On successfully avoiding communication inequalities and instilling positive impacts: The experience of the 2012-2016 WIXX campaign in Québec.

Communication campaigns can contribute to promoting physical activity (PA) among children. However, health inequalities can ensue from this type of public health intervention. Using a pre-test posttest design, we examined the effects of social disadvantage on the large-scale WIXX communication campaign and whether or not social disadvantage moderated WIXX's impact on PA. Parents of youths were identified using random digit dialing procedures and asked permission for their child to participate in a telephone survey. Surveys were conducted each year between 2012 and 2016. Moderating effects of individual-level and area-based indicators of social disadvantage on campaign effectiveness were examined. Self-reported levels of PA and trying new PAs were the outcomes. Exposure was defined as a function of ads recall and brand awareness. Logistic regression analyses controlling for survey periods, screen time, language, school grade, and attitudes toward PA were performed in 2020. Among girls, no significant interaction effects were observed for household income, parental education, and material deprivation. A significant interaction effect was observed for minority group status on PA (OR = 2.4; 95%CIs: 1.2, 4.9) and trying of new activities (OR = 2.5; 95%CIs: 1.2, 5.1). A significant interaction effect between social deprivation and exposure was observed for trying new activities among girls (OR = 1.8; 95%CIs: 1.0, 3.2). Among boys, no significant interaction effects were observed for any indicators. Results suggest no clear evidence of communication inequalities as a result of the WIXX campaign but reveal positive impacts of the campaign among more socially disadvantaged girls.

Outcomes of Equity-Oriented, Web-Based Parenting Information in Mothers of Low Socioeconomic Status Compared to Other Mothers: Participatory Mixed Methods Study.

BACKGROUND: Typically, web-based consumer health information is considered more beneficial for people with high levels of education and income. No evidence shows that equity-oriented information offers equal benefits to all. This is important for parents of low socioeconomic status (SES; low levels of education and income and usually a low level of literacy). OBJECTIVE: This study is based on a conceptual framework of information outcomes. In light of this, it aims to compare the perception of the outcomes of web-based parenting information in low-SES mothers with that of other mothers and explore the perspective of low-SES mothers on contextual factors and information needs and behavior associated with these outcomes. METHODS: A participatory mixed methods research was conducted in partnership with academic researchers and Naître et grandir (N&G) editors. N&G is a magazine, website, and newsletter that offers trustworthy parenting information on child development, education, health, and well-being in a format that is easy to read, listen, or watch. Quantitative component (QUAN) included a 3-year longitudinal observational web survey; participants were mothers of 0- to 8-year-old children. For each N&G newsletter, the participants' perception regarding the outcomes of specific N&G webpages was gathered using a content-validated Information Assessment Method (IAM) questionnaire. Differences between participants of low SES versus others were estimated. Qualitative component (QUAL) was interpretive; participants were low-SES mothers. The thematic analysis of interview transcripts identified participants' characteristics and different sources of information depending on information needs. Findings from the two components were integrated (QUAN+QUAL integration) through the conceptual framework and assimilated into the description of an ideal-typical mother of low SES (Kate). A narrative describes Kate's perception of the outcomes of web-based parenting information and her perspective on contextual factors, information needs, and behavior associated with these outcomes. RESULTS: QUAN-a total of 1889 participants completed 2447 IAM responses (50 from mothers of low SES and 2397 from other mothers). N&G information was more likely to help low-SES participants to better understand something, decrease worries, and increase self-confidence in decision making. QUAL-the 40 participants (21 N&G users and 19 nonusers) used 4 information sources in an iterative manner: websites, forums, relatives, and professionals. The integration of QUAN and QUAL findings provides a short narrative, Kate, which summarizes the main findings. CONCLUSIONS: This is the first study comparing perceptions of information outcomes in low-SES mothers with those of other mothers. Findings suggest that equity-oriented, web-based parenting information can offer equal benefits to all, including low-SES mothers. The short narrative, Kate, can be quickly read by decision policy makers, for example, web editors, and might encourage them to reach the underserved and provide and assess trustworthy web-based consumer health information in a format that is easy to read, listen, or watch.

The Overall Awareness and Impact of the WIXX Multimedia Communication Campaign, 2012-2016.

Background: Evidence regarding the impact of physical activity (PA) communication campaigns among children is scarce. This study was aimed at examining the reach of the WIXX campaign and its impact on children's PA beliefs and behaviors. Methods: This study adopted a pre-posttest design. Children (9-13 y old) were recruited using a random digit dialing procedure. Self-reported outcomes included PA beliefs, trying new PAs, and meeting PA guidelines. WIXX awareness and survey periods were the treatment variables. Logistic regression analyses were conducted to examine the main effect of treatment variables and the time-specific impact of WIXX. Results: The campaign reached 80.3% of the children. Fully adjusted results showed that girls with high (odd ratio = 1.4; 95% confidence interval, 1.0-2.0) and moderate (odd ratio = 1.4; 95% confidence interval, 1.0-1.8) awareness were more likely to have tried new PAs. Results from the sensitivity analyses suggested that this positive result was due to strategies implemented during the second year of the campaign. No other significant association between exposure and outcomes was observed. Conclusions: The WIXX campaign was successful in reaching a significant proportion of children. Although some encouraging results were observed among girls, WIXX awareness was not associated with changes on the examined outcomes among boys.

Assessing and Improving the Use of Online Information About Child Development, Education, Health, and Well-Being in Low-Education, Low-Income Parents: Protocol for a Mixed-Methods Multiphase Study.

BACKGROUND: This study is born from a partnership between Web editors of Naître et grandir (N&G) and AboutKidsHealth (AKH) and researchers who developed and validated the Information Assessment Method (IAM). N&G and AKH are popular Canadian websites with high-quality comprehensive information about child development, education, health, and well-being. IAM allows parents to assess online information and provide feedback to Web editors. High-quality online consumer health information improves knowledge, self-efficacy, and health. However, low-socioeconomic status (SES) parents underuse N&G and IAM, despite these parents being more likely to report decreased worries and increased confidence as outcomes from N&G information. OBJECTIVE: The study is aimed to improve low-SES parents' use of online child information and interaction with Web editors and explore subsequent health outcomes for parents and children. METHODS: Multiphase mixed-methods design. Our general approach is centered on organizational participatory research. In phase 1, we will conduct a qualitative interpretive study to identify barriers and facilitators to using N&G information and to interacting with N&G editors via IAM; interview more than 10 low-SES parents about their experience with N&G and IAM and more than 10 nonusers of N&G and IAM; and use thematic analysis to identify main barriers and facilitators. In phase 2, we will integrate parents' views (phase 1 findings) in N&G and IAM and implement a new version: IAM+N&G+. In phase 3, we will conduct a quantitative prospective longitudinal study (pre-/postimplementation monitoring of knowledge use and outcomes). We will compare the use of original (IAM and N&G) and new (IAM+ and N&G+) versions using Google Analytics variables, IAM variables, a material and social deprivation index, and demographics. We anticipate increased use post implementation (linear mixed modeling). In phase 4, we will conduct a qualitative descriptive study on outcomes of information use. We will interview more than 30 low-SES parents who receive and rate the N&G+ newsletter using IAM+ and analyze data in the form of life histories to describe how parents and children experience perceived outcomes. RESULTS: The project was funded in 2017 by the Canadian Institutes of Health Research and received an ethics approval by the McGill University's institutional review board. Data collection for phase 1 was completed in 2018. Phases 2 to 4 will be conducted until 2020. Findings from this study will also be used to develop a free toolkit, useful to all Web editors, with recommendations for improving health information for low-SES persons and interactions with them using IAM. CONCLUSIONS: The results of this study will provide a deep understanding of how low-SES parents use online child information and interact with Web editors. Following the implementation of IAM+N&G+, results will also elucidate subsequent health outcomes for low-SES parents and children after interaction with Web editors has been optimized. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/9996.

Correlates of Initial Recall of a Multimedia Communication Campaign to Promote Physical Activity among Tweens: the WIXX Campaign.

This study examined factors associated with children's and parents' recall of a communication campaign aimed at promoting children's physical activity. A cross-sectional population-based telephone survey was conducted among 1001 children and their parents. Respondents were recruited through a random digit dialing procedure. Respondents' recall of the campaign, beliefs, sociodemographics as well as levels of physical activity and sedentary behaviors were self-reported. Logistic regression analyses were conducted for tweens and their parents separately. Girls (odds ratio [OR] = 2.1; 95%confidence interval (CI): 1.3, 3.5) were more likely to have unaided recall when compared to boys. Tweens in primary school (OR = 1.9; 95%CI: 1.0, 3.4 and OR = 2.1; 95%CI: 1.4, 3.0) and those speaking French (OR = 3.3; 95%CI: 1.4, 8.1 and OR = 2.9; 95%CI: 1.8, 4.7) were more likely to have unaided and aided recall, respectively. Among parents, tweens' unaided (OR = 12.0; 95%CI: 5.2, 28.1) and aided (OR = 3.3; 95%CI: 1.5, 7.3) recall, obesity status (OR = 2.6; 95%CI: 1.3, 5.3), and low income (OR = 5.2; 95%CI: 1.9, 14.3) were positively associated with recall. Additional beliefs were associated with tweens' and parents' recall of the campaign. The association between sex, language, and recall is in line with the branding strategy adopted and no clear evidence for communication inequalities was observed.

Short-Term Impact of a Multimedia Communication Campaign on Children's Physical Activity Beliefs and Behavior.

To examine the short-term impact of the WIXX multimedia communication campaign on children's physical activity (PA) beliefs and behaviors, 3 repeated cross-sectional telephone surveys were conducted before, 9 months after, and 21 months after the launch of the campaign. A random-digit dialing procedure was used to recruit children ages 9 to 13 years. Children's PA beliefs, behaviors, and recall of the WIXX ads were self-reported. Logistic regression models showed that girls exposed to the WIXX ads were more likely to believe that PA would help to make new friends (odds ratio [OR] = 1.4, 95% confidence interval [CI] [1.0, 1.9]) and that they can be active even if too busy (OR = 1.4, 95% CI [1.0, 1.8]) compared to girls not exposed. Boys exposed were more likely to believe that PA would help to spend time with friends (OR = 1.4, 95% CI [1.1, 1.9]). Boys (OR = 1.5, 95% CI [1.1, 2.0.]) and girls (OR = 1.4, 95% CI [1.1, 1.8]) exposed were more likely to report having tried new PAs. No significant impact of the campaign was observed on overall PA after we controlled for confounders. Recall of the WIXX ads was associated with a significant, albeit modest, impact on some PA beliefs and intermediate PA behaviors.

Initial recall and understanding of a multimedia communication campaign to promote physical activity among tweens: a process evaluation study.

OBJECTIVE: To examine the degree of awareness and understanding of a multimedia communication campaign (WIXX) aimed at promoting physical activity among tweens (9-13years old) during the early phases of campaign implementation. METHODS: This study adopted a repeated posttest-only design. Two cross-sectional web-based surveys were conducted in Québec, Canada, among tweens three (T1; N=400) and nine (T2; N=403) months after the launch of the campaign in 2012. The activities of the WIXX campaign included website development, community events and paid advertisements. Recall, recognition and understanding of the campaign were the three outcomes. Logistic regression analyses were conducted to examine factors associated with the assessed outcomes. RESULTS: The likelihood of having unaided/aided recall (OR=0.7; 95%CI: 0.5, 0.9) rather than no recall decreased between T1 and T2. A significant sex∗survey period interaction effect was observed for recall (p=.04). Tweens were also less likely to recognize the WIXX advertisements at T2 (OR=0.6; 95%CI: 0.5, 0.9) and a significant school grade∗survey period interaction was observed for recognition (p=.002). CONCLUSIONS: The likelihood of recall and recognition decreased across survey periods. Girls were generally more likely to be aware of the WIXX multimedia campaign. Further efforts are required to maintain and increase awareness of WIXX among tweens.

Influence of area deprivation and perceived neighbourhood safety on active transport to school among urban Quebec preadolescents.

OBJECTIVE: This study examines associations between area deprivation and perceived neighbourhood safety with active transport to school among preadolescents living in urban Quebec. METHODS: A sample of 809 preadolescents aged 9 to 13 years and one each of their parents living in urban Quebec were recruited by a polling firm for a telephone interview about the Opération WIXX multimedia communication campaign. Opération WIXX was launched in 2012 by Québec en forme to promote physical activity among preadolescents. Logistic regression models predicted active transportation to school (as reported by both the child and his or her parent) from area-level material and social deprivation and from parental and children's perceptions of neighbourhood safety while controlling for socio-demographic variables. RESULTS: Child and parental reports of active commuting to school were highly concordant (Kendall's tau=0.70, p<0.001). Children whose parents felt at ease to let their children actively commute to school (OR=1.75, 95% CI 1.25-2.45; p=0.001) and who lived in areas characterized by the highest material (OR=2.02, 95% CI 1.09-3.76; p=0.026) and social (OR=3.69, 95% CI 2.12-6.42; p<0.001) deprivation were more likely to report actively commuting to school. Parents who felt at ease to let their children actively commute to school (OR=1.60, 95% CI 1.15-2.21; p=0.005) and who lived in neighbourhoods characterized by a higher social deprivation (OR=1.70, 95% CI 1.04-2.79; p=0.036, OR=2.01, 95% CI 1.23-3.29; p=0.006, OR=2.72, 95% CI 1.59-4.63; p<0.001) were more likely to report that their child actively commuted to school. CONCLUSION: Active commuting to school is associated with parental perceptions of safety and area deprivation.

Development and content validation of the information assessment method for patients and consumers.

BACKGROUND: Online consumer health information addresses health problems, self-care, disease prevention, and health care services and is intended for the general public. Using this information, people can improve their knowledge, participation in health decision-making, and health. However, there are no comprehensive instruments to evaluate the value of health information from a consumer perspective. OBJECTIVE: We collaborated with information providers to develop and validate the Information Assessment Method for all (IAM4all) that can be used to collect feedback from information consumers (including patients), and to enable a two-way knowledge translation between information providers and consumers. METHODS: Content validation steps were followed to develop the IAM4all questionnaire. The first version was based on a theoretical framework from information science, a critical literature review and prior work. Then, 16 laypersons were interviewed on their experience with online health information and specifically their impression of the IAM4all questionnaire. Based on the summaries and interpretations of interviews, questionnaire items were revised, added, and excluded, thus creating the second version of the questionnaire. Subsequently, a panel of 12 information specialists and 8 health researchers participated in an online survey to rate each questionnaire item for relevance, clarity, representativeness, and specificity. The result of this expert panel contributed to the third, current, version of the questionnaire. RESULTS: The current version of the IAM4all questionnaire is structured by four levels of outcomes of information seeking/receiving: situational relevance, cognitive impact, information use, and health benefits. Following the interviews and the expert panel survey, 9 questionnaire items were confirmed as relevant, clear, representative, and specific. To improve readability and accessibility for users with a lower level of literacy, 19 items were reworded and all inconsistencies in using a passive or active voice have been solved. One item was removed due to redundancy. The current version of the IAM4all questionnaire contains 28 items. CONCLUSIONS: We developed and content validated the IAM4all in partnership with information providers, information specialists, researchers and representatives of information consumers. This questionnaire can be integrated within electronic knowledge resources to stimulate users' reflection (eg, their intention to use information). We claim that any organization (eg, publishers, community organizations, or patient associations), can evaluate and improve their online consumer health information from a consumers' perspective using this method.

Policy options to support physical activity in schools.

Rates of child and youth obesity and associated chronic diseases are rising worldwide, in part as a result of inadequate physical activity (PA) levels. Environmental change is needed in multiple settings to encourage the adoption of healthy lifestyle behaviours at an early age. Schools are an ideal setting in which to incorporate a variety of interventions in order to improve student PA levels and healthy eating environments. This paper reviews effective and promising policies for increasing PA levels in the school setting and introduces other untested interventions that could become the basis of future well-designed studies. Policies outlined in this review should be considered by a range of stakeholders and be carefully monitored and evaluated. These policies should include daily, quality, safe physical education and physical activity; extracurricular physical activity; training of physical activity leaders; active transportation to and from school; adequate facilities; and community outreach. Successful school initiatives and stakeholders should also be recognized formally for their contribution.