Intervention materials listed below include all print materials given to parents in the direct-to-parent communication arm of STAR, as well as an overview and examples of the text messaging campaign. Use of the STAR program materials is permissible with adequate citation.

Intervention materials listed below include all print materials given to parents in the direct-to-parent communication arm of STAR, as well as an overview and examples of the text messaging campaign. Use of the STAR program materials is permissible with the following citation: Used with permission (or adapted) from the STAR study (ARRA funded, Award #R18 AE000026; PI: Elsie M. Taveras, MD, MPH). To request clean copies of any of the materials, please email Sarah Price at snprice@partners.org.

Introductory Materials

Introductory materials were mailed to parents following recruitment and enrollment into the STAR study, and were intended to encourage active study engagement among families.

This day-by-day participant schedule shows the timing of all contacts with intervention participants, including well child visits, health coaching calls and text messages.

This letter was sent two weeks before the child’s annual well child visit and included an explanation of Body Mass Index (BMI) and its role in a child’s health, an age- and gender-specific percentile chart with the child’s well child visit BMI from the previous year, and a note card with suggested questions for the parent to use to start a discussion around healthy weight with the child’s clinician.

This tri-fold brochure served as an introduction for participants assigned to the direct-to-parent group. In addition to giving parents a brief overview of STAR goals, it includes a study endorsement from their pediatric practice, a welcome note from the health coaches, and the study schedule that offers parents an idea of what to expect throughout the intervention period.

This visually-friendly schedule serves as a timeline to let families know when to expect visits and health coaching calls over the course of their year participating in the STAR study.

Participants received a STAR behavior tracking calendar and set of star stickers before their first health coaching call. The calendar was designed to engage families and encourage them to work towards a set behavioral goal by offering a visual and motivating way to track how they are doing.

This one-page handout provides a brief overview of each of the STAR target behaviors.

This poster serves as a display to remind families of the STAR goals, and encourage conversation around them and ultimately action to work towards them.

Handouts on STAR Behaviors

We created educational handouts on each of the STAR primary behaviors, as well as a couple of secondary behaviors. For most behaviors there are two handouts. The first handout is an overview of the behavior goal and an explanation for why it’s important. The second is an “action” page, providing ideas for ways to help reach the goal. Handouts were mailed to participants between health coaching calls and were also available for clinicians to distribute to patients. The materials are combined here in one document, but individual handouts can be sent as requested.

Handout topics include:

  • Sleep
  • Screen Time
  • Physical Activity
  • Sugary Drinks
  • Fast Food
  • Fruits and Vegetables

STAR Text Messages

The text message campaign was intended to keep the STAR goals present in parents’ minds and encourage them to actively pay attention to how their child was doing on them. The messages provided support and motivation for parents, while also serving as a tool for tracking behavior change progress. Participants who opted not to receive text messages had the option to receive the same messages via email. For the first nine months of the campaign, parents received two texts per week. The first was a self-monitoring message that asked how the child did with a target behavior the day before. Parents were asked to reply to these messages and immediately received an automated feedback response message tailored to whether the child was meeting the goal, almost to the goal, or far from the goal. The feedback response was further tailored to reflect how they previously reported doing on that particular goal. The second type of message, sent a few days later, was a skills training, educational tip about one of the target behaviors. In the final few months of the intervention, participants only received the weekly skills training messages.

  • Skills Training Messages: Goal-specific tips and motivational text messages were sent to parents as a way of supporting them in making behavioral changes. The weekly tips focused on each of the four targeted health behaviors, and the messages rotated weekly. Each tip provided suggestions on how to progress and reach the STAR goal. Examples:
    • STAR: Make sleep a priority. Stick to regular bedtime & wake times for your child
    • STAR: Skip the chips, and the ads. More time watching TV makes kids more likely to gain extra weight. Food ads make kids want those foods and want to snack.
  • Self-monitoring Messages: Self-monitoring questions were sent to parents to encourage them to assess their child’s behavior and track their behavior change progress and change over time. There is one self-monitoring message for each of the four targeted health behaviors, plus one on fast food, and the messages rotated weekly. Examples:
    • STAR: How many sugary drinks did your child have yesterday? *Please text back your response* Thanks!
    • STAR: How many hours did your child sleep last night? *Please text back your response* Thanks!
  • Feedback Response Messages: A feedback response system was implemented to enhance interactivity of the text message intervention. The system sends immediate feedback to participants upon receipt of a response to a self-monitoring message. Examples:
    • STAR: Your child is close to meeting the recommendation. Work together to think of small steps to help them reach the goal.
    • STAR: If working on this behavior with your child feels overwhelming, take it slow. Make smalls changes one at a time as you work towards the recommended goal.
  • Other additional text messages sent to participants included a welcome text message, reminders about health coaching calls, requests to schedule a time for a health coaching call, and reminders about upcoming Well Child visits.

Participant Newsletters

Newsletters highlighting each of the STAR targeted behavioral goals were mailed to families to engage parents and children in working on the goals together. Each newsletter featured a section that provided information on the behavioral goal, tips and ideas on how to work towards the goal, as well as a kid-friendly activity. Also in each included was a 1-page insert that featured a game or puzzle that related to the highlighted goal.

Educational Brochures for Kids

Kids’ Challenge

The Kids’ Challenge focused on the goal of avoiding sugary drinks. It was the only STAR mailing meant specifically for the children, although while it was sent enclosed in an envelope with the child’s name on it, it was mailed within in a larger envelope addressed to the parent. A letter inside explained that it was for the child, it was up to the parents to pass it along to them.

The STAR Kids’ Challenge requested that kids send us their thoughts and ideas for cutting back on sugary drinks. The challenge was a contest, and to enter kids needed to either write words or draw pictures to tell us their ideas about to encourage others to switch to drinking water instead of sugary drinks. The winner was selected by study staff from mailed entries sent in by participants.

Final Health Coaching Mailing

The STAR completion certificate marked the end of the health coaching portion of the study and was mailed to participants following the final health coaching phone call. It offers a visual summary of the study components completed and encouraged families to share it with their clinician to help initiate a conversation about the study, weight, and healthy behaviors.

Incentives

The incentives listed below were mailed to participants to further encourage study engagement while offering something fun for the child.

ChopChop Magazine

This quarterly magazine was sent to families during the intervention period to try to spark interest and family conversations around healthy foods and cooking. 

Straw

A carrot-shaped straw was sent as part of the sugary drinks mailing as a way to help make drinking water more fun. 

Pedometer

A pedometer was sent along with the physical activity handouts as a fun tool to encourage more activity. 

Bookmark

This bookmark was sent along with the screen time handouts as a way to encourage less time on screen media and to serve as a regular reminder for the child of the STAR goals.

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