運用數位媒體工具輔助兒童肥胖識能介入 - 工具發展與初步評估

Abstract

背景與目的 兒童肥胖是日益嚴峻的公共衛生議題，過去在兒童肥胖醫療介入工作中，面臨家長參與率偏低的挑戰。本研究旨在發展運用通訊軟體LINE官方帳號作為數位媒體衛教平台，輔助提升肥胖兒童家長對兒童肥胖的健康識能，並評估平台中自動推播提醒功能對家長於LINE官方帳號中活動行為的影響，特別是比較「立即推播」與「延遲推播」兩種不同策略的效果。 方法 本研究採隨機對照試驗設計。研究對象為臺北市某醫院公衛計畫中，經校園篩檢達肥胖標準且家長拒絕參與實體門診之國中小學童的家長。家長被隨機分配至「實驗組」（加入LINE官方帳號後立即開始接收為期24週的自動推播衛教訊息）或「對照組」（加入後前12週不接收主動推播，第13週才開始接收推播）。衛教內容依據健康信念模式與巧推理論設計。收集並分析24週研究期間內，兩組LINE官方帳號後台記錄的每日使用者活動數據，包括每日自動提醒率、瀏覽頁面率、操作系統率、點選互動式衛教人數比例及次數機率，並比較各衛教主題的點擊差異。統計方法包含描述性統計、曼·惠特尼U檢定、卡方檢定、Spearman相關性分析及階層迴歸分析。 結果 共招募實驗組49位、對照組45位家長，兩組加入率相似（實驗組17.0% vs. 對照組16.2%）。相關性分析顯示，每日自動提醒率與「點選互動式衛教人數比例」（rs =0.496, p<0.001）及「點選互動式衛教次數比例」（rs =0.484, p<0.001）呈顯著正相關，但與瀏覽頁面率及操作系統率無顯著相關。實驗組家長平均每人點擊互動式衛教資訊次數（5.47次）顯著高於對照組（1.93次）（p<0.001）。階層迴歸分析顯示，組別（也就是推播策略的不同）對於每日提醒率與點擊互動式衛教行為之間的關係具有顯著調節作用（p<0.05），實驗組（立即推播組）的提醒效果優於對照組（延遲推播組）。在衛教主題方面，「飲食衛教」、「運動衛教」、「肥胖與共病症介紹」及「健康體位門診介紹」等主題點擊率較高；且實驗組在「認識體重」、「飲食衛教」、「肥胖與共病症介紹」、「健康體位門診介紹」等類別的點擊率顯著高於對照組（p<0.05）。 結論 本研究證實，運用LINE官方帳號作為數位衛教平台，並結合依據健康行為理論設計的自動推播提醒，可有效提升肥胖兒童家長對相關衛教內容的互動參與。相較於延遲推播，「立即推播」策略更能有效促進家長的互動行為，顯示初期介入與維持使用者關注的重要性。儘管整體招募參與率仍有改善空間，數位媒體工具在兒童肥胖防治的健康識能介入上具有應用潛力。未來可考量優化內容呈現與互動機制，以期提升觸及率與介入成效。

Background and Objectives Childhood obesity is a growing public health concern, yet traditional medical interventions often face low parental participation rates. This study aimed to develop a digital health education platform using the LINE Official Account (OA) messaging application to enhance health literacy regarding childhood obesity among parents. It also evaluated the impact of automated push notifications within the platform on parental engagement behaviors, specifically comparing the effectiveness of immediate versus delayed push notification strategies. Methods A randomized controlled trial (RCT) design was employed. Participants were parents of primary and junior high school students identified as obese through school screenings within a public health program in Taipei, who had declined face-to-face clinic participation. Parents were randomly assigned to either the experimental group (receiving automated push educational messages for 24 weeks immediately upon joining the LINE OA) or the control group (receiving no active push notifications for the first 12 weeks, followed by 12 weeks of push notifications). Educational content was designed based on the Health Belief Model and Nudge theory. Daily user activity data from the LINE OA backend were collected and analyzed over the 24-week study period, including daily automated notification rates, page view rates, system operation rates, the proportion of users clicking interactive educational messages, and the click rate per user. Differences in clicks across various educational topics were also compared. Statistical analyses included descriptive statistics, Mann-Whitney U tests, Chi-square tests, Spearman correlation analysis, and hierarchical regression analysis. Results A total of 49 parents were recruited into the experimental group and 45 into the control group. Joining rates were similar between groups (Experimental: 17.0% vs. Control: 16.2%). Correlation analysis revealed that the daily automated notification rate was significantly positively correlated with the proportion of users clicking interactive educational messages (rs =0.496, p<0.001) and the click rate per user (rs=0.484, p<0.001), but not significantly correlated with page view rates or system operation rates. Parents in the experimental group had a significantly higher average number of clicks on interactive educational messages per person (5.47 clicks) compared to the control group (1.93 clicks) (p<0.001). Hierarchical regression analysis indicated that group assignment (notification strategy) significantly moderated the relationship between daily notification rate and engagement behavior (clicks on educational content) (p<0.05), with the immediate push strategy (experimental group) demonstrating a stronger effect than the delayed strategy (control group). Regarding educational topics, "Dietary Guidance," "Exercise Guidance," "Obesity and Comorbidities," and "Healthy Weight Clinic Introduction" received higher click rates. The experimental group showed significantly higher click rates than the control group for categories including "Understanding Body Weight," "Dietary Guidance," "Obesity and Comorbidities," and "Healthy Weight Clinic Introduction" (p<0.05). Conclusions This study demonstrates that utilizing the LINE Official Account as a digital health education platform, combined with automated push notifications designed based on health behavior theories, can effectively increase parental engagement with educational content related to childhood obesity. The "immediate push" strategy was more effective in promoting parental interaction than the "delayed push" strategy, highlighting the importance of early intervention and maintaining user attention. Although overall recruitment participation rates require improvement, digital media tools show potential for health literacy interventions in childhood obesity prevention. Future efforts could focus on optimizing content delivery and interactive features to enhance reach and intervention effectiveness.