Balancing Theory with Engagement: the Development of a Paediatric Weight Management App Targeting Parents for Local Public Health Services
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Abstract
Background: The majority of childhood obesity interventions have been delivered within school settings and had limited success. Mobile applications represent a new approach to delivering childhood weight management interventions but recent research reported that 61% of paediatric weight management apps on the market contain no recommended evidence based strategies & techniques and few apps targeted parents despite extensive research identifying parents as the largest influence on children’s weight related behaviours.
Objective: To develop a theory driven & evidenced based mobile app to support parents in childhood weight management
Methods: ‘The Behaviour Change Wheel: A Guide to Designing Interventions’, a theoretically-based approach for intervention design along with a user centred design (UCD) approach informed the development process. Theoretically-based tools, The COM-B model and Theoretical Domains Framework, were applied to understand the target behaviour (helping parents to provide appropriate portion sizes across the 5 food groups) using focus groups with case workers, parents with overweight children and consultation with experts in childhood weight-management. The focus groups were audio-recorded and transcribed to facilitate the thematic analysis & coding of data using the COM-B model. The Behaviour Change Wheel tool was used to select appropriate intervention functions (e.g. education, persuasion) which guided the selection of evidenced behaviour change techniques drawn from a review of the literature. Finally, consultation with the digital media company along with UCD sessions with parents further helped refine key features of the App with regards to engagement and acceptability.
Results: The findings revealed barriers to parent’s providing appropriate portion sizes for their children in all three COM-B domains: Capability (lack of knowledge of appropriate portion sizes & skills of measuring portions) ,Opportunity (partners & Grandparents influences on portions, resources to measure portions) and Motivation (parents low self-efficacy, fear of eating disorders, lack of recognition of the problem, beliefs about health-behaviour link). Based upon this behavioural analysis, the BCW tool selected four intervention functions: Education, Training, Persuasion, Environmental restructuring and enablement which mapped onto 14 evidence based BCTs (e.g. goal setting, identification as a role model). Finally, consultation with the digital media company helped to identify a new layer of techniques: ‘Engagement Techniques’ (EngTs). These refer specifically to techniques employed to motivate the user to (1) Download the app; (2) Engage with the intervention; and (3) Re-engage with the intervention over a sustained period of time
Conclusion: This case study highlights the need to balance theoretical elements of an intervention with engagement elements within the context of a digital environment which is of importance both in terms of practice and novel research. This work represents the first attempt to develop a theory led & UCD paediatric weight management app targeting parents for local public health family weight management services. Future research will involve conducting a full RCT to evaluate its effectiveness for childhood weight management.
Objective: To develop a theory driven & evidenced based mobile app to support parents in childhood weight management
Methods: ‘The Behaviour Change Wheel: A Guide to Designing Interventions’, a theoretically-based approach for intervention design along with a user centred design (UCD) approach informed the development process. Theoretically-based tools, The COM-B model and Theoretical Domains Framework, were applied to understand the target behaviour (helping parents to provide appropriate portion sizes across the 5 food groups) using focus groups with case workers, parents with overweight children and consultation with experts in childhood weight-management. The focus groups were audio-recorded and transcribed to facilitate the thematic analysis & coding of data using the COM-B model. The Behaviour Change Wheel tool was used to select appropriate intervention functions (e.g. education, persuasion) which guided the selection of evidenced behaviour change techniques drawn from a review of the literature. Finally, consultation with the digital media company along with UCD sessions with parents further helped refine key features of the App with regards to engagement and acceptability.
Results: The findings revealed barriers to parent’s providing appropriate portion sizes for their children in all three COM-B domains: Capability (lack of knowledge of appropriate portion sizes & skills of measuring portions) ,Opportunity (partners & Grandparents influences on portions, resources to measure portions) and Motivation (parents low self-efficacy, fear of eating disorders, lack of recognition of the problem, beliefs about health-behaviour link). Based upon this behavioural analysis, the BCW tool selected four intervention functions: Education, Training, Persuasion, Environmental restructuring and enablement which mapped onto 14 evidence based BCTs (e.g. goal setting, identification as a role model). Finally, consultation with the digital media company helped to identify a new layer of techniques: ‘Engagement Techniques’ (EngTs). These refer specifically to techniques employed to motivate the user to (1) Download the app; (2) Engage with the intervention; and (3) Re-engage with the intervention over a sustained period of time
Conclusion: This case study highlights the need to balance theoretical elements of an intervention with engagement elements within the context of a digital environment which is of importance both in terms of practice and novel research. This work represents the first attempt to develop a theory led & UCD paediatric weight management app targeting parents for local public health family weight management services. Future research will involve conducting a full RCT to evaluate its effectiveness for childhood weight management.
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