Enhancing Childhood Obesity Interventions Through Digital Media Tools

Taipei City Hospital

Status: Completed

Conditions: Pediatric Obesity; Health Literacy

Treatments: Behavioral: Delayed Automated Push Notifications; Behavioral: Immediate Automated Push Notifications

Study type: Interventional

Funder types: Other

Identifiers

NCT07501546

TCHIRB-11210004-E

Details and patient eligibility

About

This study evaluated the effectiveness of a LINE Official Account (a mobile messaging platform) as a digital health education tool to enhance parental engagement with childhood obesity-related health literacy content.

Parents of school-aged children (grades 1, 4, and 7) identified as obese through school health screenings in Taipei, Taiwan, who declined face-to-face clinic participation, were invited to join the LINE Official Account platform.

Participants were allocated to either an immediate push notification group (receiving automated educational messages for 24 weeks from enrollment) or a delayed push notification group (receiving no push notifications for the first 12 weeks, followed by 12 weeks of push notifications).

The study compared parental engagement behaviors between the two groups, including the proportion of users clicking interactive educational content and the click frequency per user, to determine whether the timing of push notification initiation affects parental engagement with digital health education content related to childhood obesity.

Full description

Background: Childhood obesity is a growing public health concern in Taiwan. A hospital-based childhood obesity intervention program in Taipei faced consistently low parental participation rates (6-10%), despite school-based screening identifying eligible children. To address this gap, a digital health education platform was developed using the LINE Official Account messaging application to deliver health literacy content to parents who declined face-to-face clinic visits.

Intervention: The LINE Official Account platform incorporated six functional modules: Understanding Obesity, Dietary Guidance, Exercise Guidance, Family Lifestyle Habits, Course Resources, and Healthy Weight Clinic Introduction. Educational content was designed based on the Health Belief Model (addressing perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy) and Nudge theory (employing reminders, imagery, simplification, rewards, defaults, and social norms).

Study Design: This was a quasi-randomized trial using systematic allocation. Parents were allocated to two groups based on the sequential order of consent form returns during telephone contact. Since the team could not predict which parents would decline clinic participation during phone calls, this systematic alternating allocation achieved a quasi-random distribution. The experimental group (Channel 1) received automated push notifications from week 1 through week 24. The control group (Channel 2) received no push notifications during weeks 1-12, with notifications beginning at week 13 through week 24. Both groups had identical educational content available on the platform at all times; the intervention variable was the timing of automated push notification delivery.

Outcomes: Daily user activity data were collected from the LINE Official Account backend system over the 24-week study period. Primary outcome measures included the daily proportion of users clicking interactive educational messages and the daily click rate per user. Secondary outcomes included page view rates, system operation rates, and click differences across educational topic categories.

Statistical Analysis: Descriptive statistics, Mann-Whitney U tests, Chi-square tests, Spearman correlation analysis, and hierarchical regression analysis were employed. Significance level was set at p<0.05. All analyses were performed using IBM SPSS.

Enrollment: 567 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Parents or legal guardians of primary school (grades 1 and 4) or junior high school (grade 7) students in Zhongzheng and Wanhua districts, Taipei City
• Their child was identified as obese (BMI above the age- and sex-specific 95th percentile based on Taiwan national standards) through school health screenings conducted by Taipei City Hospital
• Parents provided consent for the public health program to calculate their child's BMI classification and to be contacted
• Parents declined the invitation to participate in the face-to-face Healthy Weight Clinic program during telephone contact
• Parents were able to use the LINE messaging application on a smartphone

Exclusion criteria

• Parents who accepted the face-to-face Healthy Weight Clinic invitation during initial telephone contact
• Parents whose child participated in another research study within the preceding month
• Parents unable to access the LINE messaging application

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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567 participants in 2 patient groups

Immediate Push Notification Group

Experimental group

Description:

Parents joined LINE Official Account Channel 1 and received automated push notifications containing health education content from week 1 through week 24 (total 24 weeks of push notifications). Push notifications included weekly messages covering BMI education, dietary guidance, exercise guidance, obesity comorbidities, and clinic introduction, designed based on the Health Belief Model and Nudge theory.

Treatment:

Behavioral: Immediate Automated Push Notifications

Delayed Push Notification Group

Active Comparator group

Description:

Parents joined LINE Official Account Channel 2 and received no automated push notifications during weeks 1-12. Starting from week 13, they received the same automated push notification content as the experimental group through week 24 (total 12 weeks of push notifications). The same educational content was available for self-directed browsing on the platform throughout the entire 24-week period.

Treatment:

Behavioral: Delayed Automated Push Notifications