Identify Effective Intervention Components to Prevent Obesity: A Factorial Design

Jiying Ling, MS, PhD, RN   

Principal Investigator: Jiying Ling, MS, PhD, RN; Assistant Professor, College of Nursing, Michigan State University (MSU)

Co-Investigators Nicole Wieber, MSN, APRN, CPNP, Sparrow Hospital Gastroenterology Clinic Lorraine B. Robbins, PhD, RN, FAAN, Associate Professor, Michigan State University, College of Nursing Mildred Horodynski, PhD, RN, FAAN, Professor, Michigan State University, College of Nursing Mi Zhang, PhD; Assistant Professor, Michigan State University, College of Engineering

Statistician Nanhua Zhang, PhD; Assistant Professor, University of Cincinnati, Department of Pediatrics

Consultants  Kenneth Resnicow, PhD, Professor, University of Michigan, School of Public Health Margaret Grey, DrPH, RN, FAAN, Annie Goodrich Professor, Yale University, School of Nursing

The prevalence of overweight/obesity (OW/OB) in Head Start children is 1.5 times the rate of U.S. children aged 2-5 years. Few interventions, however, have targeted preschoolers from low-socioeconomic (SES) backgrounds, resulting in continuing OW/OB SES disparities. Although parents are recommended “agents of change,” involving parents in intensive face-to-face programs is costly and time-consuming, and low attendance is a problem. Studies in school-age children show that parent-child interventions are superior to child-only interventions but not superior to parent-only interventions on child’s anthropometric indicators. No similar evidence was identified for preschoolers. To address this gap, the proposed factorial trial will examine the feasibility and preliminary main and combined effects of 2 intervention components (parent and child) on children’s healthy behaviors (dietary intake and physical activity; primary outcomes), waist circumference, and BMI z-score among Head Start children aged 3-5 years.

Four urban Head Start centers will be randomly assigned to 4 experimental conditions: parent-only, child-only, parent-child, and control; and 20 parent-child dyads will be recruited from each center (N=80 dyads). Grounded in the social cognitive theory, the parent component targets parents via: 1) a Facebook-based program providing information, family fun activities, and behavior change strategies/tips, promoting peer support, and stimulating peer comparison for behavioral change; and 2) three face-to-face, teacher-parent meetings (weeks 1, 5 & 10) to establish a communication network among participants, offer resources, and discuss strategies to support children’s healthy behavioral change at home. The child component includes: 1) improving child healthy behavioral patterns via weekly healthy eating and physical activity education and hands-on experiences at Head Start centers; and 2) promoting parent-child interaction through weekly child letter sent to parents privately via Facebook messenger to share child’s perceptions of healthy eating and physical activity at school and requiring parents to actively respond to child letter.

The three aims are to: 1) examine intervention feasibility, acceptability and satisfaction; 2) examine preliminary main and combined effects of the 2 intervention components on children’s dietary intake, physical activity, waist circumference, and BMI z-score; and 3) explore if parents change along with their children on BMI, dietary intake, physical activity, knowledge, self-efficacy, and parental support. This study is innovative because it: 1) uses a factorial design to identify the effective intervention components for preschoolers; 2) integrates intervention into parents and children’s daily routines to improve sustainability; 3) connects parents who have a child in the same center via Facebook private group to support each other in improving their child’s healthy behaviors at home; 4) applies a bidirectional framework that emphasizes both the influence of parents on children and of children on parents to facilitate parent-child communication via a child letter to parents; and 5) uses an innovative training method to assist teachers to gradually adopt their role as interventionists through modeling, coaching, and practice. This intervention component selection study is important to set the stage for a future, larger-scale study using the Multiphase Optimization Strategy (MOST). Results from this pilot study will support a future R15 (PA-16-200) application submitted in June 2017.

Press Release