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How involved are parents in their child's early years setting's food decisions and practices? SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:100142. [PMID: 36606099 PMCID: PMC9748307 DOI: 10.1016/j.ssmqr.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 01/07/2023]
Abstract
As childhood obesity and poor nutrition rates in England continue to rise, parents and childcare practitioners have key partnership roles in ensuring young children have healthy balanced diets. Yet little is known about parents' understanding and involvement in their childcare settings' food decisions and practices, and how this might be strengthened. Semi-structured interviews were carried out with a purposive sample of 59 parents with one or more children attending early years settings in England. Framework analysis was used to explore the interviews. Epstein's model of parental partnerships was adapted as a reflective lens for the findings, and their implication for early years' policy and practice. Parents reported a lack of two-way communication on food, and of opportunities for active, meaningful engagement around food and healthy eating outside of one-to-one discussions of their child's specific needs and requirements. Some parents reported a lack of trust in the food related information provided by their childcare setting. As young children spend more time in formal childcare, it is increasingly important that trusting collaborative relationships are built between parents and childcare practitioners to ensure that children have the best start in life. This study adds to the limited literature on parental involvement in early years settings. Findings suggest that more policy work and development is needed in the early years sector, particularly in ensuring clear and accessible guidelines on food in early years settings are readily available, and that practitioners and parents have more clarity about their mutual roles and responsibilities in this.
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Griffiths A, Brooks R, Haythorne R, Kelly G, Matu J, Brown T, Ahmed K, Hindle L, Ells L. The impact of Allied Health Professionals on the primary and secondary prevention of obesity in young children: A scoping review. Clin Obes 2022; 13:e12571. [PMID: 36451267 DOI: 10.1111/cob.12571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/25/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022]
Abstract
Allied Health Professionals (AHPs) have the capacity to promote healthy behaviours in young children through routine 'contact points', as well as structured weight management programmes. This scoping review aims to evaluate the impact of AHPs in the prevention of obesity in young children. Databases were searched for relevant evidence between 1st January 2000 and 17th January 2022. Eligibility criteria included primary evidence (including, but not limited to; randomized controlled trials, observational studies, service evaluations) evaluating the impact of AHPs on the primary and secondary prevention of obesity in young children (mean age under 5 years old). AHP-related interventions typically demonstrated improvements in outcomes such as nutritional behaviour (e.g. lower sweetened drink intake), with some reductions in screen time. However, changes in weight outcomes (e.g. body mass index (BMI) z-score, BMI) in response to an AHP intervention were inconsistent. There was insufficient data to determine moderating effects, however tentative evidence suggests that those with a lower socioeconomic status or living in an underprivileged area may be more likely to lose weight following an AHP intervention. There was no evidence identified evaluating how AHPs use routine 'contact points' in the prevention of obesity in young children. AHP interventions could be effective in optimizing weight and nutritional outcomes in young children. However, more research is required to determine how routine AHP contact points, across the range of professional groups may be used in the prevention of obesity in young children.
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Affiliation(s)
- Alex Griffiths
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Rob Brooks
- School of Health Studies, University of Bradford, Bradford, UK
| | - Rebecca Haythorne
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Gill Kelly
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Jamie Matu
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Tamara Brown
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
| | - Kanar Ahmed
- Department of Health and Social Care, Office for Health Improvement and Disparities, England, UK
| | - Linda Hindle
- Department of Health and Social Care, Office for Health Improvement and Disparities, England, UK
| | - Louisa Ells
- Obesity Institute, School of Health, Leeds Beckett University, Leeds, UK
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Bywater T, Berry V, Blower S, Bursnall M, Cox E, Mason-Jones A, McGilloway S, McKendrick K, Mitchell S, Pickett K, Richardson G, Solaiman K, Teare MD, Walker S, Whittaker K. A proportionate, universal parenting programme to enhance social-emotional well-being in infants and toddlers in England: the E-SEE Steps RCT. PUBLIC HEALTH RESEARCH 2022. [DOI: 10.3310/bcfv2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Mental disorders have become a public health crisis. Early prevention is key. Parenting programmes are effective for children aged ≥ 3 years; however, there is a lack of evidence of their effectiveness for children aged ≤ 2 years.
Objectives
To establish if the model named Enhancing Social–Emotional Health and Well-being in the Early Years (E-SEE) Steps can (1) enhance child social emotional well-being and establish whether or not it is cost-effective at 20 months of age when compared with services as usual; and (2) be delivered as a proportionate universal model with fidelity.
Design
A pragmatic two-arm randomised controlled trial and economic appraisal, with an embedded process evaluation to examine the outcomes, implementation and cost-effectiveness of the intervention, and intervention uptake, compared with services as usual. The study had an external pilot phase (which was originally planned as an internal pilot).
Setting
The intervention was delivered in community settings by early years children’s services and/or public health staff in four sites.
Participants
A total of 341 parents of infants aged ≤ 8 weeks were randomised in a ratio of 5 : 1 (intervention, n = 285; control, n = 56). The target sample was 606 parents.
Intervention
Two Incredible Years® parenting programmes (i.e. infant and toddler) delivered in a proportionate universal model with three levels [one universal (book) and two targeted group-based parenting programmes].
Main outcome measures
Child social and emotional well-being (primary outcome) was assessed using the Ages and Stages Questionnaire: Social and Emotional, 2nd edition, at 2, 9 and 18 months after randomisation. Parent depression (secondary key outcome) was assessed using the Patient Health Questionnaire-9 items. Both questionnaires were eligibility screeners for targeted groups.
Results
The primary outcome analysis provided no evidence that the E-SEE Steps model was effective in enhancing child social and emotional well-being. The adjusted mean difference was 3.02 on the original Ages and Stages Questionnaire: Social and Emotional, 2nd edition, in favour of the control [95% confidence interval –0.03 to 6.08; p = 0.052; N = 321 (intervention, n = 268; control, n = 53)]. Analysis of the key secondary outcome (i.e. parent depression levels as assessed by the Patient Health Questionnaire-9 items) provided weak evidence on the Patient Health Questionnaire-9 items in favour of the intervention (adjusted mean difference –0.61, 95% confidence interval –1.34 to 0.12; p = 0.1). Other secondary outcomes did not differ between arms. The economic analysis showed that the E-SEE Steps model was associated with higher costs and was marginally more effective (0.031 quality-adjusted life-years gained from E-SEE Steps compared with SAU, 95% confidence interval –0.008 to 0.071) than services as usual, resulting in an incremental cost-effectiveness ratio of approximately £20,062 per quality-adjusted life-year compared with services as usual. Overall take-up of the targeted parenting programmes was low. Sites, although enthusiastic, identified barriers to delivering the intervention.
Limitations
The target sample size was not met and the study was not powered to explore the effectiveness of each level of intervention. Most parents in the sample were well educated and, therefore, the results are unlikely to be generalisable, particularly to those at greatest risk of poor social and emotional well-being.
Conclusions
The E-SEE Steps proportionate universal model did not enhance child social and emotional well-being, but generated non-significant improvements in parent health outcomes, resulting in considerable uncertainty around the cost-effectiveness of the intervention. The primary and key secondary outcome gave inconsistent signals. Although, with system changes, increased resources and adaptations to the intervention, the model could be implemented, evidence for positive outcomes from the E-SEE Steps model is poor.
Future work
The universal-level E-SEE Step data (i.e. the Incredible Years book) from the external pilot will be pooled with the main trial data for further exploration up to follow-up 1, which is the time point at which most change was seen.
Trial registration
This trial is registered as ISRCTN11079129.
Funding
This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Tracey Bywater
- Department of Health Sciences, University of York, York, UK
| | - Vashti Berry
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Sarah Blower
- Department of Health Sciences, University of York, York, UK
| | | | - Edward Cox
- Centre for Health Economics, University of York, York, UK
| | | | - Sinéad McGilloway
- Centre for Mental Health and Community Research, Maynooth University, Maynooth, Ireland
| | | | - Siobhan Mitchell
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Kate Pickett
- Department of Health Sciences, University of York, York, UK
| | | | | | - M Dawn Teare
- Sheffield Clinical Trials Research Unit, Sheffield, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Simon Walker
- Centre for Health Economics, University of York, York, UK
| | - Karen Whittaker
- School of Nursing, University of Central Lancashire, Preston, UK
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Malatskey L, Essa-Hadad J, Eldar R, Filipov I, Eilat-Tsanani S, Rudolf MCJ. Medical student lifestyle counselling for non-communicable disease: impact on students' competence and patients' health behaviors. Isr J Health Policy Res 2022; 11:23. [PMID: 35610707 PMCID: PMC9131583 DOI: 10.1186/s13584-022-00532-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/09/2022] [Indexed: 11/16/2022] Open
Abstract
Background Promoting healthy lifestyle is key to tackling lifestyle-induced diseases, yet many doctors feel unskilled and medical schools lack its inclusion in their curricula. The impact of a novel elective lifestyle course is described, where students provided 3 months’ coaching to at-risk patients. Methods Students’ attitudes, competence and lifestyle were assessed pre- and post the 18-month course. Patients’ health measures and behaviors were measured. Student and patient views were ascertained. Results Nineteen students, 13 controls, and 29 patients participated. Perception of physicians’ importance as lifestyle consultants increased in coaching students (mean ± SD 3.7 ± 0.4 vs. 3.2 ± 0.5; p = 0.05). Self-perceived competence remained high in coaching students (6.7 ± 1.8 vs. 6.7 ± 1.2; p = 0.66). Controls’ competence increased but did not attain coaching students’ levels (3.6 ± 2.1 vs. 5.5 ± 1.9; p = 0.009). Focus groups of students confirmed self-perceived acquisition of skills. More patients exercised (38% vs. 82.7%; p = 0.001); spent more time in physical activity (median mins/week + IQR) 25 + [0.180] vs. 120 + [45,300]; p = 0.039), and avoided less desirable foods, such as unhealthy snacks, sweets and drinks. LDL cholesterol showed declining trend. Patients highlighted students’ empathy and attentiveness; satisfaction was extremely high. Conclusions The course successfully enhanced students’ counselling skills, with beneficial effects for patients. This model for teaching experience-based lifestyle medicine has potential policy implications in terms of promoting effective lifestyle counselling by future physicians.
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Affiliation(s)
- Lilach Malatskey
- Department of Population Health, Faculty of Medicine, Bar-Ilan University Azrieli, Henrietta Szold 8, POB 1589, 1311502, Safed, Israel
| | - Jumanah Essa-Hadad
- Department of Population Health, Faculty of Medicine, Bar-Ilan University Azrieli, Henrietta Szold 8, POB 1589, 1311502, Safed, Israel.
| | - Reut Eldar
- Department of Population Health, Faculty of Medicine, Bar-Ilan University Azrieli, Henrietta Szold 8, POB 1589, 1311502, Safed, Israel
| | | | - Sophia Eilat-Tsanani
- Department of Population Health, Faculty of Medicine, Bar-Ilan University Azrieli, Henrietta Szold 8, POB 1589, 1311502, Safed, Israel.,Clalit Health Services, Safed, Israel
| | - Mary C J Rudolf
- Department of Population Health, Faculty of Medicine, Bar-Ilan University Azrieli, Henrietta Szold 8, POB 1589, 1311502, Safed, Israel
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Bryant M, Burton W, Collinson M, Farrin A, Nixon J, Stevens J, Roberts K, Foy R, Rutter H, Copsey B, Hartley S, Tubeuf S, Brown J. A cluster RCT and process evaluation of an implementation optimisation intervention to promote parental engagement enrolment and attendance in a childhood obesity prevention programme: results of the Optimising Family Engagement in HENRY (OFTEN) trial. Trials 2021; 22:773. [PMID: 34740373 PMCID: PMC8569980 DOI: 10.1186/s13063-021-05757-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022] Open
Abstract
Background Poor and variable implementation of childhood obesity prevention programmes reduces their population impact and sustainability. We drew upon ethnographic work to develop a multi-level, theory-based implementation optimisation intervention. This intervention aimed to promote parental enrolment and attendance at HENRY (Health Exercise Nutrition for the Really Young), a UK community obesity prevention programme, by changing behaviours of children’s centre and local authority stakeholders. Methods We evaluated the effectiveness of the implementation optimisation intervention on HENRY programme enrolment and attendance over a 12-month implementation period in a cluster randomised controlled trial. We randomised 20 local government authorities (with 126 children’s centres) to HENRY plus the implementation optimisation intervention or to HENRY alone. Primary outcomes were (1) the proportion of centres enrolling at least eight parents per programme and (2) the proportion of centres with a minimum of 75% of parents attending at least five of eight sessions per programme. Trial analyses adjusted for stratification factors (pre-randomisation implementation of HENRY, local authority size, deprivation) and allowed for cluster design. A parallel mixed-methods process evaluation used qualitative interviews and routine monitoring to explain trial results. Results Neither primary outcome differed significantly between groups; 17.8% of intervention centres and 18.0% of control centres achieved the parent enrolment target (adjusted difference − 1.2%; 95% CI − 19.5%, 17.1%); 17.1% of intervention centres and 13.9% of control centres achieved the attendance target (adjusted difference 1.2%; 95% CI − 15.7%, 18.1%). Unexpectedly, the trial coincided with substantial national service restructuring, including centre closures and reduced funds. Some commissioning and management teams stopped or reduced delivery of both HENRY and the implementation optimisation intervention due to competing demands. Thus, at follow-up, HENRY programmes were delivered to approximately half the number of parents compared to baseline (n = 433 vs. 881). Conclusions During a period in which services were reduced by external policies, this first definitive trial found no evidence of effectiveness for an implementation optimisation intervention promoting parent enrolment to and attendance at an obesity prevention programme. Trial registration ClinicalTrials.govNCT02675699. Registered on 4 February 2016 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05757-w.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences and the Hull York Medical School, University of York, YO105DD, York, UK. .,Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.
| | - Wendy Burton
- Department of Health Sciences and the Hull York Medical School, University of York, YO105DD, York, UK.,Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jane Nixon
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - June Stevens
- Departments of Nutrition and Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Kim Roberts
- HENRY Head Office, 8 Elm Place, Old Witney Road, Eynsham, OX29 4BD, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - Harry Rutter
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Bethan Copsey
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.,IRSS-IRES, Université catholique de Louvain, B-1348, Louvain, La-Neuve, Belgium
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
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Rudolf MCJ, Bord S, Hasson R, Sahar Y, Rubin L, Manor N, Paldi Y, Baron-Epel O. Between-country analysis of implementing an obesity prevention intervention using RE-AIM: HENRY in Israel and UK. Health Promot Int 2021; 37:6355311. [PMID: 34414425 DOI: 10.1093/heapro/daab119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Health Exercise Nutrition for the Really Young (HENRY) is a UK community-based early childhood obesity prevention intervention that was adopted and implemented in Israel between 2013 and 2018. The aim of this study was to explore the implementation process in Israel and compare it with that of the 'parent' programme in the UK, in order to throw light on the challenges of introducing complex interventions into different countries and cultures. Published reports from HENRY and Haifa University's evaluation of the Israeli implementation were reviewed and comparisons between the UK and Israel were carried out utilizing the RE-AIM framework. In both countries, the intention was to implement in lower SES communities. When comparing the individual items, Reach and Effectiveness, we found a difference in the Reach although Effectiveness was similar: Reach was proportionally lower in Israel, but parent and professional changes in behaviour were positive in both countries. For the organizational items Adoption, Implementation and Maintenance, we found large differences between the countries. Major challenges identified in Israel included: failing to take adequate account when planning and implementing the intervention of the different ways social and health services are organized and how local authorities are structured and provide services. In addition, differences in culture beyond language and professional variations were challenges, when trying to transfer the intervention with high fidelity from the UK to Israel. Lessons learnt may benefit others in attempting cross-country implementation of complex interventions.
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Affiliation(s)
- Mary C J Rudolf
- Department of Population Health, Azrieli Faculty of Medicine, Bar Ilan University, Safed 1311502, Israel
| | - Shiran Bord
- Department of Health Systems Management, The Max Stern Yezreel Valley Israel College, 1930600, Israel
| | - Ronnie Hasson
- Ashalaim, JDC, 9 Eliezer Kaplan, Givat Ram, Jerusalem POB 3489, 9103401, Israel
| | - Yair Sahar
- Ashalaim, JDC, 9 Eliezer Kaplan, Givat Ram, Jerusalem POB 3489, 9103401, Israel
| | - Lisa Rubin
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel Haifa 31905, Israel
| | - Niva Manor
- Department of Health Promotion, Ministry of Health, 39 Yirmiyahu St., Jerusalem 9101002, Israel
| | - Yuval Paldi
- Tovanot Institute, Ben Gefen 25, Gedera, Israel
| | - Orna Baron-Epel
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel Haifa 31905, Israel
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Stamp E, Schofield H, Roberts VL, Burton W, Collinson M, Stevens J, Farrin A, Rutter H, Bryant M. Contamination within trials of community-based public health interventions: lessons from the HENRY feasibility study. Pilot Feasibility Stud 2021; 7:88. [PMID: 33771233 PMCID: PMC8004410 DOI: 10.1186/s40814-021-00805-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/22/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Contamination occurs when participants allocated to trial control arms receive elements of the active intervention. Randomisation at cluster level, rather than individual level, may reduce or eliminate contamination, avoiding the dilution of intervention effectiveness that it may cause. However, cluster randomisation can result in selection bias and may not be feasible to deliver. We explored the extent of contamination in a qualitative study nested within a feasibility study of HENRY (Health, Exercise and Nutrition for the Really Young); a UK community-based child obesity prevention programme. We aimed to determine the nature and impact of contamination to inform a larger planned trial and other trials in community based public health settings. Method We invited participants to take part in the nested qualitative study who were already involved in the HENRY feasibility study. Semi-structured interviews/focus groups were conducted with children’s centre managers (n=7), children’s centre staff (n=15), and parents (n=29). Data were transcribed and analysed using an integrative approach. First, deductively organised using a framework guided by the topic guide and then organised using inductive thematic analysis. Results Potential for contamination between treatment arms was recognised by all stakeholder groups. Staff within the intervention centres presented the greatest risk of contamination, predominantly because they were often asked to work in other children centre’s (including control group centres). ‘Sharing of best practice’ by staff was reported to be a common and desirable phenomenon within community based settings. Parental sharing of HENRY messages was reported inconsistently; though some parents indicated a high degree of knowledge transfer within their immediate circles. Conclusions The extent of contamination identified has influenced the design of a future effectiveness trial of HENRY which will be clustered at the centre level (with geographically distinct clusters). The common practice of knowledge sharing amongst community teams means that this clustering approach is also likely to be most suitable for other trials based within these settings. We provide recommendations (e.g. cluster randomisation, training intervention facilitators on implications of contamination) to help reduce the impact of contamination in public health intervention trials with or without clustering, whilst enabling transfer of knowledge where appropriate. Trial registration ClinicalTrials.gov Identifier NCT03333733 registered 6th November 2017
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Affiliation(s)
- Elizabeth Stamp
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, LE11 3TU, UK.
| | - Holly Schofield
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | | | - Wendy Burton
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.,Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - June Stevens
- Department of Nutrition, Gillings School of Public Health, University of North Carolina, Chapel Hill, 27599, USA
| | - Amanda Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Harry Rutter
- Department of Social & Policy Sciences, University of Bath, Bath, BA2 7AY, Somerset, UK
| | - Maria Bryant
- Department of Health Sciences, University of York, York, YO10 5DD, UK.,Hull York Medical School, University of York, York, YO10 5DD, UK
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Bryant M, Collinson M, Burton W, Stamp E, Schofield H, Copsey B, Hartley S, Webb E, Farrin AJ. Cluster randomised controlled feasibility study of HENRY: a community-based intervention aimed at reducing obesity rates in preschool children. Pilot Feasibility Stud 2021; 7:59. [PMID: 33632330 PMCID: PMC7908721 DOI: 10.1186/s40814-021-00798-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 02/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Community-based obesity prevention interventions are often commissioned despite the limited evidence base. HENRY (Health, Exercise, Nutrition for the Really Young) is a programme delivered to parents of preschool children across the UK. Early evidence suggests that it may be effective, but a robust evaluation has not been conducted. We initiated a systematic evaluation of HENRY by studying the feasibility of conducting a multi-centre definitive trial to evaluate its effectiveness and cost-effectiveness to prevent obesity. Objectives were to assess the feasibility of recruiting local authorities, centres and parents; test processes and time required to train and certify intervention staff; explore HENRY commissioning processes; identify potential sources (and associated impact) of contamination; and consider the feasibility of trial procedures. METHODS We conducted a multi-centre, open labelled, two group, prospective, cluster randomised, controlled, feasibility study, with embedded process evaluation and pre-defined criteria for progression to definitive trial. We sought to recruit 120 parents from 12 children's centres, across two UK local authority (government) areas. Within each local authority, we planned to randomise three centres to HENRY and three to 'standard care' control. Our plan was to collect data in family homes at baseline and 12 months, including parent and child height and weight, and parent-reported questionnaires on self-efficacy, feeding, eating habits, quality of life and resource use. Contamination, implementation and study acceptability were explored using parent interviews. RESULTS We recruited two local authorities and 12 children's centres within eight months. One hundred and seventeen parents were recruited (average 3.9 parents per programme) and follow-up data were collected from 85% of participants. Process data from 20 parents and 24 members of staff indicate that both would benefit from more detail about their involvement as participants, but that methods were acceptable. Contamination was likely, though the impact of this on behaviour was unclear. CONCLUSION Our findings indicate that a cluster RCT of HENRY to assess its effect on childhood obesity prevention is feasible. This study has allowed us to design a pragmatic definitive trial with minimal bias, taking account of lessons learnt from conducting evaluation research in public health settings. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03333733 registered 6th November 2017.
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Affiliation(s)
- Maria Bryant
- Department of Health Sciences, University of York, York, YO10 5DD UK
- Hull York Medical School, University of York, York, YO10 5DD UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Wendy Burton
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Elizabeth Stamp
- National Centre of Sport and Exercise Medicine, Loughborough University, Epinal Way, Loughborough, Leicestershire, LE11 3TU UK
| | - Holly Schofield
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Bethan Copsey
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Edward Webb
- Academic unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT UK
| | - Amanda J. Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
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Howlett N, Roberts KPJ, Swanston D, Edmunds LD, Willis TA. Testing the feasibility of a sustainable preschool obesity prevention approach: a mixed-methods service evaluation of a volunteer-led HENRY programme. BMC Public Health 2021; 21:46. [PMID: 33407291 PMCID: PMC7789777 DOI: 10.1186/s12889-020-10031-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/09/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Over the last 10 years HENRY has been working to reduce and prevent child obesity by training health and early years professionals to deliver its evidence-based programme to parents. The aim and unique contribution of this study was to evaluate whether training volunteers to deliver this programme on a one-to-one basis was feasible. METHODS Mixed-methods service evaluation with parent-reported pre- and post-programme outcomes and focus groups conducted with parents and volunteer facilitators. The programme consisted of 8 one-to-one sessions delivered weekly by volunteers (n = 18) to build food and activity-related knowledge, skills, and understanding, and improve parenting efficacy, and parent and child eating and physical activity. Programmes took place at parent's (n = 69) home or local community venues in four London boroughs, United Kingdom. Parent-reported parenting efficacy, emotional wellbeing, eating, and physical activity data were captured, alongside parent ratings of the programme and volunteer ratings of the training. Parent and volunteer focus groups explored involvement, expectations, and experiences of the programme, training and delivery, feedback, and impact. RESULTS Parents were mostly female, had varied ethnic backgrounds, and were often not working but well educated. There were statistically significant improvements of a medium-to-large size in parent and child emotional wellbeing, parenting efficacy, fruit and vegetable consumption, family eating and food purchasing behaviours. Parent ratings of the programme were positive and qualitative data highlighted the holistic nature of the programme, which focused on more than just food, and the relationships with volunteers as key facets. Volunteers were also mostly female, had varied ethnic backgrounds, and were often well educated, but more likely to be employed than parents. Volunteers rated the training and delivery as useful in enabling them to deliver the programme confidently and for their own wellbeing. Despite finding some sessions challenging emotionally, volunteers reported positive family lifestyle improvements by parents and children and that the experience would be useful for future employment. CONCLUSIONS It is feasible to recruit and train volunteers to deliver a structured preschool obesity prevention programme, which parents considered acceptable and enjoyable, with preliminary reports of parent and child benefits.
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Affiliation(s)
- Neil Howlett
- Department of Psychology, Sport, and Geography, University of Hertfordshire, College Lane, Hatfield, Herts, AL10 9AB, UK.
| | - Kim P J Roberts
- HENRY, 8 Elm Place, Old Witney Road, Oxfordshire, OX29 4BD, UK
| | - Di Swanston
- HENRY, 8 Elm Place, Old Witney Road, Oxfordshire, OX29 4BD, UK
| | - Laurel D Edmunds
- Radcliffe Department of Medicine, Medical Sciences Division, University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9NL, UK
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Bridge GL, Willis TA, Evans CEL, Roberts KPJ, Rudolf M. The impact of HENRY on parenting and family lifestyle: Exploratory analysis of the mechanisms for change. Child Care Health Dev 2019; 45:850-860. [PMID: 31209923 DOI: 10.1111/cch.12694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childhood obesity is a major public health concern. In the United Kingdom, a quarter of children are overweight or obese at age 5 years. Overweight and obese children are more likely to develop serious health issues such as diabetes later in life. Consequently, there is an urgent need for effective, early obesity prevention and intervention. This study investigated the impact of an 8-week child obesity intervention-HENRY (Health Exercise Nutrition for the Really Young)-designed to help parents with preschool children develop the skills and knowledge needed to improve family lifestyle and well-being. We were particularly interested in exploring the potential mechanisms by which HENRY may have a positive impact. METHOD Focus groups (n = 7, total participants = 39) were completed with mothers attending the HENRY programme at one of seven locations across England. They took place within 2 weeks of programme completion. Follow-up telephone interviews were completed with a subsample of participants (n = 10) between 17 and 21 weeks later. RESULTS Parents consistently reported enhanced self-efficacy in terms of improved confidence in their ability to encourage healthier behaviours such as eating fruit and vegetables and increasing physical activity, and improvements to family health behaviours. Many changes were reportedly sustained at follow-up. Data provided insights into the potential mechanisms that created the conditions for the positive changes. Participants described the importance of mutual support, being listened to by facilitators, and encouragement to identify their own ideas. Their comments indicated the success of a solution-focused, strength-based, partnership approach to supporting family lifestyle change. CONCLUSION The results of this study contribute to the body of evidence suggesting that HENRY may have a positive impact on parenting and family lifestyle behaviour. Although data were collected in 2011, the findings contribute to an understanding of the components of effective obesity prevention in young children.
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Affiliation(s)
- Gemma L Bridge
- Leeds Business School, Leeds Beckett University, Leeds, UK
| | - Thomas A Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Charlotte E L Evans
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, Leeds, UK
| | | | - Mary Rudolf
- Azrieli Faculty of Medicine in the Galilee, Bar Ilan University, Safed, Israel
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11
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Rudolf M, Perera R, Swanston D, Burberry J, Roberts K, Jebb S. Observational analysis of disparities in obesity in children in the UK: Has Leeds bucked the trend? Pediatr Obes 2019; 14:e12529. [PMID: 31022330 PMCID: PMC6767538 DOI: 10.1111/ijpo.12529] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/01/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The prevalence of obesity in childhood is of high concern, especially in deprived populations. We explored trends in obesity following the introduction of a citywide strategy focused on preschool children. METHODS Analysis of obesity prevalence using the National Child Measurement Programme 2009 to 2017 for primary-school children in Leeds using 5-year aggregated data for Leeds, comparable cities, and England as a whole. RESULTS Prevalence of obesity in Leeds for school entry children fell significantly (9.4% to 8.8%), whilst comparable cities (CC) and England as a whole showed no change (comparison of trends: P < 0.001 and P < 0.001). The reduction in Leeds was primarily in the most deprived (11.5% to 10.5%; trend comparison CC: P < 0.001, Eng: P < 0.001), but also amongst the affluent (6.8% to 6.0%; trend comparison CC: P = 0.087, Eng: P = 0.012). Prevalence in older children in Leeds was unchanged whilst it increased for comparable cities and England (trend comparison CC: P < 0.001, Eng: P < 0.001). In the deprived, obesity increased: Leeds by 1.4%; CC 1.3%, England 1% (trend comparison Eng: P = 0.004). In the affluent, obesity prevalence reduced more in Leeds than elsewhere: 2% in Leeds, 0.8% in CC, and 0.7% in England (trend comparison CC: P < 0.001, Eng: P ≤ 0.001). CONCLUSIONS There has been a notable decrease in the prevalence of obesity especially amongst the most disadvantaged children at entry to primary school in Leeds. How this was achieved merits in-depth consideration.
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Affiliation(s)
- Mary Rudolf
- Department of Population Health, Azrieli Faculty of MedicineBar Ilan UniversitySafedIsrael
| | - Rafael Perera
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Janice Burberry
- Public Health (Children and Families) Adults and Health DirectorateLeedsUK
| | | | - Susan Jebb
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
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12
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Burton W, Twiddy M, Sahota P, Brown J, Bryant M. Participant engagement with a UK community-based preschool childhood obesity prevention programme: a focused ethnography study. BMC Public Health 2019; 19:1074. [PMID: 31395041 PMCID: PMC6688247 DOI: 10.1186/s12889-019-7410-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 07/31/2019] [Indexed: 11/18/2022] Open
Abstract
Background Children’s centres in the UK provide a setting for public health programmes; offering support to families living in the most disadvantaged areas where obesity prevalence is at its highest. Health, Exercise and Nutrition in the Really Young (HENRY) is an eight-week obesity prevention programme currently delivered in children’s centres across the UK. However, low participant engagement in some local authorities threatens its potential reach and impact. This study aimed to explore the factors influencing participant engagement with HENRY to describe where local intervention may support engagement efforts. Method A focused ethnography study was undertaken in five children’s centres delivering HENRY across the UK. One hundred and ninety hours of field observations, 22 interviews with staff (commissioners, HENRY co-ordinators, managers and facilitators) and six focus groups (36 parents), took place over five consecutive days in each centre. The Consolidated Framework for Implementation Research (CFIR) was used to guide the observations and analysis of the data. Results Three overarching themes described the factors influencing participant engagement with HENRY: local authority decision making around children’s centre programmes; children’s centre implementation of HENRY; and the participant experience of HENRY. The results indicate that factors influencing participant engagement with public health programmes begin at the commissioning body level, influencing children’s centre implementation and subsequently the experience of participants. Local authority funding priorities and constraints influence availability of places and who these places are offered to, with funding often targeted towards those deemed most at need. This was perceived to have a detrimental effect on participant experience of the programme. Conclusion In summary, participant engagement is affected by multiple factors, working at different levels of the children’s centre and local authority hierarchy, most of which are at play even before participants decide whether or not they choose to enrol and maintain attendance. For programmes to achieve their optimal reach and impact, factors at the commissioning and local implementation level need to be addressed prior to addressing participant facing issues. Electronic supplementary material The online version of this article (10.1186/s12889-019-7410-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wendy Burton
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Cottingham Rd, Hull, HU6 7RX, UK
| | - Pinki Sahota
- School of Clinical and Applied Sciences, Leeds Beckett University, City Campus, Leeds, LS1 3HE, UK
| | - Julia Brown
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Maria Bryant
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
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13
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Bradbury D, Chisholm A, Watson PM, Bundy C, Bradbury N, Birtwistle S. Barriers and facilitators to health care professionals discussing child weight with parents: A meta-synthesis of qualitative studies. Br J Health Psychol 2018; 23:701-722. [PMID: 29700900 PMCID: PMC6099303 DOI: 10.1111/bjhp.12312] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/13/2018] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Childhood obesity is one of the most serious global public health challenges. However, obesity and its consequences are largely preventable. As parents play an important role in their children's weight-related behaviours, good communication between parents and health care professionals (HCPs) is essential. This systematic review provides a meta-synthesis of qualitative studies exploring the barriers and facilitators experienced by HCPs when discussing child weight with parents. METHODS Searches were conducted using the following databases: MEDLINE (OVID), Psych INFO (OVID), EMBASE (OVID), Web of Knowledge and CINAHL. Thirteen full-text qualitative studies published in English language journals since 1985 were included. Included studies collected data from HCPs (e.g., nurses, doctors, dieticians, psychologists, and clinical managers) concerning their experiences of discussing child weight-related issues with parents. An inductive thematic analysis was employed to synthesize findings. FINDINGS Emerging subthemes were categorized using a socio-ecological framework into intra/interpersonal factors, organizational factors, and societal factors. Perceived barriers and facilitators most commonly related to intra/interpersonal level factors, that is, relating to staff factors, parental factors, or professional-parent interactions. HCPs also attributed a number of barriers, but not facilitators, at the organizational and societal levels. CONCLUSION The findings of this review may help to inform the development of future weight-related communication interventions. Whilst intra/interpersonal interventions may go some way to improving health care practice, it is crucial that all stakeholders consider the wider organizational and societal context in which these interactions take place. Statement of contribution What is already known on the subject? Childhood obesity is one of the United Kingdom's most serious current public health challenges. Health care professionals are in a prime position to identify child weight issues during routine consultations. However, they often feel unable or unequipped to raise the topic and provide information on child weight management. What does this study add? To our knowledge, this is the first review to synthesize barriers and facilitators to discussing child weight. This review interprets key barriers and facilitators in the context of the socio-ecological model. Supports the development of interventions matched to the appropriate level of the socio-economic model.
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Affiliation(s)
- Daisy Bradbury
- Physical Activity ExchangeResearch Institute for Sport and Exercise SciencesLiverpool John Moores UniversityUK
| | | | - Paula M. Watson
- Physical Activity ExchangeResearch Institute for Sport and Exercise SciencesLiverpool John Moores UniversityUK
| | | | | | - Sarah Birtwistle
- Physical Activity ExchangeResearch Institute for Sport and Exercise SciencesLiverpool John Moores UniversityUK
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14
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Bryant M, Burton W, Collinson M, Hartley S, Tubeuf S, Roberts K, Sondaal AEC, Farrin AJ. Cluster randomised controlled feasibility study of HENRY: a community-based intervention aimed at reducing obesity rates in preschool children. Pilot Feasibility Stud 2018; 4:118. [PMID: 29977593 PMCID: PMC6013860 DOI: 10.1186/s40814-018-0309-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 06/13/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In the UK and beyond, public funding is used to commission interventions delivered in public health early years settings aimed at improving health and well-being and reducing inequalities in order to promote school readiness. This is a key setting for obesity prevention programmes, which are often commissioned despite the limited evidence base. The HENRY (Health, Exercise, Nutrition for the Really Young) programme is an 8-week programme delivered to parents of preschool children, designed to support families to optimise healthy weight behaviours. Early evidence suggests that it may be effective, but a robust evaluation using a randomised controlled design has not been conducted. This study begins this process by evaluating the feasibility of conducting a multi-centre definitive trial to evaluate the effectiveness and cost-effectiveness of HENRY to prevent obesity in the early years. METHODS This is a multi-centre, open labelled, two group, prospective, cluster randomised, controlled, feasibility study aiming to recruit 120 parents from 12 children's centres, based in two local authority areas. Within each of the two local authorities, three centres will be randomised to HENRY and three will be randomised to a control arm of standard care (usual provision of services within children's centres). We will explore HENRY commissioning, provision and delivery and assess the feasibility of local authority, centre and parent recruitment, the processes and time required to train and certify staff to deliver the intervention, the potential sources (and associated risk) of contamination and the feasibility of the trial procedures. Research includes a process evaluation, feasibility of cost-effectiveness evaluation, with progression to the definitive trial judged against pre-defined criteria. DISCUSSION This feasibility study will support the decision to proceed to, and the design of, a future definitive trial, providing an evidence base of an approach to prevent childhood obesity, which has been deemed attractive to all stakeholders, including parents. Given the widespread adoption of the intervention, this has the potential to impact on public health in the UK and beyond. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT03333733 registered 6th November 2017Protocol date: 25th October 2017Protocol version: 4.0.
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Affiliation(s)
- Maria Bryant
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Wendy Burton
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Michelle Collinson
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Suzanne Hartley
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT UK
| | - Kim Roberts
- HENRY, 8 Elm Place, Old Witney Rd, Oxfordshire, OX29 4BD UK
| | | | - Amanda J. Farrin
- Clinical Trials Research Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT UK
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Peles C, Rudolf M, Weingarten M, Bentwich ME. What Can Be Learned from Health-Related Tensions and Disparities in Ultra-Orthodox Jewish Families? JOURNAL OF RELIGION AND HEALTH 2018; 57:1133-1145. [PMID: 29511923 DOI: 10.1007/s10943-018-0590-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Promoting healthy lifestyle from early childhood is a key objective in public health, yet health behaviors are often culturally driven, especially in closed-religious communities. This study aims to reveal key cultural-religious aspects of attitudes and behaviors regarding lifestyle in one such closed community-the ultra-orthodox Jewish community. In-depth interviews were conducted with 20 participants: religious leaders, educational figures, psycho-medical professionals from two major ultra-orthodox communities in Israel. A thematic analysis was used to reveal key themes in the interviews. We found tensions between conflicting themes in the parenting, nutrition and physical activity domains, while the sleep domain illustrated cultural solution for a tension. By illuminating the perceptional components of lifestyle, the study contributes to better foundations of health promotion in closed-religious communities.
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Affiliation(s)
- Chagit Peles
- Faculty of Medicine, Bar-Ilan Unversity, Safed Campus, P.O. Box 1589, Safed, Israel
| | - Mary Rudolf
- Faculty of Medicine, Bar-Ilan Unversity, Safed Campus, P.O. Box 1589, Safed, Israel
| | - Michael Weingarten
- Faculty of Medicine, Bar-Ilan Unversity, Safed Campus, P.O. Box 1589, Safed, Israel
| | - Miriam Ethel Bentwich
- Faculty of Medicine, Bar-Ilan Unversity, Safed Campus, P.O. Box 1589, Safed, Israel.
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16
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Reeves S, Fletcher S, McLoughlin C, Yim A, Patel KD. Interprofessional online learning for primary healthcare: findings from a scoping review. BMJ Open 2017; 7:e016872. [PMID: 28780560 PMCID: PMC5623444 DOI: 10.1136/bmjopen-2017-016872] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES This article presents the findings from a scoping review which explored the nature of interprofessional online learning in primary healthcare. The review was informed by the following questions: What is the nature of evidence on online postgraduate education for primary healthcare interprofessional teams? What learning approaches and study methods are used in this context? What is the range of reported outcomes for primary healthcare learners, their organisations and the care they deliver to patients/clients? SETTING The review explored the global literature on interprofessional online learning in primary healthcare settings. RESULTS The review found that the 23 included studies employed a range of different e-learning methods with contrasting course durations, use of theory, participant mix, approaches to accreditation and assessment of learning. Most of the included studies reported outcomes associated with learner reactions and positive changes in participant attitudes/perceptions and improvement in knowledge/skills as a result of engagement in an e-learning course. In contrast, fewer studies reported changes in participant behaviours, changes in organisational practice and improvements to patients/clients. CONCLUSIONS A number of educational, methodological and outcome implications are be offered. E-learning can enhance an education experience, support development, ease time constraints, overcome geographic limitations and can offer greater flexibility. However, it can also contribute to the isolation of learners and its benefits can be negated by technical problems.
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Affiliation(s)
- Scott Reeves
- Faculty of Health, Social Care and Education, Kingston University and St Georges, University London, London, UK
| | - Simon Fletcher
- Faculty of Health, Social Care and Education, Kingston University and St Georges, University London, London, UK
| | | | - Alastair Yim
- Department of Paediatrics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kunal D Patel
- Faculty of Health, Social Care and Education, Kingston University and St Georges, University London, London, UK
- Research & Advocacy, Iheed, Dublin, Ireland
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Bryant M, Burton W, Cundill B, Farrin AJ, Nixon J, Stevens J, Roberts K, Foy R, Rutter H, Hartley S, Tubeuf S, Collinson M, Brown J. Effectiveness of an implementation optimisation intervention aimed at increasing parent engagement in HENRY, a childhood obesity prevention programme - the Optimising Family Engagement in HENRY (OFTEN) trial: study protocol for a randomised controlled trial. Trials 2017; 18:40. [PMID: 28115006 PMCID: PMC5260000 DOI: 10.1186/s13063-016-1732-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 11/27/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Family-based interventions to prevent childhood obesity depend upon parents' taking action to improve diet and other lifestyle behaviours in their families. Programmes that attract and retain high numbers of parents provide an enhanced opportunity to improve public health and are also likely to be more cost-effective than those that do not. We have developed a theory-informed optimisation intervention to promote parent engagement within an existing childhood obesity prevention group programme, HENRY (Health Exercise Nutrition for the Really Young). Here, we describe a proposal to evaluate the effectiveness of this optimisation intervention in regard to the engagement of parents and cost-effectiveness. METHODS/DESIGN The Optimising Family Engagement in HENRY (OFTEN) trial is a cluster randomised controlled trial being conducted across 24 local authorities (approximately 144 children's centres) which currently deliver HENRY programmes. The primary outcome will be parental enrolment and attendance at the HENRY programme, assessed using routinely collected process data. Cost-effectiveness will be presented in terms of primary outcomes using acceptability curves and through eliciting the willingness to pay for the optimisation from HENRY commissioners. Secondary outcomes include the longitudinal impact of the optimisation, parent-reported infant intake of fruits and vegetables (as a proxy to compliance) and other parent-reported family habits and lifestyle. DISCUSSION This innovative trial will provide evidence on the implementation of a theory-informed optimisation intervention to promote parent engagement in HENRY, a community-based childhood obesity prevention programme. The findings will be generalisable to other interventions delivered to parents in other community-based environments. This research meets the expressed needs of commissioners, children's centres and parents to optimise the potential impact that HENRY has on obesity prevention. A subsequent cluster randomised controlled pilot trial is planned to determine the practicality of undertaking a definitive trial to robustly evaluate the effectiveness and cost-effectiveness of the optimised intervention on childhood obesity prevention. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02675699 . Registered on 4 February 2016.
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Affiliation(s)
- Maria Bryant
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29JT UK
| | - Wendy Burton
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29JT UK
| | - Bonnie Cundill
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29JT UK
| | - Amanda J. Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29JT UK
| | - Jane Nixon
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29JT UK
| | - June Stevens
- Department of Nutrition, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC 27599 USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC 27599 USA
| | - Kim Roberts
- HENRY Head Office, 8 Elm Place, Old Witney Road, Eynsham, OX29 4BD UK
| | - Robbie Foy
- Academic Unit of Primary Care, Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT UK
| | - Harry Rutter
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Suzanne Hartley
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29JT UK
| | - Sandy Tubeuf
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT UK
| | - Michelle Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29JT UK
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS29JT UK
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Wolfenden L, Jones J, Williams CM, Finch M, Wyse RJ, Kingsland M, Tzelepis F, Wiggers J, Williams AJ, Seward K, Small T, Welch V, Booth D, Yoong SL. Strategies to improve the implementation of healthy eating, physical activity and obesity prevention policies, practices or programmes within childcare services. Cochrane Database Syst Rev 2016; 10:CD011779. [PMID: 27699761 PMCID: PMC6458009 DOI: 10.1002/14651858.cd011779.pub2] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to:1. describe the impact of such strategies on childcare service staff knowledge, skills or attitudes;2. describe the cost or cost-effectiveness of such strategies;3. describe any adverse effects of such strategies on childcare services, service staff or children;4. examine the effect of such strategies on child diet, physical activity or weight status. SEARCH METHODS We searched the following electronic databases on 3 August 2015: the Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, EMBASE, PsycINFO, ERIC, CINAHL and SCOPUS. We also searched reference lists of included trials, handsearched two international implementation science journals and searched the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA We included any study (randomised or non-randomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. DATA COLLECTION AND ANALYSIS The review authors independently screened abstracts and titles, extracted trial data and assessed risk of bias in pairs; we resolved discrepancies via consensus. Heterogeneity across studies precluded pooling of data and undertaking quantitative assessment via meta-analysis. However, we narratively synthesised the trial findings by describing the effect size of the primary outcome measure for policy or practice implementation (or the median of such measures where a single primary outcome was not stated). MAIN RESULTS We identified 10 trials as eligible and included them in the review. The trials sought to improve the implementation of policies and practices targeting healthy eating (two trials), physical activity (two trials) or both healthy eating and physical activity (six trials). Collectively the implementation strategies tested in the 10 trials included educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing. A total of 1053 childcare services participated across all trials. Of the 10 trials, eight examined implementation strategies versus a usual practice control and two compared alternative implementation strategies. There was considerable study heterogeneity. We judged all studies as having high risk of bias for at least one domain.It is uncertain whether the strategies tested improved the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention. No intervention improved the implementation of all policies and practices targeted by the implementation strategies relative to a comparison group. Of the eight trials that compared an implementation strategy to usual practice or a no intervention control, however, seven reported improvements in the implementation of at least one of the targeted policies or practices relative to control. For these trials the effect on the primary implementation outcome was as follows: among the three trials that reported score-based measures of implementation the scores ranged from 1 to 5.1; across four trials reporting the proportion of staff or services implementing a specific policy or practice this ranged from 0% to 9.5%; and in three trials reporting the time (per day or week) staff or services spent implementing a policy or practice this ranged from 4.3 minutes to 7.7 minutes. The review findings also indicate that is it uncertain whether such interventions improve childcare service staff knowledge or attitudes (two trials), child physical activity (two trials), child weight status (two trials) or child diet (one trial). None of the included trials reported on the cost or cost-effectiveness of the intervention. One trial assessed the adverse effects of a physical activity intervention and found no difference in rates of child injury between groups. For all review outcomes, we rated the quality of the evidence as very low. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used in this review. AUTHORS' CONCLUSIONS Current research provides weak and inconsistent evidence of the effectiveness of such strategies in improving the implementation of policies and practices, childcare service staff knowledge or attitudes, or child diet, physical activity or weight status. Further research in the field is required.
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Affiliation(s)
| | | | | | | | | | - Melanie Kingsland
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | - Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthCallaghanAustralia2308
| | | | | | | | | | - Vivian Welch
- University of OttawaBruyère Research Institute85 Primrose StreetOttawaCanadaK1N 5C8
| | - Debbie Booth
- University of NewcastleUniversity LibraryUniversity DriveCallaghanAustralia2308
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Willis T, Roberts K, Berry T, Bryant M, Rudolf M. The impact of HENRY on parenting and family lifestyle: A national service evaluation of a preschool obesity prevention programme. Public Health 2016; 136:101-8. [DOI: 10.1016/j.puhe.2016.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
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Shloim N, Rudolf M, Feltbower RG, Mohebati L, Hetherington M. Breast is best: Positive mealtime interactions in breastfeeding mothers from Israel and the United Kingdom. Health Psychol Open 2015; 2:2055102915579605. [PMID: 28070352 PMCID: PMC5193277 DOI: 10.1177/2055102915579605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We examined mealtime interactions to assess whether they varied according to maternal body mass index, country and mode of feeding in 41 Israeli and UK mother–infant dyads. Feeding behaviours were coded using the Simple Feeding Element Scale. Significantly, more UK mothers breastfed during the filmed meal compared to Israeli mothers. Mealtime interactions did not vary according to maternal body mass index or country. Women who breastfed (as opposed to those who bottle fed or fed solids) provided fewer distractions during the meal, a more ideal feeding environment and fed more responsively.
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Willis TA, George J, Hunt C, Roberts KPJ, Evans CEL, Brown RE, Rudolf MCJ. Combating child obesity: impact of HENRY on parenting and family lifestyle. Pediatr Obes 2014; 9:339-50. [PMID: 23818487 DOI: 10.1111/j.2047-6310.2013.00183.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/22/2013] [Accepted: 05/15/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND One-quarter of children in England are overweight/obese at school entry. We investigated the impact of a programme designed to provide parents of infants and preschool children with the skills required for a healthier family lifestyle. METHOD A cohort of families was followed across the 8-week HENRY (Health Exercise Nutrition for the Really Young) parent course at nine locations in England. Seventy-seven parents enrolled on the course, of which 71 agreed to complete questionnaires addressing eating behaviours, dietary intake and parental self-efficacy. Pre- and post-course data was available from 60 (84.5%) parents (8-week follow-up data from 58 parents) and was analysed using repeated measures analyses. RESULTS Significant changes were observed, with most sustained at follow-up. Parents reported increased self-efficacy and ability to encourage good behaviour (P < 0.001). Increased consumption of fruits and vegetables was reported in both children and adults, together with reduced consumption of sweets, cakes and fizzy drinks in adults (all P < 0.01). There were also positive changes in eating behaviours (e.g., frequency of family mealtimes and eating while watching television or in response to negative emotion [P < 0.01] ) and reduced screen time in adults (P < 0.001). DISCUSSION The results build upon earlier evaluation, indicating that the HENRY intervention has a beneficial impact upon the families of infants and preschool children. Furthermore, the findings suggest that positive changes inspired by the programme can be maintained beyond its completion. Such changes may serve to protect against later obesity.
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Affiliation(s)
- T A Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Lewis KO, Cidon MJ, Seto TL, Chen H, Mahan JD. Leveraging e-learning in medical education. Curr Probl Pediatr Adolesc Health Care 2014; 44:150-63. [PMID: 24981664 DOI: 10.1016/j.cppeds.2014.01.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 01/23/2014] [Indexed: 10/25/2022]
Abstract
e-Learning has become a popular medium for delivering instruction in medical education. This innovative method of teaching offers unique learning opportunities for medical trainees. The purpose of this article is to define the present state of e-learning in pediatrics and how to best leverage e-learning for educational effectiveness and change in medical education. Through addressing under-examined and neglected areas in implementation strategies for e-learning, its usefulness in medical education can be expanded. This study used a systematic database review of published studies in the field of e-learning in pediatric training between 2003 and 2013. The search was conducted using educational and health databases: Scopus, ERIC, PubMed, and search engines Google and Hakia. A total of 72 reference articles were suitable for analysis. This review is supplemented by the use of "e-Learning Design Screening Questions" to define e-learning design and development in 10 randomly selected articles. Data analysis used template-based coding themes and counting of the categories using descriptive statistics.Our search for pediatric e-learning (using Google and Hakia) resulted in six well-defined resources designed to support the professional development of doctors, residents, and medical students. The majority of studies focused on instructional effectiveness and satisfaction. There were few studies about e-learning development, implementation, and needs assessments used to identify the institutional and learners' needs. Reviewed studies used various study designs, measurement tools, instructional time, and materials for e-learning interventions. e-Learning is a viable solution for medical educators faced with many challenges, including (1) promoting self-directed learning, (2) providing flexible learning opportunities that would offer continuous (24h/day/7 days a week) availability for learners, and (3) engaging learners through collaborative learning communities to gain significant learning and augment continuous professional development. Several important recommendations for faculty instructors interested in providing and/or improving e-learning activities for today's learners are detailed.
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Affiliation(s)
- Kadriye O Lewis
- Children׳s Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, MO
| | - Michal J Cidon
- Department of Pediatrics, Lucile Packard Children׳s Hospital at Stanford, Palo Alto, CA
| | - Teresa L Seto
- Division of Neonatology, Cincinnati Children׳s Hospital Medical Center, Cincinnati, OH
| | - Haiqin Chen
- Department of Psychology, The Ohio State University, Columbus, OH
| | - John D Mahan
- Nationwide Children׳s Hospital, The Ohio State University College of Medicine, Columbus, OH
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Bohman B, Ghaderi A, Rasmussen F. Training in methods of preventing childhood obesity increases self-efficacy in nurses in child health services: a randomized, controlled trial. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2014; 46:215-218. [PMID: 24220044 DOI: 10.1016/j.jneb.2013.10.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 10/09/2013] [Accepted: 10/14/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the effects of training in methods of preventing childhood obesity on self-efficacy (SE) in nurses. METHODS In a randomized, controlled trial conducted in child health services in Sweden, nurses in the intervention and control groups of the PRIMROSE prevention trial of childhood obesity were offered a 5-day workshop on dietary and physical activity interventions, and motivational interviewing. Self-efficacy for influencing parents to promote healthy dietary and physical activity behaviors in their children was measured using an 18-item instrument. Difference in SE between groups at post-assessment was analyzed using multiple linear regression analysis. RESULTS Compared to control nurses (n = 38), intervention nurses (n = 22) demonstrated higher SE (β = 14.70, P < .001). CONCLUSIONS AND IMPLICATIONS Training in methods of preventing childhood obesity increased SE in nurses. Self-efficacy should be included as a construct in evaluations of clinical training.
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Affiliation(s)
- Benjamin Bohman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Finn Rasmussen
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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Lakshman R, Mazarello Paes V, Hesketh K, O'Malley C, Moore H, Ong K, Griffin S, van Sluijs E, Summerbell C. Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses. Syst Rev 2013; 2:28. [PMID: 23663239 PMCID: PMC3691606 DOI: 10.1186/2046-4053-2-28] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 04/22/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The aim of these reviews is to inform the design and content of interventions to reduce obesity in young children. The behaviors that are associated with obesity/overweight have been studied extensively; however, the factors associated with these behaviors in young children (0 to 6 years) have not been systematically reviewed. Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood. In order to develop effective interventions and change behavior, it is important to understand the factors that are associated with those behaviors. For example, we need to understand whether it would be more important to target the family, childcare settings or the wider environment and identify the most effective way of changing these energy balance related behaviors. METHODS/DESIGN Quantitative (intervention and observational) and qualitative literature on determinants/correlates of fruit and vegetable intake, sugar sweetened beverage and other unhealthy diet intake, and physical activity and sedentary behaviors in young children will be systematically identified, mapped and reviewed. A common search strategy (no language or period restrictions) will be used to identify papers from eight electronic databases and this will be supplemented by hand-searching. Next, studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years (at baseline) will be screened and mapped descriptively followed by in-depth data extraction, quality assessment and synthesis. Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis, and qualitative studies using thematic analysis. Qualitative evidence will be integrated with the quantitative evidence, using a parallel synthesis approach, to provide a deeper understanding of effective strategies to influence these energy balance related behaviors. DISCUSSION In addition to updating and mapping current research, these reviews will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group (0 to 6 years) with the aim of informing future interventions. TRIAL REGISTRATION International Prospective Register for Systematic Reviews (PROSPERO) Registration number: CRD42012002881.
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Ljungkrona-Falk L, Brekke H, Nyholm M. Swedish nurses encounter barriers when promoting healthy habits in children. Health Promot Int 2013; 29:730-8. [DOI: 10.1093/heapro/dat023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Willis TA, Potrata B, Hunt C, Rudolf MCJ. Training community practitioners to work more effectively with parents to prevent childhood obesity: the impact of HENRY upon Children's Centres and their staff. J Hum Nutr Diet 2012; 25:460-8. [PMID: 22489933 DOI: 10.1111/j.1365-277x.2012.01247.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND One in four children in England is overweight/obese upon starting school. HENRY (Health Exercise Nutrition for the Really Young) offers a novel, preventive approach to this problem by training practitioners to work more effectively with the parents of preschool children around obesity and lifestyle issues. The programme is being delivered to all Sure Start Children's Centres (the UK government initiative providing family support and childcare in disadvantaged areas) in Leeds, UK. METHODS The evaluation covered the first 12 Centres to be trained (these had a reach of approximately 5000 families). A series of semi-structured interviews were conducted with Centre managers, and 'drop boxes' were provided for all staff to leave their comments. Interviews took place up to 11 months post-training, allowing a consideration of any long-term impact. RESULTS Data from 12 interviews and 106 comment slips indicated that HENRY training was associated with considerable changes to the Centre environment. Immediate effects included changes to Centre policy and practice, including the provision of age-appropriate portion sizes and the introduction of healthy snacks; a strengthening of team working and increased staff confidence around tackling lifestyle change; and enhanced skills when working with families. Training also induced changes within the staff's personal lives (e.g. increased physical activity and family mealtimes). CONCLUSIONS The findings suggest that positive and lasting lifestyle effects can be achieved by brief training courses involving Children's Centre staff teams. Both staff and attendant families appear to benefit. The effect on levels of preschool obesity across the city once HENRY has extended to the remaining Centres is yet to be seen.
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Affiliation(s)
- T A Willis
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
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