Padres Preparados, Jóvenes Saludables: Parent and Youth Nutrition mHealth App
Childhood obesity is a growing public health concern that can have lifelong consequences such as increased risk for chronic disease and cancer, and poorer quality of life (Freedman et al., 2005; Schwimmer, 2003; Sun et al., 2008). National childhood obesity rates are alarming high (18.5%), with even higher rates (25.8%) for Latino children.(Hales, Carroll, Fryar, & Ogden, 2017; Ogden, Carroll, Kit, & Flegal, 2014) Studies show that family-based, culturally adapted programs are most successful in Latino populations. (Bender & Clark, 2011; Institute of Medicine (US) Committee on Health and Behavior: Research, Practice, and Policy, 2001) Unfortunately, the few such programs that exist primarily work with mothers. Fathers face substantial participation challenges in these family-skills programs due to inflexible and unpredictable work schedules and transportation problems.
To address childhood obesity prevention among Latinos, researchers from the Universities of Minnesota and Maryland created a community-based father-focused childhood obesity prevention program titled Padres Preparados, Jóvenes Saludables (PPJS). Because Latino fathers are usually considered the head of the household with primary responsibility for leadership and major decisions, researchers determined that incorporating fathers was vital to a successful program implementation for obesity prevention.
The PPJS program was developed using the principles of community-based participatory research and relied on social cognitive theory, modeling, reasoning and teaching, home availability and accessibility, and social support. The formative stage engaged a father advisory board, focus groups, and community steering committee. The final intervention based on an existing program(Allen et al., 2017) included in-person 8-session program (2.5 hours each) focused on improving diet and physical activity levels by strengthening parenting practices. The pilot PPJS program implementation targeted Latino fathers (n = 26) and their adolescent children. Preliminary data analysis from the longitudinal on-going efficacy trail (n=103) suggests improvements in father’s health expectations and modelling behaviors, parent’s healthy food intake, child food (fruit) intake, among others. However, many fathers are unable to complete the 8 sessions.
Based on feedback from participating fathers after the pilot program, researchers determined there was a need for innovation to increase participant engagement and remove participation barriers, such as scheduling conflicts and transportation challenges. Since a recent study revealed Latinos were more likely to own and use mobile device , the team decided to develop a “blended-approach” which allows participants to participate both in-person and virtually through a mobile app. Blended learning has been used in school education and has been found to be helpful in clinical training for nurses, showing promise as a nutrition education approach.(McCutcheon, O’Halloran, & Lohan, 2018; Schuster, 2013) This approach uses a mobile app together with in-person experience to increase fathers’ overall program engagement and comprehension by providing a convenient and engaging delivery of the curriculum. Fathers are able to benefit from interaction with fellow participants and participate in hands-on activities in-person but do not need to commit to weekly sessions. The PPJS blended approach offers four in-person sessions and three virtual sessions though either the mobile app or accompanying website.
To minimize development costs, the team used WordPress, an open-source General Public License (GPL) software as the supporting framework for the app. With off-the-shelf plugins, we quickly built both iOS and Android apps for phone and tablet viewports. The app was customized to be user-friendly and culturally acceptable. Short videos and audio clips of the salient points outlined in the PPJS in-person curriculum were developed to prevent literacy barriers for the fathers. Special care was given to reduce the overall word count of the app, so the fathers could engage without much encumbrance.
To increase user engagement, bi-directional text messaging was incorporated so participants would receive three text messages weekly with encouraging and educational information. Each session includes three evaluation questions to ensure participants are completing the sessions and encourages participants to set weekly goals. The app also provides a resource library that includes local food shelters for participants that need access to food. The login process was simplified by using the participants’ cell phone numbers or emails allowing for the fathers to gain access to the app without needing an email address. Furthermore, because some members of the family may not have access to a mobile phone or tablet, we created a website where participants could access the curriculum online by visiting https://padressaludables.com/. The first app prototype was developed and approved by the Google Play and iTunes stores and is available for free download by searching for “Padres Preparados, Jóvenes Saludables.” Usability testing is currently underway, and we are gathering feedback from participants, community-based organizations, and other researchers. This feedback will inform current and future development modifications for successive iterations and adaptations of the app. We are currently piloting this “blended approach” to Latino study participants (n = 44) through a community-based organization in Minnesota, and Extension EFNEP program in Baltimore City.
The blended approach will make interventions more accessible and reduce high rates of drop out from participants’ inability to attend in-person sessions. The open-source app development approach allows affordable adaptation for different populations and/or health topics, with significant potential for scaling future mHealth interventions.
Our team is currently seeking funding to explore new ways to virtually connect adolescents with their parents using the app. Parent engagement with adolescents is one of the highlights of the in-person experience for fathers and we seek to learn how to make these parent-child engagements meaningful in a blended learning context. This is a nascent field of inquiry and so there does not appear to be much literature discussing mHealth apps and parent-child interactions. Having more funding to research this area has the potential of being adapted for other intervention contexts.
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