Recruitment results among families contacted for an obesity prevention intervention: the Obesity Prevention Tailored for Health Study

A Hybrid Mobile Phone Feasibility Study Focusing on Latino Mothers, Fathers, and Grandmothers to Prevent Obesity in Preschoolers

OBJECTIVE

To pilot the feasibility of a mobile phone childhood obesity intervention for family caregivers of Latino preschool-aged children.

METHODS

An evidence-based early childhood obesity intervention was adapted to have cultural relevance and a shorter-length curriculum for mothers, fathers, and grandmothers of 2- to 5-year-old Latino children. Traditional in-person group sessions (four weeks) were combined with eight weeks of mobile phone content to support parenting skills and evidence-based and age-appropriate nutritional practices in either English or Spanish. A convenience sample of Latino families were recruited from WIC and Early Education Centers in East Los Angeles. Feasibility measures were collected. Child and caregiver height and weight were measured, and caregiver surveys of child dietary intake were collected at baseline, 1- and 6-month post-baseline. Changes in child's dietary intake and BMI, as well as caregiver BMI, were examined using a mixed effects linear regression model with family random intercept and nested random slope for time period of measurement.

RESULTS

The program was delivered to 64 low-income Latino families (46 mothers, 34 fathers, 16 grandmothers, and 48 children). Children had a reduction in raw BMI, BMI percentile, and BMI z-scores at 6-months post-baseline compared to baseline measurements. The study also demonstrated stable BMI outcomes among all caregivers.

CONCLUSION

The pilot study shows promise in preventing childhood obesity, and having a multi-generational impact on weight outcomes. Leveraging the high-use of mobile phones has the potential to shorten in-person interventions, and engage fathers and grandmothers who play an important role in shaping healthy weight practices in young children.

Facilitators and barriers of children's participation in nutrition, physical activity, and obesity interventions: A systematic review

Recruitment of children into clinical trials is challenging. Most systematic reviews exploring facilitators and barriers of child recruitment in clinical trials are related to drugs or experimental treatments for various health conditions. This may differ in nutrition, physical activity, and obesity interventions. The objective was to conduct a systematic review of facilitators and barriers for children's participation in nutrition, physical activity, and obesity interventions from the perspective of parents, children, and researchers. Studies were identified from five databases and restricted to children 2-18 years and the English language. Studies without results on facilitators and barriers of recruitment were excluded. Four hundred twenty-three records were identified; 94 duplicates and 269 unrelated records were initially excluded; 60 records were reviewed for full-text, and subsequently 34 were excluded, for a total of 26 included studies. The top barriers for recruiting children into clinical trials were time constraints, understanding of clinical trial information or complexity of consent/trial info, and transportation/lack of childcare. The most common facilitators were benefits to others and self, compensation/incentives, physician recommendations/referrals, and support. These barriers and facilitators should be addressed in future studies to assist in the successful recruitment of children into nutrition, physical activity, and obesity interventions.

Recruiting and retaining parents in behavioral intervention trials: Strategies to consider

OBJECTIVE

Recruitment and retention are paramount to the success of randomized controlled trials (RCTs); however, strategies and challenges to optimize recruitment and retention are often omitted from outcomes papers. The current manuscript presents strategies used to recruit and retain over 97% parents of young children newly diagnosed with type 1 diabetes for over 15-months post-randomization enrolled in First STEPS, a behavioral, two-site RCT.

METHOD

Participants included 157 primary caregivers of young children newly diagnosed with type 1 diabetes. Recruitment and retention strategies are described and include collaboration with medical teams, careful selection and training of study staff, inclusion of a behavioral run-in prior to randomization, financial incentives, creation of a study identity using retention items, obtainment of feedback from community stakeholders, and minimization of participant burden.

RESULTS

Use of recruitment and retention strategies resulted in enrollment of 58% of eligible and reached families, with retention of the enrolled sample above 97% for over 15 months. Participants reported high acceptability of and satisfaction with specific recruitment and retention strategies.

CONCLUSIONS

The strategies used to recruit and retain caregivers of young children newly diagnosed with a chronic illness were feasible to implement within multidisciplinary diabetes clinics and may apply to other pediatric populations. Future research may benefit from a focus on strategies to engage more diverse samples.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02527525.

Feasibility of Targeting Hispanic Fathers and Children in an Obesity Intervention: Papás Saludables Niños Saludables

Background: Hispanic children and men carry a high burden for obesity and associated medical conditions. Healthy Dads Healthy Kids was the first obesity prevention intervention targeting fathers and demonstrated weight loss among fathers and behavior change among fathers and children in Australia. The aim of this study was to assess the feasibility of a culturally adapted version of the program for Hispanic families, Papás Saludables Niños Saludables. Methods: A randomized waitlist controlled trial with a process evaluation was conducted to assess the feasibility of Papás Saludables Niños Saludables(NCT03532048). Fathers, their partner (mother), and one to three children were enrolled. A priori feasibility criteria were: (1) recruit 40 Hispanic fathers and their families in ≤4 months; (2) retain 80% of participants for pre- and postassessments; (3) maintain ≥70% attendance to the 10 sessions; (4) obtain 80% "excellent" or "good" satisfaction from participants; and (5) collect anthropometric and behavioral data on ≥75% of participants at baseline and follow-up. Results: The study enrolled 90% (n = 36) of the goal from one local pediatric clinic between May and August 2018; retained 75% of participants for postassessment; maintained 72% attendance among those who started the program; and achieved 100% "excellent/good" satisfaction ratings among the participating fathers and mothers. One hundred percent of participants had most anthropometric and behavioral data at baseline and 72% at follow-up. Conclusions: With oversampling and improvements in the recruitment strategies, Papás Saludables Niños Saludables is feasible for a randomized controlled clinical trial to address whether a father-targeted lifestyle program is efficacious among low-income Hispanic men and their children.

Public health nurse referrals for paediatric weight management: A nested mixed-methods study

AIMS AND OBJECTIVES

To (a) characterise and determine proportions of referred and enrolled children and (b) explore public health nurses' (PHNs) experiences, perspectives and recommendations regarding a new nurse-led referral pathway for paediatric weight management.

BACKGROUND

Children with obesity and their families in Canada access specialised services for obesity management through physician referral. Since this requirement can prevent timely access to health services, we established and tested a referral pathway whereby PHNs directly refer children to specialised care for obesity management.

DESIGN

Nested mixed-methods study reported using GRAMMS.

METHOD

Our research study included children (2-17 years of age; body mass index ≥85th percentile) referred by a PHN to the Pediatric Centre for Weight and Health (PCWH; Stollery Children's Hospital, Edmonton, Alberta, Canada) from April 2017-September 2018. We summarised referral and enrolment data using descriptive statistics and conducted one-on-one, semi-structured telephone interviews with PHNs; interviews were audio-recorded, transcribed verbatim, managed using NVivo 12 and analysed by two independent reviewers using content analysis.

RESULTS

Our sample included 79 referred children (4.4 ± 1.8 years old; 3.4 ± 1.3 BMI z-score; 52.7% male), of which 47 (59.5%) enrolled in care. PHNs' (n = 11) experiences, perspectives and recommendations regarding the new referral pathway were grouped into four categories: (a) practicality of the referral pathway (e.g., simple and straightforward), (b) utility of the referral pathway (e.g., economic and timesaving), (c) uptake of the referral pathway (e.g., physician's influence) and (d) recommendations to improve the referral pathway (e.g., having electronic access to the referral form).

CONCLUSIONS

A PHN-specific referral pathway led most children and families to enrol in paediatric weight management and overall was perceived as acceptable and appropriate among PHNs.

RELEVANCE TO CLINICAL PRACTICE

Our results highlight the valuable role that PHNs can play in directly referring children to specialised services for weight management. This pathway has the potential to reduce wait times and enhance treatment enrolment.

Predicting Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management

OBJECTIVES

To characterize the children who were referred, determine the proportion of referred children who enrolled, and examine factors associated with enrollment in multidisciplinary clinical care for pediatric weight management.

STUDY DESIGN

This cross-sectional study included the population of children (2-17 years of age; body mass index of ≥85th percentile) referred to 1 of 3 hospital-based multidisciplinary weight management clinics in Alberta, Canada, from April 2013 to April 2016. Referral and enrollment data were obtained from Alberta Health Services databases. Bivariate and multivariable logistic regression models were used to determine the independent and combined effects of predictors of enrollment.

RESULTS

Of the 2014 children (51.8% male; mean body mass index z-score: 3.42 ± 0.03) referred to multidisciplinary clinical care, 757 (37.6%) enrolled in care. Most referred children had severe obesity and were referred by physicians. Several factors independently predicted enrollment; however, in our most parsimonious multivariable model, only the time gap (OR, 0.94; 95% CI, 0.88-0.99; P = .03) between the attendance date of the orientation session and the booking date of initial appointment predicted enrollment for all children. Body mass index z-score (OR, 0.81; 95% CI, 0.67-0.98; P = .03) and time gap (OR, 0.92; 95% CI, 0.85-0.99; P = .02) predicted enrollment in children with severe obesity exclusively.

CONCLUSIONS

Fewer than 40% of referred children enrolled in multidisciplinary clinical care. Reducing the duration of enrollment and providing additional support for treatment initiation to children with severe obesity may enhance treatment uptake for pediatric weight management.

Participant Outcomes from Methods of Recruitment for Videogame Research

OBJECTIVE

The most productive methods of recruitment for a videogame for health (G4H) trial are not known. Success or failure of recruitment methods has been reported for a variety of clinical trials, but few specifically for G4H trials. This study's goal was to recruit 444 overweight or obese (body mass index percentile between the 84.5th-99.4th percentiles) children between the ages of 10-12 years. The article reports the results of different methods of participant recruitment.

MATERIALS AND METHODS

Participants had to agree to three fasting blood samples (baseline, immediately after, and 2 months later); be willing to wear an accelerometer for 7 days at each assessment; read and speak English fluently (because the games were in English); have no history of any condition that would affect what he/she could eat or how much physical activity he/she could get; and have an eligible home computer purchased in the last 5 years with high-speed internet. Hardware criteria reflected the types of computers upon which Diab-Nano could be effectively played. Recruitment was conducted over a 35-month period and included electronic media, print advertising, community recruitment, and an internal volunteer list. Respondents were guided to a web-based screening questionnaire that asked for source of hearing about the study.

RESULTS

Although diverse recruitment methods were used, slow recruitment resulted in obtaining only 45% of the recruitment goal (n = 199). Electronic media (e.g., radio, television, and internet), which reached millions of targeted parents, resulted in only 76 respondents, of whom 13 became participants; print media (e.g., magazine, newsletter/newspaper, and mail), which also reached large numbers of parents, resulted in 192 respondents, of whom 19 became participants; community recruitment (e.g., school, friend or family, doctors office, flyer, work, community program) resulted in 162 respondents, of whom 38 became participants; and the internal volunteer list resulted in 413 respondents, of whom 128 became participants.

CONCLUSION

Inclusionary and exclusionary criteria and restricted access by gatekeepers could be deterrents to successful recruitment. The documented payoff of alternative comprehensive methods of recruitment should benefit other investigations in optimally allocating their recruitment resources.

Jump2Health Website™ for Head Start parents to promote a healthy home environment: Results from formative research

Background: In US, approximately 23% of children between the ages of 2-5 years are overweight or obese. Parents need access to information to create healthy home environments for obesity prevention, yet participation for in-person education programs is challenging. Web-based interventions are promising educational tools due to 24/7 availability. However, information is limited on their development and evaluation. Design and Methods: This study reports on a rigorous development process that included six focus group discussions (FGD) with stakeholders (three FGD each with parents and teachers) to assess education needs and inform the development of the Jump2Health Website^™ by a multidisciplinary team. After development, the Website was evaluated by telephone interviews with stakeholders (five parents and six teachers) and reviewed by an expert panel of five Registered Dietitians. Results: Twenty Head Start parents and 22 Head Start teachers participated in the FGD. To address the needs identified by these stakeholders, the Website was designed to include components that were enabling and motivating, such as descriptions of health benefits by achieving the desired behaviours, short videos on easy meal preparation, and tip sheets on how to achieve healthy behaviours in easy, economical ways. Stakeholder evaluation of the Website indicated that the information was helpful, easy to use, and would be beneficial for parents. Conclusions: The development of Jump2Health Website^™ was strengthened by FGD with stakeholders that assessed educational needs. Interviews with stakeholders and an expert panel review showed that the Website may be an effective educational method to teach parents about healthy behaviours related to obesity prevention.

Geographic Information Systems to Assess External Validity in Randomized Trials

INTRODUCTION

To support claims that RCTs can reduce health disparities (i.e., are translational), it is imperative that methodologies exist to evaluate the tenability of external validity in RCTs when probabilistic sampling of participants is not employed. Typically, attempts at establishing post hoc external validity are limited to a few comparisons across convenience variables, which must be available in both sample and population. A Type 2 diabetes RCT was used as an example of a method that uses a geographic information system to assess external validity in the absence of a priori probabilistic community-wide diabetes risk sampling strategy.

METHODS

A geographic information system, 2009-2013 county death certificate records, and 2013-2014 electronic medical records were used to identify community-wide diabetes prevalence. Color-coded diabetes density maps provided visual representation of these densities. Chi-square goodness of fit statistic/analysis tested the degree to which distribution of RCT participants varied across density classes compared to what would be expected, given simple random sampling of the county population. Analyses were conducted in 2016.

RESULTS

Diabetes prevalence areas as represented by death certificate and electronic medical records were distributed similarly. The simple random sample model was not a good fit for death certificate record (chi-square, 17.63; p=0.0001) and electronic medical record data (chi-square, 28.92; p<0.0001). Generally, RCT participants were oversampled in high-diabetes density areas.

CONCLUSIONS

Location is a highly reliable "principal variable" associated with health disparities. It serves as a directly measurable proxy for high-risk underserved communities, thus offering an effective and practical approach for examining external validity of RCTs.

Researchers' perspectives on pediatric obesity research participant recruitment

Background

Childhood obesity prevalence has tripled over the last three decades. Pediatric obesity has important implications for both adult health as well as the United States economy. In order to combat pediatric obesity, exploratory studies are necessary to create effective interventions. Recruitment is an essential part of any study, and it has been challenging for all studies, especially pediatric obesity studies. The objective of this study was to understand barriers to pediatric obesity study recruitment and review facilitators to overcome recruitment difficulties.

Methods

Twenty four childhood obesity researchers were contacted. Complete data for 11 researchers were obtained. Interviews were transcribed and analyzed using content analysis. Grounded Theory methodological approach was used, as this was an exploratory study. Investigators YP and MM coded the interviews using 28 codes.

Results

Barriers to recruitment included: family and study logistics, family economics, lack of provider interest, invasive protocols, stigma, time restraints of clinicians, lack of patient motivation/interest, groupthink of students in a classroom, and participants who do not accept his or her own weight status. Facilitators to enhance recruitment practices included accommodating participants outside of regular clinic hours, incentivizing participants, cultivating relationships with communities, schools and clinics prior to study recruitment, emphasizing benefits of a study for the patient, and shifting language to focus on health rather than obesity.

Conclusions

Pediatric obesity researchers face many standard and some unique challenges to recruitment, reflecting challenges common to clinical research as well as some specific to pediatrics and some specific to obesity research. Both pediatric studies as well as obesity studies are an added challenge to the already-difficult task of general study recruitment. Our findings can be used to make researchers more aware of potential difficulties, approaches and on-going needs for enhancing recruitment and enrollment practices, and in turn if applied, may result in increased study efficiency.

An online tool for obesity intervention and public health

BACKGROUND

Though the United States of America (U.S.A.) obesity rate shows signs of leveling off, rates remain high. Poor nutrition contributes to the development of obesity, and physical inactivity is an important cause of numerous diseases and directly linked to obesity. Efforts to improve diet, increase physical activity and pursue other behavioral changes seem imperative. However, the effective management of intervention strategies for large number of participants are challenging because services in primary, secondary, and tertiary cares are often under-resourced, relatively uncoordinated with other parts of the health system. It is thus necessary to have accompanying intervention strategies that can be carried out at population level. In this paper, we describe an online intervention tool designed for the Obesity Prevention Tailored for Health II project to help achieve such goals.

RESULTS

The first part of the online tool locates healthy food stores and recreational programs within a specified distance of a participant's home or a place of interest. The food environments include fruit & vegetable stores, farmers' markets and grocery stores, and the companying popup window shows the street address and contact information of each store. The parks and recreational programs are displayed on names of park or recreational program, types of program available, and city each amenity belongs to. The tool also provides spatial coverage of vegetation greenness, air pollution and of historical traffic accidents involving active travel. The second part of the tool provides optimized travel options for reaching various amenities. By incorporating bicycling, walking and public transit into the trip planner, this online tool helps increase active transport and reduce dependence on automobiles. It promotes transportation that encourages safety awareness, physical activity, health, recreation, and resource conservation.

CONCLUSIONS

We developed the first Google-based online intervention tool that assists obese and overweight participants in finding food and recreational amenities around locations of interest and identifying optimized routes that fit their personal preferences. This tool can also serve general public and policy makers for education, disease prevention and health promotion.

Effective Strategies to Recruit Young Adults Into the TXT2BFiT mHealth Randomized Controlled Trial for Weight Gain Prevention

Background

Younger adults are difficult to engage in preventive health, yet in Australia they are gaining more weight and increasing in waist circumference faster than middle-to-older adults. A further challenge to engaging 18- to 35-year-olds in interventions is the limited reporting of outcomes of recruitment strategies.

Objective

This paper describes the outcomes of strategies used to recruit young adults to a randomized controlled trial (RCT), healthy lifestyle mHealth program, TXT2BFiT, for prevention of weight gain. The progression from enquiry through eligibility check to randomization into the trial and the costs of recruitment strategies are reported. Factors associated with nonparticipation are explored.

Methods

Participants were recruited either via letters of invitation from general practitioners (GPs) or via electronic or print advertisements, including Facebook and Google—social media and advertising—university electronic newsletters, printed posters, mailbox drops, and newspapers. Participants recruited from GP invitation letters had an appointment booked with their GP for eligibility screening. Those recruited from other methods were sent an information pack to seek approval to participate from their own GP. The total number and source of enquiries were categorized according to eligibility and subsequent completion of steps to enrolment. Cost data and details of recruitment strategies were recorded.

Results

From 1181 enquiries in total from all strategies, 250 (21.17%) participants were randomized. A total of 5311 invitation letters were sent from 12 GP practices—16 participating GPs. A total of 131 patients enquired with 68 participants randomized (68/74 of those eligible, 92%). The other recruitment methods yielded the remaining 182 randomized participants. Enrolment from print media was 26% of enquiries, from electronic media was 20%, and from other methods was 3%. Across all strategies the average cost of recruitment was Australian Dollar (AUD) $139 per person. The least expensive modality was electronic (AUD $37), largely due to a free feature story on one university Web home page, despite Facebook advertising costing AUD $945 per enrolment. The most expensive was print media at AUD $213 and GP letters at AUD $145 per enrolment.

Conclusions

The research indicated that free electronic media was the most cost-effective strategy, with GP letters the least expensive of the paid strategies in comparison to the other strategies. This study is an important contribution for future research into efficacy, translation, and implementation of cost-effective programs for the prevention of weight gain in young adults. Procedural frameworks for recruitment protocols are required, along with systematic reporting of recruitment strategies to reduce unnecessary expenditure and allow for valuable public health prevention programs to go beyond the research setting.

Trial Registration

Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000924853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362872 (Archived by WebCite at http://www.webcitation.org/6YpNfv1gI).