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In this chapter, James Tully takes us deep into the phenomenology of the kind of dialogue across traditions that is capable of disrupting the unjust power structures that currently connect diverse traditions in the modern global order. He contrasts “genuine dialogue,” in which traditions have equal status as forms of human understanding, with the many kinds of “false dialogue” that are likely to emerge under circumstances of unequal power and power-knowledge. As beings that make sense of the world through our received traditions, we tend to project onto others the terms that make the world meaningful to us. Deparochializing our political thought must begin by “reparochializing” it, recognizing that the truths we hold to be self-evident have arisen within a sociohistorically specific context. The “deep listening” required for genuine dialogue requires practices of the self that must be cultivated over time before dialogue can generate reciprocal elucidation and transformation. When we succeed, participants in this dialogue can achieve not only mutual understanding but also the possibility of bringing to light ways of “thinking, judging, deliberating, and acting together in response to the situation they share that were unimaginableand unthinkable prior to the dialogue.”
Smartphone mHealth apps can help children with obesity modify their rate of eating(1) and monitor physical activity(2). However, owing to issues with adherence, mHealth interventions require rigorous feasibility testing(3).
To evaluate, using a randomised design, the feasibility and acceptability of a mHealth intervention to reduce rate of eating and track physical activity among children in treatment for obesity.
Children (9–16 years) with obesity (BMI ≥ 98th centile) were recruited at a tertiary healthcare centre. The Research Ethics Committee at Temple St. Children's University Hospital granted ethical approval. Upon completing informed consent and assent, participants completed 2-week baseline testing including anthropometry, rate of eating by Mandometer® and physical activity using myBigO app. Thereafter participants were randomised to:(1)Treatment: Usual clinical care + Mandometer® training or (2)Control: Usual clinical care. Gender and age (9.0–12.9 years and 13.0–16.9 years) stratifications were applied. After a 4-week treatment period, participants repeated the 2-week testing period. Feasibility measures included fidelity with planned recruitment, randomisation, and intervention delivery and attrition. Acceptability measures included objective clinical portal engagement data and feedback from participants.
Of 20 recruited, eight were randomised to intervention and 12 to control, with no significant age, gender or BMI SDS differences between groups. At baseline, 7 intervention (87.5%) and 8 control (66.7%) participants recorded rate of eating. Eighteen participants (90%) registered with myBigO app, with 16 recording data successfully. Two had smartphones incompatible with myBigO (n = 1 intervention;n = 1 control) and two did not engage with myBigO app (n = 1 intervention;n = 1 control). Among 4 participants who completed Mandometer® intervention, dose received ranged from 7%-92% of planned meals. 37.5% intervention and 58.3% control participants completed post-intervention measures. Attrition was higher in the intervention (n = 5;62.5%) than control (n = 3;25%) group. Reasons cited for withdrawing included loss of interest (n = 3 intervention), child felt overwhelmed or self-conscious (n = 2 control), lack of time (n = 1 intervention), behavioural issue with child (n = 1 control), and family illness (n = 1 intervention). No significant age, gender or BMI SDS differences were observed between non-completers and completers. Participant engagement and feedback indicated mixed acceptability among this cohort.
Based on results, the current protocol for study design and intervention should be improved, if engagement is to be maximised.
The study is part of EU H2020 BigO Study (Big Data Against Childhood Obesity, Grant No. 727688.https://bigoprogram.eu/).