Recipient Organization
NORTH CAROLINA A&T STATE UNIV
1601 EAST MARKET STREET
GREENSBORO,NC 27411
Performing Department
Family and Consumer Sciences
Non Technical Summary
Childhood obesity continues to be a major public health concern in the United States, affecting 1 in 5 school-age children and youth ages 6 to 19 years old. If an adolescent is overweight or obese, there is a 70% chance that he or she will remain overweight or obese as an adult, which may lead to a higher risk of developing chronic diseases, such as type 2 diabetes, heart disease, certain cancers, and asthma. Unfortunately, childhood obesity and its consequences have a higher impact on children who live in rural regions. Therefore, evidence and theory have suggested including parents/caregivers as change agents can be pivotal to childhood obesity prevention efforts. Due to the alarming prevalence and impacts of childhood obesity, there is a large body of literature documenting the efficacy of family-based childhood obesity (FBCO) interventions. Parents play an influential role in the prevention of childhood obesity due to their knowledge of familial needs, motivations, and resources for behavioral change. They also understand their family dynamics and ecological factors that influence their daily living. Engaging parents in childhood obesity efforts can lead to better integration of parents' socio-cultural context as well as lead to improvements in program acceptability, cultural relevance, and program participation (Jurkowski, Mills, Lawson, Bovenzi, Quartimon & Davison, 2012). Two approaches to engaging rural families in programming efforts is through Community Based Participatory Research (CBPR) and interactive technology. CBPR is an approach to research that actively and equitably involves community members in the research process that builds on the strengths and resources of communities by promoting co-learning and trust building.The proposed study plans to provide families with the knowledge and support to improve lifestyle risk factors that have direct relevance to childhood obesity, through a technology-based intervention, Family Connections. Families will be provided with the knowledge to make choices about selecting nutritious food and living healthy lifestyles that will potentially reduce their risk of developing chronic diseases related to obesity. This research will also aid in understanding the unique role family relationships have on childhood obesity outcomes since parents will be the primary delivery agents of the program.
Animal Health Component
100%
Research Effort Categories
Basic
(N/A)
Applied
100%
Developmental
(N/A)
Goals / Objectives
Using a Community Based Participatory Research approach, we will enhance our existing community-based partnerships in Halifax, County to a Community Taskforce guided by the PRECEDE-PROCEED Model. The PRECEDE-PROCEED Model is a planning and evaluation model that incorporates the ideas of the community in the process of conceiving, planning, implementing, and evaluating a community intervention (Crosby & Noar, 2011; Green & Kreuter, 1999). This model is divided into eight phases, starting with the social assessment (Phase 1), epidemiological assessment (Phase 2), educational and ecological assessment (Phase 3), administrative assessment and intervention alignment (Phase 4) implementation (Phase 5), process evaluation (Phase 6), impact evaluation (Phase 7), and outcome evaluation (Phase 8). The PRECEDE-PROCEDE model will be the most effective complementary framework to our proposal because it enhances program effectiveness and sustainability since it is structured as a participatory model that incorporates the voice of the community (Gielen, McDonald, Gary, & Bone, 2008; Green & Kreuter, 1999). This model will provide us with more accurate information about the issues surrounding childhood obesity, and how to effectively implement Family Connections. The primary focus of this Taskforce will be to aid in the recruitment and planning of Family Connections. Since committed community leaders and organizations in the region are ready to take action to address childhood obesity, this provides the research team with an opportune time to leverage research and community expertise to move forward towards the 'action-oriented health intervention phases' to test Family Connections.Family ConnectionsFamily Connections was developed using an integrated research-practice partnership to develop an evidence-based program that would be practical and attractive to families and would match resource availability for sustained delivery (Estabrooks et al., 2009; Zoellner et al., 2019). Family Connections was based on the work of Golan and associates because the model: (1) stressed a health-centered, rather than weight centric, approach; (2) demonstrated short and long-term effectiveness in reducing child BMI z-scores; (3) demonstrated effectiveness in improving parental health, and; (4) demonstrated that effectiveness in reducing child eating disorder symptoms. Family Connections also has a strong focus on the parental cognitive and behavior change, home environment change, and parental modeling of healthy behaviors (Golan et al., 2006; Estabrooks et al., 2009; Zoellner et al., 2019). This 6-month program consists of a workbook, two group sessions, and ten automated Interactive Voice Response (IVR) telephone calls. These calls will be tailored to individual family participants for a span of 6-months. The Family Connections evidence-based program does not require broadband internet to be effective. These calls can be completed on a landline. The calls will be completed with high frequency initially and then scaled back over time (Month 1-1call /week; Month 3 to 4- 1 call/two weeks; Month 5 to 6-1 call/month) (Golan et al., 2006; Zoellner et al., 2019). Therefore, we will work with existing partners using a mix methods approach to examine the proposed aims:Specific Aim 1: Recruitment and Planning: Utilizing community-based approaches to engage new and existing partners in Halifax County to build a Community Taskforce to aid in the recruitment and planning of Family Connections in Halifax County.a. Research Question: Utilizing community-based approaches, will the development and implementation of Community Taskforce aid in the recruitment and planning of Family Connections in Halifax County?Specific Aim 2: Intervention Testing: Pilot test Family Connections in families (n=30) in Halifax County. We will accomplish this aim by, using Phases 4-8 of the PRECEDE-PROCEED Model to implement Family Connections in two cohorts (Cohort 1, n=15 families and Cohort 2, n=15 families) to determine the potential reach (i.e., the proportion of the target population and representativeness), effectiveness (i.e., changes in child BMI z-scores over 6 months), and feasibility (i.e., the degree to which the intervention can be adopted and implemented as intended) of the program in Halifax County.b. Research Question: Utilizing Phases 4-8 of the PRECEDE-PROCEED Model, will implementing Family Connections in two cohorts to reach the target population, improve child BMI z-scores, and be a feasible program for Halifax County? The primary aims of this application are to develop a Community Taskforce to aid in the recruitment, planning, and effectiveness of Family Connections in Halifax County. This mixed approach to research will assess child BMI-z scores as the primary quantitative measure of program success. Qualitative milestones will be assessed through interviews and focus groups with the community taskforce and program participants. Formative evaluation will consist of one-on-one semi-structured qualitative interviews that will take place at the end of Year 1, Year 2, and Year 3 with the community taskforce to ensure.
Project Methods
The primary aims of this application are to develop a Community Taskforce to aid in the recruitment and planning of Family Connections in Halifax County. Partnership formation and maintenance is a fundamental component when engaging in recruitment and retaining community members in programming efforts. The results generated from this project will be used for future studies executed within the Halifax Region to successfully evaluate the effectiveness of implementing Family Connections. Through our partnership with First Baptist Church, we will recruit additional community representatives (n=7) to participate in our Community Taskforce. Recruitment efforts will be through the local cooperative extension agency, faith-based organizations, other affiliated youth-based organizations in the community, as well as civic organizations i.e., Masonic lodge, sororities, and fraternities.Specific Aim 1: Recruitment and PlanningA variety of techniques to build trust and recruit Community Taskforce members will be implemented at the start of the project. During the first six months, the goal is to recruit at least seven community representatives to patriciate in our Taskforce with our existing partners. In the initial phase of recruitment, formal letters will be sent to community representatives identified by our community partners at First Baptist Church. In the letter, we will explain the purpose of our Community Taskforce and how Family Connections may be an effective tool for improving childhood obesity in the community. Following the letters, we will schedule a special meeting for potential taskforce members to provide them with more information on their role as program recruitment agents and how Family Connections can be a cost-effective tool for their community. Once community members have been recruited, the taskforce will develop a structure for meeting organization and decision making. We anticipate bi-monthly meetings at the start of year one. Following this step, the process planning framework used to guide this task force will be the PRECEDE-PROCEED model. Before planning for Family Connections, the Community Taskforce will collaboratively engage in developing and executing the Taskforce Evaluation Plan, which will include identifying agenda items throughout this proposed supplement. The Evaluation Plan will assess how the task force collaborates and shares power throughout the proposal. During the development of the Taskforce Evaluation Plan, the Community Taskforce will reflect and prioritize capacity and group dynamic dimensions that are most important to evaluate over time and define partnership success. In turn, this information will guide the development of the mixed-methods evaluation and critical reflection data points. We anticipate using a mixed-methods evaluation that will include brief quantitative ratings and critical reflections following Community Taskforce meetings every 6 months. Additionally, one-on-one semi-structured qualitative interviews will take place at the end of Year 1, Year 2, and Year 3. These meetings will be critical reflection points that will be guided by Israel and colleagues' Perceived Control Scale Items: Multiple Levels of Empowerment Indices. Also, throughout this process, the Community Taskforce will continue to discuss and develop action steps to promote Community Taskforce sustainability and develop future goals of the Community Taskforce. Since phases 1-3 have been successfully executed by our current partnership, we will begin with Phase 4 of the model. We will utilize the next 6 months in Phase 4 to identify the best practices and other sources of guidance for intervention design, as well as administrative, regulation, and policy issues within the community that can influence the program intervention. To execute this phase, we will work with our taskforce to develop a recruitment plan for families and build upon community resources that will be essential to the implementation of the Family Connections.Specific Aim 2: Intervention TestingThe secondary aim is to evaluate the implementation of Family Connections in Halifax County. This will take place in year 2 of our proposal. During the first 6 months, we will recruit (n=30) families to participate in both cohorts of Family Connections. Recruitment strategies will be identified by the Community Taskforce. We expect recruitment strategies will include but will not be limited to; faith-based institutions, the Halifax County Health Department, local schools, social media, and other best-suited recruitment strategies identified by the Community Taskforce. Participants must be residents of Halifax County, and be categorized by the following: 1) families with children between the ages 7-14 years old who have BMI z-score in the 85th percentile or higher (overweight or obese). Those expressing an interest will be scheduled for an appointment at First Baptist Church. After arriving, parents will be given further information about the project timeline, in addition to details about the study. They will then be asked to complete a demographic questionnaire including phone number(s), street and mailing addresses, email address(es), ages of household members, and a BMI screening to ensure children have BMI z-score in the 85th percentile range or higher. Parents will also complete a consent form and their child(ren) will sign assent forms. Families will be randomly assigned to cohort 1 or cohort 2 of Family Connections. Cohort 1 will take place in the last 6 months of year 2 and cohort two will begin in the first 6 months of year 3. Families (n=15) will be recruited for cohort 1 of Family Connections and families (n = 15) will be recruited in the cohort 2 of Family Connections. To encourage families to participate, we will give each family a monetary incentive for their time and participation. Also, we will be providing bi-monthly check-in calls to families participating in phase 2 of the Family Connections, since their participation will begin 6 months after our initial meeting. Since Family Connections showed a significant reduction in child BMI z-scores throughout the program in children ages 8-12, we would like to expand our target age range to 7-14 years of age. As a result, we will implement the program twice (end of year 2 and beginning of year 3). Cohort1 will provide the taskforce with information on how to enhance program quality for cohort 2 families. Following intervention implementation, the last 6 months of year 3 will include evaluation, data analysis, and reporting, which includes Phases 6,7, and 8 of the PRECEDE-PROCEED Model.