RESUMO
BACKGROUND: Families who cook, eat, and play together have been found to have more positive health outcomes. Interventions are needed that effectively increase these health-related behaviors. Technology is often incorporated in health-related interventions but is not always independently assessed. OBJECTIVE: The objective of this study was to describe challenges and facilitators to incorporating technology into the iCook 4-H intervention program. METHODS: Dyads (n=228) composed of children (mean 9.4, SD 0.7 years old) and an adult primary meal preparer (mean 39.0, SD 8 years) were randomly assigned to a control (n=77) or treatment group (n=151). All treatment group dyads participated in 6 in-person sessions designed to increase families cooking, eating, and playing together. We incorporated Web-based between-session technological components related to the curriculum content throughout the intervention. Assessments were completed by both groups at baseline and at 4, 12, and 24 months; they included measured anthropometrics for children, and online surveys about camera and website skill and use for dyads. Session leaders and participants completed open-ended process evaluations after each session about technological components. We computed chi-square analysis for sex differences in technological variables. We tested relationships between video posting frequency and outcomes of interest (cooking frequency, self-efficacy, and skills; dietary intake; and body mass index) with Spearman correlations. Process evaluations and open-ended survey responses were thematically analyzed for beneficial and inhibiting factors, including technological components in the curriculum. RESULTS: Only 78.6% (81/103) of children and 68.3% (71/104) of adults reported always being comfortable accessing the internet postintervention. Boys reported being more comfortable than girls with technological tasks (P<.05). Children who posted more videos had a higher level of cooking skills at 4 months postintervention (r=.189, P=.05). Barriers to website usage reported most frequently by children were lack of accessibility, remembering, interactivity, motivation, time, and lack of parental encouragement. CONCLUSIONS: Incorporating technological supports, such as cameras and websites, into children's programs may help produce improved outcomes. Identifying barriers to and patterns of technology usage need to be considered when developing future child health promotion interventions. TRIAL REGISTRATION: ISRCTN Registry ISRCTN54135351; https://www.isrctn.com/ISRCTN54135351.
RESUMO
Sub-Saharan African refugees in the US have reported food security rates seven times below the national average. Dietary acculturation issues may be a contributing factor. Criterion-specific sample (n = 18) was recruited using network then snowball sampling methods. Semi-structured interviews were facilitated with the aid of a culturally and linguistically appropriate interpreter. An iterative, two cycle coding analytic process was completed within NVivo 11 by two coders who sought inter-rater reliability. Codes were organized into hierarchical maps and coding matrices for direct content analysis, and pattern and theme detection. Saturation was achieved and validated with an additional two interviews. Participants were primarily Burundian (67% vs. 33% Congolese), married (72%), held no high school degree (72%), unemployed (56%) and reported limited English proficiency (72%). Barriers and facilitators to food security across all levels of the Socio-Ecological Model (SEM) were noted. Emerging themes included difficulty with language, cooking, and shopping; transportation; social network support; orientation services; reliance on nutrition assistance programs; limited culturally relevant food and land access; and program policy miscomprehension. The complex relationship between dietary acculturation barriers and facilitators at various SEM levels demonstrates the need for a multi-level intervention to improve food security among refugees.