Browsing by Author "Ho, Josephine"

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    A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol
    (2023-01-23) Ball, Geoff D. C.; O’Neill, Marcus G.; Noor, Rafat; Alberga, Angela; Azar, Rima; Buchholz, Annick; Enright, Michelle; Geller, Josie; Ho, Josephine; Holt, Nicholas L.; Lebel, Tracy; Rosychuk, Rhonda J.; Tarride, Jean-Eric; Zenlea, Ian
    Abstract Background Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families’ access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children’s and caregivers’ acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. Methods In our 2.5-year study, 108 6–17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families’ barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. Discussion Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. Trial registration This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).
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    Acute Impaired Glucoregulation and Disrupted Gastrointestinal Hormone Secretion in Adolescents in Response to Caffeine-Containing and Nutritionally Fortified “Energy Shots”
    (2017) Virtanen, Heidi; Shearer, Jane; Ho, Josephine; Pacaud, Danièle; Reimer, Raylene; Michelle, Jackman
    Caffeine-containing energy drinks (CCED) are beverages containing simple sugars, caffeine and mixtures of vitamin, mineral and/or herbal preparations which are aggressively marketed to adolescents and young adults. This study analyzed the metabolic impact of acute, non-nutritive sweetener-containing CCED consumption on glucoregulation and gut peptide response in adolescents, and how it is affected by genetic variance. CCED consumption induced acute insulin resistance following an oral glucose tolerance test when compared with placebo, with glucose and insulin concentrations rising by 15.8% and 73.0%, respectively. Glucagon-like peptide-1, gastric inhibitory peptide, C-peptide, and pancreatic peptide YY concentrations rose following caffeine and decaffeinated treatments when compared with placebo. Genetically fast caffeine metabolizers had exaggerated glucose and insulin curves following caffeine trials, while slow metabolizers were relatively unchanged. This response to CCED consumption could be detrimental to individuals predisposed to metabolic deficits. Results provoke further exploration into the mechanisms involved in this transient insulin resistance.
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    Aim2Be mHealth intervention for children with overweight and obesity: study protocol for a randomized controlled trial
    (2020-02-03) Mâsse, Louise C; Vlaar, Janae; Macdonald, Janice; Bradbury, Jennifer; Warshawski, Tom; Buckler, E. J; Hamilton, Jill; Ho, Josephine; Buchholz, Annick; Morrison, Katherine M; Ball, Geoff D C
    Abstract Background The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person, family-based, multidisciplinary interventions that target lifestyle behaviors (e.g., diet, physical activity, and sedentary behaviors). These programs are costly to operate, have limited success, and report recruitment and retention challenges. With recent advances in technology, mobile health or mHealth has been presented as a viable alternative to in-person interventions for behavior change, especially with teens. Purpose The primary aim of this study is to test the efficacy of Aim2Be, a gamified app based on behavior change theory with health coaching to improve weight outcomes (i.e., decrease in standardized body mass index (zBMI)) and lifestyle behaviors (i.e., improve dietary quality, increase fruit and vegetable intake, reduce sugar-sweetened beverage intake, increase physical activity, and reduce screen time) among children 10- to 17-years old with overweight or obesity versus their peers randomized into a waitlist control condition. The secondary aims of this study are to 1) test whether supplementing the Aim2Be program with health coaching increases adherence and 2) examine the mediators and moderators of adherence to the Aim2Be intervention. Methods We will employ a randomized controlled trial design and recruit 200 child and parent dyads to participate in the study (2019–2020). Participants will be recruited from Canadian pediatric weight management clinics and through online advertisements. Child participants must be between the ages of 10 and 17 years, have overweight or obesity, be able to read English at least at a grade 5 level, and have a mobile phone or home computer with internet access. Following baseline data collection, participants will be randomized into intervention and waitlist control groups. Intervention participants will receive access to Aim2Be, with access to health coaching. After having their data collected for 3 months, the control group will gain access to Aim2Be, with no access to health coaching. Participants will control their frequency and duration of app usage to promote autonomy. Discussion Findings from this study will determine the efficacy of using Aim2Be in improving child weight outcomes and lifestyle behaviors and guide future mHealth interventions for pediatric weight management. Trial registration ClinicalTrials.gov, NCT03651284. Registered 29 August 2018.
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    Assessment of prevalence and associated risk factors for secondary diabetes in Canadian children
    (2006) Ho, Josephine; Sauve, Reginald S.; Pacaud, Daniele
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    Evaluation of a Targeted Video for Transition from Pediatric To Adult Care For Patients with Type 1 Diabetes Mellitus
    (2016) Winston, Karin; Dewey, Deborah; Pacaud, Danièle; Rabi, Doreen; Hebert, Marilynne; Ho, Josephine
    Transition from pediatric to adult care is challenging for patients with complex, chronic illnesses such as type 1 diabetes mellitus. To optimize successful transition of care, providers put great efforts into preparing patients for the change. This thesis evaluated the use of videos for patient decision-making in general and one video in particular that was designed to facilitate transition of care. The scoping review demonstrated that there is a vast amount of published data, which show that videos are effective in helping patients make decisions. The focus group study affirmed that patients appreciate the incorporation of a video in their transition preparation. These participants also noted that the process of transition required then to deal with complex emotional ambiguity as well as navigate logistic challenges. Video resources, which may be particularly useful to prepare in youth and young adults for important junctions in care, are valuable tools that should continue to be developed and refined.
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    The CANadian Pediatric Weight management Registry (CANPWR): lessons learned from developing and initiating a national, multi-centre study embedded in pediatric clinical practice
    (2018-07-19) Morrison, Katherine M; Ball, Geoff D C; Ho, Josephine; Mackie, Pam; Buchholz, Annick; Chanoine, Jean-Pierre; Hamilton, Jill; Laberge, Anne-Marie; Legault, Laurent; Thabane, Lehana; Tremblay, Mark; Zenlea, Ian
    Abstract Background There is increasing recognition of the value of “real-world evidence” in evaluating health care services. Registry-based, observational studies conducted in clinical settings represent a relevant model to achieve this directive. Starting in 2010, we undertook a longitudinal, observational study (the CANadian Pediatric Weight management Registry [CANPWR]), which is embedded in 10 multidisciplinary, pediatric weight management clinics across Canada. The objective of this paper was to share the lessons our team learned from this multi-centre project. Methods Data sources included a retrospective review of minutes from 120 teleconferences with research staff and investigators, notes taken during clinical site visits made by project leaders, information from quality control processes to ensure data accuracy and completeness, and a study-specific survey that was sent to all sites to solicit feedback from research team members (n = 9). Through an iterative process, the writing group identified key themes that surfaced during review of these information sources and final lessons learned were developed. Results Several key lessons emerged from our research, including the (1) value of pilot studies and central research coordination, (2) need for effective and regular communication, (3) importance of consensus on determining outcome measures, (4) challenge of embedding research within clinical practice, and (5) difficulty in recruiting and retaining participants. The sites were, in spite of these challenges, enthusiastic about the benefits of participating in multi-centre collaborative studies. Conclusion Despite some challenges, multi-centre observational studies embedded in pediatric weight management clinics are feasible and can contribute important, practical insights into the effectiveness of health services for managing pediatric obesity in real-world settings.
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    The readiness and motivation interview for families (RMI-Family) managing pediatric obesity: study protocol
    (2017-04-11) Ball, Geoff D C; Spence, Nicholas D; Browne, Nadia E; O’Connor, Kathleen; Srikameswaran, Suja; Zelichowska, Joanna; Ho, Josephine; Gokiert, Rebecca; Mâsse, Louise C; Carson, Valerie; Morrison, Katherine M; Kuk, Jennifer L; Holt, Nicholas L; Kebbe, Maryam; Gehring, Nicole D; Cesar, Melody; Virtanen, Heidi; Geller, Josie
    Abstract Background Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth. Methods From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13–17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children’s hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined. Discussion As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families’ needs.