Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Minority Preadolescents: A Randomized Controlled Trial (Preprint)

BACKGROUND Childhood obesity prevalence has remained high, especially in minority populations with low incomes. This epidemic has been 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. The purpose of this study was to assess the feasibility and acceptability of Intervention INC, a Web-based tool comprising a 6-chapter interactive nutrition comic. The tool’s preliminary effectiveness on diet-related psycho-social variables and behaviors was also explored. OBJECTIVE The purpose of this study was to assess the feasibility and acceptability of Intervention INC, a Web-based tool comprising a 6-chapter interactive nutrition comic. The tool’s preliminary effectiveness on diet-related psycho-social variables and behaviors was also explored. METHODS 89 Black/African American and Hispanic pre-adolescents (mean age=10.4±1.0 years, 61% female, 62% Black, 42% Hispanic, 53% overweight/obese, and 34% annual household income <$20,000) from New York City participated in a pilot two-group randomized study, comprising a 6-week intervention and a 3-month follow-up period. Participants were randomly assigned to the experimental (E) (n=45) group, who received the web-based comic tool, or the comparison (C) (n=44) group, who received online nutrition newsletters. Primary measures included feasibility (measured by tool usage) and usability (measured by a 30-item questionnaire) at intervention mid-point (T2) and intervention end (T3). Semi-structured interviews were also conducted at the same time to assess participant acceptability and satisfaction. Secondary measures included attitudes, beliefs, and behaviors related to fruit, vegetable, water, sugar and junk food intake, which were collected at baseline (T1), T2, T3 and at 3-month follow-up (T4). Descriptive analyses were conducted for usage and usability data. Interviews were systematically analyzed to facilitate identification of patterns/themes. Secondary data were analyzed using mixed models with repeated assessments (T1-T3), condition (E-C), and time by condition interaction. Within- and between-group effect sizes were reported. RESULTS During the intervention, 72.3% and 60.3% of the E and C groups, respectively, accessed their tool on a weekly basis. Mean total usability score was moderately high for both groups (on 5-point Likert scale), however, the E group score was higher (4.01 ± 0.37 and 3.81 ± 0.51, respectively; p=0.048). Overall, children in both groups found their tool to be acceptable and very few reported any difficulties logging in or accessing content. Within-group effect sizes for dietary beliefs and attitudes were generally larger in the E group at T3, however, improvements were largely diminished by T4. The E group reported a statistically significant (p<.05) increase in fruit, vegetable and water intake, which were maintained at T4. CONCLUSIONS This pilot and feasibility study suggests an interactive comic tool may be an appealing and useful format to promote positive dietary behaviors in minority preadolescents. However, further research, including a full-scale RCT with a longer follow-up period, is warranted to determine the effectiveness of Intervention INC. CLINICALTRIAL NCT03165474 INTERNATIONAL REGISTERED REPORT RR2-10.2196/10682