Feasibility and Acceptability of a Culturally Tailored Website to Increase Fruit and Vegetable Intake and Physical Activity Levels in African American Mother-Child Dyads: Observational Study

Abstract

Background African American youth (aged 8-14 years) do not adhere to national dietary and physical activity guidelines. Nonadherence to these recommendations contributes to disproportionate rates of obesity compared with their white counterparts. Culturally tailored electronic health (eHealth) solutions are needed to communicate nutrition and physical activity messages that resonate with this target population. Objective This study aimed to identify the impact of exposure to a website hosting culturally tailored cartoons to inspire fruit and vegetable uptake and physical activity levels in African American mother-child dyads. Methods Statistical analysis included paired sample t tests to evaluate knowledge gains, self-efficacy, and readiness to change. Adapted items from Prochaska’s Stages of Change toward the following 4 behaviors were assessed with pre- and posttest surveys: (1) fruit and vegetable selection on my plate, (2) meal preparation, (3) fruit and vegetable selection outside of home, and (4) physical activity. Open-ended comments on videos from mother-child dyads were used to determine user acceptance. Observations of repeated responses during content analysis informed coding and development of key themes. Results A final sample size of 93 mother-child dyads completed the study. Mothers reported significant improvement from precontemplation or contemplation stages to preparation or action stages for (1) fruit and vegetable selection on her plate ( P =.03), (2) meal preparation for her family ( P =.01), (3) fruit and vegetable selection outside the home ( P <.001), and (4) physical activity ( P <.001). Significant improvements were found in knowledge, stage of change, and self-efficacy for the 4 target behaviors of interest ( P <.001). Children’s open-ended commentary reported vicarious learning and positive character identification with brown-skinned cartoons exhibiting healthful food and exercise behaviors. Mothers commented on the lack of accessible produce in their neighborhoods not depicted in the cartoon videos. Conclusions Culturally adapted cartoons that incorporate tailored preferences by African American families, such as race or demography, may help increase adherence to target health behaviors when developing eHealth behavior solutions.

Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review

“…Racial and ethnic minority youth are heavily targeted for fast food marketing [49,50], and communities of color tend to be inundated by food swamps (ie, an abundance of fast food restaurants concentrated in a ZIP Code). Therefore, in order to act against these high-calorie, nutrient-poor advertising messages [51], culturally tailored approaches are needed to promote healthful eating behaviors among this population [52]. In addition, health literacy has been identified as a key social determinant of health among adolescents [53].…”

Examining Whether the Social Cognitive Theory Concepts Predict Childhood Obesity Prevention Outcome Expectations

“…The existing literature indicates that, on average, only one to two SCT concepts are employed in interventions to explain the childhood obesity-related behaviors. 19,21,22 Thus, the results of the study will assist public health professionals and others in more effectively using the SCT theory to design interventions targeting childhood obesity within rural, predominantly African American settings. Finally, this study promotes the importance of operationalizing, measuring, and applying the SCT concepts within the context of childhood obesity.…”

“…20 In contrast, African American mother-child dyads experienced an increase in self-efficacy for diet and behavior changes (e.g., consumption of more fruit and vegetables in-and outside of the home and participation in more physical activity) after participation in an eHealth intervention. 21 Similarly, African American families discussed an increase in self-efficacy to start and sustain positive weight-related behaviors after participation in the Families Improving Together randomized controlled trial. 22 Other empirical studies have found relationships between self-efficacy and behavioral capability and self-efficacy and outcome expectations.…”