinikum rechts der Isar”, Technical University of Munich, Georg-Brauchle-Ring 62, 5th Floor, Munich, 80992, Germany, 49 89 289 249 23, christina.holzapfel@tum.de %K adolescents %K children %K communication %K motives %K mobile phone %K needs %K nutrition %K obesity %K overweight %K preferences %K serious games %K survey %D 2019 %7 13.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents. Objective: This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games. Methods: We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS. Results: In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0%) and television (97/291, 33.3%), while school education (161/291, 55.3%) and parents or other adults (209/291, 71.8%) were the most relevant nondigital information sources. Most participants (242/283, 85.5%) reported that they regularly play digital games. More than half (144/236, 61.0%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70% (151/282, 66.5%) reported playing digital games for ≤30 minutes without any interruption. One-half of respondents (144/280, 51.4%) also stated that they were interested in receiving information about nutrition while playing digital games. Conclusions: This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents. %M 30758290 %R 10.2196/10284 %U http://formative.jmir.org/2019/1/e10284/ %U https://doi.org/10.2196/10284 %U http://www.ncbi.nlm.nih.gov/pubmed/30758290 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11964 %T An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial %A Hammersley,Megan L %A Okely,Anthony D %A Batterham,Marijka J %A Jones,Rachel A %+ Early Start, Faculty of Social Sciences, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 242215670, megan.hammersley1@uowmail.edu.au %K internet %K eHealth %K food intake %K physical activity %K screen time %K sleep %K self efficacy %K body mass index %D 2019 %7 08.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children. Objective: This study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy. Methods: The Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection. Results: A total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate −1.36, 95% CI −2.27 to −0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes. Conclusions: The trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power. Trial Registration: Australian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ). %M 30735139 %R 10.2196/11964 %U http://www.jmir.org/2019/2/e11964/ %U https://doi.org/10.2196/11964 %U http://www.ncbi.nlm.nih.gov/pubmed/30735139 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e9967 %T Predicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthy %A Grutzmacher,Stephanie K %A Munger,Ashley L %A Speirs,Katherine E %A Vafai,Yassaman %A Hilberg,Evan %A Braunscheidel Duru,Erin %A Worthington,Laryessa %A Lachenmayr,Lisa %+ School of Biological and Population Health Sciences, College of Public Health and Human Sciences, Oregon State University, 118 Milam Hall, Corvallis, OR, 97331, United States, 1 3019080779, stephanie.grutzmacher@oregonstate.edu %K text messaging %K retention %K diet, food, and nutrition %K food assistance %K parents %K survival analysis %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text-based programs have been shown to effectively address a wide variety of health issues. Although little research examines short message service (SMS) text messaging program characteristics that predict participant retention and attrition, features of SMS text message programs, such as program duration and intensity, message content, and the participants’ context, may have an impact. The impact of stop messages—messages with instructions for how to drop out of an SMS text message program—may be particularly important to investigate. Objective: The aim of this study was to describe attrition from Text2BHealthy, a text-based nutrition and physical activity promotion program for parents of low-income elementary school children, and to determine the impact of message content and number of stop messages received on attrition. Methods: Using data from 972 parents enrolled in Text2BHealthy, we created Kaplan-Meier curves to estimate differences in program duration for different SMS text message types, including nutrition, physical activity, stop, and other messages. Covariates, including rurality and number of stop messages received, were included. Results: Retention rates by school ranged from 74% (60/81) to 95.0% (132/139), with an average retention rate of 85.7% (833/972) across all schools. Program duration ranged from 7 to 282 days, with a median program duration of 233 days and an average program duration of 211.7 days. Among those who dropped out, program duration ranged from 7 to 247 days, with a median program duration of 102.5 days. Receiving a stop message increased the probability of attrition compared with receiving messages about nutrition, physical activity, or other topics (hazard ratio=51.5, 95% CI 32.46-81.7; P<.001). Furthermore, each additional stop message received increased the probability of attrition (hazard ratio=10.36, 95% CI 6.14-17.46; P<.001). The degree of rurality also had a significant effect on the probability of attrition, with metropolitan county participants more likely to drop out of the program than rural county participants. The interaction between SMS text message type and total number of stop messages received had a significant effect on attrition, with the effect of the number of stop messages received dependent on the SMS text message type. Conclusions: This study demonstrates the potential of SMS text message programs to retain participants over time. Furthermore, this study suggests that the probability of attrition increases substantially when participants receive messages with instructions for dropping out of the program. Program planners should carefully consider the impact of stop messages and other program content and characteristics on program retention. Additional research is needed to identify participant, programmatic, and contextual predictors of program duration and to explicate the relationship between program duration and program efficacy. %M 30664489 %R 10.2196/mhealth.9967 %U https://mhealth.jmir.org/2019/1/e9967/ %U https://doi.org/10.2196/mhealth.9967 %U http://www.ncbi.nlm.nih.gov/pubmed/30664489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11867 %T Mobile Apps to Support Healthy Family Food Provision: Systematic Assessment of Popular, Commercially Available Apps %A Mauch,Chelsea E %A Wycherley,Thomas P %A Laws,Rachel A %A Johnson,Brittany J %A Bell,Lucinda K %A Golley,Rebecca K %+ Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Level 7, Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, Australia, 61 882047075, chelsea.mauch@flinders.edu.au %K diet %K nutrition %K family %K mobile applications %K behavior modification %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Modern families are facing conflicting demands on their time and resources, which may be at the detriment of child and family diet quality. Innovative nutrition interventions providing parents with behavioral support for the provision of healthy food could alleviate this issue. Mobile apps have the potential to deliver such interventions by providing practical behavioral support remotely, interactively, and in context. Objective: This review aimed to identify and assess popular, commercially available food- and nutrition-related mobile apps that offer support for the provision of healthy family food by (1) describing app scope and characteristics, (2) assessing app quality, and (3) conducting a behavioral analysis of app content and features. Methods: Searches in the Google Play Store and Apple App Store between August 2017 and November 2017 identified apps addressing the food provision process. Apps were included if they were applicable to parents or families, written in English, and with a user rating of ≥4 stars. Weight loss and diet monitoring apps and subscription apps with no free versions were excluded. App quality was assessed using the Mobile App Rating Scale (4 domains: engagement, functionality, aesthetics, and information). App content and features were extracted and behavior change techniques (BCTs) identified. Results: Of the 2881 apps screened, 1.77% (51/2881) were included for assessment, comprising 23 recipe and recipe manager apps, 12 meal planning apps, 10 shopping list apps, 4 family organizers, and 2 food choice apps. Half (n=26) of the apps functioned primarily through user data input. Food choice and family organizer apps scored highest for app quality (mean 3.5 [SD 0.6] out of 5), whereas most apps scored well for functionality and poorly for engagement. Common app features with the potential to support healthy food provision included meal planners (n=26), shopping lists (n=44), and the ability to share app content (n=48). Behavioral support features mapped to relatively few BCTs (mean 3.9 [SD 1.9] per app), with Adding objects to the environment present in all apps, and 65% (33/51) including Instruction on how to perform the behavior. Conclusions: Recipe and recipe manager apps, meal planning apps, and family organizers with integrated meal planning and shopping lists scored well for functionality and incorporated behavioral support features that could be used to address barriers to healthy food provision, although features were focused on planning behaviors. Future apps should combine a range of features such as meal planners, shopping lists, simple recipes, reminders and prompts, and food ordering to reduce the burden of the food provision pathway and incorporate a range of BCTs to maximize behavior change potential. Researchers and developers should consider features and content that improve the engagement quality of such apps. %M 30578213 %R 10.2196/11867 %U http://mhealth.jmir.org/2018/12/e11867/ %U https://doi.org/10.2196/11867 %U http://www.ncbi.nlm.nih.gov/pubmed/30578213 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e11619 %T Body Mass Index Screening and Follow-Up: A Cross-Sectional Questionnaire Study of Pennsylvania School Nurses %A Francis,Erica %A Hoke,Alicia Marie %A Kraschnewski,Jennifer Lynn %+ Department of Pediatrics, Penn State University, 90 Hope Drive, Suite 1103, Mail Code A145, Hershey, PA, 17033, United States, 1 717 531 1440 ext 8, efrancis@psu.edu %K body mass index %K childhood overweight %K childhood obesity %K pediatric obesity %K Pennsylvania %K school nursing %K Web-based survey %D 2018 %7 21.12.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Childhood overweight and obesity health concerns can affect a student’s academic performance, so it is important to identify resources for school nurses that would help to improve self-efficacy, knowledge, and confidence when approaching parents with sensitive weight-related information and influence overall obesity prevention efforts in the school setting. Objective: The purpose of this study was to conduct a Pennsylvania (PA) state-wide 29-item survey addressing school nursing barriers and practices, supplementing information already known in this area. Although the survey covered a range of topics, the focus was body mass index (BMI) screening and its related practice within the schools. Methods: We conducted a state-wide Web-based survey of school nurses in PA to understand current areas of care, find ways to address child health through school BMI screenings and follow up, and identify current educational gaps to assist school nurses with providing whole child care within the realm of weight management. Chi-square test of independence was conducted to determine the relationship between BMI screening follow up and interest in a BMI toolkit. Results: Nurse participants (N=210), with a 42% (210/500) response rate, represented 208 school districts across PA. Participants were asked about their current process for notifying parents of BMI screening results. The majority (116/210, 55.2%) send a letter home in the mail, while others (62/210, 29.5%) send a letter home with students. A small number (8/210, 3.8%) said they did not notify parents altogether, and some (39/210, 18.6%) notify parents electronically. More than one-third (75/210, 35.7%) of nurses reported receiving BMI screening inquiries from parents; however, under half (35/75, 46.7%) of those respondents indicated they follow up with parents whose child screens overweight or obese. Overall, the vast majority (182/210, 86.7%) do not follow up with parents whose child screens overweight or obese. The majority (150/210, 71.4%) of the nurses responded they would benefit from a toolkit with resources to assist with communication with parents and children about BMI screenings. A significant association between respondent follow up and interest in a BMI toolkit was observed (P=.01). Conclusions: Schools must start recognizing the role school nurses play to monitor and promote children’s health. This goal might include involving them in school-based preventive programs, empowering them to lead initiatives that support whole child health and ensuring opportunities for professional development of interest to them. Nonetheless, the first step in facilitating obesity prevention methods within schools is to provide school nurses with meaningful tools that help facilitate conversations with parents, guardians, and caregivers regarding their child’s weight status and health through a BMI screening toolkit. %M 30578174 %R 10.2196/11619 %U http://www.i-jmr.org/2018/2/e11619/ %U https://doi.org/10.2196/11619 %U http://www.ncbi.nlm.nih.gov/pubmed/30578174 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e11093 %T Digital Weight Loss Intervention for Parents of Children Being Treated for Obesity: A Prospective Cohort Feasibility Trial %A Kay,Melissa C %A Burroughs,Jasmine %A Askew,Sandy %A Bennett,Gary G %A Armstrong,Sarah %A Steinberg,Dori M %+ Duke Global Digital Health Science Center, Duke Center for Childhood Obesity Research, Duke University, 310 Trent Drive, Durham, NC, 27708, United States, 1 781 249 3062, melissa.kay@duke.edu %K obesity %K parent %K child %K digital weight loss intervention %K self-monitoring %K weight %K text %D 2018 %7 20.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of childhood obesity continues to increase, and clinic-based treatment options have failed to demonstrate effectiveness. One of the strongest predictors of child weight is parent weight. Parental treatment for weight loss may indirectly reduce obesity in the child. We have previously demonstrated the effectiveness among adults of a fully automated, evidence-based digital weight loss intervention (Track). However, it is unknown if it is feasible to deliver such a treatment directly to parents with obesity who bring their child with obesity to a weight management clinic for treatment. Objective: The objective of our study was to evaluate the feasibility of and engagement with a digital weight loss intervention among parents of children receiving treatment for obesity. Methods: We conducted a 6-month pre-post feasibility trial among parents or guardians and their children aged 4-16 years presenting for tertiary care obesity treatment. Along with the standard family-based treatment protocol, parents received a 6-month digital weight loss intervention, which included weekly monitoring of personalized behavior change goals via mobile technologies. We examined levels of engagement by tracking completed weeks of self-monitoring and feasibility by assessing change in weight. Results: Participants (N=48) were on average 39 years old, mostly female (35/42, 82% ), non-Hispanic Black individuals (21/41, 51%) with obesity (36/48, 75%). Over a quarter had a yearly household income of