Koa Family Study--A Community-Based Intervention to Improve Health and Well-Being

The Koa Family Study is a randomized controlled trial testing a 17-week intervention, the Koa Family Program (KFP), consisting of three components: (1) the Whole Health Program (WHP)-a weekly, online group session facilitated by a health coach using the Zoom platform; (2) social media support including texting of health messages and a private Facebook group; and (3) a community empowerment arm designed around tree planting. The KFP addresses well-being from physical, mental, and social health perspectives. The program is intended to increase weight loss while fostering self-empowerment and connections to community resources to help sustain long-term weight management. This study will test the following hypotheses: 1. Intervention participants, consisting of low-income overweight or obese women living in urban communities, receiving the KFP will have greater average weight loss and reduction in body mass index (BMI) than participants in the control group (who do not participate in the KFP); 2. KFP participants will show greater improvements in dietary practices compared with participants in the control group; 3. KFP participants will have greater increases in physical activity compared with control group participants; 4. KFP participants will have greater improvements in measures of well-being) compared with control group participants; 5. There will be a dose-response effect where greater engagement with the components of the KFP will be associated with larger improvements in the above endpoints (weight, diet, physical activity, and well-being). Study design. The primary study will employ a prospective, randomized controlled trial (RCT) design. One hundred twenty eligible participants will be assigned to either the intervention (n=60) or control (n=60) group. Intervention. The intervention group (n=60) will participate in the 17-week, KFP that supports physical, mental, and social well-being. It consists of: (1) theWHP-a weekly, online group session facilitated by a health coach using the Zoom platform; (2) social media support including texting of health messages and a private Facebook group; and (3) a community empowerment arm designed around tree planting. The WHP is a small group-focused intervention designed to build "micro-communities" of mothers supporting one another in healthy living. Groups of 5-10 women living in the same community will meet online for 75 minutes weekly via the Zoom platform, for a total of 17 sessions. Each weekly session will cover a topic on whole-person living, including healthy eating, physical activity, weight management, coping, and resilience. The content of the WHP is based, in part, on the Centers for Disease Control and Prevention's National Diabetes Prevention Program (PT2) and Family Hui, a peer-led, women's group program to increase positive parenting skills and help families thrive. For social media support, the intervention participants will receive brief text messages on their cell phones to encourage healthy lifestyle choices and connect to supportive community events and resources. EZTexting will be used to send text messages to participants. The participants also will be invited to join a private Facebook community, linked to each WHP group. The principles and practice for tree planting and stewardship will be taught within the WHP sessions. If public health policy at the time, relating to managing Coronavirus Disease (COVID)-19 permits, participants may choose to participate in community tree plantings while complying with public health directives. The control group participants will be enrolled for study measurements only and after the intervention period, will receive information based on what is proven effective in the RCT. This information will be delivered in a series of three webinars delivered after the last study data are collected at 25 weeks after baseline. Data Collection. All participants will be asked to complete a phone-based, questionnaire administered by trained research staff. It will take about 50 minutes to complete the questionnaire. Questions will cover diet, physical activity, and well-being. The questionnaire will be administered at baseline, at week 18 after completion of the 17-week intervention, and at week 26 of the study. At about week 8, an online focus group will be conducted as part of one of the sessions to qualitatively assess participants' experiences with the KFP. Weight will be collected, daily, through a research-quality, Bluetooth-enabled scale that can transmit participant weights via the Internet to a secure server.