Using mobile technology for family-based prevention in families with low incomes: Lessons from a randomized controlled trial of a childhood obesity prevention program

Authors: POWER, THOMAS - Washington State University; BAKER, SUSAN - Colorado State University; BARALE, KAREN - Washington State University Extension Service; ARAGON, MARIA - Washington State University Extension Service; LANIGAN, JANE - Washington State University; PARKER, LOUISE - Washington State University Extension Service; SILVA GARCIA, KARINA - Washington State University; AULD, GARRY - Colorado State University; MICHELI, NILDA - Children'S Nutrition Research Center (CNRC); HUGHES, SHERYL - Children'S Nutrition Research Center (CNRC)

Submitted to: Prevention Science
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 12/28/2023
Publication Date: 2/7/2024
Citation: Power, T.G., Baker, S.S., Barale, K.V., Aragon, M.C., Lanigan, J.D., Parker, L., Silva Garcia, K., Auld, G., Micheli, N., Hughes, S.O. 2024. Using mobile technology for family-based prevention in families with low incomes: Lessons from a randomized controlled trial of a childhood obesity prevention program. Prevention Science. 25:369–379. https://doi.org/10.1007/s11121-023-01637-8.
DOI: https://doi.org/10.1007/s11121-023-01637-8

Interpretive Summary: Family-based childhood obesity programs have been successful; however, the ability to reach some parents has been difficult because parents of young children are busy and may not have the time, flexibility, resources, or support to participate in in-person programs. The purpose of this study was to better understand how online curriculum designed to prevent childhood obesity could be used successfully with parents with low incomes. Parents in this study attended in-person nutrition education classes as part of the Expanded Food and Nutrition Education Program (EFNEP) in Colorado and Washington states; classes were offered in English and Spanish. A total of 168 parents who were participating in nutrition education classes through EFNEP were also sent links to a newly developed, mobile-based curriculum designed to teach best practices for reducing obesity in young children. These parents only accessed 47% of the videos from the online content. Results showed that parents engaged with the online materials based on their ethnicity and acculturation. For example, non-Hispanic parents accessed the most videos, Hispanic parents with low acculturation accessed the second most, and Hispanic parents with high acculturation accessed the least. Mobile-based programs can be an optimal way to engage parents with low incomes in obesity prevention efforts for their children.

Technical Abstract: Researchers are increasingly using web-based technologies to deliver family-based, prevention programming. Few studies have examined the success of such approaches for families with low incomes. The purpose of this study was to describe the level of in-class and online engagement in a childhood obesity prevention program for parents with low incomes, to examine the demographic correlates of parent engagement, and to examine dosage effects on parental feeding outcomes as a function of online exposure. All participants attended in-class nutrition education classes (Eating Smart-Being Active) as part of the Expanded Food and Nutrition Education Program (EFNEP) in Colorado and Washington State (classes were offered in English and Spanish). Participants in this analysis were 168 parents from a larger cluster randomized controlled trial who had been randomly assigned to also receive a newly developed, mobile-based version of an efficacious, feeding-focused, childhood obesity prevention program. Results showed that despite high levels of in-person attendance (70%), participants only accessed 47% of the videos (online content). Older parents and parents of girls showed higher levels of in-person attendance; currently employed parents showed lower levels. Online engagement varied as a function of ethnicity and acculturation: non-Hispanic parents accessed the most videos, low-acculturated Hispanic parents accessed the second most, and highly acculturated Hispanic parents accessed the least. In contrast, low-acculturated Hispanic parents showed the highest in-person attendance. For all but one outcome, significant online program effects were found only for parents who accessed at least half of the videos. Implications for mobile-based, family-based prevention programs for parents with low incomes are considered.