title: Working With Parents to Prevent Childhood Obesity: Protocol for a Primary Care-Based eHealth Study.
abstract: BACKGROUND
  Parents play a central role in preventing childhood obesity. There is a need for innovative, scalable, and evidence-based interventions designed to enhance parents' motivation to support and sustain healthy lifestyle behaviors in their children, which can facilitate obesity prevention.
  
  
  OBJECTIVE
  (1) Develop an online screening, brief intervention, and referral to treatment (SBIRT) eHealth tool to enhance parents' concern for, and motivation to, support children's healthy lifestyle behaviors, (2) refine the SBIRT eHealth tool by assessing end-user acceptability, satisfaction, and usability through focus groups, and (3) determine feasibility and preliminary effectiveness of the refined SBIRT eHealth tool through a randomized controlled trial.
  
  
  METHODS
  This is a three-phase, multi-method study that includes SBIRT eHealth tool development (Phase I), refinement (Phase II), and testing (Phase III). Phase I: Theoretical underpinnings of the SBIRT tool, entitled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), will be informed by concepts applied within existing interventions, and content will be based on literature regarding healthy lifestyle behaviors in children. The SBIRT platform will be developed in partnership between our research team and a third-party intervention development company. Phase II: Focus groups with parents, as well as health care professionals, researchers, and trainees in pediatrics (n=30), will explore intervention-related perceptions and preferences. Qualitative data from the focus groups will inform refinements to the aesthetics, content, structure, and function of the SBIRT. Phase III: Parents (n=200) of children-boys and girls, 5 to 17 years old-will be recruited from a primary care pediatric clinic while they await their children's clinical appointment. Parents will be randomly assigned to one of five groups-four intervention groups and one control group-as they complete the SBIRT. The randomization function is built into the tool. Parents will complete the eHealth SBIRT using a tablet that will be connected to the Internet. Subsequently, parents will be contacted via email at 1-month follow-up to assess (1) change in concern for, and motivation to, support children's dietary and physical activity behaviors (primary outcome), and (2) use of online resources and referrals to health services for obesity prevention (secondary outcome).
  
  
  RESULTS
  This research was successfully funded and received ethics approval. Development of the SBIRT started in summer 2012, and we expect all study-related activities to be completed by fall 2016.
  
  
  CONCLUSIONS
  The proposed research is timely and applies a novel, technology-based application designed to enhance parents concern for, and motivation to, support children's healthy lifestyle behaviors and encourage use of online resources and community services for childhood obesity prevention. Overall, this research builds on a foundation of evidence supporting the application of SBIRTs to encourage or "nudge" individuals to make healthy lifestyle choices. Findings from Phase III of this project will directly inform a cluster randomized controlled trial to study the effectiveness of our intervention across multiple primary care-based settings.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT02330588; http://clinicaltrials.gov/ct2/show/NCT02330588 (Archived by WebCite at http://www.webcitation.org/6WyUOeRlr).
authors.affiliation: Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Jillian Ls
authors.identifier: http://orcid.org/0000-0003-1901-5870
authors.initials: JL
authors.lastname: Avis
authors.forename: Andrew L
authors.identifier: http://orcid.org/0000-0001-8148-4454
authors.initials: AL
authors.lastname: Cave
authors.forename: Stephanie
authors.identifier: http://orcid.org/0000-0002-6183-5138
authors.initials: S
authors.lastname: Donaldson
authors.forename: Carol
authors.identifier: http://orcid.org/0000-0003-0829-7999
authors.initials: C
authors.lastname: Ellendt
authors.forename: Nicholas L
authors.identifier: http://orcid.org/0000-0001-9856-3802
authors.initials: NL
authors.lastname: Holt
authors.forename: Susan
authors.identifier: http://orcid.org/0000-0002-6891-9430
authors.initials: S
authors.lastname: Jelinski
authors.forename: Patricia
authors.identifier: http://orcid.org/0000-0002-5872-5149
authors.initials: P
authors.lastname: Martz
authors.forename: Katerina
authors.identifier: http://orcid.org/0000-0001-9842-1927
authors.initials: K
authors.lastname: Maximova
authors.forename: Raj
authors.identifier: http://orcid.org/0000-0003-3541-2817
authors.initials: R
authors.lastname: Padwal
authors.forename: T Cameron
authors.identifier: http://orcid.org/0000-0002-9947-7428
authors.initials: TC
authors.lastname: Wild
authors.forename: Geoff Dc
authors.identifier: http://orcid.org/0000-0002-9432-3120
authors.initials: GD
authors.lastname: Ball
keywords: Canada; Internet; body weight; child; childhood obesity; parents; prevention; primary health care
references.citation: BMC Med Res Methodol. 2001;1:2
references.pmid: 11336663
references.citation: Clin Pract Epidemiol Ment Health. 2011 Mar 04;7:19-28
references.pmid: 21552423
references.citation: Open Med Inform J. 2009 May 07;3:27-31
references.pmid: 19587808
references.citation: Circulation. 2011 Sep 6;124(10):1182-203
references.pmid: 21824925
references.citation: J Psychiatr Res. 2011 May;45(5):626-9
references.pmid: 21035130
references.citation: BMC Med Res Methodol. 2010 Jan 06;10:1
references.pmid: 20053272
references.citation: Health Rep. 2007 May;18(2):17-32
references.pmid: 17578013
references.citation: Res Nurs Health. 1995 Apr;18(2):179-83
references.pmid: 7899572
references.citation: Health Rep. 2006 Aug;17(3):27-42
references.pmid: 16981484
references.citation: Int J Pediatr Obes. 2011 Jun;6(2-2):e58-61
references.pmid: 20799914
references.citation: Qual Health Res. 2009 Jan;19(1):140-6
references.pmid: 19074635
references.citation: ANS Adv Nurs Sci. 2009 Jul-Sep;32(3):222-40
references.pmid: 19707091
references.citation: Health Rep. 2012 Sep;23(3):37-41
references.pmid: 23061263
references.citation: Pediatrics. 2008 Jun;121(6):e1495-502
references.pmid: 18519453
references.citation: Prev Med. 2013 Nov;57(5):550-4
references.pmid: 23872428
references.citation: Milbank Q. 2005;83(3):457-502
references.pmid: 16202000
references.citation: Nutr Rev. 2004 Jan;62(1):39-50
references.pmid: 14995056
references.citation: Prev Med. 2010 Sep-Oct;51(3-4):199-213
references.pmid: 20600264
references.citation: Qual Health Res. 2008 Sep;18(9):1206-19
references.pmid: 18689534
references.citation: Qual Health Res. 2000 May;10(3):293-308
references.pmid: 10947477
references.citation: Soc Work Health Care. 2011;50(10):787-800
references.pmid: 22136345
references.citation: Health Rep. 2011 Mar;22(1):15-23
references.pmid: 21510586
references.citation: J Med Internet Res. 2006 Apr 12;8(2):e5
references.pmid: 16867968
references.citation: Pediatrics. 2006 Mar;117(3):681-90
references.pmid: 16510647
references.citation: Int J Behav Nutr Phys Act. 2012 Apr 30;9:52
references.pmid: 22546283
references.citation: J Am Diet Assoc. 2008 Nov;108(11):1902-6
references.pmid: 18954581
references.citation: Ann Behav Med. 2008 Dec;36(3):209-16
references.pmid: 19052828
references.citation: J Hum Nutr Diet. 2004 Jun;17 (3):191-208
references.pmid: 15139891
references.citation: MCN Am J Matern Child Nurs. 2007 Jan-Feb;32(1):36-41
references.pmid: 17308456
references.citation: Child Obes. 2014 Dec;10(6):461-73
references.pmid: 25496035
references.citation: Cochrane Database Syst Rev. 2009 Jan 21;(1):CD001872
references.pmid: 19160202
references.citation: Drug Alcohol Rev. 2009 May;28(3):301-23
references.pmid: 19489992
references.citation: Public Health Nutr. 2010 Aug;13(8):1221-8
references.pmid: 19941692
references.citation: Am J Public Health. 2003 Apr;93(4):635-41
references.pmid: 12660210
references.citation: Pediatrics. 2013 Mar;131(3):e894-902
references.pmid: 23382447
references.citation: Obes Rev. 2011 May;12(5):e298-314
references.pmid: 21348921
references.citation: J Adv Nurs. 2013 Jan;69(1):16-30
references.pmid: 22757605
references.citation: J Behav Health Serv Res. 2000 Nov;27(4):446-53
references.pmid: 11070638
references.citation: Patient Educ Couns. 2012 Apr;87(1):10-7
references.pmid: 21925825
references.citation: Circulation. 2012 Mar 6;125(9):1186-207
references.pmid: 22271754
references.citation: Res Nurs Health. 2000 Aug;23(4):334-40
references.pmid: 10940958
references.citation: Obesity (Silver Spring). 2010 Jul;18(7):1341-7
references.pmid: 19910934
references.citation: BMJ. 2011 Oct 18;343:d5928
references.pmid: 22008217
references.citation: Stat Med. 1999 Apr 15;18(7):855-88
references.pmid: 10327531
references.citation: Obes Rev. 2001 May;2(2):117-30
references.pmid: 12119663
references.citation: Paediatr Child Health. 2010 Sep;15(7):419-26
references.pmid: 21886445
references.citation: Child Obes. 2013 Feb;9(1):57-63
references.pmid: 23308372
references.citation: Ambul Pediatr. 2005 May-Jun;5(3):150-6
references.pmid: 15913408