86 - Using community-engaged research and human centered design to optimize implementation of an obesity prevention program for low-income, Latino families.

Publication Number: 2082.86

Michelle W. Katzow, Northwell Health, New Hyde Park, NY, United States; Mary Jo Messito, New York University Grossman School of Medicine, New York, NY, United States; Sara DaCunha, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Bedford, NY, United States; Dulce G. Pineda, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Stamford, CT, United States; Andrea Lopez, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Brooklyn, NY, United States; Pamela A. Reichert-Anderson, Northwell Health, New Hyde Park, NY, United States; Sophia Jan, Cohen Children's Medical Center of Northwell Health, New Hyde Park, NY, United States; Rachel S. Gross, New York University Grossman School of Medicine, New York, NY, United States

Background: Evidence-based interventions that begin in pregnancy and address early child obesity risk in low-income, Latino families, have been challenging to implement at scale. Community-engaged research (CEnR) and human-centered design (HCD) principles can identify and address implementation challenges most relevant to the target setting in real-time, but have not been well-described in this context.

Objective: To describe a CEnR/HCD approach to optimizing prenatal implementation outcomes (recruitment, attendance, engagement) of StEP OUT, an evidence-based child obesity prevention program enhanced by WhatsApp group chat for added peer and professional support.

Design/Methods: Building on two years of formative research, we used CEnR and HCD methods (e.g., participatory design, group brainstorm, iterative testing) to conduct a single arm prenatal intervention adaptation study. We worked with two Community Advisory Boards (CABs; one English, one Spanish), study participants, and content experts to identify challenges and adapt implementation strategies on an ongoing basis. We enrolled pregnant, publicly-insured Latina women into four WhatsApp group chats facilitated by a bilingual/bicultural registered dietician/certified lactation counselor. Two online synchronous didactic sessions were offered prior to delivery. We tracked implementation outcomes and assessed differences by strategy and over time.

Results: We enrolled 49 participants (Table 1) using three strategies: health system records (unsolicited calls/texts), community events and referrals, and in-person approach in prenatal clinic. Recruitment rates were 17%, 70%, and 36%, respectively (p < 0.001). We adapted implementation strategies (Figure 1) to address recruitment, attendance, and engagement (Table 2). Recruitment and engagement improved over time but attendance to synchronous sessions worsened.

Conclusion(s): A community-engaged, iterative adaptation approach to implementing a WhatsApp enhanced prenatal intervention improved recruitment and WhatsApp engagement, but decreased structured session attendance over time. Future research should investigate facilitators and barriers to synchronous didactic sessions versus via facilitated WhatsApp group and compare efficacy between modalities.

Table 1: Baseline characteristics of 49 pregnant Latina participants enrolled in StEP OUT.
a.Mean of 4-item Perceived Stress Scale with each item response options on likert scale (1 to 5), with higher numbers representing higher stress; b.Mean of 3-item UCLA Loneliness Scale with each item response options on Likert scale (1 to 3), with higher numbers representing more loneliness; c.Based on a single item from the Maternal Social Support Index that asks how many people one can count on in times of need, dichotomized as 0-1 (low) or at least 2 (high); d.Based on the 2-item Hunger Vital Sign; e.Representing response of "yes" to having experienced "serious financial problems," "inability to pay bills," or utilities turned off in last 12 months.

Figure 1. Implementation strategies to optimize prenatal recruitment, attendance, and WhatsApp engagement in StEP OUT, an online, group-based child obesity prevention program.
Plus signs indicate that a new implementation strategy was added. Arrows indicate that an implementation strategy was changed/replaced by a new strategy.

Table 2. Implementation outcomes over time.