Text messaging to help women with overweight or obesity lose weight after childbirth:the intervention adaptation and SMS feasibility RCT

Background There is a need to develop weight management interventions that fit seamlessly into the busy lives of women during the postpartum period. Objective The objective was to develop and pilot-test an evidence- and theory-based intervention, delivered by short message service, which supported weight loss and weight loss maintenance in the postpartum period. Design Stage 1 involved the development of a library of short message service messages to support weight loss and weight loss maintenance, with personal and public involvement, focusing on diet and physical activity with embedded behaviour change techniques, and the programming of a short message service platform to allow fully automated intervention delivery. Stage 2 comprised a 12-month, single-centre, two-arm, pilot, randomised controlled trial with an active control. Setting This study was set in Northern Ireland; women were recruited via community-based approaches. Participants A total of 100 women with overweight or obesity who had given birth in the previous 24 months were recruited. Interventions The intervention group received an automated short message service intervention about weight loss and weight loss maintenance for 12 months. The active control group received automated short message service messages about child health and development for 12 months. Main outcome measures The main outcomes measured were the feasibility of recruitment and retention, acceptability of the intervention and trial procedures, and evidence of positive indicative effects on weight. Weight, waist circumference and blood pressure were measured by the researchers; participants completed a questionnaire booklet and wore a sealed pedometer for 7 days at baseline, 3, 6, 9 and 12 months. Outcome assessments were collected during home visits and women received a voucher on completion of each of the assessments. Qualitative interviews were conducted with women at 3 and 12 months, to gather feedback on the intervention and active control and the study procedures. Quantitative and qualitative data were used to inform the process evaluation and to assess fidelity, acceptability, dose, reach, recruitment, retention, contamination and context. Results The recruitment target of 100 participants was achieved (intervention, n = 51; control, n = 49); the mean age was 32.5 years (standard deviation 4.3 years); 28 (28%) participants had a household income o

Problems recruiting and retaining postnatal women to a pilot randomised controlled trial of a web-delivered weight loss intervention ISRCTN48086713 ISRCTN

Abstract Objective This paper highlights recruitment and retention problems identified during a pilot randomised controlled trial and process evaluation. The pilot trial aimed to evaluate the feasibility and acceptability of a web-delivered weight loss intervention for postnatal women and associated trial protocol. Results General practice database searches revealed low rates of eligible postnatal women per practice. 16 (10%) of the 168 identified women were recruited and randomised, seven to the intervention and nine to the control. 57% (4/7) of the intervention women completed 3 month follow-up measurements in comparison to 56% (5/9) in the control group. By 12 months, retention in the intervention group was 43% (3/7), with 2/7 women active on the website, in comparison to 44% (4/9) of the control group. Interview findings revealed the web as an acceptable method for delivery of the intervention, with the suggestion of an addition of a mobile application. Alternative recruitment strategies, using health visitor appointments, midwifery departments or mother and baby/toddler groups, should be explored. Greater involvement of potential users should enable better recruitment methods to be developed. Trial registration ISRCTN: ISRCTN48086713, Registered 26 October 201

Food4toddlers. Fostering healthy dietary habits through targeting toddlers' food and eating environment : The Food4toddlers study

Aims and objectives: 1) to develop, implement, and evaluate an eHealth intervention, aiming to promote healthy dietary habits in toddlers by targeting parents’ awareness of their child’s food and eating environments, and 2) to examine associations between parental food choice motives, parental feeding practices, and children’s fruit and vegetable intake. Results: The study’s rationale and development were described in a protocol paper, along with a presentation of the baseline characteristics of the included participants. In total, 404 parents signed up for participation, and 298 answered baseline questionnaires and were randomized into either the control (n=150) or intervention (n=148) group. Most of the parents were highly educated mothers. From baseline to the first follow-up there was a significant time by group interaction for the frequency of vegetable intake (p = 0.02), showing a higher change in intake in the intervention group compared with the control group (paper III). A borderline significant between-group difference in the variety of vegetable intake in favor of the intervention group was seen from baseline to both follow-ups. No significant differences were observed for other food groups. The process evaluation of the study (paper IV) revealed that 86.5% of the participants in the intervention group visited the website. Most parents found the website appropriate to the child’s age as well as self-explanatory (86–95%) and appreciated the layout and interface (55–63%). The recipes were valued as the most appreciated element included in the website. Highly educated participants (> 4 years of university/college) reported that they used end learned more from the website than participants with ≤ 4 years of education. Regarding the second aim (paper II), the results showed that higher parental scores on health motives were associated with a higher child intake of vegetables (τ = 0.394 (SE = 0.098), p < 0.001). No associations with fruit or vegetables were found for other parental food choice motives. Some associations between food choice motives and child vegetable or fruit intakes were mediated by the feeding practices assessed, though solely for health and sensory appeal motives. Effect sizes of the observed associations were generally small. Conclusions: Our findings support the use of eHealth interventions for supporting parents in their children's dietary upbringing. Through making the parents aware of dietary determinants and encouraging them to create a healthy food and eating environment, child diet was slightly improved, i.e., higher vegetable intake in the intervention group was observed. The intervention was well received by the parents, although especially by highly educated parents. Still, we did not manage to engage 13% of the participants, who did not enter the website at all. Health motives were associated with child vegetable intake, and healthpromoting feeding practices had some mediation effect. Our findings contribute to a better understanding of the relations affecting toddler’s eating habits. However, more research is needed to examine the prospective and experimental evidence of interventions to enhance toddlers’ diet and to clarify interactions between elements in the child’s food and eating environment that affect the diet.publishedVersio

Characteristics of Smartphone Applications for Nutrition Improvement in Community Settings: A Scoping Review

Reproduced by permission of Oxford University Press https://academic.oup.com Copyright © 2019 American Society for NutritionSmartphone applications are increasingly being used to support nutrition improvement in community settings. However, there is a scarcity of practical literature to support researchers and practitioners in choosing or developing health applications. This work maps the features, key content, theoretical approaches, and methods of consumer testing of applications intended for nutrition improvement in community settings. A systematic, scoping review methodology was used to map published, peer-reviewed literature reporting on applications with a specific nutrition-improvement focus intended for use in the community setting. After screening, articles were grouped into 4 categories: dietary self-monitoring trials, nutrition improvement trials, application description articles, and qualitative application development studies. For mapping, studies were also grouped into categories based on the target population and aim of the application or program. Of the 4818 titles identified from the database search, 64 articles were included. The broad categories of features found to be included in applications generally corresponded to different behavior change support strategies common to many classic behavioral change models. Key content of applications generally focused on food composition, with tailored feedback most commonly used to deliver educational content. Consumer testing before application deployment was reported in just over half of the studies. Collaboration between practitioners and application developers promotes an appropriate balance of evidence-based content and functionality. This work provides a unique resource for program development teams and practitioners seeking to use an application for nutrition improvement in community settings

Evaluating the impact of physical activity apps and wearables: interdisciplinary review

Background: Although many smartphone apps and wearables have been designed to improve physical activity, their rapidly evolving nature and complexity present challenges for evaluating their impact. Traditional methodologies, such as randomized controlled trials (RCTs), can be slow. To keep pace with rapid technological development, evaluations of mobile health technologies must be efficient. Rapid alternative research designs have been proposed, and efficient in-app data collection methods, including in-device sensors and device-generated logs, are available. Along with effectiveness, it is important to measure engagement (ie, users’ interaction and usage behavior) and acceptability (ie, users’ subjective perceptions and experiences) to help explain how and why apps and wearables work. Objectives: This study aimed to (1) explore the extent to which evaluations of physical activity apps and wearables: employ rapid research designs; assess engagement, acceptability, as well as effectiveness; use efficient data collection methods; and (2) describe which dimensions of engagement and acceptability are assessed. Method: An interdisciplinary scoping review using 8 databases from health and computing sciences. Included studies measured physical activity, and evaluated physical activity apps or wearables that provided sensor-based feedback. Results were analyzed using descriptive numerical summaries, chi-square testing, and qualitative thematic analysis. Results: A total of 1829 abstracts were screened, and 858 articles read in full. Of 111 included studies, 61 (55.0%) were published between 2015 and 2017. Most (55.0%, 61/111) were RCTs, and only 2 studies (1.8%) used rapid research designs: 1 single-case design and 1 multiphase optimization strategy. Other research designs included 23 (22.5%) repeated measures designs, 11 (9.9%) nonrandomized group designs, 10 (9.0%) case studies, and 4 (3.6%) observational studies. Less than one-third of the studies (32.0%, 35/111) investigated effectiveness, engagement, and acceptability together. To measure physical activity, most studies (90.1%, 101/111) employed sensors (either in-device [67.6%, 75/111] or external [23.4%, 26/111]). RCTs were more likely to employ external sensors (accelerometers: P=.005). Studies that assessed engagement (52.3%, 58/111) mostly used device-generated logs (91%, 53/58) to measure the frequency, depth, and length of engagement. Studies that assessed acceptability (57.7%, 64/111) most often used questionnaires (64%, 42/64) and/or qualitative methods (53%, 34/64) to explore appreciation, perceived effectiveness and usefulness, satisfaction, intention to continue use, and social acceptability. Some studies (14.4%, 16/111) assessed dimensions more closely related to usability (ie, burden of sensor wear and use, interface complexity, and perceived technical performance). Conclusions: The rapid increase of research into the impact of physical activity apps and wearables means that evaluation guidelines are urgently needed to promote efficiency through the use of rapid research designs, in-device sensors and user-logs to assess effectiveness, engagement, and acceptability. Screening articles was time-consuming because reporting across health and computing sciences lacked standardization. Reporting guidelines are therefore needed to facilitate the synthesis of evidence across disciplines