Recruitment and retention of mothers of preschoolers and school-aged children in a social media-delivered healthy eating intervention: lessons learned from a randomized controlled trial

BACKGROUND

Social media represent cost-effective platforms to advance the dissemination and uptake of health research to improve population health. However, there is limited evidence available to support researchers overcome methodological challenges related to recruitment and retention of participants in studies using social media for delivering behavior change interventions. This study aims to describe the recruitment and the retention strategies used in a randomized controlled trial (RCT) that evaluated a blog-delivered healthy eating intervention among mothers of preschoolers and school-aged children.

METHODS

Eighty-four adult mothers of children aged between two and 12 years old living in Quebec City, Quebec, Canada, were recruited between October 2015 and February 2017 using traditional methods (e.g. institutional email lists, flyers, newspapers, and word of mouth) and Facebook advertisements. Retention rates were calculated at the end of the 6-month intervention and at a 12-month follow-up assessment. Sociodemographic characteristics, Internet use behaviors and retention rates of mothers recruited through traditional methods and Facebook were compared using Wilcoxon-Mann-Whitney tests and Fisher exact tests.

RESULTS

Of the 196 mothers who responded to the recruitment call, 87 (44.4%) were eligible and 84 (42.9%) were randomized to the trial, representing a recruitment success of 76.4% (84/110) from the planned sample size target. Among those, a minority (3.6%) were recruited using Facebook. Those mothers presented similar sociodemographic characteristics to those recruited using traditional methods. Retention rates were 73.8% and 66.7% at 6 and 12 months, respectively, with similar rates between mothers recruited using Facebook and traditional methods. Various challenges associated with population retention were highlighted with lack of time being mothers' main reason for withdrawing from the study.

CONCLUSIONS

The methodological challenges experienced during the conduct of the blog-delivered healthy eating intervention allowed to draw upon several lessons regarding the recruitment process and the retention of mothers of preschoolers and school-aged children to inform future social media-delivered research. Recommendations for future research include exploring mothers' perceptions and preferences to tailor social media recruitment, ensure that interventions are delivered to them using social media platforms that are already integrated into their routine, and are providing remote outcome assessments to increase participant retention.

TRIAL REGISTRATION

Clinical Trial Protocol NCT03156803 . Registered on 17 May 2017, retrospectively registered.

The home food environment and associations with dietary intake among adolescents presenting for a lifestyle modification intervention

BACKGROUND

The home food environment may be an important target for addressing adolescent obesity. The aim of this study was to investigate associations between aspects of the home food environment and the diets of adolescents who present for obesity treatment.

METHODS

Cross-sectional baseline data were collected from 167 overweight/obese adolescent-parent pairs participating in an e-health lifestyle modification intervention. Adolescent intake of specific foods (fruit and vegetables, total fat, sugar-sweetened beverages, desserts/treats, and snacking occasions) was assessed by three 24-h dietary recalls, while household factors were collected from adolescent and parent questionnaires. Structural Equation Modeling, controlling for relevant covariates, was used to examine the relationship between adolescent diet and the following household factors: parent modeling, parenting style, family meal practices, and home food/beverage availability.

RESULTS

Findings reveal that few characteristics of the home food environment were associated with adolescent dietary intake. Greater home availability of high-fat foods was moderately associated with adolescent snack intake (β = 0.27, p < .001). Associations with fruit/vegetables and fat intake were small and some were in unexpected directions. Parent modeling of healthful food choices and healthier family meal practices were associated with lower availability of high-fat foods and treats in the home, but were not directly associated with adolescent diets.

CONCLUSIONS

Parent modeling of healthy foods and positive mealtime routines might contribute to the healthfulness of foods offered in the homes of adolescents who are overweight/obese. Additional research is needed to better characterize the complex aspects of the household environment that influence adolescent diet.

Healthcare providers' gestational weight gain counselling practises and the influence of knowledge and attitudes: a cross-sectional mixed methods study

OBJECTIVE

To understand current gestational weight gain (GWG) counselling practices of healthcare providers, and the relationships between practices, knowledge and attitudes.

DESIGN

Concurrent mixed methods with data integration: cross-sectional survey and semistructured interviews.

PARTICIPANTS

Prenatal healthcare providers in Canada: general practitioners, obstetricians, midwives, nurse practitioners and registered nurses in primary care settings.

RESULTS

Typically, GWG information was provided early in pregnancy, but not discussed again unless there was a concern. Few routinely provided women with individualised GWG advice (21%), rate of GWG (16%) or discussed the risks of inappropriate GWG to mother and baby (20% and 19%). More routinely discussed physical activity (46%) and food requirements (28%); midwives did these two activities more frequently than all other disciplines (P<0.001). Midwives interviewed noted a focus on overall wellness instead of weight, and had longer appointment times which allowed them to provide more in-depth counselling. Regression results identified that the higher priority level that healthcare providers place on GWG, the more likely they were to report providing GWG advice and discussing risks of GWG outside recommendations (β=0.71, P<0.001) and discussing physical activity and food requirements (β=0.341, P<0.001). Interview data linked the priority level of GWG to length of appointments, financial compensation methods for healthcare providers and the midwifery versus medical model of care.

CONCLUSIONS

Interventions for healthcare providers to enhance GWG counselling practices should consider the range of factors that influence the priority level healthcare providers place on GWG counselling.