| Overall |
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More than one message Main message is not at the beginning of section. Pictures could represent more ethnicities (people and food) Some sentences are in passive voice |
Include most of the intervention handouts in the workbook
Change activities—Simplify to facilitate time management at classroom
Change activities—Use “rounded” number to facilitate calculation |
“1 think that the workbook was put together really well. It was organized and in sections, and explained each section thoroughly. It was easy to read … and we will continue to refer to it as needed.” s“Something that 1 think would be helpful is it has them in this book, but then it stays in this book … if it was on my refrigerator every time 1 opened it, 1 would be like, oh, okay.” |
Reorganized content to focus in one main message with is stated in the first paragraph
Changed pictures for include more diverse ethnicity.
Included most of the handouts as part of the workbook.
Made the tracking sheets and goal settings as “tear out” without compromising the content (blank back)
Added the Tips for You section
Changed remained passive voice sentences to active voice |
| Chapter 1 |
Describe energy balance and how it influences weight. Identify the food groups included in MyPlate. Identify that children should participate in 60 min of moderate to vigorous activity daily. Set a specific, time-based, and achievable goal for eating and physical activity. |
[Need to] focused on energy balance
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Better discussion about calories and energy balance (make clear that they need imbalance) Setting SMART goals were too intense for young kids next time have kids set 1 goal /SMART goal setting was “too much to digest” for kids |
“Plain and simple.” “This explained it in real details and everything.” “[Had] anything that could be done to this section to make better” Energy balance was hard [to understand], 1 mean … We need imbalance right?” |
Changed energy balance content language (energy “in-burned” to “in-out”), and pictures (changed scale to body outlines)
Reduced the SMART goals to kids |
| Chapter 2 |
Choose foods to eat more often, and to cut back on foods to eat less often. Identify how to be physically active in a way that fits their preferences and lifestyle. Help their children to identify barriers and address them at daily bases without focusing overly on weight. |
Pictures of sometime/anytime foods might be more helpful than words alone (there are sometimes graphics—arrows + smiley face—but no food pictures on graphics in this section. First statement could state the health foods are anytime food. May need more diverse pictures—more non- White people. [Heath snacks] Dried fruit and nuts can be expensive and people don’t know what hummus is. |
Families were not using the tracking system. |
“1 think it could have been a little bit more with healthy foods and choices.” “Maybe put the name of the food because that was kind of hard to tell [by the picture]” “1 actually like this [exercise] pyramid. 1 think it would be clearer and maybe if it was a tear-out and we could put in on the refrigerator it would be great” “1 would like to see on my fridge; that we could reference every day without having to go into a notebook (…) It would really make my kids more accountable and think about that.” “1 think the activity pyramid is helpful. But it’s just don’t make it so pixelated so we can actually read it. “1 like color and what 1 see is a whole bunch of black and white (…) this seems like schoolwork a lot of times (…) 1 look this part and think: Boring!” “The information is great. 1 think it just should have been more visual pictures, and then maybe added a couple of extra pages and … it’s like all this information in one place.” “They need to highlight some of the main points or something.” “1 think its [multiple choice] a good way to get started because I’ve never really set goals like this (…) And 1 think this was a good way to kind of get the ball rolling.” |
Made the tracking sheets and goal settings as “tear out” without compromising the content (blank back)
Changed layout to include more pictures, less text dense and more colorful.
Made a new adapted version of the excise pyramid which was more clear and included race variety images.
Added legend to food pictures
Added an annex section with health snacks options that are quick, easy and affordable. |
| Chapter 3 |
Define the appropriate portion sizes for parents and kids. Recognize when they are hungry and when are enough. Identify ways to cut back screen time to less than 2 hours per day. Develop strategies to change home environment cues so that they support healthy eating and physical activity. |
More active voice: screen time “it is recommended” is passive consider “we recommend” and take out “can” and make it clear. Calories in food not rounded. Consider breaking up the “cut back on screen time” paragraphs in bullets. |
Discussion on home environment and goal sheets were good. Change “hand portion activity” to match the instructions. |
“Screen time focused in all no just TV.” “My kids grasped it and they were able to really use it [hand measurement], you know, as far as even going out to eat, you know. They would say is this the right size for chicken? And we would say well look at your hand.” “It [home environment] gets lost in the workbook. Because this is actually really good because, you know, then I’m looking at it again. It’s really, really a good thing to have. But like the other worksheet that they hand out, 1 use that and 1 put that on the refrigerator to schedule things, you know.” |
Changed “hand portion activity” to match the instructions and include race diverse pictures.
Changed the Screen time section including all screen types no just TV and added a screen time calendar for families.
Made the home environment quiz a “tear out.” |
| Chapter 4 |
Understand and making sense of a food label. Understand importance of games and how they can help them to improve health. Identify appropriate rewards for healthy behaviors and weight loss. Identify how they can be a role model for their family and friends. |
Need to better outline ways to help to be successful. |
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“More information on the label part.” -
“1 think the food label message was really good.
My son, he bought into that, you know, looking at calories and sugar and stuff like that, and my daughter as well (…) The one thing that 1 think we went over that 1 think we should have talked more about is the ingredients.”
“It broke it down really good for her [my daughter], and she even now does it on her own.” “That’s something y’all should include is how much we need as far as our nutrients and sodium and how much a person should be taking in, because that really wasn’t in there.” “1 don’t know what 1 can do about sugar … 1 can’t just cut off all from my kids … 1 need an acceptable daily number …” “1 didn’t necessarily use the chart, but we learned from it; that making activity a reward is much better than ice cream, you know. And 1 learned, too, that my kids like it better. “More pictures” |
Added more information on label section including sugar and sodium (the “5/10 rule”), and ingredients information.
Added more pictures illustrating recommended actions. |
| Chapter 5 |
Reflect on eating choices in the last week and identify triggers to that lead to unhealthy eating. Identify movements and intensity routines of activities using music & dance that can help them to improve their family’s health. Identify strategies and resources to help their children to deal with bullying and teasing situations using the five- step strategy AWARE. |
None |
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“1 think they were explained really well, especially this first page. It looks like a summary of everything, you know, with my plate and using their hand. The energy balance, you know, it was just a really nice summary before we moved on to the next section … 1 think that’s really important.” “1 would like to see more maybe pictures of some of the exercises. Some of the exercises that we did or maybe some that the program suggested that we do at home. That would be helpful.” “1 think the bullying part maybe, you know, just like the other part where you’re talking about elaborating on it a little more (…) Maybe a different picture or other pictures, because this triangle is good, but 1 think maybe we can do better, you know, to really drive home the whole bullying thing.” “1 like these /Choose [tracker] where you had the vegetables … well the fruit vegetables, grain, protein, dairy, and sometimes food … 1 think that’s great because that kind of its one thing to just think you’re doing all right. Versus you see it in print and you’re thinking, oh, 1 thought 1 had more vegetables than that. You know, it just brings it home. So 1 think this was a really good tool.” |
Included an appendix which exercises that families did in the exercise class (circuit), and also which exercise that could be done at home
Improved bulling section by reducing content and focusing in strategies.
Included in all sections a “recap” paragraph at the beginning of each chapter. |
| Chapter 6 |
Describe relapse and recovery in a healthy eating and physical activity. Identify and practice exercises that can help to decrease stress. Identify strategies and resources to prevent relapse and to recovery after a relapse. |
“1 feel this should be more goal based + strategies to avoid relapse” [X] suggested making title mention lapse/relapse more clear [Y] felt it was fine the way it was since the cycle graphic is just underneath. Not sure why the image about “desserts is stress backwards.” Seems counter to our main goals because the image with a cake did not support recommended behaviors and its purpose was unclear. One list exceeded seven bullets, but barely and the items in the list are short and easy to read. |
Replace Desserts image with a culturally more appropriate image of health stress management methods such as those in the text next to the image. |
“1 think you used very familiar words that you’re used to hearing about if you listen to anything about weight loss and stuff; they do talk about lapses and those kinds of things and healthy habits. You know, recovery is probably not a word I’ve heard used before with like lapses and relapses. That’s not a word 1 would necessarily think of.” “When we first got the book and 1 saw recovery, I’m like recovery? Is this talking about alcoholics?” “My take on it is that 1 like strong language like that because it makes me … it motivates me to get back on the wagon or whatever. Get me back on the trail to doing what 1 personally need to do, you know, to reach my goals. It means something positive to me because of my background. So 1 guess you guys, you have to find a balance between me and [participant Y] is it?” “1 think it was proactive [plan]. It’s always important to be proactive because, once something happens, you react and you don’t always have the best thought process. But if you have a plan in place, then you’re like, okay, 1 did this. Let me go to this and let me figure out where 1 should do from here to fix it. “1 like that [stress management] … And 1 like how you guys have this all set up, but 1 think maybe you could elaborate just a little bit more. Give us a little bit more tools of relaxation because, you know, us superwomen need all the help we can get, you know, to tackle the day.” “1 think this is helpful, you know, because it helps you to sustain, you know, all the lessons that you learned through the program. 1 have not actually cracked the book open and wrote down my strategies. 1 mean, 1 have it up in here and 1 have it in my heart. And 1 feel that I’m using the tools that you guys gave me. And this book is more of a reference for me, but 1 haven’t opened it up and started writing anything down.” |
Replaced images with a culturally more appropriate image of health stress management methods.
Review bullet list to contain less up to seven items.
Reviewed content to be more goal based and focused in the family plan after the program.
Kept lapse and relapse (strong language) to motivate the family planning for maintenance phase.
Added more stress management tools for families.
Included a family contract to stimulate parents keeping changes after program ends. |
