A Feasibility and Efficacy Randomized Controlled Trial of an Online Preventative Program for Childhood Obesity: Protocol for the EMPOWER Intervention

Health Promotion & Education Program, University of Cincinnati, Cincinnati, OH, United States. .
JMIR research protocols 06/2012; 1(1):e5. DOI: 10.2196/resprot.2141
Source: PubMed


Background: The home and family environment is a highly influential psychosocial antecedent of pediatric obesity. Implementation of conventional family- and home-based childhood obesity interventions is challenging for parents, often requiring them to attend multiple educational sessions. Attrition rates for traditional interventions are frequently high due to competing demands for parents’ time. Under such constraints, an Internet-based intervention has the potential to modify determinants of childhood obesity while making judicious use of parents’ time. Theory-based interventions offer many advantages over atheoretical interventions, including reduced intervention dosage, increased likelihood of behavioral change, and efficient resource allocation. Social cognitive theory (SCT) is a robust theoretical framework for addressing childhood obesity. SCT is a behavior change model rooted in reciprocal determinism, a causal paradigm that states that human functioning is the product of a dynamic interplay of behavioral, personal, and environmental factors.
Objectives: To evaluate the efficacy of the Enabling Mothers to Prevent Childhood Obesity Through Web-Based Education and Reciprocal Determinism (EMPOWER) program, an Internet-based, theory-driven intervention for preventing childhood overweight and obesity. The project goal is supported by two specific aims: (1) modification of four obesogenic protective factors related to childhood obesity (minutes engaged in physical activity, servings of fruits and vegetables consumed, servings of sugar-sweetened and sugar-free beverages consumed, and minutes engaged in screen time), and (2) reification of five maternal-mediated constructs of SCT (environment, expectations, emotional coping, self-control, and self-efficacy).
Methods: We will recruit mothers with children ages 4 to 6 years from childcare centers and randomly assign them to either the theory-based (experimental) or knowledge-based (control) arm of the trial. Data for the intervention will be collected at three intervals: baseline (week 0), posttest (week 4), and follow-up (8 weeks). At each phase of data collection, we will collect from both groups (1) measures of the four obesogenic protective factors, and (2) summated SCT construct scores. Constructs will be measured by a psychometrically valid and reliable SCT-based instrument. Behaviors will be evaluated by a behavior log. We will use a repeated-measures one-between-, one-within-participants design to evaluate intervention results. Constructs will be modified through Web-based learning modules, online interactive worksheets, and mother–child home-based activities. Process evaluation will assess program fidelity.

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    • "Details of both interventions have been published (please see: Knowlden et al., 2015; Knowlden & Sharma, 2012a). Briefly, both interventions were newly designed programs developed by the research team to target the specific aims of the trial (Knowlden & Sharma, 2012a). Treatments for both interventions included five modules, with one module devoted to each child behavior. "
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    ABSTRACT: The purpose of this study was to evaluate the efficacy of the Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism (EMPOWER) intervention at 1-year, postintervention follow-up. A mixed between-within subjects design was used to evaluate the trial. Independent variables included a two-level, group assignment: EMPOWER (experimental intervention) based on social cognitive theory (SCT) as well as a knowledge-based intervention Healthy Lifestyles (active control intervention). Dependent variables were evaluated across four levels of time: baseline (Week 0), posttest (Week 4), 1-month follow-up (Week 8), and 1-year follow-up (Week 60). Dependent variables included five maternal-facilitated SCT constructs (environment, emotional coping, expectations, self-control, and self-efficacy) as well as four child behaviors (minutes of child physical activity, cups of fruits and vegetables consumed, 8-ounce glasses of sugar-sweetened beverages consumed, and minutes of screen time). Null hypotheses implied no significant group-by-time interactions for the dependent variables under investigation. A significant group-by-time interaction for child fruit and vegetable consumption was found in the experimental group (p = .012) relative to the control group. At 1 year, results suggested an overall increase of 1.847 cups of fruits and vegetables (95% confidence interval = 1.207-2.498) in the experimental group (p < .001). Analysis suggested changes in the maternal-facilitated home environment accounted for 13.3% of the variance in the change in child fruit and vegetable consumption. Improvements in child physical activity, sugar-free beverage intake, and screen time first detected at 1-month follow-up in both groups were no longer significant at 1-year follow-up. An online family-and-home-based intervention was efficacious for improving child fruit and vegetable consumption. Follow-up booster sessions may assist in maintaining treatment effects. © 2015 Society for Public Health Education.
    Full-text · Article · Aug 2015 · Health Education & Behavior
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    • "However, implementation of conventional family-and home-based childhood obesity interventions is challenging for parents, often requiring them to attend multiple educational sessions. Attrition rates for traditional interventions are frequently high, namely 30% to 50%, due to competing demands for parents' time (Knowlden and Sharma, 2012). For example, in Switzerland, less than one percent of overweight children can participate in those programs due to limited personal and financial resources (Hänggli et al., 2008). "
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    ABSTRACT: The globally increasing prevalence of childhood obesity is one of the most serious public health challenges of the twenty-first century. Du to the need for multi-professional therapies that require a high amount of personnel and financial resources, IT-supported interventions promise help. So far, meta-studies show their limited impact on health outcomes. This work presents therefore a design theory that helps constructing health information systems (HIS) that positively impact the performance of obesity expert and children teams. Team performance is measured through self-reports, patients´ adherence to therapy and positive health outcomes. In order to assess the utility of the proposed design theory, its underlying design process was adopted by an interdisciplinary team of therapists, patients, their parents, IS researcher and computer scientists. This team developed and evaluated several HIS services collaboratively over the course of two years. Results of this design process show first evidence of the utility of the HIS design theory. However, challenges with regard to the design process still exist and are discussed.
    Full-text · Conference Paper · Jun 2014
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    ABSTRACT: Family-and-home-based interventions are an important vehicle for preventing childhood obesity. Systematic process evaluations have not been routinely conducted in assessment of these interventions. The purpose of this study was to plan and conduct a process evaluation of the Enabling Mothers to Prevent Pediatric Obesity Through Web-Based Learning and Reciprocal Determinism (EMPOWER) randomized control trial. The trial was composed of two web-based, mother-centered interventions for prevention of obesity in children between 4 and 6 years of age. Process evaluation used the components of program fidelity, dose delivered, dose received, context, reach, and recruitment. Categorical process evaluation data (program fidelity, dose delivered, dose exposure, and context) were assessed using Program Implementation Index (PII) values. Continuous process evaluation variables (dose satisfaction and recruitment) were assessed using ANOVA tests to evaluate mean differences between groups (experimental and control) and sessions (sessions 1 through 5). Process evaluation results found that both groups (experimental and control) were equivalent, and interventions were administered as planned. Analysis of web-based intervention process objectives requires tailoring of process evaluation models for online delivery. Dissemination of process evaluation results can advance best practices for implementing effective online health promotion programs.
    Full-text · Article · Mar 2014 · Health Promotion Practice