Abstract
BackgroundAlthough information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world.ObjectiveThe aim of this study was to assess the reach and acceptability of 2 information and communication technology interventions delivered as part of a French nutritional program: an SMS text messaging (short message service, SMS) attendance-reminder for collective sessions strategy and a Facebook challenge group.MethodsThis study sample comprised 262 socially less advantaged overweight adolescents aged between 13 and 18 years. The information and communication technology interventions were carried out during the 2013-2014 academic year in 33 French state-run schools. For the SMS attendance-reminder for collective sessions strategy, at the start of the academic year, adolescents were asked to give their mobile number. SMS attendance-reminders were sent shortly before each of the 5 collective sessions. For the Facebook challenge group, adolescents were invited to join a closed Facebook group in which challenges on physical activity and on diet were posted weekly. Process data and 2 sets of face-to-face interviews were also used to interpret participation rates and access to Facebook. Appreciation for both interventions was evaluated by a questionnaire at the end of the academic year.ResultsOf the recruited adolescents, 79.0% (207/262) gave their mobile number, reflecting high access to a mobile phone. Giving a number was significantly more likely for girls (odds ratio [OR] 2.1, 95% CI 1.1-3.9; P=.02) and adolescents in a vocational or general high school as opposed to middle school (OR 1.0, 95% CI 0.4-2.7; OR 0.2, 95% CI 0.1-0.5; P<.001). Indicating a mobile number at the start of the year was not significantly associated with participation in collective sessions. Of the adolescents seen at the start-of-year face-to-face interviews, 78.1% (153/196) declared an interest in the Facebook challenge group, which implies having a Facebook account or being able to have access to one. However, only 21 adolescents went through the process of joining the group. Although there was satisfaction with the Facebook group among the participants, the low participation rate in the Facebook group does not allow conclusions to be drawn with confidence.ConclusionsThe results are in line with the claim that using information and communication technologies in health programs is unlikely to widen health inequalities. However, in this population of French adolescents, mobile phone strategies seem more adapted to a high school context, and caution should be exercised with a younger audience. Although there is positive appreciation of the SMS attendance-reminders and a Facebook intervention is initially highly appealing to less advantaged adolescents, no evidence of impact could be demonstrated. These results highlight the difficulty in assessing the impact of specific interventions in complex health programs.Trial RegistrationClinicaltrials.gov NCT01688453; https://clinicaltrials.gov/ct2/show/NCT01688453 (Archived by WebCite at http://www.webcitation.org/6yy6EQ0SM)
Highlights
Background there is evidence to suggest that the rates of obesity and overweight have stabilized in recent years, social disparities persist, both for adults and children, in developed countries [1,2]
In this population of French adolescents, mobile phone strategies seem more adapted to a high school context, and caution should be exercised with a younger audience
This study focuses on a subsample of the population enrolled in the main program consisting of 262 overweight and socially less advantaged adolescents, corresponding to the low and medium categories of the Family Affluence Scale (FAS) [40]
Summary
Background there is evidence to suggest that the rates of obesity and overweight have stabilized in recent years, social disparities persist, both for adults and children, in developed countries [1,2]. In France, the latest data show that the crude prevalence of obesity is 15%, but this figure rises to 24% for individuals belonging to the lowest income category [3], and social differences in obesity and overweight prevalence seem to be increasing for adults and for children and adolescents [6,7]. It is, essential to develop health programs that do not widen health inequalities and tackle the different levels of social disadvantage, in the field of obesity and overweight reduction. Information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world
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