What practices do parents perceive as effective or ineffective in promoting a healthy diet, physical activity, and less sitting in children : parent focus groups

Background: To support parents in improving the health of their young children, examples of effective parenting practices for a healthy diet, physical activity (PA) and sedentary behavior (SB) are needed. This study explores perceived effective and ineffective parenting practices in difficult situations concerning raising healthy children and investigates their relationship with Self-Determination Theory (SDT) and Social Cognitive Theory (SCT). The current study is formative work to inform the content of a randomized controlled trial. Methods: Four focus groups were conducted between June and October 2012 at worksites during lunch break. A total of 21 unrelated parents of primary schoolchildren (6 fathers, 15 mothers) participated. A short written questionnaire introduced typical difficult situations derived from parental anecdotal reports, concerning healthy diet, PA and SB. These situations formed the backbone for the subsequent focus group discussion. In October 2012, discussions were audio-recorded and analyzed in Nvivo to identify key response items using thematic analysis. Results: Parents experienced explaining why the child should behave healthily, monitoring, being consistent, offering alternatives, reacting empathetically, modeling, motivating, increasing intrinsic value and availability, and using time-out as effective practices, whereas anger was considered ineffective. Opinions were mixed about the effectiveness of giving as much freedom as possible, obliging, rewarding and punishing, and setting rules and agreements. Parenting practices were consistent with principles from both SDT and SCT. Conclusions: Parents identified numerous perceived effective practices to respond to their child's health-related behavior. Since many of them coincide with the evidence base and the success of a parenting program depends upon the degree to which parents' concerns and motivations are integrated into the program design, important opportunities are created for future intervention programs

A self-regulation-based eHealth intervention to promote a healthy lifestyle : investigating user and website characteristics related to attrition

Background: EHealth interventions can reach large populations and are effective in increasing physical activity (PA) and fruit and vegetable intake. Nevertheless, the effects of eHealth interventions are overshadowed by high attrition rates. Examining more closely when users decide to leave the intervention can help eHealth developers to make informed decisions about which intervention components should be reshaped or simply removed. Investigating which users are more likely to quit an intervention can inform developers about whether and how their intervention should be adapted to specific subgroups of users. Objective: This study investigates the pattern of attrition in a web-based intervention to increase PA, fruit and vegetable intake. The first aim is to describe attrition rates according to different self-regulation components. A second aim is to investigate if certain user characteristics are predictors for start session completion, returning to a follow-up session and intervention completion. Methods: The sample consisted of 549 adults who participated in an online intervention, based on self-regulation theory, to promote PA and fruit and vegetable intake, called ‘MyPlan 1.0’. Using descriptive analysis, attrition was explored per self-regulation component (e.g. action planning, coping planning, …). To identify which user characteristics predict completion, logistic regression analyses were conducted. Results: At the end of the intervention programme, there was an attrition rate of 78.2%. Attrition rates were very similar for the different self-regulation components. However, attrition levels were higher for the fulfilment of questionnaires (e.g. to generate tailored feedback) than for the more interactive components. The highest amount of attrition could be observed when people were asked to make their own action plan. There were no significant predictors for first session completion. Yet, two subgroups had a lower chance to complete the intervention, namely male users (OR: 2.24, 95% CI= 1.23-4.08) and younger adults (OR: 1.02, 95% CI= 1.00-1.04). Furthermore, younger adults were less likely to return to the website for the first follow-up after one week (OR= 1.03, 95% CI= 1.01-1.04). Conclusions: This study informs us that eHealth interventions should avoid the use of long questionnaires and that users should be provided with a rationale for several components (e.g. making an action plan, completing questions, …). Furthermore, future interventions should focus first on motivating users for the behaviour change, before guiding them through action planning. Though, this study provides no evidence for removal of one of the self-regulation techniques based on attrition rates. Lastly, strong efforts are needed to motivate male users and younger adults to complete eHealth interventions

Is participatory design associated with the effectiveness of serious digital games for healthy lifestyle promotion? : a meta-analysis

Background: Serious digital games can be effective at changing healthy lifestyles, but large differences in their effectiveness exist. The extent of user involvement in game design may contribute to game effectiveness by creating a better fit with user preferences. Participatory design (PD), which represents active user involvement as informant (ie, users are asked for input and feedback) or codesigner (ie, users as equal partners in the design) early on and throughout the game development, may be associated with higher game effectiveness, as opposed to no user involvement or limited user involvement. Objective: This paper reports the results of a meta-analysis examining the moderating role of PD in the effectiveness of serious digital games for healthy lifestyle promotion. Methods: Four databases were searched for peer-reviewed papers in English that were published or in press before October 2014, using a (group-) randomized controlled trial design. Effectiveness data were derived from another meta-analysis assessing the role of behavior change techniques and game features in serious game effectiveness. Results: A total of 58 games evaluated in 61 studies were included. As previously reported, serious digital games had positive effects on healthy lifestyles and their determinants. Unexpectedly, PD (g=0.075, 95% CI 0.017 to 0.133) throughout game development was related to lower game effectiveness on behavior (Q=6.74, P<.05) than when users were only involved as testers (g=0.520, 95% CI 0.150 to 0.890, P<.01). Games developed with PD (g=0.171, 95% CI 0.061 to 0.281, P<.01) were also related to lower game effectiveness on self-efficacy (Q=7.83, P<.05) than when users were not involved in game design (g=0.384, 95% CI 0.283 to 0.485, P<.001). Some differences were noted depending on age group, publication year of the study, and on the specific role in PD (ie, informant or codesigner), and depending on the game design element. Games developed with PD were more effective in changing behavioral determinants when they included users in design elements on game dynamics (beta=.215, 95% CI .075 to .356, P<.01) and, more specifically, as an informant (beta=.235, 95% CI .079 to .329, P<.01). Involving users as informants in PD to create game levels was also related to higher game effectiveness (Q=7.02, P<.01). Codesign was related to higher effectiveness when used to create the game challenge (Q=11.23, P<.01), but to lower game effectiveness when used to create characters (Q=4.36, P<.05) and the game world (Q=3.99, P<.05). Conclusions: The findings do not support higher effectiveness of games developed with PD. However, significant differences existed among PD games. More support was found for informant roles than for codesign roles. When PD was applied to game dynamics, levels, and game challenge, this was associated with higher effectiveness than when it was applied to game aesthetics. Since user involvement may have an important influence on reach, adoption, and implementation of the intervention, further research and design efforts are needed to enhance effectiveness of serious games developed with PD

What do general practitioners think about an online self-regulation programme for health promotion?: focus group interviews

Background: Chronic diseases may be prevented through programmes that promote physical activity and healthy nutrition. Computer-tailoring programmes are effective in changing behaviour in the short- and long-term. An important issue is the implementation of these programmes in general practice. However, there are several barriers that hinder the adoption of eHealth programmes in general practice. This study explored the feasibility of an eHealth programme that was designed, using self-regulation principles. Methods: Seven focus group interviews (a total of 62 GPs) were organized to explore GPs¿ opinions about the feasibility of the eHealth programme for prevention in general practice. At the beginning of each focus group, GPs were informed about the principles of the self-regulation programme `My Plan¿. Open-ended questions were used to assess the opinion of GPs about the content and the use of the programme. The focus groups discussions were audio-taped, transcribed and thematically analysed via NVivo software. Results: The majority of the GPs was positive about the use of self-regulation strategies and about the use of computer-tailored programmes in general practice. There were contradictory results about the delivery mode of the programme. GPs also indicated that the programme might be less suited for patients with a low educational level or for old patients. Conclusions: Overall, GPs are positive about the adoption of self-regulation techniques for health promotion in their practice. However, they raised doubts about the adoption in general practice. This barrier may be addressed (1) by offering various ways to deliver the programme, and (2) by allowing flexibility to match different work flow systems. GPs also believed that the acceptability and usability of the programmes was low for patients who are old or with low education. The issues raised by GPs will need to be taken into account when developing and implementing an eHealth programme in general practice

Experiences and opinions of adults with type 2 diabetes regarding a self-regulation-based eHealth intervention targeting physical activity and sedentary behaviour

Background: Online interventions targeting a healthy lifestyle in adults with type 2 diabetes are more effective when informed by behaviour change theories. Although these theories provide guidance in developing the content of an intervention, information regarding how to present this content in an engaging way is often lacking. Consequently, incorporating users&rsquo; views in the creation of eHealth interventions has become an important target. Methods: Via a qualitative interview study with 21 adults with type 2 diabetes who had completed an online self-regulation-based intervention (&lsquo;MyPlan 2.0&rsquo;), we assessed participants&rsquo; opinions regarding the usefulness of the implemented self-regulation techniques, the design of the programme as well as their knowledge regarding physical activity and sedentary behaviour. A directed content analysis was performed to synthesize the interview data. Results: Participants experienced difficulties completing the coping planning component. The simple design of the website was considered helpful, and most participants were aware of the beneficial effects of an active lifestyle. Conclusions: &lsquo;MyPlan 2.0&rsquo; was well-accepted by the majority of participants. However, the coping planning component will need to be adapted. Based on these findings, recommendations on how to tailor eHealth interventions to the population of adults with type 2 diabetes have been formulated

Do specific parenting practices and related parental self-efficacy associate with physical activity and screen time among primary schoolchildren?: a cross-sectional study in Belgium

Objectives: To assess the association between specific parenting practices and related parental self-efficacy with children's physical activity (PA) and screen time. Parental body mass index (BMI), family socioeconomic status (SES), and child's age and gender were examined as possible influencing factors. Design: Cross-sectional. Setting: January 2014, Flanders (Belgium). Participants: 207 parents (87.4% mothers) of children aged 6-12 years. Outcome measures: Specific parenting practices, related parental self-efficacy, and children's PA and screen time. Results: The majority of investigated parenting practices and related parental self-efficacy were not significantly associated with children's PA or screen time. However, children were more physically active if sports equipment was available at home (p<0.10) and if parents did not find it difficult to motivate their child to be physically active (p<0.05). Children had a lower screen time if parents limited their own gaming (p<0.01). The associations between parenting practices and related parental self-efficacy with children's PA or screen time were significant for parents with a normal BMI, for medium-high SES families and for parents of younger children. Furthermore, the association between the parenting relating factors and children's PA and screen time differed for boys and girls. Conclusions: In contrast to what we expected, the findings of the current study show that only a very few specific parenting practices and related parental self-efficacy were associated with children's PA and screen time. It was expected that parental self-efficacy would play a more important role. This can be due to the fact that parental self-efficacy was already high in this group of parents. Therefore, it is possible that parents do not realise how difficult it is to perform certain parenting practices until they are faced with it in an intervention

The effect of an online video intervention ‘Movie Models’ on specific parenting practices and parental self-efficacy related to children’s physical activity, screen-time and healthy diet : a quasi experimental study

Background: In children, being sufficiently physically active, having low levels of screen-time and having a healthy diet are largely influenced by parenting practices. Children of parents applying positive parenting practices are at lower risk for overweight and obesity. Therefore, we investigated the effect of a health promoting online video intervention for parents ('Movie Models') on children's physical activity (PA), screen-time and healthy diet, and on specific parenting practices and parental self-efficacy related to these parenting practices. The online videos are delivered to parents of primary schoolchildren, and were based on real-life scenarios. Methods: A two-armed, quasi experimental design was used. Parents of primary schoolchildren were recruited between November and December 2013 by spreading an appeal in social media, and by contacting primary schools. Participating parents were predominantly of high socio-economic status (SES) (83.1%), and only 6.8% of children were overweight/obese. Intervention group participants were invited to watch online videos for 4 weeks. Specific parenting practices, parental self-efficacy, PA, screen-time and healthy diet of the child were assessed at baseline (T0), at one (T1) and at four (T2) months post baseline. Repeated Measures (Multivariate) ANOVAs were used to examine intervention effects. The potential moderating effect of age and gender of the child and parental SES was also examined. Results: Between T0 and T2, no significant intervention effects were found on children's PA, screen-time or healthy diet. Most significant intervention effects were found for more complex parenting practices (e.g., an increase in motivating the child to eat fruit). Subgroup analyses showed that the intervention had more effect on the actual parenting practices related to PA, screen-time and healthy diet in parents of older children (10-12 years old), whereas intervention effects on parental self-efficacy related to those behaviors were stronger in parents of younger children (6-9 years old). Conclusions: ('Movie Models') was effective in increasing some important parenting practices and parental self-efficacy related to PA, screen-time and healthy diet in children. Therefore, the current study is an important first step in promoting effective parenting-related factors, and possibly increasing children's healthy diet and PA, and decreasing screen-time

A self-regulation eHealth intervention to increase healthy Behavior through general practice : protocol and systematic development

Background: Chronic diseases are the principal cause of morbidity and mortality worldwide. An increased consumption of vegetables and fruit reduces the risk of hypertension, coronary heart disease, stroke, and cancer. An increased fruit and vegetable (FV) intake may also prevent body weight gain, and therefore indirectly affect type 2 diabetes mellitus. Insufficient physical activity (PA) has been identified as the fourth leading risk factor for global mortality. Consequently, effective interventions that promote PA and FV intake in a large number of people are required. Objective: To describe the systematic development of an eHealth intervention, MyPlan 1.0, for increasing FV intake and PA. Methods: The intervention was developed following the six steps of the intervention mapping (IM) protocol. Decisions during steps were based upon available literature, focus group interviews, and pilot studies. Results: Based on needs assessment (Step 1), it was decided to focus on fruit and vegetable intake and physical activity levels of adults. Based on self-regulation and the health action process approach model, motivational (eg, risk awareness) and volitional (eg, action planning) determinants were selected and crossed with performance objectives into a matrix with change objectives (Step 2). Behavioral change strategies (eg, goal setting, problem solving, and implementation intentions) were selected (Step 3). Tablet computers were chosen for delivery of the eHealth program in general practice (Step 4). To facilitate implementation of the intervention in general practice, GPs were involved in focus group interviews (Step 5). Finally, the planning of the evaluation of the intervention (Step 6) is briefly described. Conclusions: Using the IM protocol ensures that a theory-and evidence-based intervention protocol is developed. If the intervention is found to be effective, a dynamic eHealth program for the promotion of healthy lifestyles could be available for use in general practice

Ontwikkeling en evaluatie van een self-management eHealth interventie in de eerste lijn

Het hoofddoel van het project is de ontwikkeling, evaluatie en implementatie van een interventie die de kwaliteit en kwantiteit van primaire preventie binnen de eerste lijn kan verbeteren. Hiervoor werd de interventie ‘Mijn Actieplan’ ontwikkeld. ‘Mijn Actieplan’ is een online eHealth interventie die gebaseerd is op de zelfregulatie theorie om fruit- en groente inname en fysieke activiteit te verhogen bij volwassenen. Door op deze gedragingen te richten, wordt een gezonde levensstijl bij volwassenen gepromoot. Om ‘Mijn Actieplan’ op een evidence-based manier te ontwikkelen en te implementeren in huisartsenpraktijken, werd gebruik gemaakt van het Intervention Mapping Protocol (IMP) als planningsmodel voor de interventie. De zes stappen in het IMP zijn: needs assessment (stap 1), het maken van matrices met veranderingsdoelen (stap 2), de selectie van interventiemethoden en praktische strategieën (stap 3), de ontwikkeling van de interventie (stap 4), het plannen van adoptie, implementatie en behoud (stap 5) en de ontwikkeling van een evaluatiedesign (stap 6). In het rapport worden de genomen theoretische overwegingen en beslissingen binnen de ontwikkeling van ‘Mijn Actieplan’, gemaakt doorheen de verschillende stappen van het IMP, toegelicht. Verder worden de resultaten van de effect- en procesevaluatie van ‘Mijn Actieplan’ besproken. Uit de evaluatie van ‘Mijn Actieplan’ is gebleken dat het programma effectief is in het verhogen van de fruit- en groente-inname en fysieke activiteit van volwassenen. Enkel voor zwaar intensieve fysieke activiteit werd geen effect gevonden. De effect-evaluatie gaf ook aan dat de actieve betrokkenheid van de huisarts niet noodzakelijk was om tot effecten te leiden, en een actieve betrokkenheid van de huisarts ook geen grotere effecten gaf. Gezien ‘Mijn Actieplan’ effectief is in het veranderen van fruitinname, groente-inname en fysieke activiteit, zonder dat de actieve betrokkenheid van de huisarts noodzakelijk is, kan deze interventie in de toekomst dus ook verder verspreid worden via verschillende andere kanalen en settings. Een belangrijk aandachtspunt in zowel de pre-test studie als de evaluatie studie van ‘Mijn Actieplan’ binnen Vlaamse huisartspraktijken, is de hoge drop-out van deelnemers gedurende de interventie. Uit de procesevaluatie bleek dat het moeilijk was huisartsen actief te betrekken bij het implementeren van het programma waardoor de deelnemers niet extra gemotiveerd werden door de huisarts voor verdere deelname. Deelnemende patiënten gaven bij de procesevaluatie ook aan dat een belangrijke reden om te stoppen met het programma een gebrek aan tijd was. Uit de procesevaluatie is ook gebleken dat het programma ‘Mijn Actieplan’ mogelijks in een gewijzigde vorm beter geschikt zou zijn voor verdere implementatie in de dagelijkse routine van de huisartspraktijk. Suggesties uit dit onderzoek om ‘Mijn Actieplan’ verder te verspreiden binnen huisartspraktijken zijn: extra personeel opleiden om de adviezen en actieplannen te bespreken met patiënten, de ontwikkeling van een meer compacte app, de integratie van de eHealth interventie in bestaande medische programma’s (bv. via Vitalink) en/of om ‘Mijn Actieplan’ te combineren met het bestaande GMD+. Tenslotte lijken het ‘belonen’ van huisartsen en het veranderen van attitudes van huisartsen voor louter preventieve consultaties belangrijke aandachtspunten