Testing a Web-Based Interactive Comic Tool to Decrease Obesity Risk Among Racial and Ethnic Minority Preadolescents: Randomized Controlled Trial
Authors: Leung May May , Mateo Katrina F , Dublin Marlo , Harrison Laura , Verdaguer Sandra , Wyka Katarzyna 
Published: November 2024

Background
Childhood obesity prevalence remains high, especially in racial and ethnic minority populations with low incomes. This epidemic is attributed to various dietary behaviors, including increased consumption of energy-dense foods and sugary beverages and decreased intake of fruits and vegetables. Interactive, technology-based approaches are emerging as promising tools to support health behavior changes.

Objective
This study aimed to assess the feasibility and acceptability of Intervention INC (Interactive Nutrition Comics for Urban, Minority Preadolescents), a 6-chapter web-based interactive nutrition comic tool. Its preliminary effectiveness on diet-related psychosocial variables and behaviors was also explored.

Methods
A total of 89 Black or African American and Hispanic preadolescents with a mean age of 10.4 (SD 1.0) years from New York City participated in a pilot 2-group randomized study, comprising a 6-week intervention and a 3-month follow-up (T4) period. Of the 89 participants, 61% were female, 62% were Black, 42% were Hispanic, 53% were overweight or obese, and 34% had an annual household income of <US $20,000. Participants were randomly assigned to the experimental group (45/89, 50% received the web-based comic tool), or the comparison group (44/89, 50% received web-based nutrition newsletters). Primary measures included feasibility and usability at intervention midpoint (T2) and intervention end (T3). Semistructured interviews were conducted at the same time to assess acceptability and satisfaction. Secondary measures, collected at baseline (T1), T2, T3, and at T4, included attitudes, beliefs, and behaviors related to fruit, vegetable, water, sugar, and junk food intake. Descriptive analyses were conducted for use and usability data. Interviews were systematically analyzed to facilitate identification of patterns and themes. Secondary data were analyzed using descriptive statistics. Within- and between-group effect sizes were reported.

Results
In total, 72% (33/45) and 60% (27/44) of the experimental and comparison groups, respectively, accessed their tool weekly. The mean total usability score was high and moderately high for the experimental and comparison groups, respectively (mean 4.01, SD 0.37 and mean 3.81, SD 0.51; P=.048), based on a 5-point Likert scale). Children in both groups found the tool acceptable, and few reported difficulties logging in or accessing content. Between-group effect sizes for beliefs and attitudes related to dietary intake, while favoring the experimental group at T3, were in the small range. These improvements in both groups were largely diminished by T4. However, between-group effect sizes for behaviors related to fruit, vegetable, and water intake, favoring the experimental group, were medium to large and were maintained at T4.

Conclusions
This pilot feasibility study suggests that an interactive comic tool may be an appealing and useful format to promote positive dietary behaviors in racial and ethnic minority preadolescents. However, further research, including a full-scale randomized controlled trial, is warranted to determine the effectiveness of Intervention INC.

Trial Registration
ClinicalTrials.gov NCT03165474; https://clinicaltrials.gov/study/NCT03165474

International Registered Report Identifier (IRRID)
RR2-10.2196/10682