UTILIZING DIGITAL HEALTH APPROACHES TO PROMOTE EARLY CHILDHOOD HEALTHY EATING AND ACTIVITY BEHAVIORS

• Sponsoring Institution: National Institute of Food and Agriculture
• Project Status: ACTIVE
• Funding Source: AFRI COMPETITIVE GRANT
• Reporting Frequency: Annual
• Accession No.: 1024122
• Grant No.: 2021-68015-34557
• Cumulative Award Amt.: $974,836.00
• Proposal No.: 2020-03349
• Project Start Date: Apr 1, 2021
• Project End Date: Mar 31, 2026
• Grant Year: 2021
• Program Code: [A1344]- Diet, Nutrition and the Prevention of Chronic Disease

Recipient Organization
CORNELL UNIVERSITY
(N/A)
ITHACA,NY 14853

Performing Department
Food Science/Human Nutrition

Non Technical Summary
The e-HEROs Study (electronic HEalthy EnviROnments Study) is an integrated Research, Extension, and Education project targeting families of preschoolers via a digital health intervention to promote healthy eating and activity behaviors and environments (and ultimately weight outcomes). Building upon our current HEROs study (delivered face-to-face), the proposed project seeks to provide tested, evidence-based programming to families via a mobile application, allowing for enhanced accessibility and flexibility for participants and the potential for increased scalability. We will engage target audiences throughout the development of the e-HEROs app to assess acceptability, usability, feasibility, and effectiveness. We will target families with limited resources living in rural Colorado, who have the highest risk of obesity and health disparities. In a quasi-experimental controlled design, the adoption and efficacy of the e-HEROs intervention (treatment) will be compared to a delayed intervention group (control) to determine effects on: 1) parent self-efficacy, behavioral capability, and feeding and activity parenting practices; 2) children's eating behaviors; 3) children's physical activity; and 4) the home environment. An online Educational course will be developed and will integrate child development, nutrition, and physical activity topics to complement existing coursework and professional development offerings for students, early childhood educators, health practitioners, and community educators. Extension agents and community stakeholders will be instrumental in the development and dissemination of the e-HEROs intervention and online course. The project's long-term goal is consistent with USDA's goal of improving the nation's nutrition and health by promoting healthy eating and activity behaviors in young children.

Animal Health Component

100%

Research Effort Categories

Basic

(N/A)

Applied

100%

Developmental

(N/A)

Classification

Knowledge Area (KA)	Subject of Investigation (SOI)	Field of Science (FOS)	Percent
703	6020	1010	60%
724	6020	3070	40%

Knowledge Area
703 - Nutrition Education and Behavior; 724 - Healthy Lifestyle;

Subject Of Investigation
6020 - The family and its members;

Field Of Science
3070 - Psychology; 1010 - Nutrition and metabolism;

Keywords

preschool

digital health

health disparities

nutrition

obesity

physical activity

rural

Goals / Objectives
The aim of this study is to use a digital health application (e-HEROs) to transform a tested traditional parent intervention to promote healthy eating and activity behaviors and environments (and ultimately weight outcomes) for young children in the home environment for families living in rural communities. This goal will be accomplished via the 3 functions of Agriculture Knowledge Systems (Research, Extension, and Education) and 4 objectives:Objective 1: To develop and test the feasibility of a digital health intervention with parents of preschoolers, we will utilize a person-based approach to design a digital intervention and conduct a pilot study to assess feasibility. A mobile app will be developed using previously tested content from our current HEROs study in conjunction with stakeholder and end-user input. The intervention will focus on topics of stakeholders' highest demand: healthy eating (picky eating), physical activity (active play), and optimizing the home environment. Each topic will include theory-based multiple modules and application strategies for parents to engage with their child(ren). A pilot study will be conducted to test feasibility, including retention, app usage, usability, and acceptability. Once finalized, a portion of the app will be adapted for Spanish speakers to assess content and usability. This interactive app will help parents support children's adoption of healthy eating and activity behaviors and facilitate improvements in the home food and activity environments. Function: ResearchObjective 2: To implement and evaluate the adoption and efficacy of a digital health program for parents of preschoolers to improve healthy eating behaviors and physical activity patterns in young children, we will conduct a digital health intervention with rural families of limited resources who are at increased risk for childhood obesity. We will also explore whether electronic literacy is associated with the impact/adoption of the intervention target behaviors (picky eating and physical activity). Functions: Research & ExtensionObjective 3: To advance knowledge related to the development of healthy eating behaviors and physical activity patterns in early childhood, we will develop an online course to address knowledge gaps of students, ECE professionals, practitioners (Registered Dietitians, Pediatricians) and educators (Extension, Public Health). This online course will integrate child development, nutrition, and physical activity topics to complement existing coursework and professional development offerings. Functions: Education Objective 4: To reach families throughout Colorado with evidence-based nutrition and activity information, we will partner with state and local stakeholders to disseminate the e-HEROs digital health intervention. Stakeholders will include but are not limited to Head Start and preschool centers, CSU Extension, CACFP, WIC, Family Resource Centers, Early Childhood Councils, Colorado's Early Childhood Obesity Prevention work group, Pediatric Provider Network. Webinars will be conducted with stakeholders to promote the dissemination of both Education (online course) and Extension (digital health intervention) components. Functions: Extension and Education.By utilizing an interactive, digital health approach, we will enhance the flexibility, accessibility, and utility of evidence-based content and best practices addressing healthy eating and activity behaviors within the home environment. Building off previous work, this project aims to expand existing programmatic efforts in Colorado to reach our most vulnerable populations - those with limited resources, of Hispanic ethnicity, and living in rural communities.

Project Methods
Objective 1: To develop and test the feasibility of a digital health intervention with parents of preschoolers, we will utilize a person-based approach to design a digital intervention and conduct a pilot study to assess feasibility.Planning StageInitial planning of the project will entail development of a project plan that: 1) utilizes results from our HEROs study formative evaluation and feasibility study; 2) garners input from advisory committee and stakeholders; and 3) solidifies workplans and project benchmarks between the research team and technology designers.Design StageIntervention Mapping. The HEROs Study utilized Intervention Mappingto guide the development of intervention components and application of Social Cognitive and Ecocultural Theory constructs. We will modify the HEROs intervention map to encompass e-HEROs approaches and nuances of digital health and end-user and stakeholder preferences identified in the planning stage. The e-HEROs app will cover 3 topics - Healthy Eating (with emphasis on picky eating), Physical Activity and the Home Environment. Content will cover goal setting and self-monitoring, self-efficacy, and behavioral capability. We propose an 8-week intervention based on current HEROs content which expands the duration of the intervention by 2 weeks to reduce participant burden.Wireframe development and testing. A digital wireframe, also known as a page schematic or screen blueprint, is a visual guide that represents the skeletal framework of a website or app. A wireframe will be built and input on the wireframes will be gathered via multiple phases of cognitive interviews with end-users (3 phases, n=5/phase). The interview guide will walk users through the wireframe to garner initial reaction to content , usability and user experience, features, functionality. ASpanish version of the wireframe will be tested with less acculturated Spanish-only speaking parents. The Spanish wireframe will inform the overall e-HEROs app with the hopes of developing a Spanish version in a future grant.Development StageContent Development. Currently, the HEROs intervention includes content for 6, 90-minute face-to-face workshops for parents and children. This content will be re-packaged to address and meet end-users' desires for digital features addressed in the wireframe cognitive interviews.Prototype development. The final wireframe will be built into an e-HEROs app prototype. A prototype is a relatively simple working model of an app.Acceptance Testing. The initial prototype of the e-HEROs app will be assessed using an e-Health End-User Walkthrough (EEW).111 During an EEW, a participant is presented with a simple prototype and then an explanation of how the technology works is offered and the participant is questioned about relevant acceptance factorsUsability Testing. A pilot study (n=30) will be conducted to assess usability, feasibility and acceptance of the full prototype and the evaluation measures embedded within the app (self-efficacy and behavioral capability).Objective 2: To implement and evaluate the adoption and efficacy of digital health program for parents of preschoolers to improve young children's healthy eating behaviors and physical activity patterns, we will conduct a digital health intervention with rural families of limited resources who are at increased risk for childhood obesity.Study Design. We will evaluate the adoption and efficacy of the intervention by comparing 2 groups in a quasi-experimental controlled study design: 1) the intervention group will receive e-HEROs mobile app; 2) the control group will receive a delayed intervention. We will compare these 2 groups before and after the intervention programs, using a variety of outcome measures (listed below).Research questions. 1. Do parents participating in the e-HEROs intervention improve their child feeding and activity practices?Hypothesis 1.1: Parents receiving the intervention will improve their self-efficacy and behavioral capability for parenting related to children's healthy eating and activity. (Dependent Measures: Self-Efficacy & Behavioral Capability)Hypothesis 1.2: Parents will demonstrate improved child feeding and activity practices (Dependent Measures: Parent Feeding Inventory & Physical Activity Parenting Practices)2.Can increasing parents' behavioral capability and awareness of the importance of food and physical activity equipment available in the home improve the quality of the physical home environment?Hypothesis 2.1: Parents who receive the e-HEROs intervention will show improvements in the quality of the home food and activity environment. (Dependent Measures: Home IDEA3)3. Does the e-HEROs intervention result in improved child eating behaviors and PA?Hypothesis 3.1: Children whose parents receive the e-HEROs intervention will demonstrate improved eating behaviors compared to children in the control group. (Dependent Measures: Meal Quality & Consumption [Food Photography; Healthy Meal Index score] and Child Dietary Intake and Behaviors [Healthy Kids Survey]).Hypothesis 3.2: Children whose parents receive the e-HEROs intervention will demonstrate higher PA levels compared to children in the control group. (Dependent Measures: Accelerometers)Evaluation measures. The following assessments will be collected pre- and post-intervention:AnthropometricsChild Dietary Intake and BehaviorsMealtime Quality and ConsumptionNeophobiaParent Child-Feeding PracticesObjective Measurement of Physical ActivityPA Parenting PracticesParticipant CharacteristicsHome Food and Activity EnvironmentScreen timee-Health LiteracySelf-efficacyBehavioral CapabilityProcess & Implementation Measures - We willgather information on intervention delivery, receipt, and enactmentStudy outcome data analysis. To answer the 3 main research questions, we will begin with a statistical analysis of the outcomes using basic 2x2 Multivariate Analysis of Variance (MANOVA) techniques with the intervention and the control as the between-groups factor and time (pre- and post-intervention) as the within-groups factor.Objective 3: To advance knowledge related to the development of healthy eating behaviors and physical activity patterns in early childhood, we will develop an online course to address knowledge gaps of students, ECE professionals, practitioners (RDs, Pediatricians, Nurses) and educators (Extension, Public Health).Using a developmental systems perspective, this course will cover developmental stages, feeding outcomes, motor skills and milestones, and social-emotional development from birth to 60 months.Learning objectives will be measurable and will incorporate various levels of Bloom's Taxonomy (Remember, Understand, Apply, Analyze, Evaluate, and Create).146We will also map the course using Quality Matters (QM) principles to ensure alignment between objectives and assessments. We will report on learning outcomes and course engagement via Articulate 360 analytics.Objective 4: To reach families throughout Colorado with evidence-based nutrition and activity information, we will partner with state and local stakeholders to disseminate the e-HEROs digital intervention.Extension agents in the 5 rural clusters will engage with their community partners to recruit, implement, and assist in the assessing the effectiveness of the e-HEROs mobile app (Objective 2). Extension agents are one potential audience for the online Education course (Objective 3) and will be instrumental in promoting the course to other community constituents. Lastly, Extension at both the state and local level will assist with the promotion and dissemination of the e-HEROs apps statewide. We will track outreach and recruitment activities of Extension staff, as well as other community partners and stakeholders and online marketing channels (e.g. social media) to ascertain the most effective modality for recruitment and retention.

Progress 04/01/24 to 03/31/25

Outputs
Target Audience:Participants are parents of preschoolers from Head Start centers or community preschool programs. Changes/Problems:Due to uncertainties and disruptions in collaborative partners (i.e., Head Start) the timeline of the intervention delivery was pushed back. We anticipate the intervention study will be completed this grant year and will seek a second no-cost extension to complete data analysis and reporting. What opportunities for training and professional development has the project provided?Researchers/Students/Post-docs working on this project completed and/or participated in the following opportunities: Human Subjects training Responsible Conduct of Research training Maternal and Child Nutrition seminar series (weekly; fall and spring semester) Bronfenbrenner Center for Translational Research seminar series (monthly, fall and spring semester) Division of Nutritional Sciences, Cornell University, seminar series (biweekly, fall and spring semester) Cornell Center for Health Equity seminar series (2-3 seminars) Research skills: Intervention design (lab meetings); presentation skills (lab meetings); Cornell Statistical Consulting Group (select seminars and individual consultations) American Society of Nutrition Annual Conference, Chicago, IL Society for Nutrition Education and Behavior, Knoxville, TN International Society for Behavioral Nutrition and Physical Activity, Omaha, NE FUSE International Conference, Ithaca, NY Society for Behavioral Medicine, San Francisco, CA How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Objective 1: Intervention development We plan to complete pilot testing in this next year. Objective 3: Online education course We anticipate defining the course details, including primary audience and outlining the course objectives and module topics.

Impacts
What was accomplished under these goals? Objective 1: Intervention development KnowHow mobile app: The final version of the KnowHow app is comprised of 5 modules: Building Healthy Children, Building Healthy Eaters, Building Healthy Movers, Building Healthy Families, and Building Healthy Homes. Modules are focused on the topics of mindful parenting, healthy eating and physical activity. Each module is comprised of 12-15 lessons (67 total), 2 'To-Do' behavioral activities, and 1 goal setting activity. Information is provided in text, audio and/or video formats. Additionally, the app has a 'KidZone' section. The KidZone includes stories, activity cards, musical journeys and game-based apps. The KidZone includes Frankie, a preschooler, as its narrator and the SPORK family, cutlery characters, that excite and lead children through fun adventures encouraging users to try new foods and practice movement skills. App content is based on constructs of the social cognitive theory. Prior to a final app, additional testing was completed for 2 versions of a prototype. Phase 1 prototype was comprised of one complete module and a KidZone module. Testing was conducted with Head Start parents (n=10) with the app loaded on their own device. The prototype confirmed several functionality and usability attributes while identifying areas of improvement (e.g., long loading times) and minor changes to dashboard organization. Further, users expressed positive sensory, cognitive and emotional experiences in using the app. Parents expressed excitement for the KidZone components and articulated several ways they would engage with their children in the materials. At the same time of testing with parents, researchers visited 6 preschool classrooms to test the characters, images and stories. Minor edits were made to images (e.g., the plate at the end still had food left and kids wondered why the character did not finish their dinner). Phase 2 prototype testing includes the full app is being completed by 5 parents over 5 weeks (1 module per week). Surveys at the conclusion of each module and post-test will collect quantitative data on acceptability. Interviews at mid-point and a focus group at the conclusion of testing will provide insights into acceptability, usability and drive any modification that are needed prior to our feasibility pilot test in the Fall. Assessment app: In addition to the KnowHow program app, a KH assessment app was developed for data capture of baseline and post-test assessments. This includes mealtime food photos and movement skill videos. Users are provided with detailed instructions to capture their child's dinner meal via photo, 11 movement skills and to upload the photos/videos. We will test the feasibility of collecting and assessing diet quality and intake as well as motor skill performance. Objective 2: Intervention Testing Protocols, Assessments have been developed and pilot tested for a Fall 2025 launch. Objective 3: Online education course Preliminary research continued to explore platform options for our course (e.g., eCornell, Coursera, etc.).

Publications

• Type: Peer Reviewed Journal Articles Status: Published Year Published: 2025 Citation: Bellows, L.L., Oke, S.*, Reyes, L.I.*, Carmona, B.A.*, Johnson, S.L. (2025). Development of a Digital Parent Intervention to Promote Healthy Eating and Activity in Preschoolers: The eHEROs Study. Journal of Nutrition Education and Behavior, 57(5), 450-459. https://doi.org/10.1016/j.jneb.2025.01.008
• Type: Peer Reviewed Journal Articles Status: Accepted Year Published: 2025 Citation: Reyes, L.I.*, Johnson, S.L., Oke, S.*, Carmona, B.A.*, Bellows, L.L. (In Press). Understanding Parents Digital Use and Preferences for a m-Health Intervention, in Low-Income Rural Settings. Health Education Research. https://doi.org/10.1093/her/cyaf024
• Type: Conference Papers and Presentations Status: Other Year Published: 2025 Citation: 1. Bellows, L. (2024). Tapping into Technology: Using Digital Intervention Strategies in Community-Based Settings. Presented as part of Cornells 50th Anniversary Celebration Seminar at the American Society for Nutrition, Chicago, IL.
• Type: Conference Papers and Presentations Status: Other Year Published: 2024 Citation: Bellows, L. (2024). Milman Fellowship: Examining Health and Wellbeing in the Early Childhood Ecosystem. Bronfenbrenner Center for Translational Research Annual Meeting, Cornell University, Ithaca, NY.
• Type: Conference Papers and Presentations Status: Published Year Published: 2024 Citation: Bellows, L.L., Oke, S., Johnson, S.L. Wireframe Testing to Inform an mHealth Intervention for Parents to Promote Healthy Eating and Activity in Preschoolers. (2024). Journal of Nutrition Education and Behavior, 56(8), S99-S100. Presented at the Society for Nutrition Education and Behavior, Knoxville, TN.
• Type: Conference Papers and Presentations Status: Published Year Published: 2024 Citation: Oke, S., Johnson, S.L., Eisenstat, S., Bellows, L.L. (2024). Using Wireframes to Guide a User-Centered Approach in Digital Intervention Design for Parents of Preschoolers. International Society of Behavioral Nutrition and Physical Activity Annual Conference. Omaha, NE, 2024.
• Type: Conference Papers and Presentations Status: Published Year Published: 2025 Citation: Oke, S., Johnson, S.L., Bellows, L.L. (2025). Development of a User-Centered Framework for Digital Health Interventions. Society for Behavioral Medicine. San Francisco, CA.
• Type: Conference Papers and Presentations Status: Published Year Published: 2025 Citation: Mikami, S., Oke, S.A., Orman, M.C., Spiegel, L., Su, R., Chavez, M., Cheruvu, K., Liang, D., Tecum, B., Johnson, S.L., and Bellows, L.L. (2024). The Know How Program: A Digital Health Intervention for Parents of Preschoolers. Maternal Child Nutrition Poster Symposium, Cornell University, Ithaca, NY.
• Type: Conference Papers and Presentations Status: Published Year Published: 2025 Citation: Oke, S., Mikami, S., Orman, M., Liang, D., Johnson, S.L., Bellows, L.L. (2024) Applying a User-Centered Approach to Develop a Mobile App for Parents of Preschoolers. Maternal Child Nutrition Poster Symposium, Cornell University, Ithaca, NY.
• Type: Conference Papers and Presentations Status: Published Year Published: 2025 Citation: Spiegel, L., Mikami, S., Oke, S., Johnson, S.L., Bellows, L.L. (2025). Digital Assessment of Preschoolers Diet and Activity via Parent Mobile App. Bronfenbrenner Center for Translational Research Symposium. Cornell University, Ithaca, NY.
• Type: Conference Papers and Presentations Status: Published Year Published: 2025 Citation: Oke, S., Johnson, S.L., Liang, D., Bellows, L.L. (2025). Development of the KnowHow KidZone: A Child-Oriented Component of a Parenting App to Promote Healthy Eating and Physical Activity in Preschoolers. Bronfenbrenner Center for Translational Research Symposium. Cornell University, Ithaca, NY.
• Type: Conference Papers and Presentations Status: Published Year Published: 2025 Citation: Su, R., Orman, M., Bellows, L.L. (2025). Digital Discussions on Mindful Parenting: Enhancing Social Support for Families of Preschool-Aged Children. Bronfenbrenner Center for Translational Research Symposium. Cornell University, Ithaca, NY.
• Type: Conference Papers and Presentations Status: Published Year Published: 2025 Citation: Liang, D., Cheruvu, K., Tecum, B., Chavez, B., Orman, M., Mikami, S., Oke, S., Bellows, L.L. (2025). Digital Integrations in Mobile Health Interventions. Bronfenbrenner Center for Translational Research Symposium. Cornell University, Ithaca, NY.

Progress 04/01/23 to 03/31/24

Outputs
Target Audience:Participants have been parents of preschoolers from Head Start centers or community preschool programs as well as past study participants. Changes/Problems:Due to COVID and the PD moving institutions, the timeline of the project is delayed. We will seek a no-cost extension. What opportunities for training and professional development has the project provided?Researchers/Students/Post-docs working on this project completed and/or participated in the following opportunities: Human Subjects training Responsible Conduct of Research training Maternal and Child Nutrition seminar series (weekly; fall and spring semester) Bronfenbrenner Center for Translational Research seminar series (monthly, fall and spring semester) Division of Nutritional Sciences, Cornell University, seminar series (biweekly, fall and spring semester) Cornell Center for Health Equity seminar series (2-3 seminars) Research skills: Intervention design (lab meetings); presentation skills (lab meetings); Cornell Statistical Consulting Group (select seminars and individual consultations) American Society of Nutrition Annual Conference, Boston, MA Society for Nutrition Education and Behavior, Washington, DC International Society for Behavioral Nutrition and Physical Activity, Upsala, Sweden How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Objective 1: Intervention development We plan to complete the app and begin prototype and pilot testing in this next. Objective 3: Online education course We anticipate defining the course details, including primary audience, and outlining the course objectives and module topics.

Impacts
What was accomplished under these goals? Objective 1: Intervention development This grant year was largely spent on app development. Specifically, multiple phases to test mobile app schematics (wireframes) was conducted with parents of preschoolers. Software developers and the research team partnered to develop 2 phases of wireframes and testing protocols (using Google Ventures Scripts). Phase 1 consisted of 33 app screens and Phase 2, 37 screens and both phases included 15 semi-structured interview questions to test using user-centered design constructs of functionality (navigation, interaction, ease of use), usability (information structure, instructional comprehension), and user experience (sensory, cognitive, emotional experiences). Virtual testing sessions, via Zoom, were conducted and comprised of observations of user interactions with the wireframe, user think-aloud techniques, and interview questions. Ten sessions (n=5/phase; 51-73 minutes) were conducted with 8 participants. Participants in both phases had positive experiences with functionality: interactions with various features (e.g., audio/video buttons, checklists, text boxes, photo uploads, and dashboards) were intuitive and acceptable; ease of use in moving through the app was high and "almost common sense". Usability items showcased that more complex features, including behavior change activities (i.e., goal setting), were not as intuitive and more attention was needed to contextualize these activities. Phase 2 added complexity to the wireframe and tested the user experience construct, revealing that for positive sensory and cognitive experiences, participants desired color and graphics, simplicity in design and function, text in small chunks, and content delivered in multiple formats (i.e., text, audio, video). A positive emotional experience was tied to an acknowledgement of participants' progress (i.e., progress bar, affirmations, and congratulatory phrases). Insights from the 2 phases of wireframe testing are being incorporated into app development. In addition to finalizing app features and a development plan, the software developers and research team worked collaboratively to develop an app editor for content upload and management. Additionally, content specific work was conducted, including intervention mapping and graphic design of app and supporting materials. A study protocol was finalized for pilot testing. Objective 3: Online education course Preliminary research continued to explore platform options for our course (e.g., eCornell, Coursera, etc.).

Publications

• Type: Conference Papers and Presentations Status: Published Year Published: 2023 Citation: Bellows, L., Reyes, L., Oke, S., Carmona, B., Brown, R., Johnson, S.L. Design and Development of an mHealth Intervention for Parents to Promote Healthy Eating and Activity in Preschoolers. Journal of Nutrition Education and Behavior, 55(7), S70. Presented at the Society for Nutrition Education and Behavior Annual Meeting, Washington, DC.
• Type: Conference Papers and Presentations Status: Published Year Published: 2023 Citation: Oke, S., Reyes, L.I., Carmona, B.A., Brown, R.C., Johnson, S.L., Bellows, L.L. Parent Preferences for a Digital Healthy Eating and Physical Activity Intervention. Current Developments in Nutrition 7(S1), 100378. Presented at the American Society of Nutritions Annual Meeting, Boston, MA. https://doi.org/10.1016/j.cdnut.2023.100378
• Type: Conference Papers and Presentations Status: Published Year Published: 2023 Citation: Reyes, L.I., Carmona, B.A., Oke, S., Johnson, S.L., Bellows, L.L. Examining Mobile Device Use, Appeal for a Digital Program, and Digital Literacy Among Parents of Preschoolers for Intervention Design. Current Developments in Nutrition 7(S1), 100390. Presented at the American Society of Nutritions Annual Meeting, Boston, MA. https://doi.org/10.1016/j.cdnut.2023.100390
• Type: Conference Papers and Presentations Status: Other Year Published: 2024 Citation: Oke, S., Johnson, S.L., Bellows, L.L. Feasibility and Acceptability of Parents Collecting Dietary and Feeding Behaviors of Preschoolers on a Digital Platform. Presented at the University of Buffalo, Center for Ingestive Behavior.
• Type: Conference Papers and Presentations Status: Other Year Published: 2024 Citation: Bellows, L. and Oke, S. Digitizing Health Interventions: Considerations and Strategies to Engage Community Audiences. Seminar presented at the Bronfenbrenner Center for Translational Research, Cornell University, Ithaca, NY.
• Type: Other Status: Other Year Published: 2024 Citation: Bellows, L., Reyes, L.I., Oke, S., Chamberlin, B., Johnson, S.L. Engaging Preschoolers in Food Tasting and Movement Activities Using Mobile Applications. Society for Nutrition Education and Behavior, Webinar, 2024.
• Type: Conference Papers and Presentations Status: Accepted Year Published: 2024 Citation: Oke, S., Reyes, L.I., Carmona, B., Eisenstat, S., Johnson, S.L., Bellows, L.L. User-Centered Approaches to Engage Parents in the Design of a Digital Health Intervention. 6th International Fuse Conference. Ithaca, NY, 2024.

Progress 04/01/22 to 03/31/23

Outputs
Target Audience:Our target audience included Head Start grantees, specifically directors and coordinators, who were interested in partnering with us on this project. Approximately, 20 Head Start grantees were contacted and10 submitted a letter of support to collaborate(5 in Colorado and 5 in New York). Mothers of preschoolers with limited resources. completed surveys and interviews. Changes/Problems: Nothing Reported What opportunities for training and professional development has the project provided?Students/Post-docs working on this project completed and/or participated in the following opportunities: Human Subjects training Responsible Conduct of Research training Maternal and Child Nutrition seminar series (weekly; fall and spring semester) Bronfenbrenner Center for Translational Research seminar series (monthly, fall and spring semester) Cornell Center for Health Equity seminar series (2-3 seminars) Research skills: Dietary assessment (lab meeting presentations); Writing Scientifically (readings and lab exercises), Cornell Statistical Consulting Group (select seminars and individual consultations) Society for Behavioral Medicine Annual Conference, Baltimore, MD How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Objective 1: Intervention development We plan to complete our formative research (survey and interviews), including data analysis and dissemination (publication and a report to Head Start centers). This will guide our mobile app development, including intervention mapping/content development, wireframe testing and protocol development. We will continue to build and nurture our relationships with community-based partners, Head Start centers and Extension personnel. Objective 3: Online education course We anticipate a platform will be chosen for the online course and we will work towards defining the primary audience and outlining the course objectives and module topics.

Impacts
What was accomplished under these goals? Objective 1: Intervention development Accomplishments related to this objective included planning with research partners for formative research with our priority population - mothers of preschoolers with limited resources. Formative research: A mixed methods protocol was developed for a needs assessment to assess digital devise usage amongst our priority population. IRB approval was obtained. Subsequently, 10 Head Start centers were recruited (5 in Colorado and 5 in New York) to deliver surveys to families. A survey (33 items) was completed in English or Spanish via Qualtrics by 116 respondents with 16 of those completing a semi-structed, virtual (Zoom) interview (12 questions with probes). Data are being analyzed for mobile device use, appeal for a digital program, and digital literacy. Findings informed the development of interactive wireframe illustrations. App Development: Initial conversations with our software developer about project scope, input on needs assessment topics/questions, and digital features took place. We worked with a graphic designer on initial brand concepts. Collectively, these concepts (digital features and project brand) were integrated into the formative research efforts, specifically interview questions. Objective 3: Online education course Preliminary research was conducted to explore platform options for our course (e.g., eCornell, Coursera, etc.)

Publications

• Type: Journal Articles Status: Published Year Published: 2022 Citation: Bellows, L.L., Lou, Y., Nelson, R., Reyes, L.I., Brown, R.M., Mena, N.Z., Boles, R.E. (2022). A Narrative Review of Dietary Assessment Tools for Preschool-Aged Children in the Home Environment. Nutrients, 14 (22), 4793. https://doi.org/10.3390/nu14224793

Progress 04/01/21 to 03/31/22

Outputs
Target Audience:Our target audience for this reporting period included Head Start grantees, specifically directors and coordinators, who were interested in partnering with us on this project. Approximately, 20 Head Start grantees were contacted and11 submitted a letter of support to collaborate(5 in Colorado and 6 in New York (NY)). Changes/Problems:The PD changed academic institutions just prior to the start of this project. Some stakeholders and partners outlined in the initiation report may differ as this embraces the opportunity to include NY partners in addition to those CO entities described in the grant. Additionally, progress was slower than anticipated as a result of the PD transition and COVID's impact on Head Start centers (e.g., staffing shortages, added responsibilities, low parent participation). What opportunities for training and professional development has the project provided?Students working on this project completed and/or participated in the following opportunities: Human Subjects training Responsible Conduct of Research training Maternal and Child Nutrition seminar series (weekly; fall and spring semester) Bronfenbrenner Center for Translational Research seminar series (monthly, fall and spring semester) Cornell Center for Health Equity seminar series (2-3 seminars) Research skills: Cornell librarian for systematic reviews (lab meeting presentation and individual consultations); Cornell Statistical Consulting Group (select seminars and individual consultations) How have the results been disseminated to communities of interest? Nothing Reported What do you plan to do during the next reporting period to accomplish the goals?Objective 1: Intervention development We plan to complete our formative research (survey and interviews), including data analysis and dissemination (publication and a report to Head Start centers). This will guide our mobile app development, including content development/repackaging, wireframe testing and protocol development. We will continue to build and nurture our relationships with community-based partners, Head Start centers and Extension personnel. Objective 3: Online education course We anticipate a platform will be chosen for the online course and we will work towards defining the primary audience and outlining the course objectives and module topics.

Impacts
What was accomplished under these goals? Objective 1: Intervention development Accomplishments related to this objective included planning with research partners for formative research with our priority population - mothers of preschoolers with limited resources. Formative research: A mixed methods protocol was developed for a needs assessment to assess digital devise usage amongst our priority population. A survey in both English and Spanish was developed for online dissemination as well as semi-structured interview guide. IRB approval was obtained. Subsequently, 11 Head Start centers were recruited (5 in Colorado and 6 in New York) to deliver surveys to families. App Development: Initial conversations with our software developer about project scope, input on needs assessment topics/questions, and digital features took place. We worked with a graphic designer on initial brand concepts. Collectively, these concepts (digital features and project brand) were integrated into the formative research efforts, specifically interview questions. Objective 3: Online education course Preliminary research was conducted to explore platform options for our course (e.g., eCornell, Coursera, etc.)

Publications