Feasibility and Effect of Adding a Concurrent Parental Component to a School-Base Wellness Program Using Two Modes of Mobile-Based Technology – Mixed Methods Evaluation of RCT

doi:10.21203/rs.3.rs-618752/v1

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Research Article

Feasibility and Effect of Adding a Concurrent Parental Component to a School-Base Wellness Program Using Two Modes of Mobile-Based Technology – Mixed Methods Evaluation of RCT

https://doi.org/10.21203/rs.3.rs-618752/v1

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published 14 Feb, 2022

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Background: This study assessed the feasibility and effect of two mobile modes (WhatsApp vs. a specially designed app) in their delivery of updates and assignments to parents.

Methods: Two three-armed, randomized, controlled feasibility studies were conducted. Participants were randomly allocated to the control arm, youth-only arm, or youth & parental component arm. In the parental component, parents received updates and were requested to complete shared assignments with their children. In the first year, the assignments were sent through WhatsApp and in the following year via the specially designed smartphone application. Students and parents filled out questionnaires at three measure points: pre and post intervention and at three months follow-up. Mixed-methods assessments were performed using semi-structured interviews with parents and school staff members, as well as a computerized self-report questionnaire.

Results: The addition of the concurrent parental component via WhatsApp was associated with superior improvement in self-esteem and identification of advertisement strategies, compared with the youth-only program. However, adolescents in the youth-only program delivered via the specially designed application demonstrated superior improvement compared to those in the youth & parental component arm.

Conclusions: Although the addition of the concurrent parenting component was praised by the actively participating parents, overall, this intervention was not statistically superior to the youth-only arm. Only a few variables demonstrated statistically significant improvement, usually with a small effect size. The use of WhatsApp had higher feasibility and uptake than the use of the specially designed application. Under the chosen structure and population, it seems that the program did not have the intended impact. Parents who expressed specific resistance may have negatively affected their children, causing them to be less engaged. A cost-benefit analysis of programs with parental components as well as the development of strategies to enhance parent-school partnership are warranted.

Trial registrations: NCT04129892 (1.11.2017) and NCT03540277 (26.4.2018)

Health Economics & Outcomes Research

Health Policy

School-based

Prevention

Self-esteem

Body esteem

Mobile application

Table 1

Content and description of the program sessions

Session number	Topic	Description
1	Introduction	• Introducing program objectives and goals. • Forming groups. • Discussing expectations. • Establishing group contract.
2	Self-care	• Discussing sleeping and eating hygiene, and exercise. • Sharing self-care experiences and outcomes.
3	Self-preservation	• Discussing territorial issues, self-space, and territorial boundaries.
4	Media literacy	• Exploring and recognizing advertisements' tactics and their impact on us. • Discussing ways to address media temptations.
5	Our feelings	• Facilitating a "feeling differentiation" activity. • Sharing and recognizing observed and hidden feelings. • Discussing feeling management strategies.
6	Accepting appearance differences	• Discussing the ideal appearance as opposed to unrealistic and narrow construction. • Learning strategies to avoid and challenge comparisons. • Recognizing that a different look is not necessarily a bad thing.
7	Accepting our weaknesses	• Discussing how people turn their defects into productive effects. • Learning how to accept disadvantages or weaknesses that cannot be changed.
8	My body and I	• Exploring physical changes during adolescence. • Learning role-play management strategies.
9	Adolescence rights and responsibilities	• Discussing how growing up makes us take on different responsibilities. • Gaining independence and rights.
10	Summary and commitment	• Reviewing key messages. • Commitment to engaging in positive self-care and positive body-image behaviors while rejecting risk factors.

Table 2

Overview of measures used to evaluate program efficacy in students and parents

	Outcome measures	Student questionnaire	Parent questionnaire	Content
Main outcomes	Self-Caring	√	√	Self-care behaviors
	RSE	√	√	Self-esteem
	BES	√		Body image
	ChEDE-Q-8	√		Disordered eating
Secondary outcomes	Advertising Scale	√		Media Literacy
Secondary outcomes	SATAQ-4 media subscale	√	√	Pressures by media
RSE, The Rosenberg Self Esteem Scale; BES,The Body Esteem Scale; ChEDE-Q-8,TheEating Disorders Examination Questionnaire-8 adapted for children; SATAQ-4, The Sociocultural Attitudes Towards Appearance Questionnaire-4

Table 3

From allocation to analysis - number and percentages of participants in both digital modes along research stages

Research arms

Stage in the flow chart

Control

Youth-only intervention

Intervention with parents

adolescents shared

attendance assignments

Allocated

WhatsApp n= 148

Special app n=266

Consented n (% from allocations)

WhatsApp n= 138 (93%)

Special app n=212 (80%)

44 (88%)

61 (63%)

48(96%)

71 (86%)

46 (96%)

80 (84%)

40 (83%)

78 (82%)

Pre-intervention -T₁ assessment (% from allocations)

WhatsApp n=138 (100%)

Special app n=196 (92.4%)

44 (88%)

55 (57%)

48 (96%)

67 (96%)

46 (96%)

74 (78%)

34 (71%)

49 (51%)

Adolescent sessions attendance (% of allocations)

WhatsApp n=135 (91.2%)

Special app n=201 (95%)

46 (92%)

84 (86%)

45 (90%)

50 (64%)

44 (92%)

67 (70%)

Dyads’ tasks submissions

27 (56%)

16 (17%)

Post-intervention-T₂ assessment (% from allocations)

WhatsApp n=127 (86%)

Special app n=166 (78.3%)

44 (88%)

45 (46%)

43 (86%)

61 (82%)

40 (83%)

60 (63%)

20 (42%)

27 (28%)

Follow-up - T₃ assessment (% from allocations)

WhatsApp n=133 (90%)

Special app n=166 (78%)

44 (88%)

43 (44%)

47 (94%)

44 (59%)

42 (87.5%)

69 (73%)

0 (0%)

2 (2%)

Filled two assessments & entered analysis

(% from allocations)

WhatsApp n=133 (90%)

Filled three assessments & entered analysis Special app n=137 (64.6%)

44 (88%)

38 (39%)

47(94%)

46 (62%)

42(87.5)

53 (71%)

20 (42%)

2 (%)

Table 4

Demographic characteristics of the study population in both digital delivery modes

Youth in the control arm

Youth-only intervention arm

Youth in parental-component arm

p-value¹

WhatsApp (total 133)

Special app (total 137)

(n=44)

(n=38)

(n=43)

(n=42)

(n=57)

Age, M (SD)

Special app

10.2 (0.4)

10.1 (0.3)

10.2 (0.4)

10.1 (0.3)

10.1 (0.4)

0.572

0.877

Gender (n, % female)

Special app

27 (54)

22 (57.9)

31 (62)

18 (42.9)

25 (52)

24 (42)

0.569

0.266

Living in a relationship vs. with separated parents (n, %)

Special app

41 (82.0)

32 (84.2)

43 (86.0)

40 (85.7)

42 (87.5)

50(87.7)

0.806

0.885

Socioeconomic status^*, M (SD)

1.1 (0.3)

1.0 (0.3)

1.2 (0.3)

1.1 (0.4)

1.0 (0.2)

1.1 (0.4)

0.802

0.721

^*Calculated by the number of people per room in residence.

M, mean; SD, standard deviation

¹chi-square test for gender/parental status, Kruskal-Wallis Test for age/Socioeconomic status.

Table 5

Adolescents' baseline outcome measures in both digital modes

Youth in the control arm

Youth-only intervention arm

Youth in parental-component arm

WhatsApp n=133

Special app n=137

Mean (SD)

p-value

Self-Caring (Total)

WhatsApp Mean (SD)

Unique app Mean (SD)

4.06 (0.43)

3.84 (0.65)

4.0 (0.41)

4.19 (0.55)

3.98 (0.47)

4.01 (0.59)

0.63

0.18

RSE

WhatsApp Mean (SD)

Special app Median (SD)

32.5 (4.0)

32.3 (4.4)

33.0 (4.1)

33.2 (4.8)

31.4 (4.4)

32.0 (3.7)

0.17

0.15

BES mean score

WhatsApp Mean (SD)

Special app Median (SD)

3.0 (0.5)

3.2 (0.5)

2.8 (0.7)

3.3 (0.7)

2.9 (0.6)

3.3 (0.6)

0.21

0.56

BES- Appearance

WhatsApp Mean (SD)

Special app Median (SD)

3.4 (0.5)

3.2 (0.4)

3.1 (0.7)

3.2 (0.6)

3.1 (0.6)

3.3 (0.6)

0.16

0.88

BES-Weight

WhatsApp Mean (SD)

Special app Median (SD)

3.2 (0.8)

3.3 (0.7)

2.9 (0.9)

3.4 (0.9)

3.0 (0.7)

3.4 (0.8)

0.29

0.42

Advertising

WhatsApp Mean (SD)

Special app Mean (SD)

2.5 (1.4)

2.0 (1.2)

2.5 (1.9)

1.0 (1.2)

2.1 (1.4)

2.0 (1.2)

0.30

0.19

Pressures by media (SATAQ-4)

6.5 (3.8)

6.5 (3.0)

7.3 (4.4)

6.0 (4.3)

7.1 (3.8)

5.0 (2.3)

0.56

0.25

M, mean; Med, median; SD, standard deviation; RSE, The Rosenberg Self Esteem Scale; BES, The Body Esteem Scale; Eat-26, The Eating Attitudes Test; SATAQ-4, The Sociocultural Attitudes Towards Appearance Questionnaire-4.

Table 6

Special application mode: Self-care territory in the three groups over time

¹Group effect (Kruskal-Wallis Test) – marked in bold the significant differences (after p-value correction)

Effect size: eta-squared interpretation is: < 0.06 (small effect), 0.06 - < 0.14 (moderate effect) and >= 0.14 (large effect).

²Time effect (Friedman's Chi-Square Test) – marked in bold the significant differences (after p. value correction)

Effect size: Kendall’s W interpretation is: < 0.3 (small effect), 0.3 - < 0.5 (moderate effect) and >= 0.5 (large effect)

M, Mean; Med, Median.

Table 7

Special application mode: Youths' self-esteem in the three groups over time

¹Group effect (Kruskal-Wallis Test) – marked in bold the significant differences (after p-value correction)

Effect size: eta-squared interpretation is: < 0.06 (small effect), 0.06 - < 0.14 (moderate effect) and >= 0.14 (large effect).

²Time effect (Friedman's Chi-Square Test) – marked in bold the significant differences (after p. value correction)

Effect size: Kendall’s W interpretation is: < 0.3 (small effect), 0.3 - < 0.5 (moderate effect) and >= 0.5 (large effect)

M, Mean; Med, Median.

Table 8

Special application mode: Youths' body-esteem in the three groups over time

¹Group effect (Kruskal-Wallis Test) – marked in bold the significant differences (after p-value correction)

Effect size: eta-squared interpretation is: < 0.06 (small effect), 0.06 - < 0.14 (moderate effect) and >= 0.14 (large effect).

²Time effect (Friedman's Chi-Square Test) – marked in bold the significant differences (after p value correction)

Effect size: Kendall’s W interpretation is: < 0.3 (small effect), 0.3 - < 0.5 (moderate effect) and >= 0.5 (large effect)

M, Mean; Med, Median.

No competing interests reported.

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Journal Publication

published 14 Feb, 2022

Read the published version in BMC Public Health →

Editorial decision: Major revision
25 Nov, 2021
Reviews received at journal
23 Nov, 2021
Reviews received at journal
01 Nov, 2021
Reviewers agreed at journal
10 Oct, 2021
Reviewers agreed at journal
04 Oct, 2021
Reviewers invited by journal
27 Sep, 2021
Editor assigned by journal
27 Sep, 2021
Editor invited by journal
16 Sep, 2021
Submission checks completed at journal
16 Sep, 2021
First submitted to journal
13 Jun, 2021

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Feasibility and Effect of Adding a Concurrent Parental Component to a School-Base Wellness Program Using Two Modes of Mobile-Based Technology – Mixed Methods Evaluation of RCT

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