Competency-Based Approaches to Community Health: A Randomized Controlled Trial to Reduce Childhood Obesity among Latino Preschool-Aged Children

Heerman, William J.; Teeters, Leah; Sommer, Evan C.; Burgess, Laura E.; Escarfuller, Juan; Wyk, Chelsea Van; Barkin, Shari L.; Duhon, Ashley A; Cole, Jesse; Samuels, Lauren R.; Singer‐Gabella, Marcy

doi:10.1089/chi.2019.0064

Cited by 12 publications

(21 citation statements)

References 40 publications

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“…Competency Based Approaches to Community Health (COACH) is a personalized behavioral intervention to prevent and treat childhood obesity among 3-5 year-old Hispanic/Latino children. In a recently completed randomized controlled trial of 117 Latino parent-child pairs, the COACH intervention achieved the primary outcome of reducing linear BMI growth in intervention participants compared to control participants [19]. By conducting focus groups among the parents of children who participated in both the intervention and control groups, we aimed to understand their perceptions of the following: 1) what changes in healthy behavior did families make in response to the intervention; 2) what were common barriers to healthy behavior change and what strategies did families learn to overcome those barriers; and 3) what components of the intervention were most effective in facilitating adoption of new behavior change strategies .…”

Section: Introductionmentioning

confidence: 99%

Qualitative analysis of COACH: A community-based behavioral intervention to reduce obesity health disparities within a marginalized community

Heerman

Cole

Teeters

et al. 2019

Contemporary Clinical Trials Communications

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BackgroundThe purpose of this study was to conduct a qualitative evaluation of a behavioral intervention to prevent and treat childhood obesity in minority children. Using qualitative methods to augment understanding of intervention success may be one way to gain insight into the types of behavior change strategies that are most effective in childhood obesity interventions.MethodsCOACH was a randomized controlled trial of 117 Latino parent-child (ages 3–5) pairs in Nashville, TN that resulted in improved child BMI in intervention vs. control families at 1-year follow-up. All participant parents were invited to focus groups after the trial. Discussions were audiotaped, transcribed, and translated into English. A hierarchical coding scheme was generated, and qualitative analysis done using an inductive/deductive approach. Both theme saturation and consensus between the coders were achieved. Responses were compared between intervention and control groups.ResultsWe conducted seven focus groups with 43 participants. 4 themes emerged from the intervention group: 1) perceived barriers to health behavior change; 2) strategies learned to overcome perceived barriers; 3) behavioral changes made in response to the program; and 4) knowledge, skills, and agency for family health behaviors. 4 themes emerged from the control group: 1) a desire to engage in health behaviors without specific strategies; 2) common set of barriers to health behavior change; 3) engagement in literacy activities, including creative problem-solving strategies; and 4) changes made in response to study visits. Analysis of coded data showed the intervention increased healthy behaviors (e.g., fruit/vegetable consumption) despite barriers (e.g., time, cost, culture, family dynamics). Intervention participants described using specific behavior change strategies promoted by the intervention including: substituting ingredients in culturally-normative recipes; avoiding grocery shopping when hungry; and coping with inability to meet goals with acceptance and problem-solving. Control participants reported little success in achieving healthy changes for their family. Intervention participants described successful health behavior changes that were shared across generations and were maintained after the program. Intervention participants reported increased awareness of their own agency in promoting their health.ConclusionsQualitative evaluation of COACH provides a more detailed understanding of the intervention's quantitative effectiveness: child and adult health behaviors and personal agency were improved.

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Section: Introductionmentioning

confidence: 99%

Qualitative analysis of COACH: A community-based behavioral intervention to reduce obesity health disparities within a marginalized community

Heerman

Cole

Teeters

et al. 2019

Contemporary Clinical Trials Communications

Self Cite

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“…One plausible explanation could be high variability in growth parameters shown between aged 0–2 years, and inter‐individual variations in weight gain rate may become less from 2 years onwards 33,34 . Two interventions in the United States observed significant decreases in BMI 35 and a slower linear BMI growth 36 among their study children. Both studies included children from 2 years onwards.…”

Section: Discussionmentioning

confidence: 99%

Effects of telephone support or short message service on body mass index, eating and screen time behaviours of children age 2 years: A 3‐arm randomized controlled trial

Wen

Taki

et al. 2021

Pediatric Obesity

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Summary Background Few randomized controlled trial (RCT) interventions targeted children's early risk behaviours using telephone or short message service (SMS) support. Objective To evaluate the effectiveness of telephone or SMS early intervention focusing on mothers' behaviours starting from late pregnancy to improve BMI, and eating and screen time behaviours of children aged 2 years in comparison with the control group. Methods A 3‐arm RCT was conducted in Australia, 2017–2019. Two arms involved the interventions using nurse‐led telephone or SMS support, delivered in nine stages from late pregnancy to age 2 years. The third arm was control. The primary outcome was children's objectively measured BMI and BMI z‐score at 2 years. Secondary outcomes included child eating and screen time behaviours as reported by parents at 2 years. Results At 2 years, 797 mother–child dyads (69%) completed the telephone survey with 666 (58%) completing weight and height measurements. The study found no statistically significant difference in BMI between the groups. The mean BMI for telephone support was 16.93 (95% CI: 16.73 to 17.13), for SMS 16.92 (95% CI: 16.73 to 17.11) or for control 16.95 (95% CI: 16.73 to 17.16) with a difference of −0.02 (95% CI: −0.31 to 0.27, p = 0.907) in telephone versus control, and a difference of −0.03 (95% CI: −0.30 to 0.24, p = 0.816) in SMS versus control. Telephone support was associated with higher odds of no bottle at bedtime (adjusted odds ratio [AOR]: 2.99; 95% CI: 2.01 to 4.47), family meals (AOR: 2.05; 95% CI: 1.26 to 3.33), drinking from a cup (AOR: 1.89; 95% CI: 1.24 to 2.88), less screen time (<1 h/day) (AOR: 1.56; 95% CI: 1.10 to 2.23) and not eating dinner in front of the TV (AOR: 1.50; 95% CI: 1.09 to 2.06). SMS support was also associated with higher odds of no bottle at bedtime (AOR 2.30, 95% CI: 1.58 to 3.33) than the control. Conclusion The telephone or SMS support intervention had no significant effects on BMI, but was effective in increasing no bottle use at bedtime. Telephone support showed more effects than SMS on reducing screen time and eating behaviours.

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“…This study used data from the Competency-Based Approaches to Community Health (COACH) randomized controlled trial to prevent and treat childhood obesity and additional diet data collected on a subset of participants immediately following the one-year intervention. Full details of the original study design, intervention description, and results have been previously reported [ 13 , 14 ]. Though this report does not present the findings from the clinical trial, it was registered on clinicaltrials.gov prior to participant enrollment (NCT03141151).…”

Section: Methodsmentioning

confidence: 99%

Validation of a new scoring approach of a child dietary questionnaire for use in early childhood among low-income, Latino populations

et al. 2022

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Background Measuring diet quality in early childhood requires time-intensive and costly measurements (e.g., 24-hour diet recall) that are especially burdensome for low-income, minority populations. This study aimed to validate a new method for calculating overall diet quality among low-income, Latino preschoolers. Methods This study was an observational study using data from a randomized controlled trial. Participants included parents of Latino preschoolers who reported child diet quality at baseline, 4-month, 7-month, 12-month, and 13-month follow-up. At each timepoint parents responded to a 28-item child dietary questionnaire (CDQ), based on the National Health and Nutrition Examination Survey (NHANES) dietary module, which generated the number of times/day that a child ate each of 28 foods in the past month. These 28 items were then used to create a total standardized child diet quality index (possible range 0-100), using a percent of maximum method. Parents were asked to complete three 24-hour diet recalls at the 13-month follow-up, from which the 2015 Healthy Eating Index (HEI) was derived. Construct validity was evaluated by Spearman’s rank correlations between the new child diet quality index and the 2015 HEI at the 13-month follow-up. Test-retest reliability was assessed by intraclass correlation coefficients (ICC) for sequential pairs of time points. Results Among 71 eligible parent-child pairs, mean child age was 4.2 (SD = 0.8) years, 50.7% of children were female, and mean child body mass index (BMI) was 17.8 (SD = 2.0) kg/m2. Mean Child Diet Quality Index was 45.2 (SD = 3.2) and mean HEI was 68.4 (SD = 10.5). Child Diet Quality Index and HEI total scores were significantly correlated (r = 0.37; p = 0.001). Test-retest ICCs were statistically significant between all sequential pairs of time points. Conclusion The new approach for calculating a measure of overall diet quality from the previously-validated 28-item dietary questionnaire demonstrated modest construct validity. When time and resources are limited, this new measure of overall diet quality may be an appropriate choice among low-income, Latino preschoolers. Trial Registration This reports presents observational data collected as a part of a clinical trial, which was registered on clinicaltrials.gov prior to participant enrollment (NCT03141151).

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Competency-Based Approaches to Community Health: A Randomized Controlled Trial to Reduce Childhood Obesity among Latino Preschool-Aged Children

Cited by 12 publications

References 40 publications

Qualitative analysis of COACH: A community-based behavioral intervention to reduce obesity health disparities within a marginalized community

Qualitative analysis of COACH: A community-based behavioral intervention to reduce obesity health disparities within a marginalized community

Effects of telephone support or short message service on body mass index, eating and screen time behaviours of children age 2 years: A 3‐arm randomized controlled trial

Validation of a new scoring approach of a child dietary questionnaire for use in early childhood among low-income, Latino populations

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