Childhood obesity is a serious clinical and public health issue in the United States, with disproportionately high rates among low-income minority children. This complex epidemic is attributed to various dietary behaviors, such as decreased fruit and vegetable consumption, and increased sugary drink and energy-dense snack consumption. Food preferences established in childhood often continue into adulthood; therefore, it is important to intervene at this critical period. Technology-based interventions focused on dietary behavior change can allow users to engage with culturally-relevant and tailored health information on their own time, at their own pace, and in their preferred environment.

The research team designed and developed a narrative-based, interactive, mobile-enabled dietary self-management intervention with the goal of reducing risk of childhood obesity in Black/African American, and Latino children. The tool, named Intervention INC, consists of a six-chapter interactive nutrition comic for children that includes a goal-setting and self-assessment feature, and weekly text, email messages, and reminders.

The specific aims of the research were as follows:

• Conduct focus groups to identify the perceived individual, social, and environmental factors that influence children’s obesity-related dietary behaviors among low-income, minority, inner-city children age 10 to 12 and their parents and caregivers. 
• Design and develop an interactive, Internet mobile-enabled intervention promoting dietary self-management focused on reducing childhood obesity risk among low-income, minority, inner-city children ages 10 to 12. 
• Assess the feasibility and participant acceptability of the intervention and explore whether it improves knowledge, attitudes, and food preferences associated with the targeted behaviors to reduce childhood obesity risk, from baseline to post-test. 

To inform the development of Intervention INC, children and parents participated in focus groups and interviews about dietary behaviors, technology use, and the use of comic narratives to highlight nutrition concepts. They were involved in design activities to create prototypes that underwent usability testing. The child-parent dyads also participated in a pilot single-blind randomized study of the tool, with a 6-week intervention and 3-month followup. The experimental group received the Intervention INC web-based comic with health messages primarily promoting either fruit and vegetables or water consumption. In the comparison group, children and parents received web-based newsletters with health information similarly promoting primarily either food and vegetable or water consumption. Parents in the intervention group also received the web-based health newsletters.

Preliminary results demonstrated the usability, feasibility, and acceptability of the tool. Children who read the comic consumed significantly greater amounts of vegetables and water, and less sugar. In addition, self-efficacy toward fruits, vegetables, and water as well as attitudes toward vegetables improved. The research team will investigate the possibility of conducting a full-scale randomized controlled trial to test the tool’s effectiveness. Dissemination, implementation, and integration of the tool into a community-based healthcare system will be explored in future studies. The tool has the potential for broad reach, since if it is found to be effective, it could be publicly available online and integrated into various settings such as clinics, schools, and community-based organizations.