Camp NERF: Caregiver Outcomes from a Theory‐Based Nutrition Education Recreation and Fitness Program Aimed at Preventing Unhealthy Weight Gain in Underserved Children during Summer Months
Authors: Hopkins Laura Christine , Webster Alison , Sharn Amy , Gunther Carolyn 
Published: November 2023

Background

Data indicate that school‐age children, particularly underserved children, experience unhealthy gains in BMI more than twice as fast during the summer months. Few efforts have been directed at implementing evidence‐based programming to prevent this negative trend. Because caregivers help children establish and reinforce diet and physical activity behaviors through role modeling, their involvement, either directly or indirectly, in child‐targeted behavioral interventions is essential.

Study Design

Camp NERF 2015 was a citywide scale up of an 8‐week, multi‐component (nutrition, physical activity (PA), and mental health), theory‐based program for underserved school‐age children in grades K‐5 coupled with the USDA Summer Food Service Program. Twelve eligible elementary school sites were randomized to 1 of 3 programming groups: 1) Active Control (non‐nutrition, PA, or mental health); 2) Standard Care (nutrition and PA); or 3) Enhanced Care (nutrition, PA, mental health, and caregiver engagement) programming. Caregiver engagement strategies were: 1) Traditional print materials sent home weekly with children; 2) Text messaging; and 3) Social media.

Methods

Caregiver outcomes included self‐efficacy (SE) for healthy behaviors, physical activity level, and weight status (or BMI) and were assessed at baseline and post‐intervention. Among all caregiver participants, change outcomes were assessed utilizing hierarchical linear model analyses. Among Enhanced Care group caregiver participants, text messaging exposure – none, low, high – was added to the model to assess the effect of the texting intervention. To determine acceptability of caregiver engagement strategies, in‐depth interviews were completed with a subset of participating caregivers, transcribed verbatim, and analyzed qualitatively utilizing interpretive phenomenology and grounded theory.

Results

Caregiver retention rate was 93% (n=81). Approximately 87.4% (n=76) were female and 75.7% (n=66) were Black. At baseline, 80.5% (n=70) were overweight or obese. No significant differences in caregiver SE for healthy behaviors, PA, or BMI were demonstrated between groups from baseline to post‐intervention (p‐values > 0.10). Among the Enhanced Care group, texting participation rate was 62.2% and social media participation rate was less than 3%. When texting exposure was included in the models, mean physical activity score significantly decreased among the low‐exposure group compared to the no‐exposure group (p=0.02); there were no significant changes for the high‐exposure group. Three main themes emerged from the in‐depth interviews: 1) Texting Provided a Means of Connection; 2) Desired More Involvement with Program; and 3) Feared Privacy Intrusion with Social Media.

Conclusions

Results from this study will be utilized to improve caregiver engagement strategies in the delivery of this and other similar health behavior interventions for underserved school‐age children during the summer months.

Support or Funding Information

Acknowledgements: The Camp NERF research team would like to thank the Aetna Foundation and The Ohio State University Office of Outreach and Engagement for funding this study.