Table 2.

Parent/caregiver participation in digital health interventions and behavioral and weight status outcomes.

Study	Parent/Caregiver participation measures	Parent/Caregiver participation outcomes	Retention/Loss to follow-up/Withdrawal Rate	Parent/Caregiver behavioral and/or weight status outcomes	Child behavioral and/or weight status outcomes
Armstrong et al. (49)	- Text message response rate. - Acceptability of text message frequency, timing, and content. - Perceived usefulness. - Text message dose.	Text message response rate: - Parents/caregivers responded at least once to 80% of text messages and parents/caregivers responded twice or more to 30% of text messages. Acceptability: - 81% of parents/caregivers enjoyed receiving messages; 92% felt they were personalized; 62% wanted to receive texts past the study period; and 92% would recommend to a friend. Perceived usefulness: - 95% of parents/caregivers perceived the frequency “just right,” and 95% said messages “almost always” or “always” helped them make a good decision about their child's health. Text message dose: - Participants received a mean of 60 messages over the study period.	−81% retention rate	- No significant differences observed.	- No significant differences observed.
Baranowski et al. (50)	Weekly log-on rates.	Weekly log-on rate: - Mean log-on rate for parents/caregivers was 47%.	- Reports camp attendance.	- Not applicable.	- No significant differences observed.
Cullen et al. (51)	Website log-on. Website evaluation: parents/caregivers asked to grade the program.	Website log-on: - Website log-on rate over intervention period was 86%. - 66% of parents/caregivers logged onto all 8 sessions. Website evaluation: - Parents/caregivers in both conditions reported liking the program components; 63 parents/caregivers graded it an A or B.	−66% of intervention families and 74% of control families completed all data collection surveys.	- Meat modification was significantly higher at follow-up for both intervention and control parents/caregivers. - The reduced-fat scale and the substitutions scale was significantly higher at post-intervention and at follow-up for intervention parents/caregivers. - The fruit and vegetables scale was significantly higher at post-intervention and follow-up for intervention parents/caregivers and at follow-up for control group parents/caregivers.	- No significant differences observed.
Frenn et al. (52)	Feasibility: Number of returned completed consent forms, and visits to intervention components in the online program.	Feasibility - Of the 161 parents/caregivers invited, no response was received from 98. - Parents/caregivers of 5th graders = 52% response rate. - Parents of 7th−8th graders = 30% response rate at public school; 36% at private school. - 81% of parents/caregivers and children completed pretest data. - 9 parents/caregivers who agreed to complete the online modules did not.	−30% retention for parents/caregivers - 90% for children	- No significant differences observed.	- No significant differences observed.
Haines et al. (53)	Parent/caregiver satisfaction with program.	−89% of parents/caregivers reported being “satisfied” or “very satisfied” with the program. - 98% were “satisfied” or “very satisfied” with the counseling received during home visits. - 98% were “satisfied” or “very satisfied” with the counseling received during coaching calls. - 98% of parents reported they would recommend the program to friends and family.	- Intervention group = 6 lost to follow-up. - Control group = 2 lost to follow-up.	- No significant differences observed.	- Significant decrease in BMI by a mean of 0.18 in the intervention group and increased by 0.21 in the control group at 6-mos. - Significant increase in sleep duration by 0.56 h/day in the intervention group and decreased by 0.19 h/day in the control group. - Significant, larger decreases in weekend TV viewing were observed among intervention group compared with the control (−1.06 h/d; 95% CI, −1.97 to −0.15).
Newton et al. (54)	- Website log-on rates and views. - Self-monitoring of step counts. - Text message response frequency.	- Website log-on rates and views: - 38% of parents/caregivers accessed 9 or more articles; 23% accessed between 4 and 8; 38% accessed < 4 articles; 2 parents never accessed an article. - Parents/caregivers accessed 70% of articles in Month 1; 60% in Month 2; and 37.5% in Month 3. Self-monitoring of step counts: - Parents/caregivers visited the steps/day graph an average of 25.3 (SD 24.5) times over the course of the study (2.1 times/week). Number of text messages sent: - Parents/caregivers in control group sent 162 (0.96/week) text messages. - Parents/caregivers in intervention group sent 419 (2.7/week) text messages.	- None lost to follow-up.	- No significant differences observed.	- For pedometer step counts, children in both groups demonstrated significant increases in steps by 1427.6 (SD 583.0) for control and 2832.8 (SD 604.9) for intervention. The between-group and group by time difference was not statistically significant. - No other significant differences detected.
Nezami et al. (55)	- Program utilization. - Program satisfaction.	Program utilization:- Parents/caregivers submitted an average of 21.5 (4.3) out of 24 weeks of self-monitoring texts and responded to an average of 15.4 (1.7) out of 18 goal progress assessment texts.	- Retention rate: 86% at 3-months and 82% at 6-months.	- Self-monitoring and goal progress assessment texts predicted greater weight loss; intervention group lost 2.4 kg, which was significantly greater than the weight gain of 0.9 kg observed among control group.	- Significant difference observed for change in child SSB/juice intake at both 3 and 6 months; children in intervention group had a greater reduction compared with the control group at 3 months (−9.9fl. oz. day vs. −2.7fl. oz. day) and 6 months (−9.7fl. oz./day vs. −1.7fl. oz./day).
		- Parents/caregivers reported spending ~50 min/week completing study-related activities. - Program satisfaction - All intervention parents/caregivers reported that they would “probably” or “definitely” recommend the program to a friend. - 91% of parents/caregivers reported being satisfied with the program.		- A greater proportion of intervention parents/caregivers (37%) reached a weight loss of 3% compared to control (4%), and a greater proportion reached a weight loss of 5% compared to control (22 vs. 0%). - Intervention parents/caregivers had a greater reduction in caloric beverages compared with the control parents/caregivers (−11.5fl. oz./day vs. 0.4fl.oz./day).	- Significant difference observed for meeting SSB goal, 52% of children met the goal of consuming <4 oz./day of SSB/juice at 6 months, compared with 21% in the control group.
Robinson et al. (56)	- Number of START lessons received. - Use of TV Allowance time manager.	START lessons: - Delivered mean of 12.4 out of 25 START lessons. - 70% of families received at least the first 7 lessons, 29% received 7–14 lessons, 34% received 15–20 lessons, and 7% received 21 or more. TV Allowance: - 77% of families hooked up at least one TV allowance manager (12% two or more). - The mean reported weekly screen time budget goal was 10.0 ± 2.4 h.	−18 girls were lost to follow-up; 94% of girls in the intervention condition and 92.1% of girls in the control condition completed at least one follow-up assessment.	- Treatment parents had significantly increased preference for Black American things compared to control parents.	- No significant differences observed.
Taveras et al. (57)	- Text messages: Percent received and satisfaction. - Neighborhood Resource Guide: Percent received and satisfaction. - Percent completion of health coach visits.	Text messages: - In the enhanced primary care group, 91% of parents/caregivers reported they received text messages and 53% were satisfied with their content. - In the enhanced primary care + coaching group, 100% of parents/caregivers reported receiving the study text messages and 72% were very satisfied with their content. - Neighborhood Resource Guide - In the enhanced primary care group, 60% of parents/caregivers reported receiving the Neighborhood Resource Guide and 66% reported being very satisfied with its content. - In the enhanced primary care + coaching group 96% reported receiving neighborhood resource information and 76% were very satisfied with the information. Health Coach Visits: - In the enhanced primary care, 65% completed all 6 visits with a health coach.	Retention rate for intervention group: - 90% for parents/caregivers - 93% for children.	- No significant differences observed.	- No significant differences observed.
Trude et al. (58)	Intervention Exposure Questionnaire: Self-reported viewing of communication materials, participation in food environment intervention activities, enrollment in social media, receipt of text messages.	- Parents/caregivers presented an overall exposure score of 1.38 points, SD ± 1.2 (range: 0–6.9). - The Communication Materials exposure score was 0.6 points. - The Food Environment exposure score was 0.3 points. - The Social Media exposure score was 0.2 points. - Text Messaging exposure score (based on the frequency of text messages received per week) was 1.10 points.	- Attrition rate = 24.9%	- No significant differences observed for food acquisition, home food preparation, and daily consumption of FV. - For each one-point increase in exposure score, there was a 0.24 increase in mean daily fruit serving for parents/caregivers in intervention group (0.24 ± 0.11; 95% CI 0.04; 0.47). - For each one-point increase in the social media exposure score, there was an increased three servings of daily fruit intake (3.16 ± 0.92; 95% CI 1.33; 4.99) and an increase in daily fruit and vegetable intake (2.94 ± 1.01; 95% CI 0.96; 4.93). - Higher social media exposure score was associated with increased unhealthful food acquisition score (0.47 ± 0.23; 95% CI 0.02; 0.93).	- Not reported.
White et al. (59)	- Website log-on rates. - Weekly quiz completion. Frequency counts of the number of food diaries and exercise self-monitoring forms submitted.	- Website log-on rates - Intervention group website visits: mean of 557.3 (SD 500.4). - Control group website visits: mean of 226.8 (SD 161.8). - Other parent participation outcomes not reported.	Lost to follow-up: 17.8% in the intervention group and 6.9% in the control group.	No significant differences detected.	Adolescents in the behavioral group lost more fat than those in the control group (F = 3.44, p < 0.05, b = 0.28, p < 0.05).
Wright et al. (60)	- Use, credibility, and satisfaction. - Feasibility.	Use, credibility, and satisfaction: - Of parents/caregivers who made ≥ 1 call, ≥75% agreed it was useful, easy to use, made for people like them, credible, and helped them eat healthy foods, and watch less TV. - 100% of parents/caregivers would recommend it to a friend, and 100% agreed they liked it because they could use it at home. Feasibility: - 76% of parents/caregivers called the IVR at least once; of those who called at least once, the mean number of total calls was 9.1 (SD = 5.2). - Parents/caregivers made an average of 5.2 (SD = 2.8) education and behavior calls and 3.9 (SD = 2.6) tracking calls.	Lost to follow-up: 12.5% in the intervention group and 15.4% in the control group.	- Intervention parents/caregivers consumed 1.1 more cups of fruit per day than control [F(1,40) = 4.22, p = 0.046); but intervention parents/caregivers consumed fewer servings of vegetables than control parents/caregivers [F(1,40) = 6.88, p = 0.012]. - Analyses of high vs. low users of IVR found that the high users consumed significantly fewer calories compared to the low users.	No significant differences observed.