PC1146: Evaluation of Community Appropriateness of a Pediatric Wellness Program: Implementing a Novel Mobile Health Technology Within an Integrated Care Model

Background: Pediatric obesity rates in South Carolina are significantly higher than the national prevalence, as individuals living in low-income households of racial and ethnic-minority heritage and residing in rural areas are at the highest risk of being overweight or obese. Historically, pediatric obesity interventions have yielded mixed results. However, recent technology-based interventions targeting adolescents have demonstrated significant improvements in health behaviors and subsequent changes in BMI. These programs offer an approach toward developing a practical, accessible, affordable, and integrated care model to address pediatric obesity.
Building from previous work involving unidirectional text messaging, the novel chatbot--Pediatric Wellness Chat--engages participants and their families using an innovative care delivery model that enhances primary care and associated care coordination services through mobile health technology. The unique chatbot has been designed to promote improved lifestyle behaviors including physical activity, nutrition, sleep, and screen time while assessing social determinants of health and escalating care through primary care as needed. Our primary goals include 1.) Identifying implementation trends and assessing implementation fidelity; 2.) Measuring the program’s effectiveness in identifying participants who are at risk for poor lifestyle behaviors due to SDOH needs and connecting them with effective resources to meet established goals; 3.) Ensure the chatbot's cultural, linguistic, and age appropriateness for participants.

Methods: The Pediatric Wellness Chat serves patients aged 2 through 18 with a BMI ≥ 85th-percentile referred by their primary care providers, using a customized order set for provider convenience. Our target sample is estimated to include 9,800 participants, based on the number of individuals who met the inclusion criteria at primary well-child care visits across an extensive health system from April 2021 through March 2022.
Chatbot utilization reports collect patient-specific data based on reach and enrollment, engagement, fidelity, and satisfaction throughout the program. We are collecting qualitative data in the form of focus groups with caregivers of enrolled patients and independent teenage users as well as in-depth interviews with individuals at increased risk of obesity to evaluate the chatbot utilization and effectiveness. Additionally, in-depth interviews will evaluate the care coordination process among individuals at increased risk of obesity due to SDOH needs.
Preliminary meetings through the Patient Engagement Studio were conducted to guide seed grant development in January 2022, and ongoing data will be collected from May 2022 through April 2023.

Results: Initial findings suggest that the chatbot is culturally and age-appropriate, as determined by caregivers and teenage users. Further data related to reach and enrollment, fidelity, and satisfaction are continually collected via chatbot utilization reports.

Conclusion: This program will continue to examine the reach and effectiveness of the Pediatric Wellness Chat as a novel mobile health technology to promote the adoption of healthy lifestyle behaviors among children and their families to combat pediatric obesity.