Table 1.

Characteristics of studies included in systematic review.

Study (Author name, year, and city/state, risk of bias)	Sample size	Characteristics of population	DHI methodology	Brief description of DHI	Duration and Dose	Behavioral and weight status measures
Armstrong et al., 2018, Durham, NC, USA, low risk of bias (49)	N = 100	Children aged 5–12 years old and their parent/guardian enrolling in tertiary-care obesity treatment. 48% of participants identified as Black American.	Text messages.	Usual care plus daily text messages to parents. Text messages consisted of 100 Motivational Interviewing (MI) prompts. The week's first text message persuaded parents/guardians to identify and set a family health goal. Reply text messages reinforced evidence-based goals that were likely to lead to the reduction of child BMI. Each week, parents/guardians were invited to choose a new goal or continue working on the previously selected goal. Text messages were sent on weekdays at 12 pm and replies to parents' responses were twice/day and sent by 5 pm. Appointment reminders were sent by text 24–48 h before a scheduled usual care appointment.	Duration: 12-weeks Dose: First week included three text messages and three parent replies. Subsequent weeks included 1–2 text messages and 1–2 parent responses.	- Parent/Guardian: Body Mass Index (BMI). - Child: Food Frequency Questionnaire (FFQ), BMI, physical activity, screen time.
Baranowski et al., 2003, Houston, TX, USA, low risk of bias (50)	N = 35	Black American 8-year-old girls attending summer camp and one of their parents/guardians.	Website with email reminders.	Website consisted of weekly behavioral or environmental goals for children and parents/guardians. Children's webiste included: (1) comic book with summer camp characters who overcame barriers in making lifestyle changes consistent with diet and physical activity goals; (2) problem solving for diet and physical activity barriers; (3) review of previous week's goals; (4) opportunities to set new diet and/or physical activity goals; (5) photo album from the camp; (6) ask the expert feature; and (7) links to various websites. If children did not click on a webpage item within 10-s, items on the page began to flash, to encourage a click. Parent/Guardian website included: (1) comic book where a character commented on each frame of the child's comic; (2) a poll regarding the best methods to support lifestyle changes in their children with feedback from all parents the following week; (3) opportunity to set a goal to help their children make a lifestyle change each week; (4) review of previous week's goal attainment for parents and children; (5) ask the expert feature; (6) links to various websites; (7) link to their child's website.	Duration: Summer, July-August - Dose: Website updated and e-mail reminders sent weekly.	- Child: 24-h dietary recall, accelerometer, physical activity questionnaire, waist circumference, body fat percentage (DEXA scan), BMI.
Cullen et al., 2017, Houston, TX, USA, low risk of bias (51)	N = 126	Black American families with 8–12-year-old children, with access to a home computer with high-speed Internet.	Website with video stories.	The 8 stories follow an Black American family with two 8–12-year-old children as they try to develop healthier dietary habits. After viewing the video story, parents/guardians set a goal for the next week and viewed a family food problem. Parents/Guardians provided their opinion on how to solve the food problem via a website poll. The following week, parents/guardians viewed poll results and recorded whether they met their goal. Session content and recipes could be downloaded from the website. Session content included: (1) deciding behavior change; (2) getting started; (3) menu planning at home; (4) eating away from home; (5) recipe modification; (6) grocery shopping; (7) healthy food prep practices; (8) maintaining healthy family eating habits.	Duration: 2-months. - Dose: Weekly; parents/guardians could only view one session/week but could view other materials and watch the video story as needed.	- Parent/Guardian: Dietary behaviors, home availability of fruit, vegetables, and high-, low-, and fat-free foods. - Child: Fruit and vegetable intake.
Frenn et al., 2013, Midwest, USA, unclear risk of bias (52)	N = 62 dyads	Low- to middle-income 5th, 7th, and 8th grade students and one parent/guardian from three urban schools. 28% of students identified as Black American and 7% identified as Latinx.	Website.	Parent/Guardian intervention: 6-modules to teach parents/guardians effective authoritative parenting, strategies to provide positive reinforcement for healthy eating and physical activity, and role modeling healthy behaviors. Opportunities to participate in online discussions, websites for family outings, and recipes provided on website. Child intervention: Four 2–3-min videos with diverse child actors from similar schools. Interactive components, additional websites, and ideas on recipes children could make with parent/guardian.	Duration: 3–4 weeks. - Dose: Self-paced; each parent/guardian module took 5–10 min to complete; each child module took 10–30 min to complete.	- Parent/Guardian: BMI, family support for reduction in dietary fat, sedentary behavior, and physical activity, and Food/Activity Parenting Practices Questionnaire. - Child: BMI, dietary fat, physical activity.
Haines et al., 2013, Boston, MA, USA, low risk of bias (53)	N = 121	Families with 2–5-year-old children with a TV in child's bedroom. About 33% identified as Black American and 51% identified as Latinx.	Text messages plus coaching calls and home visits.	Bilingual health educators used MI techniques to review progress and setbacks to behavior change, discuss goals, and provide an activity or tool to support behavior change. Monthly coaching calls were designed to assess progress on making changes, provide support for challenges, and reinforce study messages. The intervention focused on promotion of the key household behaviors with particular attention to achieving the goals in low-resource home environments. Text message content focused on the adoption of household routines discussed during coaching calls and home visits.	Duration: 6-months. - Dose: Twice weekly text messages for the first 16 weeks and weekly text messages for last 8-weeks; Monthly coaching calls; Four home visits.	- Parents: Frequency of meals where at least some family members ate together in past 7 days. - Child: Sleep duration, screen time, BMI.
Newton et al., 2014, Louisiana, USA, high risk of bias (54)	N = 27 dyads	6–10-year-old children and one of their parents/guardians. About 59% identified as Black American.	Website and text messages.	Parent/guardian website provided access to view their child's daily step goal, monitor their child's step counts, view a color-coded steps/day graph to see how their child's daily steps compared to target step goal, and read weekly behavioral articles. Text messages were designed to help parents/guardians encourage their child's physical activity, remind parents/guardians of behavioral concepts presented in the website articles, and motivate parents/guardians to support their child's behavior change.	Duration: 12 weeks. Dose: Website updated weekly; about seven text messages/week in minimal intervention group; about 13 text messages/week in intensive intervention group.	- Parent/Guardian: Home and Neighborhood Food Environment Questionnaire (FFQ). - Child: Sedentary behavior, FFQ, pedometer, BMI, waist circumference, body fat percentage, fat free mass.
Nezami et al., 2018, Chapel Hill, NC, USA, low risk of bias (55)	N = 51 dyads	Parent/guardians (mothers) with overweight or obesity, who had a 2–5-year-old child that consumed ≥ 12 fluid oz./day of sugar sweetened beverages (SSB). About 44% identified as Black American.	Website, text messages, e-mail.	The goal of the intervention was to slowly reduce the child's SSB/juice consumption until the child was consuming 1 serving per day (1 child serving = 4fl. oz.). Parent/guardians self-monitored their weight, number of servings of caloric beverages, and the child's servings of SSB/juice in a paper or smartphone diary. Parent/guardians received a text message prompt each week to submit their diaries, which were used to create personalized feedback. Feedback was delivered via email and was tailored to whether specific goals had been met. Parents/guardians completed monthly brief questionnaires in which they selected their greatest barrier to meeting their goals. Reported barriers were used to provide additional personalized feedback in subsequent feedback email. Parents/guardians accessed lessons on a mobile website. The lessons focused on behavioral strategies to achieve goals, including parent/guardian-child communication, problem solving, skills targeted to maternal weight loss such as reading food labels and relapse prevention strategies. Text messages included link to lessons, tips, motivational messages, and goal progress assessments with a semi-automated tailored feedback message based on responses.	Duration: 6 months. Dose: One 75-min in-person group session; Website content updated weekly during weeks 2–12 and biweekly during weeks 13–24; 3–4 text messages/week; Weekly emails on self-monitoring for first 12-weeks then bi-weekly emails for next 12-weeks.	- Parent/Guardian: 24-h dietary recall, BMI. - Child: 24-h dietary recall.
Robinson et al., 2010, Oakland, CA, USA, low risk of bias (56)	N = 261	8–10-year-old Black American girls and their parents/guardians.	Videotaped feedback and TV allowance electronic time manager.	The after-school dance intervention included dance performances every 8 weeks for families and friends; videotaped feedback; opportunities for girls to teach each other and choreograph routines; opportunities for participant choice and control; and performances at public events. Sisters Taking Action to Reduce Television (START) was a home-based screen time reduction intervention designed to incorporate African or Black American history and culture to reduce screen time. Young Black American female mentors met with families in their homes to deliver each lesson.	Duration: After school dance intervention was 9-months; START was conducted over 2-years. Dose: After school dance intervention offered 5 days/week for 2.5 h; START 12–24 lessons over 2-years.	- Parents/Guardians: Black American cultural identity. - Child: Accelerometer, screen time, meals eaten with television on, 24-h dietary recall.
Taveras et al., 2017, Massachusetts, USA, low risk of bias (57)	N = 721	2–12-year-old children with a BMI ≥85th percentile from six primary care practices; about 33% identified as Black American and 21.8% as Latinx.	Text messages, email, video calls, and online community resource map.	Clinicians received a computerized, clinical decision support (CDS) alert during primary care visits identifying children with a BMI ≥ 85th percentile. They also received additional CDS tools to assist in overweight and obesity management of children. Clinicians provided parents/guardians with a set of educational materials to support behavior change. The materials focused decreasing screen time and SSBs; improving diet quality; increasing moderate and vigorous physical activity; and improving sleep duration and quality. In the enhanced primary care + coaching arm, parents/guardians received individualized coaching tailored to their socio-environmental context from health coaches who used MI techniques. Health coaches contacted parents/guardians by phone, videoconference, or in-person visits, according to parent/guardian preference. Parents/guardians received text messages or emails, following each coaching session with educational materials to support behavior change goals. At each contact, health coaches used an online community resource map to identify resources within each parent/guardian's community that could support behavior change. Parents/guardians also received a 1-month free YMCA membership and were invited to attend a healthy grocery shopping program.	Duration: 1 year. Dose: Video calls every other month; Twice weekly text messages or emails.	- Parent/Guardian: Parent Resource Empowerment Scale. - Child: BMI.
Trude et al., 2019, Baltimore, MD, USA, low risk of bias (58)	N = 533	Families with 9–15-year-old children residing in low-income, predominantly Black American neighborhoods with low access to healthy foods.	Text messages and social media.	The intervention used an ecological and food systems approach. Individual-level components were based in community recreation centers, using youth leaders to provide education and nutrition skills to youth. The family-level included social media and text messages to target family-level nutrition behaviors. Recipes, news, and intervention-specific activities were featured in social media and text messages. Text messages and social media platforms provided parents/guardians with guidance to set and achieve dietary goals for themselves and their families, as well as promoting intervention community activities. The intervention promoted healthy foods/beverages and behaviors in three sequential phases, each lasting two months: (1) healthier beverages, (2) healthier snacks, and (3) healthier cooking methods.	Duration: 6 months. Dose: Text messages sent three times/week.	- Parent/Guardian: Fruit and vegetable intake, household food preparation, frequency of food acquisition.
White et al., 2004, Louisiana, USA, unclear risk of bais (59)	N = 57	11–15-year-old Black American girls who were overweight and had a parent/guardian with obesity (BMI>30).	Website and email.	Participants were provided with a home computer and free internet access. Participants visited website weekly and accessed material which focused on weight loss, and included information on nutrition, physical activity, and healthy food choices. Behavior change strategies were highlighted in weekly emails sent by a weight management case manager. Topics included: self-monitoring, goal setting, problem solving, behavioral contracting, and relapse prevention. Participants completed daily food records and submitted them on the website. Food records were reviewed by a dietician. Automated feedback was also provided. A computer program generated an image of the Food Guide Pyramid and indicated the extent to which the food records complied with the recommended nutritional values.	Duration: 2-years (6-month outcomes reported). Dose: Website content updated, and emails sent weekly.	- Parent/Guardian: Body fat (DEXA), BMI. - Child: Body fat (DEXA), BMI, dietary self-efficacy, 24-h dietary recall, and FFQ.
Wright et al., 2013, Boston, MA, USA, low risk of bias (60)	N = 50 dyads	9–12-year-old children with obesity and their parents/guardians attending an urban pediatric outpatient clinic. The majority of participants (72%) identified as Black American.	Interactive voice technology (IVR).	The IVR monitored, educated, and counseled parents/guardians and children on healthy weight management and screen time. The IVR spoke using text-to-speech technology. Participants communicated by speaking or by pressing keys on telephone keypad. The IVR conversation was tailored to each participant; it asked questions and provided tailored feedback. Child intervention: Concepts from the Traffic Light Diet (TLD) and the Student Media Awareness to Reduce Television program guided the child IVR conversations (e.g., increase consumption of green foods, reduce TV time to < 2 h/day). Conversation objectives included: (1) learn the TLD; (2) learn about rules; (3) self-monitor diet and screen time behaviors; and (4) set up contracts and rewards. Parent/Guardian intervention: IVR conversation content mirror children's conversation to encourage support and teamwork. Conversation objectives: (1) create a healthy home; (2) role modeling; (3) developing respectful parent/guardian-child relationship; (4) using praise and encouragement to motivate children; (5) follow the TLD with child to support efforts. Children and parents/guardians were provided a guidebook to support the calls. Data captured in the child IVR system were sent to child's pediatrician via electronic health record. Recommendations for praising, encouraging and problem solving behaviors were provided to pediatrician.	Duration: 12 weeks Dose: Two calls per week.	- Parent/Guardian: Block Data Systems dietary screener, screen time. - Child: Block Data Systems dietary screener, screen time, and time spent on recreational activities.