Use of Text Messaging and Facebook Groups to Support the Healthy Children, Strong Families 2 Healthy Lifestyle Intervention for American Indian Families

Abstract

Background Few obesity interventions have been developed for American Indian (AI) families despite the disproportionate risk for obesity experienced within AI communities. The emergence of mobile technologies to enhance intervention delivery may particularly benefit AI communities, many of which are hard-to-reach and underserved. Objective This study aimed to assess the use and perceptions of text messaging and Facebook to support delivery of the Healthy Children, Strong Families 2 (HCSF2) mailed healthy lifestyle/obesity prevention intervention and discuss lessons learned regarding intervention support via these platforms among AI participants. Methods From among AI families with young children (2–5 years old), 450 adult/child dyads were recruited from five rural and urban communities for a year-long intervention. Intervention content was delivered by mail and supported by text messaging and optional Facebook groups. Participants provided feedback on text message and Facebook components post-intervention, and Facebook analytic data were tracked. Results Self-report feedback indicated high satisfaction with both text messaging and Facebook, with tangible content (e.g., recipes, physical activity ideas) cited as most useful. Overall, participants reported higher satisfaction with and perceived efficacy of Facebook content compared to text messaging. Analytic data indicate the optional HCSF2 Facebook groups were joined by 67.8% of adult participants. Among those who joined, 78.4% viewed, 50.8% “liked”, and 22.6% commented on one or more post. Engagement levels differed by urban-rural status, with more urban participants “liking” (P = 0.01) and commenting on posts (P = 0.01). Of note, nearly 1/3 of participants reported changing phone nubsmbers during the intervention. Conclusions This paper demonstrates high satisfaction regarding mobile delivery of HCSF2 intervention support components. Best practices and challenges in utilizing different mobile technologies to promote wellness among AI families are discussed, with particular focus on urban-rural differences. Future mobile-based interventions should consider the context of unstable technology maintenance, especially in low-resource communities. Clinicaltrials.gov ID: NCT01776255

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