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Metzendorf MI, Wieland LS, Richter B. Mobile health (m-health) smartphone interventions for adolescents and adults with overweight or obesity. Cochrane Database Syst Rev 2024; 2:CD013591. [PMID: 38375882 PMCID: PMC10877670 DOI: 10.1002/14651858.cd013591.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
BACKGROUND Obesity is considered to be a risk factor for various diseases, and its incidence has tripled worldwide since 1975. In addition to potentially being at risk for adverse health outcomes, people with overweight or obesity are often stigmatised. Behaviour change interventions are increasingly delivered as mobile health (m-health) interventions, using smartphone apps and wearables. They are believed to support healthy behaviours at the individual level in a low-threshold manner. OBJECTIVES To assess the effects of integrated smartphone applications for adolescents and adults with overweight or obesity. SEARCH METHODS We searched CENTRAL, MEDLINE, PsycINFO, CINAHL, and LILACS, as well as the trials registers ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform on 2 October 2023 (date of last search for all databases). We placed no restrictions on the language of publication. SELECTION CRITERIA Participants were adolescents and adults with overweight or obesity. Eligible interventions were integrated smartphone apps using at least two behaviour change techniques. The intervention could target physical activity, cardiorespiratory fitness, weight loss, healthy diet, or self-efficacy. Comparators included no or minimal intervention (NMI), a different smartphone app, personal coaching, or usual care. Eligible studies were randomised controlled trials of any duration with a follow-up of at least three months. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology and the RoB 2 tool. Important outcomes were physical activity, body mass index (BMI) and weight, health-related quality of life, self-efficacy, well-being, change in dietary behaviour, and adverse events. We focused on presenting studies with medium- (6 to < 12 months) and long-term (≥ 12 months) outcomes in our summary of findings table, following recommendations in the core outcome set for behavioural weight management interventions. MAIN RESULTS We included 18 studies with 2703 participants. Interventions lasted from 2 to 24 months. The mean BMI in adults ranged from 27 to 50, and the median BMI z-score in adolescents ranged from 2.2 to 2.5. Smartphone app versus no or minimal intervention Thirteen studies compared a smartphone app versus NMI in adults; no studies were available for adolescents. The comparator comprised minimal health advice, handouts, food diaries, smartphone apps unrelated to weight loss, and waiting list. Measures of physical activity: at 12 months' follow-up, a smartphone app compared to NMI probably reduces moderate to vigorous physical activity (MVPA) slightly (mean difference (MD) -28.9 min/week (95% confidence interval (CI) -85.9 to 28; 1 study, 650 participants; moderate-certainty evidence)). We are very uncertain about the results of estimated energy expenditure and cardiorespiratory fitness at eight months' follow-up. A smartphone app compared with NMI probably results in little to no difference in changes in total activity time at 12 months' follow-up and leisure time physical activity at 24 months' follow-up. Anthropometric measures: a smartphone app compared with NMI may reduce BMI (MD of BMI change -2.6 kg/m2, 95% CI -6 to 0.8; 2 studies, 146 participants; very low-certainty evidence) at six to eight months' follow-up, but the evidence is very uncertain. At 12 months' follow-up, a smartphone app probably resulted in little to no difference in BMI change (MD -0.1 kg/m2, 95% CI -0.4 to 0.3; 1 study; 650 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in body weight change (MD -2.5 kg, 95% CI -6.8 to 1.7; 3 studies, 1044 participants; low-certainty evidence) at 12 months' follow-up. At 24 months' follow-up, a smartphone app probably resulted in little to no difference in body weight change (MD 0.7 kg, 95% CI -1.2 to 2.6; 1 study, 245 participants; moderate-certainty evidence). A smartphone app compared with NMI may result in little to no difference in self-efficacy for a physical activity score at eight months' follow-up, but the results are very uncertain. A smartphone app probably results in little to no difference in quality of life and well-being at 12 months (moderate-certainty evidence) and in little to no difference in various measures used to inform dietary behaviour at 12 and 24 months' follow-up. We are very uncertain about adverse events, which were only reported narratively in two studies (very low-certainty evidence). Smartphone app versus another smartphone app Two studies compared different versions of the same app in adults, showing no or minimal differences in outcomes. One study in adults compared two different apps (calorie counting versus ketogenic diet) and suggested a slight reduction in body weight at six months in favour of the ketogenic diet app. No studies were available for adolescents. Smartphone app versus personal coaching Only one study compared a smartphone app with personal coaching in adults, presenting data at three months. Two studies compared these interventions in adolescents. A smartphone app resulted in little to no difference in BMI z-score compared to personal coaching at six months' follow-up (MD 0, 95% CI -0.2 to 0.2; 1 study; 107 participants). Smartphone app versus usual care Only one study compared an app with usual care in adults but only reported data at three months on participant satisfaction. No studies were available for adolescents. We identified 34 ongoing studies. AUTHORS' CONCLUSIONS The available evidence is limited and does not demonstrate a clear benefit of smartphone applications as interventions for adolescents or adults with overweight or obesity. While the number of studies is growing, the evidence remains incomplete due to the high variability of the apps' features, content and components, which complicates direct comparisons and assessment of their effectiveness. Comparisons with either no or minimal intervention or personal coaching show minor effects, which are mostly not clinically significant. Minimal data for adolescents also warrants further research. Evidence is also scarce for low- and middle-income countries as well as for people with different socio-economic and cultural backgrounds. The 34 ongoing studies suggest sustained interest in the topic, with new evidence expected to emerge within the next two years. In practice, clinicians and healthcare practitioners should carefully consider the potential benefits, limitations, and evolving research when recommending smartphone apps to adolescents and adults with overweight or obesity.
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Affiliation(s)
- Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - L Susan Wieland
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Bernd Richter
- Institute of General Practice, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Deslippe AL, González ODJ, Buckler EJ, Ball GDC, Ho J, Bucholz A, Morrison KM, Mâsse LC. Do Individual Characteristics and Social Support Increase Children's Use of an MHealth Intervention? Findings from the Evaluation of a Behavior Change MHealth App, Aim2Be. Child Obes 2023; 19:435-442. [PMID: 36576875 DOI: 10.1089/chi.2022.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Purpose: Mobile health (mHealth) apps may support improved health behavior practice among youth living in larger bodies. However, long-term use is low, limiting effectiveness. This study evaluated whether youths' motivation, satisfaction, engagement with social features, or parent co-participation supported long-term use of an app named Aim2Be. Methods: A secondary analysis of two versions of Aim2Be (preteen and teen versions) using covariate-adjusted multivariable regression was conducted. We evaluated associations between social support features (a virtual coach, a social poll, or a social wall), parent co-participation (time spent in the parent app), and app satisfaction on use (time spent in Aim2Be). Models were stratified by age and satisfaction was explored as a moderator. Results: Preteens (n = 83) engagement with the social poll (β = 0.26, p < 0.001), virtual health coach (β = 0.24, p = 0.01), app satisfaction (β = 0.31, p = 0.01), and parent co-participation (β = 0.24, p = 0.01) predicted use. In teens (n = 90), engagement with the virtual coach (β = 0.31, p < 0.001) and full utilization of social wall features (β = 0.41, p < 0.001) predicted use. Furthermore, satisfaction moderated the effects of partial utilization of the social wall among teens (β = 0.32 p = 0.02). Conclusion: Social support in mHealth apps may impact users differently depending on age. Features that include health professionals or peers may be more advantageous across ages. App developers should consider age when designing interventions. Clinical Trial Registration NCT03651284.
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Affiliation(s)
- Alysha L Deslippe
- Human Nutrition, Land and Food Systems, University of British Columbia, Vancouver, British Columbia, Canada
- Healthy Starts, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Olivia De-Jongh González
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Evidence to Innovation (Behaviour Change Group), BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - E Jean Buckler
- School of Exercise Science, Physical and Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Josephine Ho
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Annick Bucholz
- Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
- Evidence to Innovation (Behaviour Change Group), BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
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Buckler EJ, González ODJ, Ball GDC, Hamilton J, Ho J, Morrison KM, Mâsse LC. Recruiting families using social media versus pediatric obesity clinics: A secondary analysis of the Aim2Be RCT. Contemp Clin Trials 2023; 133:107322. [PMID: 37661006 DOI: 10.1016/j.cct.2023.107322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/19/2023] [Accepted: 08/28/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Recruitment of participants continues to be a challenge that researchers must overcome to yield successful study results. Over the past decade, there has been a dramatic increase in the use of social media platforms to recruit research participants. We conducted a secondary analysis of the Aim2Be randomized controlled trial (RCT) to examine if there was variability between participants recruited via social media versus pediatric obesity clinics. METHODS Parents and their children living with overweight or obesity were recruited through social media (i.e., Facebook advertisements) (n = 119) or pediatric obesity management clinics (n = 95) to participate in the Aim2Be RCT. We compared recruitment costs, recruitment rate, participant retention, intervention engagement, obesity-related risk factors, and behavioral habits. RESULTS Facebook recruitment resulted in more participant contacts, but higher attrition during 'high effort' stages of the recruitment process. Group differences emerged regarding costs (Facebook: $407 versus clinics: $699). There were no group differences in participant retention or intervention engagement. Families recruited from Facebook were younger parents (42.6 versus 46.0 years; p < 0.001) and children (12.2 versus 13.9 years; p < 0.001), a higher percentage male children, and fewer had previously participated in a pediatric weight management program. Parents recruited from Facebook self-reported greater screen time for themselves, and their children reported lower physical activity levels and higher caloric and sugar intake. CONCLUSIONS Social media and clinical site recruitment are complementary strategies that appear to draw in families with different profiles, but regardless of how they were recruited, all families had the potential to benefit from pediatric obesity management.
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Affiliation(s)
- E Jean Buckler
- School of Exercise Science, Physical and Health Education, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2, Canada; Institute on Aging and Lifelong Health, University of Victoria, BC, Canada.
| | - Olivia De-Jongh González
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, 938 W 28th Ave, Vancouver, BC, Vancouver, BC V5Z 4H4, Canada.
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 11405-87 Avenue Edmonton, Alberta T6G 1C9, Canada.
| | - Jill Hamilton
- Department of Paediatrics, Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada.
| | - Josephine Ho
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada.
| | - Katherine M Morrison
- Department of Pediatrics, Center for Metabolism, Obesity and Diabetes Research, McMaster University, Health Sciences Centre, 3A, 1280 Main St W, Hamilton, Ontario L8S 4K1, Canada.
| | - Louise C Mâsse
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, 938 W 28th Ave, Vancouver, BC, Vancouver, BC V5Z 4H4, Canada.
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Ball GDC, O’Neill MG, Noor R, Alberga A, Azar R, Buchholz A, Enright M, Geller J, Ho J, Holt NL, Lebel T, Rosychuk RJ, Tarride JE, Zenlea I. A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol. Pilot Feasibility Stud 2023; 9:14. [PMID: 36691103 PMCID: PMC9868519 DOI: 10.1186/s40814-023-01246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families' access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children's and caregivers' acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. METHODS In our 2.5-year study, 108 6-17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families' barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. DISCUSSION Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. TRIAL REGISTRATION This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).
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Affiliation(s)
- Geoff D. C. Ball
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Marcus G. O’Neill
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Rafat Noor
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Angela Alberga
- grid.410319.e0000 0004 1936 8630Department of Health, Kinesiology, and Applied Physiology, Concordia University, Montreal, QC Canada
| | - Rima Azar
- grid.260288.60000 0001 2169 3908Psychobiology of Stress & Health Lab, Department of Psychology, Mount Allison University, Sackville, NB Canada
| | - Annick Buchholz
- grid.34428.390000 0004 1936 893XDepartment of Psychology, Carleton University, Ottawa, ON Canada
| | | | - Josie Geller
- grid.17091.3e0000 0001 2288 9830Department of Psychiatry, University of British Columbia, Vancouver, BC Canada
| | - Josephine Ho
- grid.22072.350000 0004 1936 7697Department of Paediatrics, University of Calgary, Calgary, AB Canada
| | - Nicholas L. Holt
- grid.17089.370000 0001 2190 316XFaculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB Canada
| | - Tracy Lebel
- Patient and Family Partner, Edmonton, AB Canada
| | - Rhonda J. Rosychuk
- grid.17089.370000 0001 2190 316XDepartment of Pediatrics, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 87th Ave, Edmonton, AB T6G 1C9 Canada
| | - Jean-Eric Tarride
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON Canada
| | - Ian Zenlea
- grid.17063.330000 0001 2157 2938Department of Pediatrics, University of Toronto, Toronto, ON Canada
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Alghamdi AS, Bitar HH. The positive impact of gamification in imparting nutritional knowledge and combating childhood obesity: A systematic review on the recent solutions. Digit Health 2023. [DOI: 10.1177/20552076231154380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Objective This paper reviews the recent gamified interventions that focus on the dietary factor to explore the effectiveness of using gaming elements in combating the prevalence of childhood obesity. Methods Two electronic databases were searched (PubMed and ProQuest); to identify the relevant papers published between 2018 and 2021. The keywords that use to search the entire selected databases were gamification and obesity. There were no restrictions regarding the language. Two independent reviewers screened the titles, abstracts, and keywords for relevance. Results 407 papers were identified initially, while only 18 articles met the inclusion criteria. Most of the included articles indicated the positive impact of gamification on changing children eating behaviors. This systematic review summarizes the theories followed in developing such interventions and suggests some other theories to use and follow. Moreover, we synthesized the main findings into six recommendations that would assist in combating the global concern regarding childhood obesity if IS/IT researchers and other implement them during the development of any IT intervention. Conclusions Using gamification and gaming elements in imparting nutritional knowledge to children and improving their eating habits and behaviors is considered effective generally. It provides them with the needed knowledge and promotes the acquisition of better habits within enjoyable environment.
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Affiliation(s)
- Athir S Alghamdi
- Department of Information Systems, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hind H Bitar
- Department of Information Systems, King Abdulaziz University, Jeddah, Saudi Arabia
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De-Jongh González O, Tugault-Lafleur CN, Buckler EJ, Hamilton J, Ho J, Buchholz A, Morrison KM, Ball GD, Mâsse LC. The Aim2Be mHealth Intervention for Children With Overweight or Obesity and Their Parents: Person-Centered Analyses to Uncover Digital Phenotypes. J Med Internet Res 2022; 24:e35285. [PMID: 35 PMCID: PMC9221987 DOI: 10.2196/35285] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 04/07/2022] [Accepted: 04/23/2022] [Indexed: 11/20/2022] Open
Abstract
Background Despite the growing number of mobile health (mHealth) interventions targeting childhood obesity, few studies have characterized user typologies derived from individuals’ patterns of interactions with specific app features (digital phenotypes). Objective This study aims to identify digital phenotypes among 214 parent-child dyads who used the Aim2Be mHealth app as part of a randomized controlled trial conducted between 2019 and 2020, and explores whether participants’ characteristics and health outcomes differed across phenotypes. Methods Latent class analysis was used to identify distinct parent and child phenotypes based on their use of the app’s behavioral, gamified, and social features over 3 months. Multinomial logistic regression models were used to assess whether the phenotypes differed by demographic characteristics. Covariate-adjusted mixed-effect models evaluated changes in BMI z scores (zBMI), diet, physical activity, and screen time across phenotypes. Results Among parents, 5 digital phenotypes were identified: socially engaged (35/214, 16.3%), independently engaged (18/214, 8.4%) (socially and independently engaged parents are those who used mainly the social or the behavioral features of the app, respectively), fully engaged (26/214, 12.1%), partially engaged (32/214, 15%), and unengaged (103/214, 48.1%) users. Married parents were more likely to be fully engaged than independently engaged (P=.02) or unengaged (P=.01) users. Socially engaged parents were older than fully engaged (P=.02) and unengaged (P=.01) parents. The latent class analysis revealed 4 phenotypes among children: fully engaged (32/214, 15%), partially engaged (61/214, 28.5%), dabblers (42/214, 19.6%), and unengaged (79/214, 36.9%) users. Fully engaged children were younger than dabblers (P=.04) and unengaged (P=.003) children. Dabblers lived in higher-income households than fully and partially engaged children (P=.03 and P=.047, respectively). Fully engaged children were more likely to have fully engaged (P<.001) and partially engaged (P<.001) parents than unengaged children. Compared with unengaged children, fully and partially engaged children had decreased total sugar (P=.006 and P=.004, respectively) and energy intake (P=.03 and P=.04, respectively) after 3 months of app use. Partially engaged children also had decreased sugary beverage intake compared with unengaged children (P=.03). Similarly, children with fully engaged parents had decreased zBMI, whereas children with unengaged parents had increased zBMI over time (P=.005). Finally, children with independently engaged parents had decreased caloric intake, whereas children with unengaged parents had increased caloric intake over time (P=.02). Conclusions Full parent-child engagement is critical for the success of mHealth interventions. Further research is needed to understand program design elements that can affect participants’ engagement in supporting behavior change. Trial Registration ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/NCT03651284 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-020-4080-2
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Affiliation(s)
- Olivia De-Jongh González
- School of Population and Public Health, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Claire N Tugault-Lafleur
- School of Nutrition Sciences, Faculty of Health Sciences, The University of Ottawa., Ottawa, ON, Canada
| | - E Jean Buckler
- School of Exercise Science, Physical and Health Education, University of Victoria., Victoria, BC, Canada
| | - Jill Hamilton
- Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Josephine Ho
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Katherine M Morrison
- Department of Pediatrics, Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Geoff Dc Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Louise C Mâsse
- School of Population and Public Health, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Tugault-Lafleur CN, De-Jongh González O, Macdonald J, Bradbury J, Warshawski T, Ball GDC, Morrison K, Ho J, Hamilton J, Buchholz A, Mâsse L. Efficacy of the Aim2Be intervention in changing lifestyle behaviours among adolescents with overweight and obesity: A Randomized Controlled Trial (Preprint). J Med Internet Res 2022; 25:e38545. [PMID: 37097726 PMCID: PMC10170359 DOI: 10.2196/38545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/13/2022] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Aim2Be is a gamified lifestyle app designed to promote lifestyle behavior changes among Canadian adolescents and their families. OBJECTIVE The primary aim was to test the efficacy of the Aim2Be app with support from a live coach to reduce weight outcomes (BMI Z score [zBMI]) and improve lifestyle behaviors among adolescents with overweight and obesity and their parents versus a waitlist control group over 3 months. The secondary aim was to compare health trajectories among waitlist control participants over 6 months (before and after receiving access to the app), assess whether support from a live coach enhanced intervention impact, and evaluate whether the app use influenced changes among intervention participants. METHODS A 2-arm parallel randomized controlled trial was conducted from November 2018 to June 2020. Adolescents aged 10 to 17 years with overweight or obesity and their parents were randomized into an intervention group (Aim2Be with a live coach for 6 months) or a waitlist control group (Aim2Be with no live coach; accessed after 3 months). Adolescents' assessments at baseline and at 3 and 6 months included measured height and weight, 24-hour dietary recalls, and daily step counts measured with a Fitbit. Data on self-reported physical activity, screen time, fruit and vegetable intake, and sugary beverage intake of adolescents and parents were also collected. RESULTS A total of 214 parent-child participants were randomized. In our primary analyses, there were no significant differences in zBMI or any of the health behaviors between the intervention and control groups at 3 months. In our secondary analyses, among waitlist control participants, zBMI (P=.02), discretionary calories (P=.03), and physical activity outside of school (P=.001) declined, whereas daily screen time increased (P<.001) after receiving access to the app compared with before receiving app access. Adolescents randomized to Aim2Be with live coaching reported more time being active outside of school compared with adolescents who used Aim2Be with no coaching over 3 months (P=.001). App use did not modify any changes in outcomes among adolescents in the intervention group. CONCLUSIONS The Aim2Be intervention did not improve zBMI and lifestyle behaviors in adolescents with overweight and obesity compared with the waitlist control group over 3 months. Future studies should explore the potential mediators of changes in zBMI and lifestyle behaviors as well as predictors of engagement. TRIAL REGISTRATION ClinicalTrials.gov NCT03651284; https://clinicaltrials.gov/ct2/show/study/NCT03651284. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13063-020-4080-2.
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Affiliation(s)
- Claire N Tugault-Lafleur
- School of Nutrition Sciences, Faculty of Health Sciences, The University of Ottawa, Ottawa, ON, Canada
| | - Olivia De-Jongh González
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Katherine Morrison
- Department of Pediatrics, Center for Metabolism, Obesity and Diabetes Research, McMaster University, Hamilton, ON, Canada
| | - Josephine Ho
- Cumming School of Medicine, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Jill Hamilton
- Department of Paediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Annick Buchholz
- Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
| | - Louise Mâsse
- School of Population and Public Health, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
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Lin Y, Mâsse LC. A look at engagement profiles and behavior change: A profile analysis examining engagement with the Aim2Be lifestyle behavior modification app for teens and their families. Prev Med Rep 2021; 24:101565. [PMID: 34976631 PMCID: PMC8683902 DOI: 10.1016/j.pmedr.2021.101565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/07/2021] [Accepted: 09/15/2021] [Indexed: 12/12/2022] Open
Abstract
Mobile-Health is increasingly used to deliver lifestyle modification interventions; however, little is known about how users engage with these apps. This study aims to profile how teens engage with Aim2Be- a lifestyles behavior modification app), characterize engagement profiles, and examine which engagement profiles support changes in behaviors (diet, physical activity, screen time and sleep) and changes in the mediators targeted by the app. Data were collected from 301 teens (14.8 years, 49% boys, 68% Caucasian) living in Canada, from March to October 2018, who utilized the Aim2Be app for 4.5 months. App-analytics tracked teen engagement with the app features (selecting aims, completing tasks and quick wins, using the knowledge center and social wall, and accessing the virtual coach). Factor mixture modeling identified the following engagement profiles: Uninvolved (32%) did not use most app features; Dabblers (25%) minimally used the app features; Engaged (24%) had moderate-to-high use of app features; and Keeners (19%) had the highest use of all app features. Regression models showed that teens were more engaged with Aim2Be if their parents were involved and if they participated with their mothers and/or an educated parent. Finally, Keeners significantly improved on most mediators of behavior change and increased their fruit and vegetable intake. The findings suggest that parental engagement supported teen engagement of the Aim2Be app and high engagement was needed to support behavior change among teens. Gaining a greater understanding of the features that appeal to teens is necessary to support behavior change.
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Affiliation(s)
- Yingyi Lin
- Spatial Sciences Institute, Dana and David Dornsife College of Letters, Arts and Sciences, University of Southern California, 3616 Trousdale Parkway, AHF B57A Los Angeles, CA 90089-0374, United States
| | - Louise C. Mâsse
- BC Children’s Hospital Research Institute, School of Population and Public Health, University of British Columbia, Canada
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9
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Soltero EG, O'Connor TM, Thompson D, Shaibi GQ. Opportunities to Address Obesity Disparities Among High-Risk Latino Children and Adolescents. Curr Obes Rep 2021; 10:332-341. [PMID: 34263434 PMCID: PMC9116051 DOI: 10.1007/s13679-021-00445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW This review highlights obesity-related disparities among Latino children and adolescents, discusses the social determinants of health (SDoH) that drive disparities, and presents case studies of strategies for reducing disparities and promoting health equity. RECENT FINDINGS Recommended strategies for reducing obesity-related disparities include the use of culturally grounded programming, multi-sector collaborations, and technology. We present two exemplar studies that demonstrate that integrating cultural values and enhancing the overall cultural fit of prevention programs can increase engagement among high-risk Latino families. We also examine the use of multi-sector collaborations to build community capacity and address key SDoH that impact health behaviors and outcomes. Our last example study demonstrates the utility of technology for engaging youth and extending the reach of prevention strategies in vulnerable communities. To address growing obesity-related disparities, there is an urgent need to develop and test these strategies among high-risk, vulnerable populations like Latino children and adolescents.
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Affiliation(s)
- Erica G Soltero
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA.
| | - Teresia M O'Connor
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Deborah Thompson
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, 1100 Bates Avenue, Houston, TX, 77030, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
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10
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Belghali M, Statsenko Y, Al-Za'abi A. Improving Serious Games to Tackle Childhood Obesity. Front Psychol 2021; 12:657289. [PMID: 34025521 PMCID: PMC8134678 DOI: 10.3389/fpsyg.2021.657289] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/13/2021] [Indexed: 11/13/2022] Open
Abstract
Childhood obesity has become a global public health issue. Today, there are opportunities to promote health through technological devices such as serious games. Despite the major advancement of this field of research, the use of serious games as a validated intervention in clinical practice requires further clarifications on some methodological aspects. In this perspective article, we report the pros and cons of existing serious games. Besides, we attempt to propose a new methodology of design of a serious game that could help to cope with childhood obesity. The proposed idea consists of a serious game in virtual reality based on enjoyment, movement, education, and executive functioning (EF) training. Longitudinal studies and solid research protocol would certainly ensure consistency and aid interpretation.
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Affiliation(s)
- Maroua Belghali
- Department of Health and Physical Education, College of Education, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Yauhen Statsenko
- College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Abdulsalam Al-Za'abi
- Department of Health and Physical Education, College of Education, United Arab Emirates University, Al-Ain, United Arab Emirates
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11
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Chang K, Harbin M, Shuster C, Griesdale DEG, Foster D, Sweet D, Wood MD, Dhingra VK. Adding vitamin C to hydrocortisone lacks benefit in septic shock: a historical cohort study. Can J Anaesth 2020; 67:1798-1805. [PMID: 32939746 PMCID: PMC7493833 DOI: 10.1007/s12630-020-01814-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/20/2020] [Accepted: 09/11/2020] [Indexed: 01/02/2023] Open
Abstract
PURPOSE Sepsis has high incidence and mortality rates, particularly in the intensive care unit (ICU). Corticosteroids may improve outcomes, and vitamin C may add benefit. We aimed to assess whether vitamin C and corticosteroids improved outcomes compared with corticosteroids alone. METHODS This historical cohort study (11 December 2016 to 21 February 2018) was conducted in the ICU of a quaternary referral hospital. Patients with an ICU admission diagnosis of sepsis or septic shock who received vitamin C and hydrocortisone within 72 hr were compared with those who received only hydrocortisone. All patients received standard sepsis care including source control, antibiotics, and fluid resuscitation. Most patients received thiamine as standard ICU care. The primary outcome was hospital mortality. Secondary outcomes included ICU mortality, ventilator-free days, vasopressor-free days, dialysis use, and duration of ICU admission. RESULTS One hundred and forty-four patients were included in the study. The mean (standard deviation [SD]) age was 64 (15) yr; 39% were female; and the mean (SD) Acute Physiology And Chronic Health Evaluation IV score was 89 (30). Eighty-eight patients did not receive vitamin C and 52 received vitamin C. There was no observed difference in hospital mortality between the non-vitamin C (36%) and vitamin C (39%) groups (adjusted odds ratio for hospital death, 0.52; 95% confidence interval, 0.20 to 1.34; P = 0.18). There were no statistically significant differences in any secondary outcomes. CONCLUSION In this small observational study of ICU patients with septic shock, the addition of vitamin C to hydrocortisone therapy did significantly affect hospital mortality or other measures of mortality or organ dysfunction.
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Affiliation(s)
- Kimberley Chang
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Megan Harbin
- Department of Pharmaceutical Sciences, Vancouver General Hospital, and Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Constantin Shuster
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Donald E G Griesdale
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Denise Foster
- Department of Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - David Sweet
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Michael D Wood
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Vinay K Dhingra
- Division of Critical Care Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada.
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12
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Piatkowski C, Faulkner GE, Guhn M, Mâsse LC. User Characteristics and Parenting Practices Associated with Adolescents' Initial Use of a Lifestyle Behavior Modification Intervention. Child Obes 2020; 16:367-378. [PMID: 32598175 DOI: 10.1089/chi.2020.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background and Purpose: E-health interventions can provide Canadian adolescents (13-17 years old) with personalized support to help them modify their obesogenic behaviors. However, use of e-health interventions among adolescents has not been extensively examined. This study examined user characteristics and parenting practices associated with adolescents' initial use of the Aim2Be app; a health behavior modification intervention delivered through a smartphone app. Methods: A total of 371 adolescent-parent dyads completed a baseline assessment and were invited to use the Aim2Be app. Mean adolescent age was 14.9 years and 50.1% were male (n = 186). Mean adult age was 44.1 years and 34.7% were male (n = 129). Using Mplus (v.8), path analyses were completed to identify adolescent characteristics and parenting practices that were significantly associated with initial use of the app. Analyses were then stratified to explore whether these associations were confounded by parents' gender. Results: 79.2% of adolescents (n = 294) initially used the Aim2Be app. Adolescent engagement in healthy behaviors was directly associated with increased odds of using the app (odds ratio [OR] = 1.08; 95% confidence interval [CI] = 1.01-1.14), whereas autonomous motivation was indirectly associated (OR = 1.02; 95% CI = 1.00-1.04). Structure parenting practices were indirectly associated with increased odds of using the app (OR = 1.02; 95% CI = 1.00-1.04). When analyses were stratified by parent's gender, differences in the associations emerged. Conclusions: Both user characteristics and parenting practices were significantly associated with adolescents' initial use of Aim2Be. These findings will help inform future e-health interventions increase user engagement by identifying the characteristics of individuals who are not accessing the intervention, as well as identifying factors of the household environment that support use.
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Affiliation(s)
- Camilla Piatkowski
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy E Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Guhn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Louise C Mâsse
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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