Browsing by Author "Hou, Xiaolu"

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    From Bright Bodies to iChoose: Using a CBPR Approach to Develop Childhood Obesity Intervention Materials for Rural Virginia
    Brito, Fabiana A.; Zoellner, Jamie M.; Hill, Jennie L.; You, Wen; Alexander, Ramine C.; Hou, Xiaolu; Estabrooks, Paul A. (2019-03-21)
    This community-based participatory research (CBPR) project used a collaborative process to develop a culturally relevant workbook for parents of overweight children. We followed a mixed methods iterative process to assess clear communication using a CBPR approach. Materials were evaluated using readability tests, the Clear Communication Index (CCI), and the Suitability Assessment of Materials (SAM). In addition, we used surveys and focus groups to investigate parents' perceptions and gather feedback from delivery staff using the workbook. While workbook materials maintained adequate grade reading levels, our iterative process and the use of CCI and SAM led to significant improvements in (a) clearly communicating the objectives of the program, (b) being culturally relevant, and (c) reaching a high satisfaction among users. These findings suggest that evaluative measures for written materials should move beyond readability and need to account for level of clarity and cultural appropriateness of messages. Furthermore, we found that that an iterative process to intervention's material development using clear communication strategies while involving community members, parents, and research partners can lead to workbook materials that are culturally relevant to the target audience, and better communicate program objectives. Finally, this is a potentially generalizable process for improving clear communication of written health information materials.
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    The Implementation of Support Calls in a Pilot Childhood Obesity Intervention
    Hou, Xiaolu (Virginia Tech, 2017-02-15)
    Low health literacy in parents has been linked to increased obesity risk for their children. When providing information to patients with low health literacy, teach-back (TB) and teach-to-goal (TTG) methods are recommended, but no studies have examined the degree to which TB/TTG strategies can be implemented with fidelity in community-based programs. A study was conducted to determine if type of delivery staff (community or research) is related to implementation fidelity; the degree to which TB/TTG methods are necessary for parent/caregiver understanding of childhood obesity learning objectives; and if baseline parent/caregiver health literacy level is related to support call response. Ninety-four families with overweight/obese children aged 8-12 years were enrolled in a pilot childhood obesity intervention that included 6 bi-weekly parent/caregiver support calls integrating TB/TTG methods into a 5 A's approach. Research partners (n=2) delivered all calls in Wave 1. During Waves 2 and 3, community staff (n=5) delivered a majority of calls with training and support from research staff. ). Average completion rate across calls was 62% and did not differ according to participant health literacy level. Community partners were more likely than research partners to complete calls with participants (68% versus 57%), but this trend was not significant. Both research and community partners adhered to call scripts with high fidelity (97% versus 98%). A significant main effect of health literacy level on TB/TTG performance was found for Call 1 and Call 3 during Wave 1 and for Call 1 during Waves 2 and 3 of iChoose (p<0.05, 0.01, and 0.05). An interaction effect of health literacy level and question number was found for Call 3 during Wave 1 only (p<0.05). For all calls in which TB/TTG performance differed significantly by health literacy level, participants with adequate health literacy were found to have better performance. Following the program, participants expressed they felt satisfied and comfortable with follow-up calls (9.1 (2.0) and 9.5 (1.2) on a 10-point scale), while agreeing that calls helped improve their eating and PA habits (8.1 (2.6) and 7.5 (2.7)) and helped them learn class material better (8.1 (2.7)). Trained community partners were able to deliver the same support call content with similarly high fidelity, completion, and acceptability. Although participant baseline health literacy level had less impact on the need for TB/TTG and on program perception than we anticipated, our findings open up different possibilities to utilize these strategies while using precious resources more efficiently.
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    Participatory development and pilot testing of iChoose: an adaptation of an evidence-based paediatric weight management program for community implementation
    Hill, Jennie L.; Zoellner, Jamie M.; You, Wen; Brock, Donna J.; Price, Bryan; Alexander, Ramine C.; Frisard, Madlyn I.; Brito, Fabiana A.; Hou, Xiaolu; Estabrooks, Paul A. (2019-01-29)
    Background To describe the identification, adaptation, and testing of an evidence-based pediatric weight management program for a health disparate community. Methods A community advisory board (CAB) of decision-makers and staff from local health care, public health, and recreation organizations engaged with academic partners to select an evidence-based program (EBP) for local implementation. Three EBPs were identified (Traffic Light, Bright Bodies, Golan and colleagues Home Environmental Model) and each EBP was rated on program characteristics, implementation and adaptation, and adoptability. Following selection of the EBP that was rated highest, the POPS-CAB made adaptations based on the program principles described in peer-reviewed publications. The adapted intervention, iChoose, was then pilot tested in 3 iterative phases delivered initially by research partners, then co-delivered by research and community partners, then delivered by community partners. The RE-AIM framework was used to plan and evaluate the iChoose intervention across all waves with assessments at baseline, post program (3 months), and follow-up (6 months). Results Bright Bodies rated highest on program characteristics and adoptability (p’s < 0.05), while Home Environmental Model rated highest on implementation factors (p < 0.05). Qualitatively, the selection focused on important program characteristics and on matching those characteristics to the potential to fit within the community partner services. The adapted program—iChoose—had 18% reach and with participants that were representative of the target population on age, gender, ethnicity, and race. Effectiveness was demonstrated by modest, but significant reductions in BMI z-scores at post-program compared to baseline (MΔ = − 0.047; t = − 2.11, p = 0.046). This decrease returned to values similar to baseline 3 months (MΔ = 0.009) after the program was completed. Implementation fidelity was high and implementation fidelity did not differ between community or research delivery agents. Conclusions The process to help organizations identify and select evidence-based programs appropriate for their community led to consensus on a single EBP. While iChoose was successful in initiating changes in BMI z-scores, could be implemented in a low resource community with fidelity, it was insufficient to lead to sustained child BMI z-scores. In response to these data, maintenance of program effects and delivery are the current focus of the CBPR team.