Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Minority Preadolescents: Protocol for a Pilot Randomized Control Trial

Abstract

Background: Childhood obesity is a public health crisis, particularly in low-income, minority populations in the United States. Innovative and technology-enhanced interventions may be an engaging approach to reach at-risk youth and their parents to improve dietary behaviors and feeding practices. However, such tools are limited, especially ones that are theory-based; co-developed with user-centered approaches; tailored to low-income, minority preadolescents; and include parent-focused content.

Objective: The objectives of this study include assessing the feasibility and acceptability and exploring the potential impact of the Intervention INC (Interactive Nutrition Comics for urban, minority preadolescents) Web-based tool, which is focused on decreasing childhood obesity risk in black/African American and Latino children aged 9 to 12 years.

Methods: Intervention INC is underpinned by the narrative transportation theory, social cognitive theory, and health belief model, and it was co-developed by children and parents from the intended population. The child component consists of a 6-chapter interactive nutrition comic optimized for use on tablet devices, a goal-setting and self-assessment feature, and weekly text/email messages and reminders. The parental component consists of 6 Web-based newsletters, access to the child comic, and weekly text/email messages and reminders. The tool was evaluated using a pilot, single-blind, 2-group randomized controlled study design. Child-parent dyads were randomized to either the experimental or comparison group and assigned to a targeted behavior (increase fruit/vegetable or water intake) based on initial screening questions. Data were collected at 4 time points: baseline (T1), intervention midpoint (T2), intervention endpoint (T3), and 3 months postintervention (T4). Primary measures comprise usage, usability, and feasibility of the Web-based tool. Secondary measures comprise dietary knowledge, preferences, and intake and anthropometric measures (for child) and feeding practices and home food environment (for parent).

Results: Study enrollment was completed in November 2017. A total of 89 child-parent dyads were randomized to either the experimental (n=44) or comparison (n=45) group. Data analysis is currently being conducted.

Conclusions: This study aims to implement and assess an innovative approach to deliver health messages and resources to at-risk minority preadolescents and their parents. If found to be acceptable, engaging, feasible, and a potential approach to improve dietary behaviors, a full-fledged randomized controlled trial will be conducted to assess its efficacy and potential impact.

Trial registration: ClinicalTrials.gov NCT03165474; https://clinicaltrials.gov/ct2/show/NCT03165474 (Archived by WebCite at http://www.webcitation.org/73122IjgP).

International registered report identifier (irrid): RR1-10.2196/10682.

Keywords: child; diet; mHealth; minority; parents; pediatric obesity; vulnerable populations.

Figure 1

Study design of Intervention INC.

Figure 2

Conceptual framework of Intervention INC. BMI: body mass index; HBM: health belief model; NTT: narrative transportation theory; SCT: social cognitive theory.

Figure 3

Experimental group (child) website homepage (top left) and snapshot of the comic (bottom left) and comparison group (child) Web-based newsletter example (right).

Figure 4

Experimental group (child) goal-setting component (top) with link in the character message at the end of each comic chapter (top left), list of goals (top center), and goal-specific tip (top right) and comparison group (child) goal-setting component (bottom) with link in the Web-based newsletter (bottom left), list of goals (bottom center), and goal-specific tip (bottom right).

Figure 5

Examples of text messages sent to children in the experimental group (left) and comparison group (right).

Figure 6

Examples of Web-based newsletters sent to parents in the experimental group (left) and comparison group (right).