title: Automated Behavioral Text Messaging and Face-to-Face Intervention for Parents of Overweight or Obese Preschool Children: Results From a Pilot Study.
abstract: BACKGROUND
  Children are 5 times more likely to be overweight at the age of 12 years if they are overweight during the preschool period.
  
  
  OBJECTIVE
  The purpose of this study was to establish the feasibility, acceptability, and preliminary effects of a cognitive behavioral intervention (TEXT2COPE) synergized with tailored mobile technology (mHealth) on the healthy lifestyle behaviors of parents of overweight and obese preschoolers delivered in a primary care setting.
  
  
  METHODS
  Fifteen preschooler-parent dyads recruited through primary care clinics completed a manualized 7-week cognitive behavioral skills building intervention. Beck's Cognitive Theory guided the TEXT2COPE intervention content and Fogg's Behavior Model guided the implementation. The intervention employed a combination of face-to-face clinic visits and ecological momentary interventions using text messaging (short message service, SMS). To enhance the intervention's relevance to the family's needs, parents dictated the wording of the text messages and also were able to adapt the frequency and timing of delivery throughout program implementation.
  
  
  RESULTS
  Self-reported findings indicate that the program is feasible and acceptable in this population. The intervention showed preliminary effects with significant improvements on parental knowledge about nutrition (P=.001) and physical activity (P=.012) for their children, parental beliefs (P=.001) toward healthy lifestyles, and parental behaviors (P=.040) toward engaging in healthy lifestyle choices for their children. Effect sizes were medium to large for all variables. The timing, frequency, and wording of the text messages were tailored to the individual families, with 69% of parents (9/13) increasing the frequency of the tailored SMS from being sent once weekly to as many as 5 times a week.
  
  
  CONCLUSIONS
  Utilizing a cognitive behavioral skills intervention with SMS has great potential for supporting clinical care of overweight and obese preschool children and their families. Further exploration of the potential effects on health and behavioral outcomes is warranted.
authors.affiliation: The Ohio State University, College of Nursing, Columbus, OH, United States. militello.14@osu.edu.
authors.forename: Lisa
authors.identifier: http://orcid.org/0000-0001-7827-1466
authors.initials: L
authors.lastname: Militello
authors.forename: Bernadette Mazurek
authors.identifier: http://orcid.org/0000-0002-4704-1198
authors.initials: BM
authors.lastname: Melnyk
authors.forename: Eric B
authors.identifier: http://orcid.org/0000-0002-7434-0775
authors.initials: EB
authors.lastname: Hekler
authors.forename: Leigh
authors.identifier: http://orcid.org/0000-0002-2904-8468
authors.initials: L
authors.lastname: Small
authors.forename: Diana
authors.identifier: http://orcid.org/0000-0002-6067-5910
authors.initials: D
authors.lastname: Jacobson
keywords: Behavior Therapy; Child; Health Behavior; Mobile Health; Obesity; Overweight; Parents; Psychology; Telemedicine; Text Messaging/SMS