Control Case Study: E-Health Text Messaging Based Intervention on Developing Lifestyle Changes Related to the Improvement of Childhood Obesity




Patel, Kavita
Robinson, Christina


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The prevalence of chronic diseases in the United States including heart disease and cancer is majorly attributable to adverse lifestyle factors such as smoking, physical inactivity, poor diet, stress, negative emotion, etc. (CDC, 2012). Recent studies have shown that mothers with unhealthy lifestyles serve as an impetus for childhood obesity (Dhana et al, 2018). Community health promotion efforts and lifestyle interventions are successful in introducing healthy behaviors and promoting its adherence (Dickinson et al., 2006; Kent et al., 2015; Pekmezi, Marquez, & Marcus-Blank, 2010; Tucker et al., 2014; Tucker et al., 2016). Our study evaluates the utilization of an E-health text message system as an effective intervention for caregivers of obese pediatric patients to improve lifestyle behaviors that influence childhood obesity.

Case Presentation:

A 30 year old African American female presented to the Pediatric Mobile Clinic with her 3 year old child who had a BMI in the 82nd percentile. The caregiver and child met the inclusion and exclusion criteria including adequate biometric markers before they were randomized to one of 2 intervention arms: control health group or e-health group. This subject was randomized into the control intervention arm. Participants of the control arm received weekly text messages for 6 months inquiring subjects on any SMART goal and duration of their choosing as well as assessing their motivation and confidence related to that goal (scored on a scale of 10). They also received follow-up messages asking introspective questions regarding habit formation and messages with self-scripted inspirational statements. The intervention arm differed in that the SMART goal chosen by subjects had to focus on one of six lifestyle medicine factors emphasized for that week's duration. The SMART goals input by this subject centered on improving the outlook, organization, and control of her finances and career. The subject's motivation scores were similar to her confidence scores for each specific goal even though they varied overall. More importantly, both scores trended upwards within self chosen goal periods lasting ≥ 3 weeks. Additionally, a common theme emphasized in the subject’s responses to introspective questions regarding her goals focused on maintaining "positivity”. The patient indicated a 7/10 on her 6-month exit survey, highlighting that the program "somewhat” supported the patient on a road to wellness by helping her "break things down into achievable goals each week”.


This case illustrates the role an E-health intervention program had in helping the patient construct and keep track of achievable goals. The program was still beneficial to the control-intervention arm subject as indicated by her exit survey. Observed increases in confidence and motivation scores within prolonged goal periods highlights the impact this program had in establishing the self-accountability necessary for conceiving new goals and maintaining consistency. In effect, this case emphasizes how the intervention aids in promoting a subject’s intrinsic motivation in relation to the development of their goals and eventual habits. Overall, this case suggests that having any intervention in place, even to the degree involved within case controls, is significant compared to no intervention.