1. Make a Move: An Intervention to Reduce Childhood Obesity Kimberly Nerud, PhD, RN International Rural Nursing Conference Rapid City, South Dakota July 19, 2016

2. Objectives Identify significance of need for early interventions to reduce childhood obesity Define intervention process used Discuss results and implications for rural areas Identify recommendations for future studies in rural and underserved areas

3. Introduction One-third of children in the US are obese Low-income children account for the largest number Parents are key controllers Effective interventions are needed to safeguard against the continued epidemic of childhood obesity

4. Significance A child 2-5 years of age is considered at risk for overweight if they are in the ≥ 85 th percentile Parents need guidance to become the agents of change By strengthening parental understanding of balanced nutrition and adequate physical activity, more effective parent role-modeling can evolve

5. Conceptual Framework Conceptual framework guiding this study was based on the Social Cognitive Theory (SCT) –Personal, behavioral, and environmental factors influence one another –People have an agency or ability to influence their own behavior and the environment in a purposeful, goal directed manner –SCT assumes that learning involves not just the acquisition of new behaviors, but also of knowledge, cognitive skills, concepts, and values that can affect attitudes.

6. Literature Review Socioeconomic Factors Parental Perception Obesity Promoting Behaviors Parental Attitudes and Role Modeling Community Adapted Interventions

7. Purpose of the Study The purpose of this pilot was to study the influences of “Make a Move”, a face to face provider-led family intervention targeting parents with children 3-5 years of age.

8. Study Aims Aim 1: To compare the experimental intervention to a control intervention in producing changes on the primary outcomes (knowledge, attitude and behavior specific to physical activity and healthy eating). Aim 2: To examine the feasibility of, and participant satisfaction with, “Make a Move”, a family-based, childhood obesity intervention.

9. Hypotheses Aim 1 1a: The intervention group will report an increased parental knowledge of healthy eating compared to the control group. 1b: The intervention group will report an increased parental knowledge of physical activity compared to the control group. 1c: The intervention group will report a greater improvement in attitude toward healthy eating compared to the control group. 1d: The intervention group will report a greater improvement in attitude of physical activity compared to the control group. 1e: The intervention group will report a greater improvement in behavior toward healthy eating compared to the control group. 1f: The intervention group will report a greater improvement in behavior of physical activity compared to the control group.

10. Hypotheses Aim 2 2a: At least half (50%) of the experimental group participants will complete 100% of the intervention sessions. 2b: The experimental group participants (80%) report that they were somewhat to very satisfied with the intervention.

11. Method Design –Randomized controlled trial - pilot study –Intervention group and control group –Pre- and post- test surveys Sample –Head Start parent participants with children aged 3-5 years in a Mid-western area –n = 27 participants (n=13) intervention group, (n=14) control group

12. Intervention Process Cultivate parent’s skill-building to improve –Family’s healthy food choices –Family’s physical activity level Protocol –Provider-led sessions with group interaction –Written material and demonstrations –4 sessions, offered weekly for 4 weeks ~ 1 hour –Pre- and post-test data collection

13. “Make a Move” Intervention Parents were encouraged through four sessions to: –Increase healthy foods in home –Understand portion size –Understand energy in and energy out –Increase physical activity of family –Reduce screen time

14. Control Group Participants will be contacted personally to complete Parent Curriculum Questionnaire (PCQ) prior to the first intervention session (pre-test) Participants will be contacted personally to complete PCQ after the last intervention session (post-test)

15. Instruments Parent Curriculum Questionnaire (PCQ) –Pre- and post-test both groups –Measures variables relevant to “Make a Move” –Focused on constructs of SCT –Demographic data, 51 line items with true/false and 1-5point scale questions Make a Move Satisfaction Survey –5 questions –For post-test intervention group only

16. Hypotheses Findings 1a: Knowledge of Healthy Eating : z = 1.99, p = 0.05* PretestIntervention groupMdn = 2Control GroupMdn = 2 PosttestIntervention groupMdn = 3Control GroupMdn = 2.5 1b: Knowledge of Physical Activity : z = 0.44, p = 0.66 PretestIntervention groupMdn = 5Control GroupMdn = 5 PosttestIntervention groupMdn = 5Control GroupMdn = 5 *statistically significant

17. Hypotheses Findings 1c: Attitude of Healthy Eating : z = 1.14, p = 0.25 PretestIntervention groupMdn = 17Control GroupMdn = 17 PosttestIntervention groupMdn = 17Control GroupMdn = 16.5 1d: Attitude of Physical Activity : z = 2.72, p < 0.01* PretestIntervention groupMdn = 38Control GroupMdn = 38 PosttestIntervention groupMdn = 41Control GroupMdn = 38 *statistically significant

18. Hypotheses Findings 1e: Behavior of Healthy Eating : z = 1.37, p = 0.17 PretestIntervention groupMdn = 42Control GroupMdn = 45.5 PosttestIntervention groupMdn = 43Control GroupMdn = 45 1f: Behavior of Physical Activity : z = 2.03, p = 0.04* PretestIntervention groupMdn = 35Control GroupMdn = 42 PosttestIntervention groupMdn = 36Control GroupMdn = 40.5 *statistically significant

19. Hypotheses 2a & 2b Findings 2a: 77% of participants completed all 4 sessions, 23% of participants completed 3 sessions 2b: 100% reported mostly to very satisfied with intervention –70% very satisfied –30% mostly satisfied

20. Limitations Study population and setting Recruitment Contamination Duration of study Retention Nature of data

21. Implications for Rural Areas Utilization of one consistent provider Written and interactive material designed for ease of use Populations and settings Supports Healthy People 2020 objectives

22. Recommendations Provider-led sessions, face-to-face and group contact Retention strategies Measurement tools Self reported data Larger, more diverse sample

23. Future Research Plans Submitted for publication Grant proposal submitted Community project using 4-H youth Collaboration with WIC program

24. "The physical and emotional health of an entire generation and the economic health and security of our nation is at stake. This isn't the kind of problem that can be solved overnight, but with everyone working together, it can be solved”. Let's Move Launch Announcement, 2/9/2010