Leung May May, Mateo Katrina F, Dublin Marlo, Harrison Laura, Verdaguer Sandra, Wyka Katarzyna
Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States.
Graduate School of Public Health Policy, City University of New York, New York, NY, United States.
JMIR Form Res. 2025 Jan 15;9:e58460. doi: 10.2196/58460.
Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes.
This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored.
A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of <US $20,000. Participants were randomly assigned to the experimental group (45/89, 50% received the web-based comic tool), or the comparison group (44/89, 50% received web-based nutrition newsletters). Primary measures included feasibility and usability at intervention midpoint (T2) and intervention end (T3). Semistructured interviews were conducted at the same time to assess acceptability and satisfaction. Secondary measures, collected at baseline (T1), T2, T3, and at T4, included attitudes, beliefs, and behaviors related to fruit, vegetable, water, sugar, and junk food intake. Descriptive analyses were conducted for use and usability data. Interviews were systematically analyzed to facilitate identification of patterns and themes. Secondary data were analyzed using descriptive statistics. Within- and between-group effect sizes were reported.
In total, 72% (33/45) and 60% (27/44) of the experimental and comparison groups, respectively, accessed their tool weekly. The mean total usability score was high and moderately high for the experimental and comparison groups, respectively (mean 4.01, SD 0.37 and mean 3.81, SD 0.51; P=.048), based on a 5-point Likert scale). Children in both groups found the tool acceptable, and few reported difficulties logging in or accessing content. Between-group effect sizes for beliefs and attitudes related to dietary intake, while favoring the experimental group at T3, were in the small range. These improvements in both groups were largely diminished by T4. However, between-group effect sizes for behaviors related to fruit, vegetable, and water intake, favoring the experimental group, were medium to large and were maintained at T4.
This pilot feasibility study suggests that an interactive comic tool may be an appealing and useful format to promote positive dietary behaviors in racial and ethnic minority preadolescents. However, further research, including a full-scale randomized controlled trial, is warranted to determine the effectiveness of Intervention INC.
ClinicalTrials.gov NCT03165474; https://clinicaltrials.gov/study/NCT03165474.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/10682.
儿童肥胖患病率仍然很高，尤其是在低收入的种族和少数民族人群中。这种流行归因于各种饮食行为，包括能量密集型食品和含糖饮料的消费量增加，以及水果和蔬菜的摄入量减少。基于互动技术的方法正成为支持健康行为改变的有前景的工具。
本研究旨在评估Intervention INC（面向城市少数民族青春期前儿童的互动营养漫画）的可行性和可接受性，这是一种基于网络的6章互动营养漫画工具。还探讨了其对与饮食相关的心理社会变量和行为的初步效果。
来自纽约市的89名黑人或非裔美国人和西班牙裔青春期前儿童，平均年龄为10.4（标准差1.0）岁，参与了一项2组随机试验性研究，包括为期6周的干预和3个月的随访（T4）期。在89名参与者中，61%为女性，62%为黑人，42%为西班牙裔，53%超重或肥胖，34%的家庭年收入低于20000美元。参与者被随机分配到实验组（45/89，50%接受基于网络的漫画工具）或对照组（44/89，50%接受基于网络的营养通讯）。主要测量指标包括干预中期（T2）和干预结束时（T3）的可行性和可用性。同时进行半结构化访谈以评估可接受性和满意度。在基线（T1）、T2、T3和T4收集的次要测量指标包括与水果、蔬菜、水、糖和垃圾食品摄入相关的态度、信念和行为。对使用和可用性数据进行描述性分析。对访谈进行系统分析以促进模式和主题的识别。使用描述性统计分析次要数据。报告组内和组间效应量。
实验组和对照组分别有72%（33/45）和60%（27/44）的人每周访问他们的工具。基于5点李克特量表，实验组和对照组的平均总可用性得分分别为高和中等偏高（平均分4.01，标准差0.37和平均分3.81，标准差0.51；P=0.048）。两组儿童都认为该工具是可接受的，很少有人报告登录或访问内容有困难。与饮食摄入相关的信念和态度的组间效应量在T3时有利于实验组，但范围较小。两组的这些改善在T4时基本消失。然而，与水果、蔬菜和水摄入相关行为的组间效应量有利于实验组，为中等到较大，并在T4时保持。
这项试验性可行性研究表明，互动漫画工具可能是一种有吸引力且有用的形式，可促进种族和少数民族青春期前儿童的积极饮食行为。然而，需要进一步研究，包括全面的随机对照试验，以确定Intervention INC的有效性。
ClinicalTrials.gov NCT03165474；https://clinicaltrials.gov/study/NCT03165474。
国际注册报告识别号（IRRID）：RR2-10.2196/10682。
