1Department of Nutrition, School of Public Health, University of Sao Paulo, Sao Paulo, Brazil, Sao Paulo, Brazil.
Introduction: In addition to historical rates of stunting and micronutrient deficiencies, children in the Brazilian Amazon are also facing a high prevalence of overweight triggered by a significant increase in food insecurity, which has affected local dietary patterns. Objectives: To develop and culturally adapt persuasive multimedia messages to be sent to parents of Amazonian schoolchildren in a Randomized Controlled Trial to promote changes in eating behavior. Methods: To better understand the study population dietary practices, we conducted a phone-based interview with guardians and analyzed results from Food Frequency Questionnaires previously applied to target children. Also, to write the messages, six behavior change techniques and five persuasive writing strategies were applied. The messages were planned following the guidelines of the Food Guide for the Brazilian Population. For cultural adaptation, 11 health care professionals with experience in the Amazon region were invited to answer a 5-point Likert Scale formulary evaluating messages’ three domains: cultural accordance, understanding and relevance. A text box for comments was also provided. To assess the probability of chance of agreement occurring by experts, Modified Cohen Kappa (k*) was calculated for each domain of each message. Messages with k* lower than 0.74 were reformulated and resubmitted for a new evaluation. Also, Scale-Content Validity Index Average (S-CVI-Ave) was calculated to assess the mean content validity of the message set domains. Excellent content validity should have a S-CVIAve >0.90. Results: Overall, 55 text messages were drafted. On the first round of expert’s evaluation, eight messages reach a k*=0,72. They were reformulated according to experts’ suggestions and resubmitted for a new evaluation. Then, all messages obtained k*>0,74. The S-CVI-Ave for each domain was: cultural accordance =0.97, understanding = 0.96 and relevance =0.97. Conclusion: The message set has excellent agreement on cultural accordance, understanding and relevance for the target population according to the experts’ evaluation. We expect that this study contributes with the provision of reliable and attractive nutritional content to improve Amazon children’s eating habits.
Keywords: childhood obesity, mhealth, eating behavior.