Nudges: Fun, Motivational Messages to Encourage and Reassure Parents in the HomeStyles Randomized Controlled Trial

Abstract

Short, empowering messages sent to intervention study participants can motivate them to remain active in the study and continue working toward health behavior change goals. As part of the childhood obesity prevention HomeStyles randomized controlled trial, parents of preschool children were sent motivational nudges by SMS, email, and/or voice mail, per participant preference, to promote the application of the behavior changes promoted in the 4‐page mini‐magazine‐style informational guide the parent had most recently selected. The treatment group received guides designed to improve weight‐related home environment and lifestyle practices in families with preschool children whereas those in the control group received equivalent guides focusing on home safety. Parents were encouraged to focus on one guide ~every 3 to 4 weeks before selecting a new guide; nudges were sent every 4 days. Six nudges were written for each of the 12 weight‐related and 12 home safety guides; the first 4 nudges sent focused directly on the selected guide content and the last 2 nudges encouraged parents to choose a new guide. The nudges were developed by: 1) health communication experts who drafted an array of nudges for each guide, ensuring the length adhered to SMS maximums; 2) iterative cognitive testing and refinement of nudge messages with 98 English‐speaking parents; 3) in‐culture translation into Spanish and iterative cognitive testing and refinement with 92 Spanish‐speaking parents; 4) selection of nudges identified by parents as most motivational; and 5) final refinement of nudges. During cognitive testing, parents were asked to read each nudge and use a 5‐point scale to rate the overall likelihood the messages would motivate them to keep working on their goals. Overall, parents rated the nudges as very motivating (mean=4.34±0.84SD, scale 1–5). Parents especially liked nudges that contained novel ideas (“Move to the music and get active! Turn on some cool music and get your family swaying on the dance floor.”), were concise and relatable (“Eating family meals together is easier than you think! Unplug the TV and talk to each other about your day.”); parents did not prefer nudges with information incongruent with their existing mental models (e.g., a few did not believe that screen time before bed would interfere with child sleep quality), that seemed to chastise (e.g., “Maybe it's time to pay attention to your sleep patterns. Be sure to give your body the sleep it deserves!” “Make breakfast a priority! Breakfast skippers get so hungry they overeat at other meals.”), suggestions they thought would take too much effort to operationalize (e.g., “Try limiting active games and scary TV before bed. Instead, rub kids backs and read them stories.”), and deemed “catchy”. Nudges rated by parents as motivating have the potential to help retain study participants and encourage them to make changes to their lifestyles and home environments to prevent obesity and protect family health.Support or Funding InformationUSDA NIFA #2011‐68001‐30170