A Feasibility and Efficacy Randomized Controlled Trial of an Online Preventative Program for Childhood Obesity: Protocol for the EMPOWER Intervention

BACKGROUND The home and family environment is a highly influential psychosocial antecedent of pediatric obesity. Implementation of conventional family- and home-based childhood obesity interventions is challenging for parents, often requiring them to attend multiple educational sessions. Attrition rates for traditional interventions are frequently high due to competing demands for parents' time. Under such constraints, an Internet-based intervention has the potential to modify determinants of childhood obesity while making judicious use of parents' time. Theory-based interventions offer many advantages over atheoretical interventions, including reduced intervention dosage, increased likelihood of behavioral change, and efficient resource allocation. Social cognitive theory (SCT) is a robust theoretical framework for addressing childhood obesity. SCT is a behavior change model rooted in reciprocal determinism, a causal paradigm that states that human functioning is the product of a dynamic interplay of behavioral, personal, and environmental factors. OBJECTIVES To evaluate the efficacy of the Enabling Mothers to Prevent Childhood Obesity Through Web-Based Education and Reciprocal Determinism (EMPOWER) program, an Internet-based, theory-driven intervention for preventing childhood overweight and obesity. The project goal is supported by two specific aims: (1) modification of four obesogenic protective factors related to childhood obesity (minutes engaged in physical activity, servings of fruits and vegetables consumed, servings of sugar-sweetened and sugar-free beverages consumed, and minutes engaged in screen time), and (2) reification of five maternal-mediated constructs of SCT (environment, expectations, emotional coping, self-control, and self-efficacy). METHODS We will recruit mothers with children ages 4 to 6 years from childcare centers and randomly assign them to either the theory-based (experimental) or knowledge-based (control) arm of the trial. Data for the intervention will be collected at three intervals: baseline (week 0), posttest (week 4), and follow-up (8 weeks). At each phase of data collection, we will collect from both groups (1) measures of the four obesogenic protective factors, and (2) summated SCT construct scores. Constructs will be measured by a psychometrically valid and reliable SCT-based instrument. Behaviors will be evaluated by a behavior log. We will use a repeated-measures one-between-, one-within-participants design to evaluate intervention results. Constructs will be modified through Web-based learning modules, online interactive worksheets, and mother-child home-based activities. Process evaluation will assess program fidelity.