Enhancing Childhood Obesity Interventions Through Digital Media Tools

Background: Childhood obesity is a growing public health concern in Taiwan. A hospital-based childhood obesity intervention program in Taipei faced consistently low parental participation rates (6-10%), despite school-based screening identifying eligible children. To address this gap, a digital health education platform was developed using the LINE Official Account messaging application to deliver health literacy content to parents who declined face-to-face clinic visits.

Intervention: The LINE Official Account platform incorporated six functional modules: Understanding Obesity, Dietary Guidance, Exercise Guidance, Family Lifestyle Habits, Course Resources, and Healthy Weight Clinic Introduction. Educational content was designed based on the Health Belief Model (addressing perceived susceptibility, severity, benefits, barriers, cues to action, and self-efficacy) and Nudge theory (employing reminders, imagery, simplification, rewards, defaults, and social norms).

Study Design: This was a quasi-randomized trial using systematic allocation. Parents were allocated to two groups based on the sequential order of consent form returns during telephone contact. Since the team could not predict which parents would decline clinic participation during phone calls, this systematic alternating allocation achieved a quasi-random distribution. The experimental group (Channel 1) received automated push notifications from week 1 through week 24. The control group (Channel 2) received no push notifications during weeks 1-12, with notifications beginning at week 13 through week 24. Both groups had identical educational content available on the platform at all times; the intervention variable was the timing of automated push notification delivery.

Outcomes: Daily user activity data were collected from the LINE Official Account backend system over the 24-week study period. Primary outcome measures included the daily proportion of users clicking interactive educational messages and the daily click rate per user. Secondary outcomes included page view rates, system operation rates, and click differences across educational topic categories.

Statistical Analysis: Descriptive statistics, Mann-Whitney U tests, Chi-square tests, Spearman correlation analysis, and hierarchical regression analysis were employed. Significance level was set at p<0.05. All analyses were performed using IBM SPSS.

Inclusion criteria

• Parents or legal guardians of primary school (grades 1 and 4) or junior high school (grade 7) students in Zhongzheng and Wanhua districts, Taipei City
• Their child was identified as obese (BMI above the age- and sex-specific 95th percentile based on Taiwan national standards) through school health screenings conducted by Taipei City Hospital
• Parents provided consent for the public health program to calculate their child's BMI classification and to be contacted
• Parents declined the invitation to participate in the face-to-face Healthy Weight Clinic program during telephone contact
• Parents were able to use the LINE messaging application on a smartphone

Exclusion criteria

• Parents who accepted the face-to-face Healthy Weight Clinic invitation during initial telephone contact
• Parents whose child participated in another research study within the preceding month
• Parents unable to access the LINE messaging application