Barriers and facilitators to parents' engagement with and perceived impact of a childhood obesity app: A mixed-methods study.

Childhood obesity is a growing global health concern. Although mobile health apps have the potential to deliver behavioural interventions, their impact is commonly limited by a lack of sufficient engagement. The purpose of this study was to explore barriers and facilitators to engagement with a family-focused app and its perceived impact on motivation, self-efficacy, and behaviour. Parents with at least one child under 18 and healthcare professionals working with children were recruited; all participants were allocated to use the NoObesity app over a 6-month period. The mixed-methods design was based on the Non-adoption, Abandonment, Scale-Up, Spread, and Sustainability and Reach, Effectiveness, Adoption, Implementation, and Maintenance frameworks. Qualitative and quantitative data were gathered through semi-structured interviews, questionnaires, and app use data (logins and in-app self-reported data). 35 parents were included in the final analysis; quantitative results were analysed descriptively and thematic analysis was conducted on the qualitative data. Key barriers to engagement were boredom, forgetting, and usability issues and key barriers to potential impact on behaviours were accessibility, lack of motivation, and family characteristics. Novelty, gamification features, reminders, goal setting, progress monitoring and feedback, and suggestions for healthy foods and activities were key facilitators to engagement with the app and behaviours. A key observation was that intervention strategies could help address many motivation and capability barriers, but there was a gap in strategies addressing opportunity barriers. Without incorporating strategies that successfully mitigate barriers in all three determinants of behaviour, an intervention is unlikely to be successful. We highlight key recommendations for developers to consider when designing the features and implementation of digital health interventions. Trial Registration: ClinicalTrials.gov (NCT05261555).

Real-World Evaluation of the Feasibility, Acceptability and Safety of a Remote, Self-Management Parkinson's Disease Care Pathway: A Healthcare Improvement Initiative.

BACKGROUND: There is significant unmet need for effective and efficiently delivered care for people with Parkinson's disease (PwP). We undertook a service improvement initiative to co-develop and implement a new care pathway, Home Based Care (HBC), based on supported self-management, remote monitoring and the ability to trigger a healthcare contact when needed. OBJECTIVE: To evaluate feasibility, acceptability and safety of Home Based Care. METHODS: We evaluated data from the first 100 patients on HBC for 6 months. Patient monitoring, performed at baseline and 6-monthly, comprised motor (MDS-UPDRS II and accelerometer), non-motor (NMSQ, PDSS-2, HADS) and quality of life (PDQ) measures. Care quality was audited against Parkinson's UK national audit standards. Process measures captured feasibility. Acceptability was assessed using a mixed-methods approach comprising questionnaires and semi-structured interviews. RESULTS: Between October 2019 and January 2021, 108 PwP were enrolled onto HBC, with data from 100 being available at 6 months. Over 90% of all questionnaires were returned, 97% were complete or had < 3 missing items. Reporting and communications occurred within agreed timeframes. Compared with baseline, after 6m on HBC, PD symptoms were stable; more PwP felt listened to (90% vs. 79%) and able to seek help (79% vs. 68%). HBC met 93% of national audit criteria. Key themes from the interviews included autonomy and empowerment. CONCLUSIONS: We have demonstrated acceptability, feasibility and safety of our novel remotely delivered Parkinson's care pathway. Ensuring scalability will widen its reach and realize its benefits for underserved communities, enabling formal comparisons with standard care and cost-effectiveness evaluation.

High response rate and low cost of WeChat-based data collection of infant and young child feeding data in rural Qinghai Province, China.

Background: Measuring the infant and young child feeding (IYCF) indicators is key to effectively tracking the progress of child health programs and making evidence-based decisions. WeChat is the most popular mobile social media platform in China and has become a promising tool for collecting health data. This study aims to explore the response rate and costs of a WeChat-based questionnaire on IYCF information in rural China. Methods: We conducted two cross-sectional surveys with caregivers of children aged 6-23 months in two rural counties in Qinghai Province (Menyuan and Datong County), China, from January to March 2022. Both surveys used the same WeChat IYCF questionnaire to collect household information, infant feeding practices, and caregivers' feeding knowledge. Village doctors sent a quick response (QR) code to caregivers that was linked to the WeChat IYCF questionnaire. Participating caregivers scanned the QR code using their own WeChat account on their smartphone and filled in the questionnaire online. If they could not use WeChat themselves, village doctors administered the questionnaire. Once caregivers finished the questionnaires, they received a personalized report with infant feeding recommendations. Results: We recruited 1274 caregivers of children aged 6-23 months in Menyuan County and 1748 caregivers in Datong County. The total response rate in the two counties was 98.2%; 77.6% of questionnaires were self-administered by caregivers and 20.6% were interviewer-administered by village doctors. The questionnaires were filled in twice by 209 (6.9%) caregivers. The cost of these two WeChat IYCF surveys was much lower than the cost of a previously conducted face-to-face survey: 11.8 yuan (US$1.85) in Menyuan County and 7.5 yuan (US$1.18) in Datong County for the WeChat survey vs 112.7 yuan (US$17.70) for the face-to-face survey in Huzhu County. Conclusions: This study showed that using WeChat for IYCF surveys can achieve a very high response rate at a low cost in rural China. Village doctors played a very important role in achieving this high response rate. Providing feedback to caregivers may improve their feeding practices and this intervention could be incorporated into the data collection process.

Internet of things-Enabled technologies as an intervention for childhood obesity: A systematic review.

Childhood obesity is one of the most serious public health challenges of the 21st century, with consequences lasting into adulthood. Internet of Things (IoT)-enabled devices have been studied and deployed for monitoring and tracking diet and physical activity of children and adolescents as well as a means of providing remote, ongoing support to children and their families. This review aimed to identify and understand current advances in the feasibility, system designs, and effectiveness of IoT-enabled devices to support weight management in children. We searched Medline, PubMed, Web of Science, Scopus, ProQuest Central and the IEEE Xplore Digital Library for studies published after 2010 using a combination of keywords and subject headings related to health activity tracking, weight management, youth and Internet of Things. The screening process and risk of bias assessment were conducted in accordance with a previously published protocol. Quantitative analysis was conducted for IoT-architecture related findings and qualitative analysis was conducted for effectiveness-related measures. Twenty-three full studies are included in this systematic review. The most used devices were smartphone/mobile apps (78.3%) and physical activity data (65.2%) from accelerometers (56.5%) were the most commonly tracked data. Only one study embarked on machine learning and deep learning methods in the service layer. Adherence to IoT-based approaches was low but game-based IoT solutions have shown better effectiveness and could play a pivotal role in childhood obesity interventions. Researcher-reported effectiveness measures vary greatly amongst studies, highlighting the importance for improved development and use of standardised digital health evaluation frameworks.

Feasibility of using WeChat to improve infant and young child feeding in rural areas in China: A mixed quantitative and qualitative study.

BACKGROUND: Appropriate infant and young child feeding practices are the basis for child nutrition. In China, WeChat is gradually changing the channels through which people receive information. The paper aims to explore the feasibility of using WeChat to improve infant and young child feeding in rural China. METHODS: A mixed-methods study was carried out in Huzhu County, Qinghai province, China. We conducted two cross-sectional surveys with children aged 6-23 months and their caregivers in 2012 (N = 1804) and 2018 (N = 754), respectively. Quantitative data were collected on feeding knowledge and practices, caregiver's use of smartphones and WeChat. Qualitative data were from 33 semi-structured interviews with pregnant women and mothers. In addition, we developed a WeChat feeding health education platform and asked women about their experiences with using it. RESULTS: In both cross-sectional surveys, less than 10% of caregivers knew that breastfeeding can be continued up to two years, less than 50% knew the accurate duration of exclusive breastfeeding, and only around 20% knew meat can be given to children from the age of 6-8 months. Similarly, the feeding practices were suboptimal and most key infant feeding practices did not change over the years. Only around 30% of caregivers ever received feeding information during pregnancy or after delivery in both surveys. Around 50% of caregivers received information from their relatives and friends, followed by 30% from health facilities and communities. More than 80% of mothers were currently using both a smartphone and the WeChat app, and 75.4% of them were willing to receive feeding information from WeChat official accounts. The WeChat feeding health education platform developed by our study team was generally well accepted by women. CONCLUSIONS: There was an absence of accurate information sources on infant feeding and child nutrition. WeChat could be a potential way to deliver infant feeding recommendations to pregnant women and mothers in rural China. TRIAL REGISTRATION: ChiCTR-PRC-11001446 (The controlled intervention trial for complementary food supplements "Yingyangbao"); ChiCTR1800017364 (the randomized controlled trial for WeChat).

Monitoring and evaluating the adherence to a complementary food supplement (Ying Yang Bao) among young children in rural Qinghai, China: a mixed methods evaluation study.

BACKGROUND: Large investments are currently made in community-based complementary food supplement (Ying Yang Bao, YYB) programs to improve nutrition of young children in rural areas in China. However, there is a lack of knowledge about the experience and challenges of implementing YYB programs in China. We aimed to: 1) monitor distribution of YYB; 2) assess children's adherence to and acceptability of YYB; and 3) evaluate community-based strategies to improve the program. METHODS: This mixed methods evaluation study combined data from surveys and focus groups that took place during a controlled interventional evaluation trial. The trial aimed to evaluate the effectiveness of community-based YYB distribution on improving children's health status in rural areas in China. We conducted five cross-sectional surveys with caregivers of children aged 6-23 months (baseline survey (N = 1804) in August 2012 and four follow-up cross-sectional surveys: 1) N = 494 in January 2013; 2) N = 2187 in August 2013; 3) N = 504 in January 2014; and 4) N = 2186 in August 2014) in one rural county in Qinghai Province. We used a two-stage cluster sampling technique to select mothers with eligible children for each survey. Information was collected from caregivers on household characteristics, YYB consumption and acceptability in the surveys. High adherence in each survey was defined as children who consumed at least four YYB sachets during the previous week. A logistic regression model was developed to obtain odds ratios (OR) with 95% confidence intervals of factors associated with high adherence. Also, we conducted 10 focus groups with73 caregivers and health workers involved in the YYB distribution. Content analysis was used to explore qualitative findings, which were used to gain deeper insight into the quantitative results. RESULTS: Around 90% of caregivers had ever received YYB and more than 80% of children ever took YYB. Caregivers mainly knew about YYB through their village doctors. High adherence to YYB increased from 49.4% in the first follow-up survey (January 2013) to 81.4% in the last follow-up survey (August 2014; P < 0.0001). Repeated training sessions with village doctors could increase adherence. However, due to unplanned YYB stock-out, caregivers did not receive YYB for six months, which may have led to a decrease of high adherence from 64.1% in the second follow-up survey (August 2013) to 53.6% in the third follow-up survey (January 2014; P < 0.0001). Self-reported acceptability increased from 43.2% to 71.8%, partly due to improving the taste of YYB, which was the main reason that children disliked taking YYB. Unfortunately, more than 60% of caregivers did not perceive positive health improvement in their children after taking YYB. Multivariate analysis showed that children with diarrhea (OR = 1.216, 95% CI 1.025-1.442), cough or fever (OR = 1.222, 95% CI 1.072-1.393) during the past two weeks had significantly lower adherence. CONCLUSIONS: This evaluation study showed that program monitoring in rural West China was critically important for understanding program implementation and adherence trends. This led to strategic changes to the intervention over time: improving the taste of YYB; strengthening health education of village doctors and caregivers; and ensuring continuity of YYB supply. Future programs need to monitor program implementation in other settings in China and elsewhere.

mHealth Series: Text messaging data collection of infant and young child feeding practice in rural China - a feasibility study.

BACKGROUND: Face-to-face interviews by trained field workers are commonly used in household surveys. However, this data collection method is labor-intensive, time-consuming, expensive, prone to interviewer and recall bias and not easily scalable to increase sample representativeness. OBJECTIVE: To explore the feasibility of using text messaging to collect information on infant and young child feeding practice in rural China. METHODS: Our study was part of a clustered randomized controlled trial that recruited 591 mothers of children aged 12 to 29 months in rural China. We used the test-retest method: first we collected data through face-to-face interviews and then through text messages. We asked the same five questions on standard infant and young child feeding indicators for both methods and asked caregivers how they fed their children yesterday. We assessed the response rate of the text messaging method and compared data agreement of the two methods. FINDING: In the text messaging survey, the response rate for the first question and the completion rate were 56.5% and 48.7%, respectively. Data agreement between the two methods was excellent for whether the baby was breastfed yesterday (question 1) (kappa, κ = 0.81), moderate for the times of drinking infant formula, fresh milk or yoghurt yesterday (question 2) (intraclass correlation coefficient, ICC = 0.46) and whether iron fortified food or iron supplement was consumed (question 3) (κ = 0.44), and poor for 24-hour dietary recall (question 4) (ICC = 0.13) and times of eating solid and semi-solid food yesterday (question 5) (ICC = 0.06). There was no significant difference in data agreement between the two surveys at different time intervals. For infant and young child feeding indicators from both surveys, continued breastfeeding at 1 year (P = 1.000), continued breastfeeding at 2 years (P = 0.688) and minimum meal frequency (P = 0.056) were not significantly different, whereas minimum dietary diversity, minimum accepted diet and consumption of iron-rich or iron fortified foods were significantly different (P < 0.001). CONCLUSIONS: The response rate for our text messaging survey was moderate compared to response rate of other studies using text messaging method and the data agreement between the two methods varied for different survey questions and infant and young child feeding indicators. Future research is needed to increase the response rate and improve data validity of text messaging data collection.