A mixed methods study to explore the effects of program design elements and participant characteristics on parents' engagement with an mHealth program to promote healthy infant feeding: The growing healthy program

Copyright © 2019 Taki, Russell, Lymer, Laws, Campbell, Appleton, Ong and Denney-Wilson. Purpose: Mobile health (mHealth) interventions have great potential to promote health. To increase consumer engagement in mHealth interventions it is necessary to address factors that influence the target demographic. The Growing healthy (GH) program is the first obesity prevention program delivered via a smartphone app and website offering evidence-based information on infant feeding from birth until 9 months of age. This sub-study aimed to explore how the design features, quality of the app and participant characteristics influenced parents' engagement with the GH app. Methods: A sequential mixed methods design was used. The GH app participants (225/301) were considered for this sub-study. Participant app engagement was measured through a purpose-built Engagement Index (EI) using app metrics. Participants were categorized as low, moderately or highly engaged based on their EI score upon completing the 9 months program and were then invited to participate in semi-structured telephone interviews. Participants who used the app program, given an EI score and expressed interest to participate in these interviews were eligible. The interviews explored factors that influenced app engagement including delivery features and quality. Thematic analysis networks was used for analysis. Results: 108/225 expressed interest and 18 interviews were conducted from low (n = 3), moderately (n = 7), or highly (n = 8) engaged participants based on purposeful sampling. Participants defined as highly engaged were likely to be a first-time parent, felt the app content to be trustworthy and the app design facilitated easy navigation and regularly opened the push notifications. Participants defined as having low or moderate engagement were likely to have experience from previous children, felt they had sufficient knowledge on infant feeding and the app did not provide further information, or experienced technological issues including app dysfunction due to system upgrades. Conclusions/Implications: This study demonstrated a novel approach to comprehensively analyse engagement in an mHealth intervention through quantitative (Engagement Index) and qualitative (interviews) methods. It provides an insight on maximizing data collected from these programs for measuring effectiveness and to understand users of various engagement levels interaction with program features. Measuring this can determine efficacy and refine programs to meet user requirements

Obesity prevention in infants using m-Health: the Growing Healthy program

About one quarter of Australian pre-school children are overweight. Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services including nurses in community health services and general practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. This is referred to as mobile or m-health. The Growing Healthy study aimed to explore the feasibility of providing information and support for healthy parenting through electronic media in the form of an application for smart phones (app) and a website. Our background research suggested this as an emerging and promising area for engagement with families with young children and may provide a referral option for primary health care providers. It is also an intervention with a relatively low cost and potential for high reach. As families with young children have high levels of engagement with PHC services, these could be leveraged to recruit study participants via referral to the app. Complementing and not replacing the information and support provided by these existing primary health care services was an important objective as was ensuring the online information and support aligned with that provided by primary health care services and national guidelines. The aim was to make the app a ‘trusted source’ of information and support for families with children from birth to nine months of age.The research reported in this paper is a project of the Australian Primary Health Care Research Institute which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research Evaluation and Development Strategy

Resolving the fine-scale velocity structure of continental hyperextension at the Deep Galicia Margin using full-waveform inversion

Continental hyperextension during magma-poor rifting at the Deep Galicia Margin is characterised by a complex pattern of faulting, thin continental fault blocks, and the serpentinisation, with local exhumation, of mantle peridotites along the S-reflector, interpreted as a detachment surface. In order to understand fully the evolution of these features, it is important to image seismically the structure and to model the velocity structure to the greatest resolution possible. Travel-time tomography models have revealed the long-wavelength velocity structure of this hyperextended domain, but are often insufficient to match accurately the short-wavelength structure observed in reflection seismic imaging. Here we demonstrate the application of two-dimensional (2D) time-domain acoustic full-waveform inversion to deep water seismic data collected at the Deep Galicia Margin, in order to attain a high resolution velocity model of continental hyperextension. We have used several quality assurance procedures to assess the velocity model, including comparison of the observed and modelled waveforms, checkerboard tests, testing of parameter and inversion strategy, and comparison with the migrated reflection image. Our final model exhibits an increase in the resolution of subsurface velocities, with particular improvement observed in the westernmost continental fault blocks, with a clear rotation of the velocity field to match steeply dipping reflectors. Across the S-reflector there is a sharpening in the velocity contrast, with lower velocities beneath S indicative of preferential mantle serpentinisation. This study supports the hypothesis that normal faulting acts to hydrate the upper mantle peridotite, observed as a systematic decrease in seismic velocities, consistent with increased serpentinisation. Our results confirm the feasibility of applying the full-waveform inversion method to sparse, deep water crustal datasets

Preventing obesity in infants: the growing healthy feasibility trial protocol

INTRODUCTION: Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services. METHODS: This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself. ETHICS AND DISSEMINATION: This study received approval from the University of Technology Sydney Ethics committee and will be disseminated via peer-reviewed publications and conference presentations

Resolving the fine-scale velocity structure of continental hyperextension at the Deep Galicia Margin using full-waveform inversion

Continental hyperextension during magma-poor rifting at the Deep Galicia Margin is characterized by a complex pattern of faulting, thin continental fault blocks and the serpentinization, with local exhumation, of mantle peridotites along the S-reflector, interpreted as a detachment surface. In order to understand fully the evolution of these features, it is important to image seismically the structure and to model the velocity structure to the greatest resolution possible. Traveltime tomography models have revealed the long-wavelength velocity structure of this hyperextended domain, but are often insufficient to match accurately the short-wavelength structure observed in reflection seismic imaging. Here, we demonstrate the application of 2-D time-domain acoustic full-waveform inversion (FWI) to deep-water seismic data collected at the Deep Galicia Margin, in order to attain a high-resolution velocity model of continental hyperextension. We have used several quality assurance procedures to assess the velocity model, including comparison of the observed and modeled waveforms, checkerboard tests, testing of parameter and inversion strategy and comparison with the migrated reflection image. Our final model exhibits an increase in the resolution of subsurface velocities, with particular improvement observed in the westernmost continental fault blocks, with a clear rotation of the velocity field to match steeply dipping reflectors. Across the S-reflector, there is a sharpening in the velocity contrast, with lower velocities beneath S indicative of preferential mantle serpentinization. This study supports the hypothesis that normal faulting acts to hydrate the upper-mantle peridotite, observed as a systematic decrease in seismic velocities, consistent with increased serpentinization. Our results confirm the feasibility of applying the FWI method to sparse, deep-water crustal data sets

Key lessons and impact of the growing healthy mHealth program on milk feeding, timing of introduction of solids, and infant growth: quasi-experimental study

BACKGROUND: The first year of life is an important window to initiate healthy infant feeding practices to promote healthy growth. Interventions delivered by mobile phone (mHealth) provide a novel approach for reaching parents; however, little is known about the effectiveness of mHealth for child obesity prevention. OBJECTIVE: The objective of this study was to determine the feasibility and effectiveness of an mHealth obesity prevention intervention in terms of reach, acceptability, and impact on key infant feeding outcomes. METHODS: A quasi-experimental study was conducted with an mHealth intervention group (Growing healthy) and a nonrandomized comparison group (Baby\u27s First Food). The intervention group received access to a free app and website containing information on infant feeding, sleep and settling, and general support for parents with infants aged 0 to 9 months. App-generated notifications directed parents to age-and feeding-specific content within the app. Both groups completed Web-based surveys when infants were less than 3 months old (T1), at 6 months of age (T2), and 9 months of age (T3). Survival analysis was used to examine the duration of any breastfeeding and formula introduction, and cox proportional hazard regression was performed to examine the hazard ratio for ceasing breast feeding between the two groups. Multivariate logistic regression with adjustment for a range of child and parental factors was used to compare the exclusive breastfeeding, formula feeding behaviors, and timing of solid introduction between the 2 groups. Mixed effect polynomial regression models were performed to examine the group differences in growth trajectory from birth to T3. RESULTS: A total of 909 parents initiated the enrollment process, and a final sample of 645 parents (Growing healthy=301, Baby\u27s First Food=344) met the eligibility criteria. Most mothers were Australian born and just under half had completed a university education. Retention of participants was high (80.3%, 518/645) in both groups. Most parents (226/260, 86.9%) downloaded and used the app; however, usage declined over time. There was a high level of satisfaction with the program, with 86.1% (143/166) reporting that they trusted the information in the app and 84.6% (170/201) claiming that they would recommend it to a friend. However, some technical problems were encountered with just over a quarter of parents reporting that the app failed to work at times. There were no significant differences between groups in any of the target behaviors. Growth trajectories also did not differ between the 2 groups. CONCLUSIONS: An mHealth intervention using a smartphone app to promote healthy infant feeding behaviors is a feasible and acceptable mode for delivering obesity prevention intervention to parents; however, app usage declined over time. Learnings from this study will be used to further enhance the program so as to improve its potential for changing infant feeding behaviors

Preventing obesity in infants: the Growing healthy feasibility trial protocol

Early childhood is an important period for establishing behaviours that will affect weight gain and health across the life course. Early feeding choices, including breast and/or formula, timing of introduction of solids, physical activity and electronic media use among infants and young children are considered likely determinants of childhood obesity. Parents play a primary role in shaping these behaviours through parental modelling, feeding styles, and the food and physical activity environments provided. Children from low socio-economic backgrounds have higher rates of obesity, making early intervention particularly important. However, such families are often more difficult to reach and may be less likely to participate in traditional programs that support healthy behaviours. Parents across all socio-demographic groups frequently access primary health care (PHC) services, including nurses in community health services and general medical practices, providing unparalleled opportunity for engagement to influence family behaviours. One emerging and promising area that might maximise engagement at a low cost is the provision of support for healthy parenting through electronic media such as the Internet or smart phones. The Growing healthy study explores the feasibility of delivering such support via primary health care services.This paper describes the Growing healthy study, a non-randomised quasi experimental study examining the feasibility of an intervention delivered via a smartphone app (or website) for parents living in socioeconomically disadvantaged areas, for promoting infant feeding and parenting behaviours that promote healthy rather than excessive weight gain. Participants will be recruited via their primary health care practitioner and followed until their infant is 9 months old. Data will be collected via web-based questionnaires and the data collected inherently by the app itself.This study received approval from the University of Technology Sydney Ethics committee and will be disseminated via peer-reviewed publications and conference presentations.Elizabeth Denney-Wilson, Rachel Laws, Catherine Georgina Russell, Kok-leong Ong, Sarah Taki, Roz Elliot, Leva Azadi, Sharyn Lymer, Rachael Taylor, John Lynch, David Crawford, Kylie Ball, Deborah Askew, Eloise Kate Litterbach, Karen J Campbel

IODP workshop: Core-Log Seismic Investigation at Sea – Integrating legacy data to address outstanding research questions in the Nankai Trough Seismogenic Zone Experiment

The first International Ocean Discovery Program (IODP) Core-Log-Seismic Integration at Sea (CLSI@Sea) workshop, held in January–February 2018, brought together an international, multidisciplinary team of 14 early-career scientists and a group of scientific mentors specialized in subduction zone processes at the Nankai Trough, one of the Earth's most active plate-subduction zones located off the southwestern coast of Japan. The goal of the workshop was to leverage existing core, log, and seismic data previously acquired during the IODP's Nankai Trough Seismogenic Zone Experiment (NanTroSEIZE), to address the role of the deformation front of the Nankai accretionary prism in tsunamigenic earthquakes and slow slip in the shallow portion of the subduction interface. The CLSI@Sea workshop was organized onboard the D/V Chikyu concurrently with IODP Expedition 380, allowing workshop participants to interact with expedition scientists installing a long-term borehole monitoring system (LTBMS) at a site where the workshop's research was focused. Sedimentary cores from across the deformation front were brought onboard Chikyu, where they were made available for new description, sampling, and analysis. Logging data, drilling parameters, and seismic data were also available for investigation by workshop participants, who were granted access to Chikyu laboratory facilities and software to perform analyses at sea.Multi-thematic presentations facilitated knowledge transfer between the participants across field areas, and highlighted the value of multi-disciplinary collaboration that integrates processes across different spatiotemporal scales. The workshop resulted in the synthesis of existing geophysical, geologic, and geochemical data spanning IODP Sites C0006, C0007, C0011 and C0012 in the NanTroSEIZE area, the identification of key outstanding research questions in the field of shallow subduction zone seismogenesis, and fostered collaborative and individual research plans integrating new data analysis techniques and multidisciplinary approaches.</p