Exploring the potential for technology-based nutrition education for low-income families in Alaska

Thesis (M.S.) University of Alaska Fairbanks, 2016This thesis addresses the need to identify more accessible and cost-effective ways for federal food assistance programs to deliver nutrition education to Alaska Native people living in rural and remote communities in Alaska. The ultimate aim is to explore whether technology-based nutrition education is a feasible and acceptable alternative to traditional face-to-face nutrition counseling. I begin this thesis by examining the preliminary efficacy and acceptability of an 11 week text message-based intervention to promote fruit and vegetable (F&V) intake among parents with young children (n=74) using a pre-post study design. Although there were no changes in pre-post measures, most participants reported positive changes in attitudes and behaviors related to F&V intake since participating in the intervention. Participants thought the intervention was credible (80.8%), found texts useful (71.6%), and would recommend the program to a friend (82.2%).The next chapter explores the feasibility of technology-based nutrition education in rural and remote areas of the state by estimating the use of media technology among Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participants (n=975) in Alaska Native communities using a self-administered, mailed questionnaire. The response rate was 37.7% (N=368). Respondents were primarily Alaska Native (99.1%) women (97.5%) between 18-29 years of age (56.6%). Smartphone (78.8%) and Facebook (80.3%) use were comparable to national averages, but having a computer at home (38.4%) was much less likely. Text messaging was common, with 93.3% of respondents reporting use at least once per week or more frequently. Potential barriers included slow internet (51.0%), no computer access (42.1%), and high cost of internet (35.1%). Nutrition education delivered via mobile devices is an ideal way to reach Alaska Native people in remote communities, provided that such programs limit the amount of cellular data necessary for participation. The findings from this thesis provide important evidence supporting the use of text messaging and other media technology in nutrition education efforts by WIC and other federal food assistance programs for Alaska Native people living in rural and remote communities. These findings will inform technology-based nutrition education efforts throughout Alaska.Chapter 1: Introduction -- Chapter 2: Txt4HappyKids: A text messaging pilot study to promote fruit and vegetable intake among families with young children -- Chapter 3: Exploring the potential for technology-based nutrition education among WIC recipients in remote Alaska Native villages -- Chapter 4: Conclusion

PROMOTING ENGAGEMENT IN DIGITAL WEIGHT LOSS INTERVENTIONS

Obesity has reached epidemic proportions in the United States. Digital weight loss interventions are effective for weight loss, and engagement in digital weight loss interventions, especially self-monitoring, is crucial for success. Given that engagement with self-monitoring consistently declines over time, the purpose of this dissertation was to understand effective patterns of engagement with self-monitoring, as well as whether and to what extent novel approaches for simplified self-monitoring enhance intervention engagement. Aim One used latent class growth modeling with another mixture layer to identify groups of participants based on trajectories of engagement with self-monitoring of weight, diet, and physical activity among overweight or obese adults participating in an effective 12-month digital weight loss intervention (N = 363). Four engagement patterns emerged: never-engagers, low/declining engagers, early engagers, and sustained-engagers. Predicted percent weight loss was clinically significant at 12 months for both sustained-engagers (10.4%) and early engagers (5.1%), but not for low/declining (1.3%) or never-engagers (0.48%). Aim Two was a 3-month randomized controlled pilot trial that compared the feasibility and efficacy of simplified dietary self-monitoring targeting Red Food reduction (i.e. limiting high-calorie, high-fat foods) to simplified dietary self-monitoring targeting Green Food promotion (i.e. maximizing fruits, vegetables, lean proteins, etc.) on engagement with dietary self-monitoring, self-reported weight change, and dietary intake at 3 months among overweight or obese young adults (N = 60). There were no between-group differences in engagement with dietary self-monitoring over 3 months. A greater proportion of participants in the Red Food group (23.1%) achieved a clinically meaningful 5% weight loss compared with the Green Food group (0%). Diet quality significantly increased for participants in both groups, and there were no between-group differences in change over time. Simplified dietary self-monitoring targeting Green Food promotion may improve diet quality, however, limiting Red Foods appears to be a more effective simplified dietary self-monitoring strategy for weight loss. By understanding effective patterns of multiple measures of engagement with self-monitoring over time, and exploring novel ways to promote greater engagement with dietary self-monitoring, this dissertation contributes to the body of research seeking to inform targeted efforts to promote sustained engagement with self-monitoring, which could improve the efficacy of digital weight loss interventions.Doctor of Philosoph

Recruitment Strategies and Lessons Learned from the Children's Healthy Living Program Prevalence Survey

The US Affiliated Pacific region's childhood obesity prevalence has reached epidemic proportions. To guide program and policy development, a multi-site study was initiated, in collaboration with partners from across the region, to gather comprehensive information on the regional childhood obesity prevalence. The environmental and cultural diversity of the region presented challenges to recruiting for and implementing a shared community-based, public health research program. This paper presents the strategies used to recruit families with young children (n = 5775 for children 2 - 8 years old) for obesity-related measurement across eleven jurisdictions in the US Affiliated Pacific Region. Data were generated by site teams that provided summaries of their recruitment strategies and lessons learned. Conducting this large multi-site prevalence study required considerable coordination, time and flexibility. In every location, local staff knowledgeable of the community was hired to lead recruitment, and participant compensation reflected jurisdictional appropriateness (e.g., gift cards, vouchers, or cash). Although recruitment approaches were site-specific, they were predominantly school-based or a combination of school- and community-based. Lessons learned included the importance of organization buy-in; communication, and advance planning; local travel and site peculiarities; and flexibility. Future monitoring of childhood obesity prevalence in the region should consider ways to integrate measurement activities into existing organizational infrastructures for sustainability and cost-effectiveness, while meeting programmatic (e.g. study) goals