ABSTRACT
Childhood obesity continues to be a serious public health issue in the United States (US), with disproportionate
rates among low-income, minority children. Effective, yet engaging interventions need to be designed to
capture the attention of children and their parents/caregivers living in a multi-media environment. Our work
demonstrates the novelty, appeal, and effect of multi-modal narratives in the form of comics, which convey
messages in graphics and minimal language, as a format to deliver health messages to the younger
populations. Additionally, interventions delivered on web-based/mHealth platforms can be engaging and
scalable to support health behavior change in families and also enhance and extend the impact of clinic visits
by providing online resources that reinforce health messages delivered in-person by healthcare providers. In
collaboration with our community partner, Children’s Aid (one of the oldest and largest US child welfare
organizations), an AHRQ-funded R21 study supported development and pilot testing of Intervention INC, a
family-centered, interactive, web-based health promotion tool focused on reducing childhood obesity risk. The
tool is tailored to meet the needs and preferences of low-income, black/African-American (AA) and Latino
children ages 9 to 12 and their parents/caregivers. Results of a pilot feasibility study were highly promising as
not only was the tool feasible to deliver and acceptable to our child and parent populations, children receiving
the comic tool demonstrated greater improvements (p<0.05) in vegetable, water, and sugar intake compared to
the control group, from pre- to post-intervention. However, knowledge gaps regarding tool effectiveness and
implementation in real world settings still exist. To fill these gaps, we propose a study with the following aims.
In Aim 1, formative research will be conducted with healthcare practitioners/administrators and child-parent
dyads to identify organizational (clinic) and family characteristics relevant to implementing such a tool in a clinic
setting, while in Aim 2, the tool will be adapted (based on Aim 1 findings) and usability testing of it will be
conducted. In Aim 3, a full-scale RCT will be conducted in Children’s Aid community clinics, to test the effect of
the adapted and extended tool, which will comprise a 12-week comic intervention and a 6-month maintenance
intervention, on child BMI z-score. In Aim 4, contextual factors at the clinic-, provider-, and family-level that
influence tool implementation will be explored. We believe that this family-centered web-based tool is unique
given its focus on innovative communication approaches and mHealth platform to enhance accessibility and
engagement with an often hard to reach, diverse population. It also has strong
