Children with spina bifida experience significantly higher rates of obesity, physical inactivity, poor nutrition and secondary health conditions compared to non-disabled children and children with other types of disabilities. Their ability to participate in health-promoting behaviors (i.e., physical activity, nutrition) is greatly compromisd by (a) inaccessible features in the built environment (e.g., parks, playgrounds, recreational sports programs, physical education classes, etc.);(b) lack of awareness or knowledge on the part of family members in managing their child's weight;and (c) lack of health promotion programs tailored to the needs of children with spina bifida. The primary aim of this application is to evaluate the potential for use of an Information and Communication Technology (ICT) system, referred to as POWERS - Personalized Online Weight and Exercise Response System, to provide individualized physical activity and nutrition programming to geographically diverse children with low incidence disabilities such as spina bifida. The theoretical framework is based on the Principal Investigator's current research related to a blended telecoaching/internet-assisted health promotion intervention that demonstrated successful weight loss in obese adults with physical disabilities. This e-health application will be customized for parents of children wih spina bifida to assist them in making appropriate choices in promoting increased physical activity and improved nutrition within the context of the child's current home, school and community using a blended internet- and telecoaching-assisted program. The POWERS platform includes: (a) an extensive toolkit that assesses personal and environmental factors associated with physical activity and nutrition and a health appraisal inventory examining functional limitations and secondary health conditions to allow for customization to each end user;(b) an automated system for generating specific, achievable goals tailored to each child's needs and interests and associated with the availability of home and community resources;(c) telecoaching by a trained health professional to support key health behaviors (physical activity, nutrition) through an online communication network;and (d) a feedback system that allows health providers and family members to monitor daily progress toward physical activity and nutrition goals. A feasibility pilot study will be conducted with 36 children with spina bifida (6 o 12 years) to examine the utility of the system in improving physical activity and nutrition behaviors. Target outcomes include changes in physical activity level, improved nutrition, body weight, and community participation. This proposal extends previous work to: 1) further refine and evaluate the POWERS platform, and 2) conduct a 12-week feasibility trial to determine effect size of intervention outcomes to inform a future RCT. The ICT system has the built-in capability (if proven effective) to be used by researchers and health professionals in addressing obesity disparities with other disabled populations.
The proposed study is highly relevant to public health as it aims to reduce health disparities (i.e., obesity) in children with physical disabilities through a cost-effective, scalable Information and Communication Technology (ICT) system. The ICT system (referred to as POWERS which stands for Personalized Online Weight and Exercise Response System) addresses the unique physical activity and nutritional needs of children with physical disabilities by customizing a program that is based upon interest level, barriers and availability of community resources. POWERS also provides public health professionals with effective obesity management strategies for integrating children with disabilities into existing community-based health promotion initiatives.