Feasibility of standardized methods to specify behavioral pediatric obesity prevention interventions

Abstract

Background Standardized methods are needed to evaluate what occurs within the ‘black box’ of behavioral interventions to prevent pediatric obesity. The purpose of this research is to evaluate methods to specify the behavior change techniques used and the amount of time spent discussing target weight-related behaviors in an intervention for parents of children at risk for becoming overweight or obese. Methods Independent coders were trained to identify behavior change techniques and time spent discussing weight-related behaviors in audio recordings and transcripts of intervention sessions from 100 randomly selected participants. The Behavior Change Technique Taxonomy (BCTTv1) was used to code techniques present in sessions. A newly-developed tool was used to code time spent discussing each target weight-related behavior (e.g., physical activity, screen time). Sessions from a subset of these participants (N=20) were double coded to evaluate inter-rater reliability. Results After revisions to coding protocols, coders reliably coded behavior change techniques used and time spent discussing target weight-related behaviors in sessions from the subset of 20 participants. The most commonly discussed target weight-related behavior was physical activity followed by energy intake and fruit and vegetable intake. On average, 13.9 (SD=2.8) unique behavior change techniques were present across sessions for a given participant. Conclusions These results offer reliable methods for systematically identifying behavior change techniques used and time spent discussing weight-related behaviors in a pediatric obesity prevention intervention. This work paves the way for future research to identify which specific target behaviors and techniques are most associated with the prevention of unhealthy weight gain in children.

The Family Check-Up 4 Health (FCU4Health): Applying Implementation Science Frameworks to the Process of Adapting an Evidence-Based Parenting Program for Prevention of Pediatric Obesity and Excess Weight Gain in Primary Care

“…Because the FCU4Health is individually tailored to the needs of each child and family, we further specify whether a given technique is universal (received by all families in the program) or applied selectively based on needs identified in the family health behaviors assessment. We present the 23 techniques Jaka et al ( 27 ) found to be reported at least once in their evaluation of intervention protocols, manuscripts, and workbooks, indicating salience for childhood obesity programs whereas the remaining 70 techniques are unlikely to be relevant. Further, given that FCU4Health is a family-based intervention, certain behavior change techniques are taught to caregivers to then use with the child.…”

“…There is also a description of the activities (listed in the Method section) that were used in making the described adaptations. Finally, we use the JaKa et al ( 27 ) taxonomy to specify the behavior change techniques used in FCU4Health as a means of providing a standardized comparison to similar programs.…”

“…JaKa et al ( 27 ) developed a standardized protocol to specify the type and amount of behavior change techniques used in behavioral interventions for pediatric obesity. They drew from the original 93 techniques in the Behavior change Taxonomy ( 87 ).…”

“…Third, we provide a comparison of the behavior change techniques used and their levels of emphasis and application between the original FCU and the new FCU4Health program. We used the techniques that JaKa et al ( 27 ) identified as most common in EBP protocols of behavioral interventions for pediatric obesity. Specification of techniques in this manner helps to open the “black box” of how these interventions work and allows for comparison with the active ingredients of other, similar programs.…”

“…Activities with stakeholders comprised formal and informal meetings, a pilot study at a partner agency, establishing and regularly convening a community advisory board (CAB), and conducting a multisite randomized trial (currently ongoing) called the Raising Healthy Children study 1 ( 26 ). Last, we apply a recent standardized taxonomy for specifying the behavior change techniques used in behavioral interventions for pediatric obesity ( 27 ) to the resulting adapted and enhanced version of the FCU, which we call the Family Check-Up 4 Health (FCU4Health), and contrast that with the original program components. This step is important in demonstrating that FCU4Health aligns with the characteristics of other EPBs for the prevention of pediatric obesity and excess weight gain.…”