Performing Department
Nutritional Sciences
Non Technical Summary
As childhood obesity rates remain high in the United States, novel prevention strategies are needed in early life especially for low-income, ethnic minority children at higher risk for obesity. Parents, primary decision makers for young children ages 0 to 5 years old, are a key target for early childhood obesity prevention. Understanding the best method and channel to communicate information to parents of young children about behaviors to prevent childhood obesity is important but not well researched. The use of various types of approaches such as messaging and use of technology including text messaging, video vignettes and social media to engage parents in community nutrition programs to prevent childhood obesity may serve as an innovative approach for program efficacy and retention. Therefore, the objectives of this project are to: 1) Conduct formative research with parents of children ages 0 to 5 years old to determine needed topics and delivery methods of childhood obesity prevention information; 2) Determine differences in preferred topics and delivery methods of childhood obesity prevention information by parental age, gender, education, and race/ethnicity; 3) Develop childhood obesity prevention outreach messages, materials, methods and strategies for parents of children ages 0 to 5 years old; and 4) Evaluate the feasibility, acceptability, and impact of new materials, strategies and methods targeting parents for the prevention of early childhood obesity. The findings of this research will provide timely insight into future guidance for parental outreach related to early childhood obesity prevention.
Animal Health Component
0%
Research Effort Categories
Basic
0%
Applied
100%
Developmental
0%
Goals / Objectives
Our long term goal is to reduce the risk of obesity in higher-risk families through early childhood obesity prevention efforts. The specific objective of this proposal is to evaluate the impact of new nutrition communication resources and strategies to prevent early childhood obesity for families with children ages 0 to 5 years old. The rationale for the proposed research is that once it is known what nutrition communication resources, strategies and methods to deliver the information are needed, new behaviorally based resources and messages can then be developed, implemented and evaluated for impact on nutrition behavior, parenting parameters and health outcomes to decrease the risk of childhood obesity. We will pursue this applied research in four specific aims:Conduct formative research with parents of children ages 0 to 5 years old to determine needed topics and delivery methods of childhood obesity prevention information.Determine differences in associated risk factors for childhood obesity and preferred topics and delivery methods of childhood obesity prevention information by parental age, gender, education, and race/ethnicity.Develop childhood obesity prevention outreach messages, materials, methods and strategies for parents of children ages 0 to 5 years old.Evaluate the feasibility, acceptability, and impact of new materials, strategies and methods targeting parents for the prevention of early childhood obesity.
Project Methods
Aim 1 methods: Potential participants will be recruited from EFNEP, preschools such as Head Start, the WIC program, community fatherhood initiative programs, health clinics, OBGYN offices and other community programs serving low-income families. Low-income is defined by eligibility for certain federal food assistance (e.g. SNAP, WIC) or income assistance (e.g. TANF) programs. Informed consent will be obtained before data collection. A mixed methods research design will be planned.For qualitative data collection, approximately 3-4 focus groups with a minimum number of participants (n=6-8) and/or one-on-one interviews (n=30) will be conducted with parents of children ages 0 to 5 years old to determine current nutrition practices, barriers to implementing key obesity prevention behaviors, nutrition communication resource gaps and best methods to disseminate nutrition information. Some focus groups will be conducted with men and women or parents with children of different ages within the 0 to 5 year span separately to better elicit differing opinions and needs. Focus groups and/or interviews will be conducted at the corresponding community site and will be audio-taped. Participants will receive a small incentive for their time.A questionnaire or focus group script will be developed to elicit responses grounded in a theoretical framework such as the Social Cognitive Theory. The interviews or focus groups will include direct questioning and open-ended discussion. We will also ascertain parental demographics and key characteristics as well as current dissemination methods of nutrition communication resources for low-income families with young children.Audio-taped interviews will be transcribed verbatim and analyzed for themes using the classic analysis approach. The classic analysis approach involves the follow steps to identify themes and categorize results of qualitative data.For quantitative data collection either as a component of the qualitative studies or as separate interviews, previously validated questionnaires or methods will be used to assess current parental feeding practices, mealtime routines, physical activity practices, dietary behaviors, diet quality (Dependent variables). Height and weight may also be measured of the parent and child to calculate body mass index (BMI) or BMI Z-score respectively. If we conduct a pilot feasibility study of n=60 parents equally split into two groups (intervention vs. control), we would have an estimated 76% power for a two-tailed test at alpha=.05 to detect an effect size of d=0.30 using family mealtime frequency and dietary quality as outcomes. This is based on the assumption that the groups will be weakly related to each other.Aim 2 methods:Based on the qualitative data collected as a result of Aim 1, themes will be examined for gender, education, racial and ethnic differences among parents as it relates to current barriers to promoting healthful eating and physical activity behaviors of their young children and requested resources and delivery methods of nutrition information if sample size permits and if focus groups or interviews are not homogenous.Based on the quantitative data collected as a result of Aim 1, outcome results (e.g. certain constructs related to feeding or diet quality scores as examples) from various validated questionnaires assessing nutrition, diet or physical activity outcomes will be examined by parental demographic characteristics such as age, gender, education, and race/ethnicity. Depending on the type of variable, ANOVA or cross-tabs and Chi-square will be used to examine if significant differences (P < .05) exist by parental characteristics.Aim 3 methods:Based on the findings in Aims 1 and 2, topic areas identified as highest need among parents and/or most requested nutrition communication topics for prevention of childhood obesity in families with children ages 0 to 5 years old will be newly designed or adapted from other relevant preexisting materials. Differences in childhood obesity prevention topic focuses and channels to communicate information will be decided based on if differences by parental characteristics (age, gender, education, race/ethnicity) if detected from results in Aims 1 & 2. Corresponding nutrition communication resources will then be developed based on applicable health behavior theory (e.g. Theory of Planned Behavior etc.). New messages, materials, strategies or methods to prevent early childhood obesity will include: A core set of up to 12 messages and supporting materials will be developed for parents of children ages 0 to 5 years old based on Aims 1 & 2 findings, current research evidence and/or revision of current messages available to prevent childhood obesity covering five message domains. Cultural appropriateness and literacy level will also be considered. Materials will be translated and culturally adapted for use in Spanish as well when applicable and when funds or bilingual staff is available for translation.Pilot testing of messages and materials with parents. Approximately 5-6 focus groups (~8 parents/group) with parents (n=40-50) of children will be conducted to test the core set of childhood obesity prevention messages to determine acceptability, overall comprehension and of material elements (words, pictures etc.), credibility, identification with messages, perceived target audience, relevance, feasibility, ideas for improvement and, likelihood of message exposure.Aim 4 methods:Cognitive interviewing, such as the "think aloud" technique, is a formative research method that will allow a deeper evaluation of the comprehension of new nutrition education resources by the target audience. Trials of Improved Practices (TIPs), another formative research technique, will allow the pretesting of the nutrition education materials. The impact of the TIPs will be analyzed using quantitative and qualitative methods. In addition, parents will be asked if they had a particular problem, if they accepted the recommended nutrition communication resources/strategies and which ones they selected, what were the most effective motivators, what modifications or suggestions were made and why, who in family or community influenced their behavior, what were the main barriers they had to overcome and how did they do this, what were the perceived benefits and how many intend to continue the new practice.Technology-based nutrition communication materials, methods or strategies related to preventing early childhood obesity will be further pilot tested to determine efficacy with low-income parents of young children (ages 0 to 5 years). Participant sample size will be determined using a power analysis based on the main outcome. Parents will be given exclusive access to a closed website as a venue to post and receive childhood obesity prevention information (e.g. videos, memes) during a 4 week pilot study. Preferred frequency (e.g. once/day, once/week) to receive nutrition communications will be assessed during the focus group in Aim 1 prior.Overall outcomes will consider child health as a whole and will not be centered on child weight alone. Specifically, short term outcomes may include assessments of knowledge, attitudes, beliefs, skills, self-efficacy and behavioral intentions related to previously described childhood obesity prevention practices or behaviors will be assessed as well as medium term outcomes including dietary behaviors, parent feeding style and practices, physical activity level and sedentary behaviors (e.g. screen time). Process outcomes will also be assessed in terms of amount and frequency of technology download and viewing time of technology-based nutrition communication materials.