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Luque V, Feliu A, Closa-Monasterolo R, Muñoz-Hernando J, Ferré N, Gutiérrez-Marín D, Guillen N, Basora J, Hsu P, Alegret-Basora C, Serrano MÀ, Mallafré M, Alejos AM, Balcells EN, Boada À, Paixà S, Mimbrero G, Gil-Mancha S, Tudela-Valls C, Alcazar M, Escribano J. Impact of the motivational interviewing for childhood obesity treatment: The Obemat2.0 randomized clinical trial. Pediatr Obes 2024:e13125. [PMID: 38733242 DOI: 10.1111/ijpo.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/19/2023] [Accepted: 04/22/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND AND OBJECTIVE The aim was assessing a short training for healthcare providers on patient-focused counselling to treat childhood obesity in primary care, along with dietitian-led workshops and educational materials. METHODS Randomized clustered trial conducted with paediatrician-nurse pairs (Basic Care Units [BCU]) in primary care centres from Tarragona (Spain). BCUs were randomized to intervention (MI) (motivational interview, dietitian-led education, and educational materials) or control group (SC, standard care). Participants were 8-14-year-old children with obesity, undergoing 1-11 monthly treatment visits during 1 year at primary care centres. The primary outcome was BMI z-score reduction. RESULTS The study included 44 clusters (23 MI). Out of 303 allocated children, 201 (n = 106 MI) completed baseline, final visits, and at least one treatment visit and were included in the analysis. BMI z-score reduction was -0.27 (±0.31) in SC, versus -0.36 (±0.35) in MI (p = 0.036). Mixed models with centres as random effects showed greater reductions in BMI in MI than SC; differences were B = -0.11 (95% CI: -0.20, -0.01, p = 0.025) for BMI z-score, and B = -2.06 (95% CI: -3.89, -0.23, p = 0.028) for BMI %. No severe adverse events related to the study were notified. CONCLUSION Training primary care professionals on motivational interviewing supported by dietitians and educational materials, enhanced the efficacy of childhood obesity therapy.
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Affiliation(s)
- Veronica Luque
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Tarragona, Spain
- Serra Hunter Fellow, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Albert Feliu
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Ricardo Closa-Monasterolo
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Tarragona, Spain
| | | | - Natalia Ferré
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | | | - Núria Guillen
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Tarragona, Spain
- Salut Sant Joan Reus-Baix Camp, Reus, Spain
| | | | - Pablo Hsu
- Salut Sant Joan Reus-Baix Camp, Reus, Spain
- IDIAPJGol, Reus, Spain
- EAP Sant Pere, Institut Català de la Salut, Reus, Spain
| | | | - M Àngels Serrano
- Pediatrics Department, Hospital Lleuger de Cambrils, Cambrils, Spain
| | - Marta Mallafré
- Pediatrics Department, Hospital Lleuger de Cambrils, Cambrils, Spain
| | - Ana M Alejos
- Pediatrics Department, Hospital Lleuger de Cambrils, Cambrils, Spain
| | - Eva N Balcells
- ABS Alt Camp Est, Institut Català de la Salut, Vilarodona, Spain
| | - Àngels Boada
- ABS Alt Camp Est, Institut Català de la Salut, Vilarodona, Spain
| | - Sandra Paixà
- CAP Marià Fortuny, Salut Sant Joan Reus-Baix Camp, Reus, Spain
| | | | | | | | - Mireia Alcazar
- Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
| | - Joaquín Escribano
- Pediatric Nutrition and Human Development Research Unit, Universitat Rovira i Virgili, Tarragona, Spain
- Institut d'Investigació Sanitària Pere Virgili, Reus, Spain
- Salut Sant Joan Reus-Baix Camp, Reus, Spain
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Kurtzhals M, Bjerregaard AL, Hybschmann J, Müllertz ALO, DeSilva B, Elsborg P, Timm A, Petersen TL, Thygesen LC, Kurtzhals P, Flensborg-Madsen T, Bentsen P, Mygind L. A systematic review and meta-analysis of the child-level effects of family-based interventions for the prevention of type 2 diabetes mellitus. Obes Rev 2024:e12742. [PMID: 38684203 DOI: 10.1111/obr.13742] [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: 11/16/2022] [Revised: 01/31/2024] [Accepted: 02/28/2024] [Indexed: 05/02/2024]
Abstract
AIMS The purpose of this systematic review and meta-analysis was to investigate the effects of family-based health promotion interventions on child-level risk factors for type 2 diabetes in vulnerable families. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for systematic reviews formed the methodological framework. CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science were searched on January 12, 2024. The NTP-OHAT Risk of Bias Assessment Tool was used to assess the risk of bias in the individual studies, and meta-analyses were performed. RESULTS The 4723 studies were identified, and 55 studies met the inclusion criteria. Results showed significant effects on children's body mass index (mean difference [MD], -0.18, 95% CI [-0.33 to -0.03], p = 0.02), body fat percentage (MD, -2.00, 95% CI [-3.31 to -0.69], p = 0.003), daily activity (standardized mean difference [SMD], 0.23, 95% CI [0.01; 0.44], p = 0.04), physical activity self-efficacy (SMD, 0.73, 95% CI [0.36 to 1.10], p < 0.01), intake of snacks (MD, -0.10, 95% CI [-0.17 to -0.04], p = 0.002), and sugar-sweetened beverages (SMD, -0.21, 95% CI [-0.42 to -0.01], p = 0.04). Subgroup analyses suggested that interventions aiming to change child and parent behavior simultaneously have larger effect on fasting glucose and nutrition consumption, and that interventions longer than 26 weeks have larger effects on body composition and physical activity behavior than shorter interventions.
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Affiliation(s)
- Mette Kurtzhals
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Jane Hybschmann
- Children's Hospital Copenhagen and Juliane Marie Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Alberte Laura Oest Müllertz
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Bianca DeSilva
- School of Exercise Science, Physical & Health Education, University of Victoria, Victoria, British Columbia, Canada
| | - Peter Elsborg
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Anne Timm
- Health Promotion Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
| | | | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Peter Kurtzhals
- Novo Nordisk A/S, Global Chief Medical Office, Soeborg, Denmark
| | | | - Peter Bentsen
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Geoscience and Natural Resource Management, University of Copenhagen, Frederiksberg, Denmark
| | - Lærke Mygind
- Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- School of Psychology, Deakin University, Geelong, Australia
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3
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Norman J, Furber S, Bauman A, Okely AD. The feasibility, acceptability and potential efficacy of a parental text message and social media program on children's vegetable consumption and movement behaviours: A pilot randomised controlled trial. Health Promot J Austr 2024. [PMID: 38200657 DOI: 10.1002/hpja.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 11/29/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
ISSUE ADDRESSED Australian children fall short of meeting the dietary, physical activity and sedentary behaviour guidelines. This study aimed to test the feasibility, acceptability and potential efficacy of a parental text message and social media program on, primarily, their school-aged children's vegetable consumption and movement behaviours, and, secondarily, their own. METHODS Between August and November 2022, we conducted a two-armed randomised controlled trial with 242 parents/caregivers of primary school-aged children in New South Wales. The 'Adventure & Veg' intervention ran for 8 weeks, promoting vegetable eating behaviours, local outdoor physical activity opportunities and ideas for reducing screen time. Feasibility and acceptability were assessed via recruitment and retention data, intervention metrics and self-reported participant data. Vegetable intake and movement behaviour data were collected via online-surveys and effect sizes were examined. RESULTS Most participants reported that they enjoyed receiving the text messages (88%) and the delivery frequency was acceptable (94%). Limitations to Facebook as a delivery platform were reported. The majority of participants used the text messages to influence the vegetable eating (65%) and movement (77%) behaviours of their child. Significant effects were observed among intervention child participants compared with control for mean daily vegetable consumption (0.45 serves, CI: .19; .71, p = .001, d = .5); weekly vegetable variety (1.85, CI: .25; 3.45, p < .001, d = .6); and weekly physical activity variety (.64 CI: .09; 1.19, p = .022, d = .3). Parents in the intervention group increased their daily vegetable intake by .44 serves (CI: .11; .78, p = .01, d = .4). CONCLUSIONS A parental text message and social media program has potential to support children's vegetable intake and movement behaviours. Further research is required to explore different online delivery methods to promote local outdoor activity options. SO WHAT?: The Adventure & Veg program holds promise as a stand-alone health promotion intervention or as a useful adjunct to current family or school-based healthy lifestyle programs.
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Affiliation(s)
- Jennifer Norman
- Health Promotion Service, Illawarra Shoalhaven Local Health District, New South Wales Health, Wollongong, New South Wales, Australia
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Susan Furber
- Health Promotion Service, Illawarra Shoalhaven Local Health District, New South Wales Health, Wollongong, New South Wales, Australia
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Adrian Bauman
- School of Public Health, and the Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony D Okely
- Early Start, School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
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4
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Evans EW, Darling KE, Egbert A, Hayes JF, Jelalian E, Warnick J, Topor LS, Goldschmidt AB. Leveraging seasonality and timing to optimize pediatric weight management interventions: Novel directions for future research. Obes Sci Pract 2023; 9:688-695. [PMID: 38090686 PMCID: PMC10712410 DOI: 10.1002/osp4.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 02/01/2024] Open
Abstract
National estimates suggest that more than 35% of American children, ages 2-19 years, are overweight or obese, which increases their risk for weight-related comorbidities including diabetes, cancer, cardiovascular disease risk factors, depression, and anxiety. While obesity prevention is most cost-effective, for youth with existing obesity, the United States Preventive Services Task Force recommends ≥26 h of comprehensive lifestyle intervention over 6-12 months. This include standard behavioral therapy, dietary counseling, and an emphasis on physical activity. Although such programs are effective in reducing weight status, there are many barriers to completing these programs. A novel consideration for both the prevention and treatment of childhood obesity is the recognition that the timing of intervention, both duration and time of the year, can impact family engagement and intervention effectiveness. This paper discusses the potential of targeting high-risk periods for weight gain and offering brief behavioral intervention, in hopes of inspiring research on novel approaches to the prevention and treatment of childhood obesity.
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Affiliation(s)
- E. Whitney Evans
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Katherine E. Darling
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Amy Egbert
- Department of Psychological SciencesUniversity of ConnecticutStorrsConnecticutUSA
| | - Jacqueline F. Hayes
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Elissa Jelalian
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Jennifer Warnick
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Lisa Swartz Topor
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
- Pediatric Endocrinology and Diabetes CenterHasbro Children's HospitalProvidenceRhode IslandUSA
| | - Andrea B. Goldschmidt
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
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5
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Moore WS, Maldonado-Molina MM, Mobley AR, Shelnutt KP, McVay MA. Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program. Child Obes 2023. [PMID: 37366662 DOI: 10.1089/chi.2023.0033] [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] [Indexed: 06/28/2023]
Abstract
Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.
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Affiliation(s)
- Wendy S Moore
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Mildred M Maldonado-Molina
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Amy R Mobley
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
| | - Karla P Shelnutt
- Department of Family, Youth, and Community Sciences, Institute of Food and Agricultural Science (IFAS), University of Florida, Gainesville, FL, USA
| | - Megan A McVay
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, Gainesville, FL, USA
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Schmied EA, Madanat H, Chuang E, Moody J, Ibarra L, Cervantes G, Strong D, Boutelle K, Ayala GX. Factors predicting parent engagement in a family-based childhood obesity prevention and control program. BMC Public Health 2023; 23:457. [PMID: 36890461 PMCID: PMC9996842 DOI: 10.1186/s12889-023-15359-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 03/02/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Family-based interventions are efficacious at preventing and controlling childhood overweight and obesity; however, implementation is often hindered by low parent engagement. The purpose of this study was to evaluate predictors of parent engagement in a family-based childhood obesity prevention and control intervention. METHODS Predictors were assessed in a clinic-based community health worker (CHW)-led Family Wellness Program consisting of in-person educational workshops attended by parents and children. This program was part of a larger effort known as the Childhood Obesity Research Demonstration projects. Participants included 128 adult caretakers of children ages 2-11 (98% female). Predictors of parent engagement (e.g., anthropometric, sociodemographic, psychosocial variables) were assessed prior to the intervention. Attendance at intervention activities was recorded by the CHW. Zero-inflated Poisson regression was used to determine predictors of non-attendance and degree of attendance. RESULTS Parents' lower readiness to make behavioral and parenting changes related to their child's health was the sole predictor of non-attendance at planned intervention activities in adjusted models (OR = 0.41, p < .05). Higher levels of family functioning predicted degree of attendance (RR = 1.25, p < .01). CONCLUSIONS To improve engagement in family-based childhood obesity prevention interventions, researchers should consider assessing and tailoring intervention strategies to align with the family's readiness to change and promote family functioning. TRIAL REGISTRATION NCT02197390, 22/07/2014.
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Affiliation(s)
- Emily A Schmied
- School of Public Health, San Diego State University, San Diego, 92182, USA. .,Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, USA.
| | - Hala Madanat
- Division of Research and Innovation, San Diego State University, San Diego, 92182, USA
| | - Emmeline Chuang
- School of Social Welfare, University of California Berkeley, Berkeley, 94720, USA
| | - Jamie Moody
- San Diego State University Research Foundation, San Diego, 92182, USA
| | - Leticia Ibarra
- School of Public Health, San Diego State University, San Diego, 92182, USA
| | | | - David Strong
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, San Diego, 92093, USA
| | - Kerri Boutelle
- Department of Pediatrics, University of California San Diego, San Diego, 92161, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University, San Diego, 92182, USA.,Institute for Behavioral and Community Health, San Diego State University Research Foundation, San Diego, USA
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Skjåkødegård HF, Hystad S, Bruserud I, Conlon RPK, Wilfley D, Frisk B, Roelants M, Juliusson PB, Danielsen YS. Perceived barriers in family-based behavioural treatment of paediatric obesity - Results from the FABO study. Pediatr Obes 2023; 18:e12992. [PMID: 36468217 PMCID: PMC10078207 DOI: 10.1111/ijpo.12992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 10/24/2022] [Accepted: 11/18/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND To date, few studies have investigated perceived barriers among those who participate in and drop out of family-based behavioural treatment (FBT) for paediatric obesity. Examining experienced barriers during treatment, and their role in participation and completion of treatment has important implications for clinical practice. OBJECTIVES To compare perceived barriers to participating in a family-based behavioural social facilitation treatment (FBSFT) for obesity among families who completed and did not complete treatment. METHODS Data were analysed from 90 families of children and adolescents (mean (M) age = 12.8 years, standard deviation (SD) = 3.05) with severe obesity enrolled in a 17-session FBSFT program. After completing 12 sessions or at the time of dropout, parents and therapists completed the Barriers to Treatment Participation Scale (BTPS), a 5-point Likert scale (1 = never a problem, 5 = very often a problem) which includes four subscales: 1. Stressors and obstacles that compete with treatment, 2. Treatment demands and issues, 3. Perceived relevance of treatment, 4. Relationship with the therapist. RESULTS Families who did not complete treatment scored significantly higher on the BTPS subscales stressors and obstacles that compete with treatment (M = 2.03, SD = 0.53 vs. M = 1.70, SD = 0.42), p = 0.010 and perceived relevance of treatment (M = 2.27, SD = 0.48 vs. M = 1.80, SD = 0.50), p < 0.001 than families who completed treatment. No other significant differences between groups were observed. CONCLUSION Families are more likely to drop out of FBSFT when experiencing a high burden from life stressors or when treatment is not meeting the expectations and perceived needs of the family.
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Affiliation(s)
| | - Sigurd Hystad
- Department of Psychosocial ScienceUniversity of BergenBergenNorway
| | - Ingvild Bruserud
- Faculty of HealthVID Specialized UniversityBergenNorway
- Department of PediatricsHaukeland University HospitalBergenNorway
| | - Rachel P. K. Conlon
- Department of PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Denise Wilfley
- Department of PsychiatryWashington University School of MedicineSt. LouisMissouriUSA
| | - Bente Frisk
- Department of Health and FunctioningWestern Norway University of Applied SciencesBergenNorway
- Department of PhysiotherapyHaukeland University HospitalBergenNorway
| | - Mathieu Roelants
- Department of Public Health and Primary CareKU Leuven, University of LeuvenLeuvenBelgium
| | - Petur B. Juliusson
- Department of Clinical ScienceUniversity of BergenBergenNorway
- Children and Youth ClinicHaukeland University HospitalBergenNorway
- Department of Health Registry Research and DevelopmentNorwegian Institute of Public HealthBergenNorway
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Predictors of Effectiveness and Adherence in a Multimodal Obesity Treatment Program for Children and Adolescents in Routine Care. Nutrients 2022; 15:nu15010136. [PMID: 36615793 PMCID: PMC9824499 DOI: 10.3390/nu15010136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022] Open
Abstract
Multimodal obesity treatments for children and adolescents generally showed only small to modest treatment effects and high dropout rates. Potential variations by patients' clinical and sociodemographic factors remain, however, largely unclear. For this reason, our study analyzed psychological, physical, and sociodemographic predictors of treatment success and adherence in a multimodal obesity treatment over 12 months. The intent-to-treat sample included n = 361 children and adolescents (ages 3-17 years), of which n = 214 or 59.28% of patients completed treatment. A younger age and, in the sensitivity analysis, additionally a greater eating disorder psychopathology and treatment initiation before COVID-19 pandemic predicted greater BMI-SDS reductions (Body Mass Index-Standard Deviation Score). In contrast, predictors of treatment adherence were not found. The results underline the importance of early treatment of juvenile obesity. Additionally, eating disorder psychopathology includes restrained eating, which implies the ability to self-regulate eating behavior and therefore may have a positive effect on the treatment goal of controlled food intake. Challenges from altered treatment procedures due to the COVID-19 pandemic nonetheless remain.
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de Pooter N, van den Eynde E, Raat H, Seidell JC, van den Akker EL, Halberstadt J. Perspectives of healthcare professionals on facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle. PEC INNOVATION 2022; 1:100074. [PMID: 37213756 PMCID: PMC10194305 DOI: 10.1016/j.pecinn.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 08/15/2022] [Accepted: 08/15/2022] [Indexed: 05/23/2023]
Abstract
Objective To explore the perspectives of healthcare professionals (HCPs) within an integrated care approach on the facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle. Methods Semi-structured interviews were conducted with eighteen HCPs working within a Dutch integrated care approach. The interviews were analyzed by performing a thematic content analysis. Results Main facilitators identified by HCPs were support from parents and the social network. Main barriers were first and foremost family's lack of motivation, which was singled out as a precondition for starting the behavior change process. Other barriers were child's socio-emotional problems, parental personal problems, lack of parenting skills, parental lack of knowledge and skills regarding a healthier lifestyle, parental lack of problem awareness and HCP's negative attitude. To overcome these barriers, main needs that HCPs suggested were a tailored approach in healthcare and a supportive HCP. Conclusion The HCPs identified the breadth and complexity of underlying factors of childhood obesity, of which the family's motivation was pointed out as a critical factor to address. Innovation Understanding the patient's perspective is important for HCPs to provide the tailored care needed to address the complexity of childhood obesity.
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Affiliation(s)
- Naomi de Pooter
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands
- Corresponding author at: Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam Public Health Institute, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Emma van den Eynde
- Department of Pediatrics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Hein Raat
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jacob C. Seidell
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | | | - Jutka Halberstadt
- Department of Health Sciences, Vrije Universiteit Amsterdam, the Netherlands
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10
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Carroll C, Sworn K, Booth A, Pardo‐Hernandez H. Stakeholder views of services for children and adolescents with obesity: Mega-ethnography of qualitative syntheses. Obesity (Silver Spring) 2022; 30:2167-2184. [PMID: 36321275 PMCID: PMC9828799 DOI: 10.1002/oby.23558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/21/2022] [Accepted: 07/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The efficacy of services for children and adolescents with obesity is well researched, but this review describes what actually matters to stakeholders (children, caregivers, and professionals) in relation to such services. METHODS A mega-ethnography, an innovative review-of-reviews approach that uses conceptual findings as primary data, was performed. Twelve bibliographic databases (2010-2020) were searched for reviews that considered the values and preferences of stakeholders concerning services or interventions (diet, exercise, lifestyle) that targeted children and adolescents with obesity. RESULTS From 485 citations, 17 relevant reviews were identified. The synthesis found that the perceived need to address obesity is determined by subjective norms of weight and interactions with health professionals. Children's and caregivers' participation in obesity management services is shaped by their response to content, acceptability, and perceived benefits and demands. Whether they continue with and complete an intervention are determined by its perceived success, beyond just weight loss, including behavior change, enhanced self-esteem, and the provision of timely and relevant support. CONCLUSIONS Obesity management services must be promoted in a sensitive manner and must be tailored, be varied, and make positive use of family and schools if children and caregivers are to seek and actively engage with them.
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Affiliation(s)
| | - Katie Sworn
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
| | - Andrew Booth
- School of Health and Related ResearchUniversity of SheffieldSheffieldUK
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Kinlin LM, Oreskovich SM, Dubrowski R, Ball GD, Barwick M, Dettmer E, Haines J, Hamilton J, Kim TH, Klaassen M, Luca P, Maguire JL, Moretti ME, Stasiulis E, Toulany A, Birken CS. Managing Obesity in Young Children: A Multiple Methods Study Assessing Feasibility, Acceptability, and Implementation of a Multicomponent, Family-Based Intervention. Child Obes 2022; 18:409-421. [PMID: 35085455 PMCID: PMC9492792 DOI: 10.1089/chi.2021.0221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background: We developed a multicomponent, family-based intervention for young children with obesity consisting of parent group sessions, home nursing visits, and multidisciplinary clinical encounters. Our objective was to assess intervention feasibility, acceptability, and implementation. Methods: From 2017 to 2020, we conducted a multiple methods study in the obesity management clinic at a tertiary children's hospital (Toronto, Canada). We included 1-6 year olds with a body mass index ≥97th percentile and their parents; we also included health care providers (HCPs) who delivered the intervention. To assess feasibility, we performed a pilot randomized controlled trial (RCT) comparing the intervention to usual care. To explore acceptability, we conducted parent focus groups. To explore implementation, we examined contextual factors with HCPs using the Consolidated Framework for Implementation Research. Results: There was a high level of ineligibility (n = 34/61) for the pilot RCT. Over 21 months, 11 parent-child dyads were recruited; of 6 randomized to the intervention, 3 did not participate in group sessions or home visits. In focus groups, themes identified by parents (n = 8) related to information provided at referral; fit between the intervention and patient needs; parental gains from participating in the intervention; and feasibility of group sessions. HCPs (n = 10) identified contextual factors that were positively and negatively associated with intervention implementation. Conclusions: We encountered challenges related to intervention feasibility, acceptability, and implementation. Lessons learned from this study will inform the next iteration of our intervention and are relevant to intervention development and implementation for young children with obesity. Clinical Trial Registration number: NCT03219658.
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Affiliation(s)
- Laura M. Kinlin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Stephan M. Oreskovich
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Raluca Dubrowski
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Geoff D.C. Ball
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Dettmer
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jess Haines
- Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Ontario, Canada
| | - Jill Hamilton
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Theresa H.M. Kim
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | | | - Paola Luca
- Section of Pediatric Endocrinology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Jonathon L. Maguire
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Pediatrics, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Myla E. Moretti
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Clinical Trials Unit, Ontario Child Health Support Unit, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elaine Stasiulis
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alene Toulany
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Catherine S. Birken
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Nutritional Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Address correspondence to: Catherine S. Birken, MD, MSc, FRCPC, Division of Paediatric Medicine, The Hospital for Sick Children, Toronto M5G 1X8, Ontario, Canada
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O'Connor RM, Kenny PJ. Utility of 'substance use disorder' as a heuristic for understanding overeating and obesity. Prog Neuropsychopharmacol Biol Psychiatry 2022; 118:110580. [PMID: 35636576 DOI: 10.1016/j.pnpbp.2022.110580] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 02/07/2023]
Abstract
Rates of obesity and obesity-associated diseases have increased dramatically in countries with developed economies. Substance use disorders (SUDs) are characterized by the persistent use of the substance despite negative consequences. It has been hypothesized that overconsumption of palatable energy dense food can elicit SUD-like maladaptive behaviors that contribute to persistent caloric intake beyond homeostatic need even in the face of negative consequences. Palatable food and drugs of abuse act on many of the same motivation-related circuits in the brain, and can induce, at least superficially, similar molecular, cellular, and physiological adaptations on these circuits. As such, applying knowledge about the neurobiological mechanisms of SUDs may serve as useful heuristic to better understand the persistent overconsumption of palatable food that contributes to obesity. However, many important differences exist between the actions of drugs of abuse and palatable food in the brain. This warrants caution when attributing weight gain and obesity to the manifestation of a putative SUD-related behavioral disorder. Here, we describe similarities and differences between compulsive drug use in SUDs and overconsumption in obesity and consider the merit of the concept of "food addiction".
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Affiliation(s)
- Richard M O'Connor
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, United States of America
| | - Paul J Kenny
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, United States of America.
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13
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Understanding the perceptions of parents and preschool principals on the determinants of weight management among Iranian preschoolers: A directed qualitative content analysis. PLoS One 2022; 17:e0270244. [PMID: 35737692 PMCID: PMC9223302 DOI: 10.1371/journal.pone.0270244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/07/2022] [Indexed: 11/19/2022] Open
Abstract
The current study aimed to understand the perceptions and experiences of Iranian parents and principals of preschool children on weight management based on the PRECEDE-PROCEED Model (PPM), a comprehensive structure for assessing health needs for designing, implementing, and evaluating health promotion, and other public health programs. PRECEDE provides a structure for planning a targeted and focused public health program, and PROCEED provides a structure for implementing and evaluating the program. Data were gathered from 17 preschoolers’ parents and two principals using semi-structured interviews in the preschool setting in Tehran, the capital of Iran, in 2019. Data were analyzed manually through directed content analysis based on constructs in phases two and three of the PPM, simultaneously with data collection. This study identified genetic, behavioral (e.g., food preferences, physical activity, sedentary behaviors, the effect of parents’, peers’, principals’ and teachers’ behavior and also influence of grandparents’ and neighbors’ behaviors) and environmental (e.g., home, grandparents’ home and preschool) factors from the epidemiological construct. Also, predisposing (e.g., child’s attitude, parent’s and principals’ attitude, as well as parents’ knowledge and parents’ and principals’ beliefs), enabling (e.g., parental skills and skills of the principals and teachers, rules and laws in the preschools, and availability), and reinforcing (e.g., family support and influences, teachers’ encouragement and influences, and peers’ influences) factors were identified from the educational and ecological construct. Additionally, “quality of child-parent relationship” was determined as a new factor affecting preschoolers’ weight management promotion; however, it was not in the PPM. In the study, parents’ and principals’ experiences regarding preschoolers’ weight management promotion confirmed the genetic, behavioral, environmental, predisposing, enabling and reinforcing factors of the PPM. “Quality of child-parent relationship” factor may be related to the culture and family relationship type of Iranian people, which is suggested to be investigated in future studies.
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Multidisciplinary Treatment for Childhood Obesity: A Two-Year Experience in the Province of Naples, Italy. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060834. [PMID: 35740771 PMCID: PMC9221826 DOI: 10.3390/children9060834] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 01/22/2023]
Abstract
Childhood obesity must be faced through an integrated multi-level preventive approach. This study was aimed at assessing the adherence and the outcomes of an outpatient service for childhood obesity treatment activated in the province of Naples, Italy, throughout a 2-year follow-up period. At first visit (T0), weight, height, waist circumference, and body composition of children were assessed, together with sociodemographic features and physical activity levels of children and parents. Anthropometric and body composition parameters of children were measured at 6 ± 3 months (T1) and 12 ± 3 months (T2). A total of 451 non-related children who accessed the service were analyzed: 220 (48.7%) of them returned at least once (attrition rate 51.3%). Returner outpatients showed higher age (p = 0.046) and father’s educational level (p = 0.041) than non-returner ones. Adherence to the treatment was found to be related to father’s (Rho = 0.140, p = 0.005) and mother’s (Rho = 0.109, p = 0.026) educational level. All the outcomes improved between T0 and T1 (p < 0.001), while only body mass index (BMI) decreased significantly at T2. Changes in BMI-SDS were associated with baseline value (OR 0.158, 95%CI 0.017−0.298, p = 0.029). The multidisciplinary approach seems to be promising to treat childhood obesity in this geographic context. Lower parents’ educational level should be considered as an attrition determinant.
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Wyse C, Case L, Walsh Ó, Shortall C, Jordan N, McCrea L, O'Malley G. Evaluating 12 Years of Implementing a Multidisciplinary Specialist Child and Adolescent Obesity Treatment Service: Patient-Level Outcomes. Front Nutr 2022; 9:895091. [PMID: 35719167 PMCID: PMC9204063 DOI: 10.3389/fnut.2022.895091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 04/29/2022] [Indexed: 01/22/2023] Open
Abstract
IntroductionChildhood obesity is a chronic disease that requires multidisciplinary and specialist intervention to address its complex pathophysiology, though access to treatment is limited globally. Evaluating the impact of evidence-based interventions implemented in real-world clinical settings is essential, in order to increase the translation of research into practice and enhance child health outcomes. In Ireland, the National Model of Care for Obesity highlighted the need to develop and improve healthcare services for children and adolescents with obesity.AimsThis study aims to evaluate the impact of a family-based, Tier 3 multi-disciplinary child and adolescent obesity outpatient service (www.w82go.ie) on standardized body mass index (BMI-SDS).MethodsFollowing referral by pediatricians, patients were assessed by a pediatric multidisciplinary team (physiotherapist, dietician, and psychologist) and personalized obesity treatment plans were developed. Anthropometric and demographic information were recorded at baseline and final visit. Descriptive statistics were used to explore distribution, central tendency and variation in the demographic data, change in BMI-SDS over time was assessed using a t-test, and multiple linear regression analysis was used to investigate the association of demographic factors on the change in BMI-SDS.ResultsThe overall mean BMI-SDS reduction across the whole cohort (n = 692) was −0.17 (95% CI = −0.20, −0.13; P < 0.001). Younger age at admission and longer duration of treatment were associated with greater BMI-SDS reduction but there was no significant association between change in BMI-SDS and any of the other parameters (deprivation score, treatment type, sex, obesity category at admission or presence of comorbid condition).ConclusionEngagement in a specialist Tier 3 pediatric obesity service was associated with reductions in BMI-SDS in children and adolescents with obesity.
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Affiliation(s)
- Cathy Wyse
- Obesity Research and Care Group, School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Lucinda Case
- W28GO Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Órla Walsh
- Adolescent Medicine and General Paediatrics, Children's Health Ireland at Temple Street, Dublin, Ireland
- Department of Paediatrics, School of Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Catherine Shortall
- W28GO Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Norah Jordan
- W28GO Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Lois McCrea
- W28GO Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
| | - Grace O'Malley
- Obesity Research and Care Group, School of Physiotherapy, Division of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- W28GO Child and Adolescent Obesity Service, Children's Health Ireland at Temple Street, Dublin, Ireland
- *Correspondence: Grace O'Malley
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16
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Murphy D, Heary C, Hennessy M, O'Reilly MD, Hennessy E. A Systematic Review of Help-Seeking Interventions for Parents of Adolescents. J Adolesc Health 2022; 70:16-27. [PMID: 34462191 DOI: 10.1016/j.jadohealth.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE Parents do not always seek timely help for adolescents when the need arises. Although interventions to increase parental help-seeking have been evaluated and published, no systematic review of these interventions has been conducted. The aim of this systematic review is to collate, synthesise, and evaluate research on help-seeking interventions for parents of adolescents. METHODS Six electronic databases were searched from inception to May 2020 using terms related to the concepts of "parent" and "help-seeking" and focusing on parents of adolescents (aged 10-19 years). Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies; the Behavioural Change Taxonomy was used to code behavioral change techniques, and "promising interventions" were identified using pre-established criteria. RESULTS Eighteen studies met inclusion criteria, with six rated strong for design and methodology. The most frequently identified Behavioural Change Taxonomies included a credible source delivering the intervention, supporting parents, and providing prompts/cues regarding services/appointments. Four interventions were identified as "promising" because of strong methodology, significant positive outcomes, and strong evidence-base. CONCLUSIONS More high-quality, theory-driven parental help-seeking interventions using common outcome measures are needed to advance the literature in this area. Future research should replicate the promising interventions identified to develop best practice guidelines.
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Affiliation(s)
- Daráine Murphy
- School of Psychology, University College Dublin, Dublin, Ireland.
| | - Caroline Heary
- School of Psychology, National University of Galway, Galway, Ireland
| | - Marita Hennessy
- College of Medicine and Health, University College Cork, Ireland
| | | | - Eilis Hennessy
- School of Psychology, University College Dublin, Dublin, Ireland
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17
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Crone MR, Slagboom MN, Overmars A, Starken L, van de Sande MCE, Wesdorp N, Reis R. The Evaluation of a Family-Engagement Approach to Increase Physical Activity, Healthy Nutrition, and Well-Being in Children and Their Parents. Front Public Health 2021; 9:747725. [PMID: 34957012 PMCID: PMC8695802 DOI: 10.3389/fpubh.2021.747725] [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: 07/26/2021] [Accepted: 11/10/2021] [Indexed: 11/13/2022] Open
Abstract
Prevention programs often are directed at either parents or children separately, thereby ignoring the intergenerational aspect of health and well-being. Engaging the family is likely to improve both the uptake and long-term impact of health behavior change. We integrated an intergenerational approach into a frequently used shared assessment tool for children's care needs. The current study's aim was 2-fold: to monitor this family-engagement tool's effects on both children and their parents' health behaviors and well-being, and to examine the different dynamics of health behavioral change within a family. Method: We followed 12 children ages 10-14 years and their parents for 12 weeks using an explanatory mixed-methods design comprising interviews, questionnaires, and an n-of-1 study. During home visits at the beginning and end of the study, we interviewed children and their parents about their expectations and experiences, and measured their height and weight. Furthermore, we collected secondary data, such as notes from phone and email conversations with parents, as well as evaluation forms from professionals. In the n-of-1 study, families were prompted three times a week to describe their day and report on their vegetable intake, minutes of exercise, health behavior goals, and psychosomatic well-being. The interviews, notes, and evaluation forms were analyzed using qualitative content analyses. For the n-of-1 study, we performed multi-level time-series analyses across all families to assess changes in outcomes after consulting the family-engagement tool. Using regression analyses with autocorrelation correction, we examined changes within individual families. Results: Five child-mother dyads and three child-mother-father triads provided sufficient pre- and post-data. The mean minutes of children's physical activity significantly increased, and mothers felt more energetic, but other outcomes did not change. In consultations related to overweight, the family-engagement tool often was used without setting specific or family goals. Conclusions: The family-engagement approach elicited positive effects on some families' health and well-being. For multifaceted health problems, such as obesity, family-engagement approaches should focus on setting specific goals and strategies in different life domains, and for different family members.
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Affiliation(s)
- Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - M Nienke Slagboom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Anneloes Overmars
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Lisa Starken
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Marion C E van de Sande
- Faculty of Social Work and Education, The Hague University of Applied Science, The Hague, Netherlands
| | - Noortje Wesdorp
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands.,Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, Netherlands.,School of Child and Adolescent Health, The Children92s Institute, University of Cape Town, Cape Town, South Africa
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18
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Alexander E, Skinner A, Gaskin K, Jones J, Wong C, Loflin C, Fleming R, Howard J, Armstrong S, Neshteruk C. A Mixed-Methods Examination of Referral Processes to Clinic-Community Partnership Programs for the Treatment of Childhood Obesity. Child Obes 2021; 17:516-524. [PMID: 34227849 DOI: 10.1089/chi.2020.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Partnerships with community programs have been used to improve access to obesity care and address clinical barriers to childhood obesity management; however, little is known about the program referral process. The objective of this study was to identify factors that affect the referral from clinics to community-based programs. Methods: Active Recreation through Community-Healthcare Engagement Study (ARCHES) is a mixed-method, implementation study designed to test the feasibility of establishing clinic-community partnerships to treat childhood obesity. We collected clinical referral and program attendance data from the six ARCHES clinic-community partnerships and conducted semistructured interviews (n = 19) with key stakeholders. Logistic regression models were used to identify referral characteristics associated with ever attending a community program. We used deductive thematic analysis to examine contextual factors affecting the clinical referral and subsequent attendance at the community programs. Results: Patients referred from individual providers [odds ratio (OR): 3.20, 95% confidence interval (CI): 1.08-9.48], specialty clinics (OR: 2.73, 95% CI: 1.48-5.05), and community wellness clinics (OR: 3.42, 95% CI: 1.05-11.13), had greater odds of ever attending the programs compared with patients from primary care clinics. Patients referred to cohort-based programs compared with open enrollment programs had greater odds of ever attending the programs. Stakeholders emphasized the value of communication within the partnership and with patients in clinical settings. Effective provider communication with patients involved engaging and program endorsing conversations to explain the value of the program. Conclusions: We identified factors that may improve the referral process in clinic-community partnerships to provide resources to primary care providers looking to address childhood obesity. Clinical Trial Registration number: NCT03246763.
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Affiliation(s)
- Emily Alexander
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Asheley Skinner
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Kiah Gaskin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical and Translational Science Institute, Durham, NC, USA
| | - Jason Jones
- Durham Parks and Recreation, Durham, NC, USA
| | - Charlene Wong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA.,Duke-Margolis Center for Health Policy, Durham, NC, USA.,Duke Center for Childhood Obesity Research, Durham, NC, USA
| | - Callan Loflin
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Rachel Fleming
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Janna Howard
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Duke Center for Childhood Obesity Research, Durham, NC, USA
| | - Sarah Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.,Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA.,Duke Center for Childhood Obesity Research, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA.,Duke Global Health Institute, Durham, NC, USA
| | - Cody Neshteruk
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Gillison FB, Grey EB, Cumming SP, Sherar LB. Does adjusting for biological maturity when calculating child weight status improve the accuracy of predicting future health risk? BMC Public Health 2021; 21:1979. [PMID: 34727900 PMCID: PMC8561871 DOI: 10.1186/s12889-021-12037-4] [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: 12/01/2020] [Accepted: 10/06/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The aim of this study was to assess whether adjusting the weight categorisation of children for their biological maturity status could improve the accuracy of predicting weight status and cardiometabolic risk at age 17. METHODS Data from 1525 participants (787 female) from the ALSPAC study were analysed. Participants' weight status at age 11 was estimated using first standard chronological age and sex adjusted BMI cut-offs, and again using maturity adjusted BMI cut-offs. Each BMI category at age 11 was regressed against cardiometabolic risk score and BMI category at age 17, controlling for sex, ethnicity and socio-economic status. RESULTS At age 11 years, 22% of boys and 46% of girls who were categorised as overweight or having obesity based on chronological age were re-categorised into a lower BMI category after adjusting for biological maturity. Biologically adjusted BMI categories better predicted BMI category at age 17 compared with non-adjusted BMI categories (∆BIC = - 21.69); the odds of having obesity at age 17 were 18.28 times greater with each increase in BMI category at age 11. Adjusted and non-adjusted BMI status at 11 years showed equivalent accuracy in predicting cardiometabolic risk at age 17; the odds ratio of high cardiometabolic risk was 1.85, with heightened risk in boys, particularly early maturers. CONCLUSION The traditional method of categorising adolescents into a BMI category may over-predict overweight and obesity, particularly in girls. Adjusting for biological maturity when estimating weight status through calculating adolescents' BMI classification was equivalent to standard approaches in predicting other cardiovascular risk at age 17.
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Affiliation(s)
- Fiona B Gillison
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Elisabeth B Grey
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Sean P Cumming
- Department for Health, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Lauren B Sherar
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
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20
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A Natural Experiment Comparing the Effectiveness of the "Healthy Eagles" Child Weight Management Intervention in School Versus Community Settings. Nutrients 2021; 13:nu13113912. [PMID: 34836167 PMCID: PMC8623922 DOI: 10.3390/nu13113912] [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: 09/22/2021] [Revised: 10/25/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022] Open
Abstract
Behavioural weight management interventions are recommended for the treatment of obesity in children. However, the evidence for these is limited and often generated under trial conditions with White, middle-class populations. Healthy Eagles is a behavioural weight management intervention designed to treat excess weight in children. It ran in the London Borough of Croydon from 2017 to 2020 and was delivered in both school and community settings, providing a natural experiment to compare outcomes. A total of 1560 participants started the Healthy Eagles programme; 347 were in the community setting and 703 in the school setting. Data were analysed for those who completed 70% of the programme. In the school setting, there was a small but significant reduction in BMI z-score (M = −0.04, 95% CI = −0.08, −0.01) for participants above a healthy weight, especially in those with severe obesity (M = −0.09, 95% CI = −0.15, −0.03); there was no significant change in any subgroup in the community setting. Linear regression analysis showed the school setting was associated with a 0.26 (95% CI = 0.13, 0.49) greater reduction in BMI z-score than the community setting after adjusting for ethnicity, deprivation, age and gender. Across both programmes, the effect was somewhat greater in participants from a Black (African/Caribbean/Other) ethnic background (M = −0.06, 95% CI = −0.09, −0.02) and from the two most deprived quintiles (M = −0.06, 95% CI = −0.11, −0.01). Data were limited, but minimal changes were measured in nutrition and physical activity behaviours regardless of setting. This evaluation provides indirect evidence of a small but significant benefit to running weight management interventions in a school versus community setting.
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21
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Smith WA, Gray E, Jones TL, Han JC, Burton ET. Waitlist management in a pediatric weight management clinic: implementing an orientation session. BMC Pediatr 2021; 21:416. [PMID: 34551757 PMCID: PMC8456555 DOI: 10.1186/s12887-021-02868-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background This study evaluates implementation of an orientation session to address a waitlist of more than 2000 referrals to a pediatric weight management clinic in the Mid-South United States. Methods An hour-long group-based orientation to the pediatric weight management clinic was implemented to provide information about the structure and expectations of the clinic as well as education on healthy lifestyle recommendations. Families were contacted from the waitlist by telephone and invited to attend an orientation session prior to scheduling a clinic appointment. Results Of 2251 patients contacted from the waitlist, 768 scheduled an orientation session, of which 264 (34 %) attended. Of the 264 orientation participants, 246 (93 %) scheduled a clinic appointment. Of those, 193 (79 %) completed a clinic visit. Waitlist times decreased from 297.8 ± 219.4 days prior to implementation of orientation sessions to 104.1 ± 219.4 days after. Conclusions Orientation has been an effective and efficient way to triage patient referrals while maximizing attendance in limited clinic slots for patients and families demonstrating interest and motivation. Elements of this approach are likely generalizable to other pediatric clinical settings that must strategically manage a large volume of patient referrals.
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Affiliation(s)
- Webb A Smith
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA. .,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.
| | - Emily Gray
- Department of Health Promotion and Disease Prevention, College of Nursing, University of Tennessee Health Science Center, TN, Memphis, USA
| | - Tamekia L Jones
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, TN, Memphis, USA
| | - Joan C Han
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Department of Physiology, College of Medicine, University of Tennessee Health Science Center, TN, Memphis, USA
| | - E Thomaseo Burton
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA.,Children's Foundation Research Institute, Le Bonheur Children's Hospital, 50 North Dunlap Street, Room 453R, TN, 38103, Memphis, USA
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22
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Fowler LA, Hampl SE, Dreyer Gillette ML, Staiano AE, Kracht CL, Graham AK, Gabbert S, Springstroh K, Thomas F, Nelson L, Hampp AE, Carlson JA, Welch R, Wilfley DE. Translating Family-Based Behavioral Treatment for Childhood Obesity into a User-Friendly Digital Package for Delivery to Low-Income Families through Primary Care Partnerships: The MO-CORD Study. Child Obes 2021; 17:S30-S38. [PMID: 34569844 PMCID: PMC8575055 DOI: 10.1089/chi.2021.0174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Significant gaps exist in access to evidence-based pediatric weight management interventions, especially for low-income families. As a part of the Centers for Disease Control and Prevention's Childhood Obesity Research Demonstration project 3.0 (CORD), the Missouri CORD (MO-CORD) team aims to increase access to and dissemination of an efficacious pediatric obesity treatment, family-based behavioral treatment (FBT), among low-income families. This article describes the MO-CORD team's approach to translating FBT into a digital package for delivery to low-income families through primary care practices. Methods: Using digital technology, the primary care setting, and existing reimbursement mechanisms, the MO-CORD team is developing a scalable user-centered design informed treatment package of FBT. This package will be implemented in primary care clinics and delivered to children (5-12 years) with obesity from low-income households in rural and urban communities. The digital platform includes three main components: (1) provider and interventionist training, (2) interventionist-facing materials, and (3) family-facing treatment materials. User-centered design techniques and continuous iterative stakeholder feedback are utilized to emphasize tailoring to a low-income population, along with scalability and sustainability of the digital package. Conclusions: The MO-CORD project addresses the critical need to increase access to obesity treatment for children from low-income households and establishes a platform for future large-scale (i.e., nation-wide) dissemination of evidence-based pediatric weight-management interventions. This study determines whether the digital FBT package can be implemented within real-world settings to create a system by which children with obesity and their families can be effectively treated in primary care settings.
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Affiliation(s)
- Lauren A. Fowler
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Sarah E. Hampl
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | | | | | | | - Andrea K. Graham
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - Sherri Gabbert
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kelly Springstroh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Fanice Thomas
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Aubrie E. Hampp
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jordan A. Carlson
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, Kansas City, MO, USA
| | - Robinson Welch
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Denise E. Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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23
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Wild CE, Rawiri N, Willing EJ, Hofman PL, Anderson YC. Health system barriers to accessing care for children with weight issues in New Zealand: An interview-based study. J Health Serv Res Policy 2021; 26:234-241. [PMID: 34282958 DOI: 10.1177/13558196211016011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To identify barriers created and maintained by the health system affecting engagement in a family-based multidisciplinary healthy lifestyle programme for children and adolescents in New Zealand. METHODS We conducted 64 semi-structured interviews with participants of the programme (n = 71) with varying levels of engagement, including those who declined contact after their referral. Half the interviews were with families with Māori children, allowing for appropriate representation. Interviews were analysed using thematic analysis. RESULTS Five health system factors affecting engagement were identified: the national policy environment, funding constraints, lack of coordination between services, difficulty navigating the health system, and the cost of primary health care. CONCLUSIONS Engaging with a health system that creates and maintains substantial barriers to accessing services is difficult, affecting programme engagement, even where service-level barriers have been minimised. Lack of access remains a crucial barrier to improved health outcomes for children and their families experiencing childhood obesity in New Zealand. There is a need for comprehensive approaches that are accompanied by a clear implementation strategy and coordinated across sectors.
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Affiliation(s)
- Cervantée Ek Wild
- Department of Paediatrics: Child and Youth Health, University of Auckland, New Zealand.,Liggins Institute, University of Auckland, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, New Zealand
| | - Ngauru Rawiri
- Liggins Institute, University of Auckland, New Zealand
| | - Esther J Willing
- Kōhatu - Centre for Hauora Māori, University of Otago, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, New Zealand.,Starship Children's Hospital, Auckland District Health Board, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, University of Auckland, New Zealand.,Liggins Institute, University of Auckland, New Zealand.,Tamariki Pakari Child Health and Wellbeing Trust, New Zealand.,Paediatrician, Department of Paediatrics, Taranaki District Health Board, New Zealand
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24
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Wild CEK, Rawiri NT, Cormack DM, Willing EJ, Hofman PL, Anderson YC. A Collaborative Indigenous-non-Indigenous Partnership Approach to Understanding Participant Experiences of a Community-Based Healthy Lifestyles Program. QUALITATIVE HEALTH RESEARCH 2021; 31:1404-1411. [PMID: 33703952 PMCID: PMC8278546 DOI: 10.1177/1049732321998640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We describe the approach of an Indigenous-non-Indigenous research partnership in the context of a qualitative study which aimed to understand barriers and facilitators to engagement in a community-based healthy lifestyles program in Aotearoa/New Zealand. Informed by Kaupapa Māori research principles and by "Community-Up" research values, this collaborative approach between the mixed Māori-non-Māori research team effectively engaged with Māori and non-Māori families for in-depth interviews on participant experience, including with non-service users. "Community-Up" research principles allowed for a respectful process which upheld the mana (status, dignity) of the interview participants and the research team. Challenges included maintaining flexibility in our conceptions of ethnicity to reflect the complexity of modern family life in Aotearoa/New Zealand. We were committed to ongoing communication, awareness, and attention to the relationships that formed the basis of our research partnership, which allowed effective navigation of challenges and was critical to the study's success.
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Affiliation(s)
- Cervantée E. K. Wild
- The University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand
| | | | | | | | - Paul L. Hofman
- The University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C. Anderson
- The University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, Taranaki, New Zealand
- Taranaki District Health Board, New Plymouth, New Zealand
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25
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Lemstra ME, Rogers M. Mental health and socioeconomic status impact adherence to youth activity and dietary programs: a meta-analysis. Obes Res Clin Pract 2021; 15:309-314. [PMID: 33992571 DOI: 10.1016/j.orcp.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/28/2021] [Accepted: 05/07/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Substantial efforts have gone into reducing the physiological and psychological harm of obesity in youth, but few studies have reviewed the factors contributing to adherence to pediatric weight management programs. The attrition rates to programs offering multiple components to address BMI improvement and healthy lifestyle change among youth are quite high. The purpose of this study is to review the literature for factors contributing to adherence to these programs among children and youth with obesity and determine pooled effect of these factors. METHODS A systematic literature search and meta-analysis was conducted through the PubMed database on pediatric weight management interventions offering at least physical activity and dietary support for obese youth aged 10-17 years, where variables contributing to adherence were reported. Only those studies achieving a threshold of methodological rigour were included. RESULTS Altogether, seven studies were included in the analysis. There was a pooled RR of lower socioeconomic status on non-adherence of 1.34 [95% confidence intervals 1.19-1.52] and poorer mental health on non-adherence of 1.12 [95% confidence intervals 1.08-1.17]. CONCLUSION It is important to address barriers related to lower socioeconomic status in pediatric weight management programs to increase adherence. Further, addressing supports for those with poorer mental health can reduce the risk of non-adherence in multi-disciplinary programs targeting youth with obesity.
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Affiliation(s)
- Mark E Lemstra
- Alliance Health, Inc. Moose Jaw, 890-A Lillooet St W, Moose Jaw, SK S6H 8B4, Saskatchewan, Canada
| | - Marla Rogers
- The Canadian Hub for Applied and Social Research, University of Saskatchewan, 9 Campus Drive, Saskatoon, Saskatchewan, S7N 5A5, Canada.
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26
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Wild CEK, Rawiri NT, Willing EJ, Hofman PL, Anderson YC. What affects programme engagement for Māori families? A qualitative study of a family-based, multidisciplinary healthy lifestyle programme for children and adolescents. J Paediatr Child Health 2021; 57:670-676. [PMID: 33354861 PMCID: PMC8247020 DOI: 10.1111/jpc.15309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 11/12/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022]
Abstract
AIM It is important that intervention programmes are accessible and acceptable for groups most affected by excess weight. This study aimed to understand the barriers to and facilitators of engagement for Māori in a community-based, assessment-and-intervention healthy lifestyle programme (Whānau Pakari). METHODS Sixty-four in-depth, home-based interviews were conducted with past service users. Half of these were with families with Māori children and half with non-Māori families. The interviews were thematically analysed with peer debriefing for validity. RESULTS Māori families experienced barriers due to racism throughout the health system and society, which then affected their ability to engage with the programme. Key barriers included the institutionalised racism evident through substantial structural barriers and socio-economic challenges, the experience of interpersonal racism and its cumulative impact with weight stigma, and internalised racism and beliefs of biological determinism. Responses to these barriers were distrust of health services, followed by renewed engagement or complete disengagement. Participants identified culturally appropriate care as that which was compassionate, respectful, and focused on relationship building. CONCLUSIONS While Whānau Pakari is considered appropriate due to the approach of the delivery team, this is insufficient to retain some Māori families who face increased socio-economic and structural barriers. Past instances of weight stigma and racism have enduring effects when re-engaging with future health services, and inequities are likely to persist until these issues are addressed within the health system and wider society.
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Affiliation(s)
- Cervantée EK Wild
- Liggins InstituteUniversity of AucklandAucklandNew Zealand,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand,Kōhatu – Centre for Hauora MāoriUniversity of OtagoDunedinNew Zealand
| | | | - Esther J Willing
- Starship Children's HospitalAuckland District Health BoardAucklandNew Zealand
| | - Paul L Hofman
- Liggins InstituteUniversity of AucklandAucklandNew Zealand,Tamariki Pakari Child Health and Wellbeing TrustNew PlymouthNew Zealand
| | - Yvonne C Anderson
- Liggins InstituteUniversity of AucklandAucklandNew Zealand,Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand,Tamariki Pakari Child Health and Wellbeing TrustNew PlymouthNew Zealand,Department of PaediatricsTaranaki District Health BoardNew PlymouthNew Zealand
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27
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Vlaev I, Taylor MJ, Taylor D, Gately P, Gunn LH, Abeles A, Kerkadi A, Lothian J, Jreige SK, Alsaadi A, Al-Kuwari MG, Ghuloum S, Al-Kuwari H, Darzi A, Ahmedna M. Testing a multicomponent lifestyle intervention for combatting childhood obesity. BMC Public Health 2021; 21:824. [PMID: 33926412 PMCID: PMC8082655 DOI: 10.1186/s12889-021-10838-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 04/14/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Childhood obesity is a major global health concern. Weight-management camps involving delivery of a program of physical activity, health education, and healthy eating are an effective treatment, although post-intervention weight-management is less well understood. Our objective was to assess the effectiveness of a weight-management camp followed by a community intervention in supporting weight-management for overweight children and children with obesity. METHODS Participants were overweight Qatari schoolchildren or schoolchildren with obesity, ages 8-14 years, (n = 300) recruited over a three-year period across 14 randomly selected schools in the Doha area. They attended a two-week weight management camp, then a 10-week program of weekly lifestyle education and physical activity sessions, which also included behavior change techniques. The programme was cognitive behavioural therapy (CBT)-focused with a strong element of behavioural economics blended in. RESULTS Participants saw a significant BMI SDS reduction as a result of the entire intervention (camp + education and activity sessions) both at the individual (p < 0.0001) and cluster/school (p = 0.0002) levels, and weight loss occurred during each intervention stage separately for the camp (p < 0.0001 for both the individual and cluster/school levels) and the lifestyle education and activity phase (p < 0.0001 and p = 0.0220 at the individual and cluster/school levels, respectively). CONCLUSIONS Weekly lifestyle education and activity sessions which include behavior change techniques may be useful in promoting continued weight management in the period following intensive, immersive childhood obesity interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02972164 , November 23, 2016.
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Affiliation(s)
- Ivo Vlaev
- Warwick Business School, University of Warwick, Coventry, UK.
| | - Michael J Taylor
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - David Taylor
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | | - Laura H Gunn
- Department of Public Health Sciences & School of Data Science, University of North Carolina at Charlotte, Charlotte, USA.,School of Public Health, Imperial College London, London, UK
| | - Aliza Abeles
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Abdelhamid Kerkadi
- Human Nutrition Department, College of Health Sciences, Qatar University, Doha, Qatar
| | | | | | | | | | | | | | - Ara Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Mohamed Ahmedna
- North Carolina Agricultural and Technical State University, Greensboro, USA
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28
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Ball GDC, Sebastianski M, Wijesundera J, Keto-Lambert D, Ho J, Zenlea I, Perez A, Nobles J, Skelton JA. Strategies to reduce attrition in managing paediatric obesity: A systematic review. Pediatr Obes 2021; 16:e12733. [PMID: 32959990 DOI: 10.1111/ijpo.12733] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/27/2020] [Accepted: 09/07/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature for strategies designed to reduce attrition in managing paediatric obesity. METHODS We searched Ovid Medline (1946 to May 6, 2020), Ovid Embase (1974 to May 6, 2020), EBSCO CINAHL (inception to May 6, 2020), Elsevier Scopus (inception to April 14, 2020), and ProQuest Dissertations & Theses (inception to April 14, 2020). Reports were eligible if they included any obesity management intervention, included 2 to 18 year olds with overweight or obesity (or if the mean age of participants fell within this age range), were in English, included experimental study designs, and had attrition reduction as a main outcome. Two team members screened studies, abstracted data, and appraised study quality. RESULTS Our search yielded 5,415 original reports; six met inclusion criteria. In three studies, orientation sessions (n = 2) and motivational interviewing (MI) (n = 1) were used as attrition-reduction strategies before treatment enrollment; in three others, text messaging (n = 2) and MI (n = 1) supplemented existing obesity management interventions. Attrition-reduction strategies led to decreased attrition in two studies, increased in one, and no difference in three. For the two strategies that reduced attrition, (a) pre-treatment orientation and (b) text messaging between children and intervention providers were beneficial. The quality of the six included studies varied (good [n = 4]; poor [n = 2]). CONCLUSION Some evidence suggests that attrition can be reduced. The heterogeneity of approaches applied and small number of studies included highlight the need for well-designed, experimental research to test the efficacy and effectiveness of strategies to reduce attrition in managing paediatric obesity.
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Affiliation(s)
- Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Canada
| | - Jessica Wijesundera
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Diana Keto-Lambert
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, Canada
| | - Josephine Ho
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Canada
| | - Arnaldo Perez
- School of Dentistry, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - James Nobles
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest University, Winston-Salem, North Carolina, USA
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29
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McGuirt JT, Enahora B, Dyson OL, Tripicchio GL, Mallard L, Rhea CK. Virtual Avatar Coaching With Community Context for Adult-Child Dyads with Low Income. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:232-239. [PMID: 33706896 DOI: 10.1016/j.jneb.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/09/2020] [Accepted: 12/09/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Examine the acceptability of an evidence-based, contextually tailored, virtual avatar coaching approach for nutrition education among adult-child dyads with low income. DESIGN Structured observations and semistructured interviews. SETTING Low-income communities in 2 midsized urban areas. PARTICIPANTS Fifteen African American adult and child (aged 5-10 years old) dyads recruited from community agencies. PHENOMENON OF INTEREST Structured observation during the use of the virtual avatar coaching program and qualitative feedback on program experience after using the program. ANALYSIS Transcripts were independently coded by 2 trained coders. Content analysis was conducted to determine trends and patterns in responses, and salient quotes were extracted from the manuscripts. RESULTS The program generated dialogue between the children and adults around preferences and dietary habits. Adults and children described the program as being helpful, informative, motivational, and fun. Adults and children liked that the avatar acknowledged them at a personal level, provided accountability, and was tailored to them and their environment. Children wanted the ability to customize the avatar, more gamification, and avatar demonstration of healthy behaviors. Children felt the program would improve their health behaviors and were interested in using it again. CONCLUSIONS AND IMPLICATIONS This study highlights information that can be used to improve avatar-based programs for nutrition education with children and their adult caregivers who have low income. Future work should assess the impact of user customization experience, program impact on dietary behaviors, and resources required to scale and maintain the program with community agencies.
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Affiliation(s)
- Jared T McGuirt
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC.
| | - Basheerah Enahora
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC
| | - Omari L Dyson
- Department of Peace and Conflict Studies, University of North Carolina Greensboro, Greensboro, NC
| | - Gina L Tripicchio
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA
| | - Lauryn Mallard
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC
| | - Christopher K Rhea
- Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC
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30
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Hayba N, Rissel C, Allman Farinelli M. Effectiveness of lifestyle interventions in preventing harmful weight gain among adolescents: A systematic review of systematic reviews. Obes Rev 2021; 22:e13109. [PMID: 32725749 DOI: 10.1111/obr.13109] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/20/2022]
Abstract
Obesity in adolescence is associated with stigma during school years, early emergence of co-morbidities in adulthood and premature mortality. Adolescence presents a key window of opportunity to intervene for building healthy eating and physical activity routines and prevent weight gain. This review of reviews assesses the evidence on the effectiveness of prevention interventions conducted with adolescents. Nine reviews assessing the effects of lifestyle interventions in adolescents (defined as age 10 to 19 years old) on weight gain were identified from the 10 health databases searched. Only four reviews conducted meta-analyses, of which, three (two exercise-focused) demonstrated positive changes in primary outcomes of body mass index (BMI) and/or BMI z-score (range of decrease in BMI from 0.06 to 0.47 kg/m2) ). Most were conducted in school settings, and all but two reviews were of low quality. Few reviews reported external validity components that would enable clearer directions for policy makers to implement in real-world settings. More than 140 distinct interventions were included in the reviews, but there remains a serious gap in evidence for effective interventions in adolescents.
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Affiliation(s)
- Nematullah Hayba
- Nutrition and Dietetics Group, School of Life and Environmental Science, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Chris Rissel
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Margaret Allman Farinelli
- Nutrition and Dietetics Group, School of Life and Environmental Science, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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31
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Nagelhout GE, Abidi L, de Vries H. Reasons for (not) participating in a community-based health promotion program for low-income multi-problem households in the Netherlands: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:241-249. [PMID: 32633021 PMCID: PMC7818491 DOI: 10.1111/hsc.13087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 05/23/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
People living in low-income multi-problem households may benefit from participation in a community-based health promotion program. Yet, low participation rates are often a problem. It is important to assess reasons for (not) participating to better tailor programs to the needs of this particular at-risk group. Back2Balance is a health promotion program for low-income multi-problem households from Apeldoorn, the Netherlands. We performed qualitative interviews among participants (n = 16) and non-participants (n = 12) of the program and asked them for their reasons for (not) participating in the program. Interview transcripts were thematically analysed using the Framework method. Participants indicated that reasons for participating encompassed intrapersonal motivators (e.g. to become healthier), interpersonal motivators (e.g. participating to get to know new people) and program level motivators (e.g. learning about a healthy lifestyle, and free or very low cost). Participants and non-participants outlined the importance of intrapersonal barriers (e.g. physical health problems), interpersonal barriers (e.g. family circumstances) and program level barriers (e.g. logistic issues, and not understanding or knowing about some part of the program). Concluding, combining health promotion with social interaction motivated participants to participate in the Back2Balance program. Yet, both participants and non-participants experienced many barriers for participation, some of which were related to their multi-problem situation.
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Affiliation(s)
- Gera E. Nagelhout
- Department of Health PromotionMaastricht University (CAPHRI)Maastrichtthe Netherlands
- IVO Research InstituteThe Haguethe Netherlands
| | - Latifa Abidi
- Department of Health PromotionMaastricht University (CAPHRI)Maastrichtthe Netherlands
| | - Hein de Vries
- Department of Health PromotionMaastricht University (CAPHRI)Maastrichtthe Netherlands
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32
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Fowler LA, Grammer AC, Staiano AE, Fitzsimmons-Craft EE, Chen L, Yaeger LH, Wilfley DE. Harnessing technological solutions for childhood obesity prevention and treatment: a systematic review and meta-analysis of current applications. Int J Obes (Lond) 2021; 45:957-981. [PMID: 33627775 PMCID: PMC7904036 DOI: 10.1038/s41366-021-00765-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/24/2020] [Accepted: 01/20/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Technology holds promise for delivery of accessible, individualized, and destigmatized obesity prevention and treatment to youth. OBJECTIVES This review examined the efficacy of recent technology-based interventions on weight outcomes. METHODS Seven databases were searched in April 2020 following PRISMA guidelines. Inclusion criteria were: participants aged 1-18 y, use of technology in a prevention/treatment intervention for overweight/obesity; weight outcome; randomized controlled trial (RCT); and published after January 2014. Random effects models with inverse variance weighting estimated pooled mean effect sizes separately for treatment and prevention interventions. Meta-regressions examined the effect of technology type (telemedicine or technology-based), technology purpose (stand-alone or adjunct), comparator (active or no-contact control), delivery (to parent, child, or both), study type (pilot or not), child age, and intervention duration. FINDINGS In total, 3406 records were screened for inclusion; 55 studies representing 54 unique RCTs met inclusion criteria. Most (89%) included articles were of high or moderate quality. Thirty studies relied mostly or solely on technology for intervention delivery. Meta-analyses of the 20 prevention RCTs did not show a significant effect of prevention interventions on weight outcomes (d = 0.05, p = 0.52). The pooled mean effect size of n = 32 treatment RCTs showed a small, significant effect on weight outcomes (d = ‒0.13, p = 0.001), although 27 of 33 treatment studies (79%) did not find significant differences between treatment and comparators. There were significantly greater treatment effects on outcomes for pilot interventions, interventions delivered to the child compared to parent-delivered interventions, and as child age increased and intervention duration decreased. No other subgroup analyses were significant. CONCLUSIONS Recent technology-based interventions for the treatment of pediatric obesity show small effects on weight; however, evidence is inconclusive on the efficacy of technology based prevention interventions. Research is needed to determine the comparative effectiveness of technology-based interventions to gold-standard interventions and elucidate the potential for mHealth/eHealth to increase scalability and reduce costs while maximizing impact.
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Affiliation(s)
- Lauren A. Fowler
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Anne Claire Grammer
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Amanda E. Staiano
- grid.250514.70000 0001 2159 6024LSU’s Pennington Biomedical Research Center, Baton Rouge, LA USA
| | - Ellen E. Fitzsimmons-Craft
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Ling Chen
- grid.4367.60000 0001 2355 7002Division of Biostatistics, Washington University School of Medicine, St. Louis, MO USA
| | - Lauren H. Yaeger
- grid.4367.60000 0001 2355 7002Washington University School of Medicine, St. Louis, MO USA
| | - Denise E. Wilfley
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
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Grootens-Wiegers P, van den Eynde E, Halberstadt J, Seidell JC, Dedding C. The "Stages Towards Completion Model": what helps and hinders children with overweight or obesity and their parents to be guided towards, adhere to and complete a group lifestyle intervention. Int J Qual Stud Health Well-being 2020; 15:1735093. [PMID: 32148191 PMCID: PMC7144242 DOI: 10.1080/17482631.2020.1735093] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: Lifestyle interventions can be effective in the management of overweight and obesity in children. However, ineffective guidance towards interventions and high attrition rates affect health impacts and cost effectiveness. The aim of this study was to gain insight into the factors influencing participation, in particular guidance towards, adherence to and completion of an intervention. Methods: A narrative literature review was performed to identify factors related to participation, leading to the development of the “Stages towards Completion Model”. Semi-structured interviews (n = 33) and three focus group discussions (n = 25) were performed with children and parents who completed two different group lifestyle interventions, as well as with their coaches. Results: The main barrier to participating in a lifestyle intervention was the complex daily reality of the participants. The main facilitator to overcome these barriers was a personal approach by all professionals involved. Conclusions: Participation in a lifestyle intervention is not influenced by one specific factor, but by the interplay of facilitators and barriers. A promising way to stimulate participation and thereby increase the effectiveness of interventions would be an understanding of and respect for the complex circumstances of participants and to personalize guidance towards and execution of interventions.
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Affiliation(s)
- Petronella Grootens-Wiegers
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Emma van den Eynde
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands.,Department of Pediatric Endocrinology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jutka Halberstadt
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Jacob C Seidell
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
| | - Christine Dedding
- Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Medical Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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34
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Abstract
Objective: The objective of the current study was to identify challenges of making and sustaining healthy lifestyle changes for families with children/adolescents affected by obesity, who were referred to a multicomponent healthy lifestyle assessment and intervention programme in Aotearoa/New Zealand (NZ). Design: Secondary qualitative analysis of semi-structured interviews. Setting: Taranaki region of Aotearoa/NZ. Participants: Thirty-eight interviews with parents/caregivers (n 42) of children/adolescents who had previously been referred to a family-focused multidisciplinary programme for childhood obesity intervention, who identified challenges of making healthy lifestyle changes. Participants had varying levels of engagement, including those who declined contact after their referral. Results: Participant-identified challenges included financial cost, impact of the food environment, time pressures, stress, maintaining consistency across households, independence in adolescence, concern for mental health and frustration when not seeing changes in weight status. Conclusions: Participants recognised a range of factors that contributed towards their ability to make and sustain change, including factors at the wider socio-environmental level beyond their immediate control. Even with the support of a multidisciplinary healthy lifestyle programme, participants found it difficult to make sustained changes within an obesogenic environment. Healthy lifestyle intervention programmes and families’ abilities to make and sustain changes require alignment of prevention efforts, focusing on policy changes to improve the food environment and eliminate structural inequities.
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Pallan M, Griffin T, Hurley KL, Lancashire E, Blissett J, Frew E, Griffith L, Hemming K, Jolly K, McGee E, Thompson JL, Jackson L, Gill P, Parry J, Adab P. Cultural adaptation of an existing children's weight management programme: the CHANGE intervention and feasibility RCT. Health Technol Assess 2020; 23:1-166. [PMID: 31293236 DOI: 10.3310/hta23330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Excess weight in children is a continuing health issue. Community-based children's weight management programmes have had some effect in promoting weight loss. Families from minority ethnic communities are less likely to complete these programmes but, to date, no programmes have been culturally adapted to address this. OBJECTIVES We aimed to (1) culturally adapt an existing weight management programme for children aged 4-11 years and their families to make it more suited to Pakistani and Bangladeshi communities but inclusive of all families and (2) evaluate the adapted programme to assess its feasibility and acceptability, as well as the feasibility of methods, for a future full-scale trial. DESIGN In phase I, a cultural adaptation of a programme that was informed by formative research and guided by two theoretical frameworks was undertaken and in phase II this adapted programme was delivered in a cluster-randomised feasibility study (for which the clusters were the standard and adapted children's weight management programmes). SETTING Birmingham: a large, ethnically diverse UK city. PARTICIPANTS In phase I, Pakistani and Bangladeshi parents of children with excess weight, and, in phase II, children aged 4-11 years who have excess weight and their families. INTERVENTIONS A culturally adapted children's weight management programme, comprising six sessions, which was delivered to children and parents, targeting diet and physical activity and incorporating behaviour change techniques, was developed in phase I and delivered in the intervention arm to 16 groups in phase II. The eight groups in the comparator arm received the standard (unadapted) children's weight management programme. MAIN OUTCOME MEASURES The primary outcome was the proportion of Pakistani and Bangladeshi families completing (attending ≥ 60% of) the adapted programme. Secondary outcomes included the proportion of all families completing the adapted programme, the feasibility of delivery of the programme, the programme's acceptability to participants, the feasibility of trial processes and the feasibility of collection of outcome and cost data. RESULTS The proportion of Pakistani and Bangladeshi families and all families completing the adapted programme was 78.8% [95% confidence interval (CI) 64.8% to 88.2%] and 76.3% (95% CI 67.0% to 83.6%), respectively. The programme was feasible to deliver with some refinements and was well received. Ninety-two families participated in outcome data collection. Data collection was mostly feasible, but participant burden was high. Data collection on the cost of programme delivery was feasible, but costs to families were more challenging to capture. There was high attrition over the 6-month follow-up period (35%) and differential attrition in the two study arms (29% and 52% in the intervention and comparator arms, respectively). LIMITATIONS The study was not designed to address the issue of low participant uptake of children's weight management programmes. The design of a future trial may include individual randomisation and a 'minimal intervention' arm, the acceptability of which has not been evaluated in this study. CONCLUSIONS The theoretically informed, culturally adapted children's weight management programme was highly acceptable to children and families of all ethnicities. Consideration should be given to a future trial to evaluate clinical effectiveness and cost-effectiveness of the adapted programme, but the design of a future trial would need to address the logistics of data collection, participant burden and study attrition. TRIAL REGISTRATION Current Controlled Trials ISRCTN81798055. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 33. See the NIHR Journals Library website for further project information. Kate Jolly is part-funded by the Collaboration for Leadership in Applied Health Research and Care West Midlands.
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Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tania Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiya L Hurley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Emma Lancashire
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jacqueline Blissett
- School of Psychology, University of Birmingham, Birmingham, UK.,Faculty Research Centre for Technology Enabled Health Research, Coventry University, Coventry, UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Griffith
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Karla Hemming
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eleanor McGee
- Birmingham Community Nutrition, Birmingham Community Healthcare NHS Trust, Birmingham, UK
| | - Janice L Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Louise Jackson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paramjit Gill
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Warwick Medical School, University of Warwick, Coventry, UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Wild CE, Rawiri NT, Willing EJ, Hofman PL, Anderson YC. Determining barriers and facilitators to engagement for families in a family-based, multicomponent healthy lifestyles intervention for children and adolescents: a qualitative study. BMJ Open 2020; 10:e037152. [PMID: 32895279 PMCID: PMC7478027 DOI: 10.1136/bmjopen-2020-037152] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVES Recruitment and retention in child and adolescent healthy lifestyle intervention services for childhood obesity is challenging, and inequalities across social groups are persistent. This study aimed to understand the barriers and facilitators to engagement in a multicomponent assessment-and-intervention healthy lifestyle programme for children and their families, based in the home and community. DESIGN Qualitative interview-based study of past users (n=76) of a family-based multicomponent healthy lifestyle programme in a mixed urban-rural region of New Zealand. Semistructured, home-based interviews were conducted and thematically analysed with peer debriefing for validity. PARTICIPANTS Families were selected through stratified random sampling to include a range of levels of engagement, including those who declined their referral, with equal numbers of interviews with Indigenous and non-Indigenous families. RESULTS Three interactive and compounding determinants were identified as influencing engagement in Whānau Pakari: acute and chronic life stressors, societal norms of weight and body size and historical experiences of healthcare. These determinants were present across societal, system and healthcare service levels. A negative referral experience to Whānau Pakari often resulted in participants declining further input or disengaging from the programme. A fourth domain, respectful and compassionate healthcare, was identified as a mitigator of these three themes, facilitating participant engagement despite previous negative experiences. CONCLUSIONS While participant engagement in healthy lifestyle programmes is affected by determinants which appear to operate outside immediate service provision, the programme is an opportunity to acknowledge past instances of stigma and the wider challenges of healthy lifestyle change. The experience of the referral to Whānau Pakari is important for setting the scene for future engagement in the programme. Respectful, compassionate care is critical to enhanced retention in multidisciplinary healthy lifestyle programmes and ongoing engagement in healthcare services overall.
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Affiliation(s)
| | - Ngauru T Rawiri
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Esther J Willing
- Kōhatu - Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Health, Auckland, New Zealand
| | - Yvonne C Anderson
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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37
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Watson PM, Dugdill L, Pickering K, Hargreaves J, Staniford LJ, Owen S, Murphy RC, Knowles ZR, Johnson LJ, Cable NT. Distinguishing factors that influence attendance and behaviour change in family-based treatment of childhood obesity: A qualitative study. Br J Health Psychol 2020; 26:67-89. [PMID: 32710510 DOI: 10.1111/bjhp.12456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 06/13/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES For the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family-based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)). DESIGN Focus groups with children and parents/carers as part of a broader mixed-methods evaluation. METHODS Eighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change. RESULTS Initial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non-judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non-attending significant others. CONCLUSIONS Factors that influence attendance and behaviour change are distinct and may be important at different stages of the family's change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention.
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Affiliation(s)
- Paula M Watson
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Lindsey Dugdill
- Formerly School of Health Sciences, University of Salford, Salford, UK
| | - Katie Pickering
- Physical Activity, Wellbeing, and Public Health Research Group, Academy of Sport and Physical Activity, Sheffield Hallam University, UK
| | | | - Leanne J Staniford
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, UK
| | - Stephanie Owen
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Rebecca C Murphy
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Zoe R Knowles
- Physical Activity Exchange, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, UK
| | - Laura J Johnson
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, UK
| | - N Timothy Cable
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, UK
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38
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Enright G, Gyani A, Hyun K, Allman-Farinelli M, Innes-Hughes C, Chen L, Redfern J. What Motivates Engagement in a Community-Based Behavior Change Strategy for Overweight Children? Health Promot Pract 2020; 23:174-184. [PMID: 32713213 DOI: 10.1177/1524839920944859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. The success of family-based community programs for childhood obesity may be increased by promoting social-cognitive factors that influence motivation and participant engagement. Incentivizing behavior can potentially enhance engagement and encourage behavior change. This research investigated motivators to engagement with a multicomponent incentive-based strategy to improve attendance and health-related behavior change in a family community-based weight management program for overweight and obese children. Method. Qualitative analysis combining; demographic data (n = 512), survey of parents (n = 273), and stakeholder (n = 10) and family interviews (n = 24). Participants were selected from program providers and families participating in an Australian community weight management program during a randomized controlled trial (n = 512 children). Maximum variation sampling (demographics and group characteristics) and inductive thematic analysis were used. Results/Conclusion. Four factors influencing engagement were (1) personal value, (2) achievement, (3) support, and (4) overwhelm. These themes corroborated with social-cognitive factors, fostered by a combination of behavior change components in the program that increased participant accountability and intrinsic motivation. Focusing on autonomous goal planning with parental involvement, tracking of goals, and reviewing of goals may complement existing strategies in child-focused treatment programs. Low-value noncash incentives linked to goal setting for encouraging healthy eating and physical activity were well accepted and may enhance family engagement and attendance.
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Affiliation(s)
- Gemma Enright
- University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Alex Gyani
- NSW Department of Premier and Cabinet, Sydney, New South Wales Australia.,Behavioural Insights Team, Sydney, New South Wales, Australia
| | - Karice Hyun
- University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | - Lily Chen
- University of Sydney, Sydney, New South Wales, Australia
| | - Julie Redfern
- University of Sydney, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
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Brown CL, Dovico J, Garner-Edwards D, Moses M, Skelton JA. Predictors of Engagement in a Pediatric Weight Management Clinic after Referral. Child Obes 2020; 16:238-243. [PMID: 32484761 PMCID: PMC7262647 DOI: 10.1089/chi.2020.0032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Little is known about factors that affect a family's ability to engage in pediatric weight management clinics (PWMCs). We aimed at comparing child and family characteristics of patients referred to a PWMC by participants' attendance at orientation, attendance at intake, or completing the program. Methods: We performed a retrospective study of patients ages 2-18 years referred to a PWMC between 2014 and 2017. We extracted data from electronic medical records and clinic databases, including age, sex, race/ethnicity, language, referral year, address, and insurance. We performed t-tests and chi-square tests to examine the association of engagement outcomes with covariates. We used separate multivariate logistic regression models to assess the predictors of engagement outcomes, including significant covariates from bivariate analyses. Results: Participants (N = 2020 referred) had a mean age of 11.5 ± 3.5 years; 72% had Medicaid, and 34% lived in city limits. Participants were 39% white, 30% black, and 27% Hispanic. Of those referred, 41% attended orientation, 14% attended intake, and 9% completed. Significant predictors of attending orientation were age [odds ratio (OR): 0.93, 95% confidence interval (CI): 0.91-0.96], male sex (OR: 0.74, 95% CI: 0.60-0.91), Hispanic ethnicity (OR: 1.69, 95% CI: 1.26-2.26), living in city limits (OR: 1.39, 95% CI: 1.11-1.75), and Medicaid (OR: 0.77, 95% CI: 0.60-0.98). Significant predictors of attending intake were age (OR: 0.93, 95% CI: 0.90-0.96), Medicaid (OR: 0.61, 95% CI: 0.46-0.81), and 2017 referral year (OR: 0.21, 95% CI: 0.12-0.35). Hispanic ethnicity was associated with twice the odds of completion (OR: 2.07, 95% CI: 1.10-3.91). Conclusions: Child and family characteristics more strongly predicted initial engagement with a PWMC than completion. Future research should examine how targeting these predictors (e.g., referring at younger age) can improve PWMC engagement.
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Affiliation(s)
- Callie L. Brown
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Address correspondence to: Callie L. Brown, MD, MPH, Department of Pediatrics, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Jaclyn Dovico
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dara Garner-Edwards
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Melissa Moses
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A. Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Brenner FIT, Wake Forest School of Medicine, Winston-Salem, NC, USA
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40
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Wild CEK, O'Sullivan NA, Lee AC, Cave TL, Willing EJ, Cormack DM, Hofman PL, Anderson YC. Survey of Barriers and Facilitators to Engagement in a Multidisciplinary Healthy Lifestyles Program for Children. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2020; 52:528-534. [PMID: 31780274 DOI: 10.1016/j.jneb.2019.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 10/14/2019] [Accepted: 10/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To understand facilitators and barriers to engagement in a multidisciplinary assessment and intervention program for children and adolescents with obesity, particularly for Māori, the Indigenous people of New Zealand. METHODS Whānau Pakari participants and caregivers (n = 71, 21% response rate) referred to the family-based healthy lifestyles program in Taranaki, New Zealand, were asked to participate in a confidential survey, which collected self-reported attendance levels and agreement with statements around service accessibility and appropriateness and open-text comments identifying barriers and facilitators to attendance. RESULTS Self-reported attendance levels were higher when respondents reported sessions to be conveniently located (P = .03) and lower when respondents considered other priorities as more important for their family (P = .02). Māori more frequently reported that past experiences of health care influenced their decision to attend (P = .03). Facilitators included perceived convenience of the program, parental motivation to improve child health, and ongoing support from the program. CONCLUSIONS AND IMPLICATIONS Program convenience and parental and/or self-motivation to improve health were facilitators of attendance. Further research is required to understand the relationship between past experiences with health care and subsequent engagement with services.
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Affiliation(s)
| | - Niamh A O'Sullivan
- Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Arier C Lee
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Esther J Willing
- Kōhatu-Centre for Hauora Māori, University of Otago, Dunedin, New Zealand
| | - Donna M Cormack
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand; Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Liggins Institute, University of Auckland, Auckland, New Zealand; Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
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41
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Morrow AS, Sandridge S, Herring W, King K, Lanciers S, Lim CS. Characterizing attendance patterns at a multidisciplinary pediatric obesity clinic. CHILDRENS HEALTH CARE 2020. [DOI: 10.1080/02739615.2020.1740884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Anne S. Morrow
- College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
- Center for Children and Families, Florida International University, Miami, FL, USA
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Shanda Sandridge
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Whitney Herring
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Krista King
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sophie Lanciers
- Pediatric Gastroenterology, Tulane University, New Orleans, LA, USA
| | - Crystal Stack Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
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Zinszer K, Caprara A, Lima A, Degroote S, Zahreddine M, Abreu K, Carabali M, Charland K, Dantas MA, Wellington J, Parra B, Fournet F, Bonnet E, Pérez D, Robert E, Dagenais C, Benmarhnia T, Andersson N, Ridde V. Sustainable, healthy cities: protocol of a mixed methods evaluation of a cluster randomized controlled trial for Aedes control in Brazil using a community mobilization approach. Trials 2020; 21:182. [PMID: 32059693 PMCID: PMC7023806 DOI: 10.1186/s13063-019-3714-8] [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: 04/17/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022] Open
Abstract
Background Dengue is increasing in its global presence with an estimated 4 billion people at-risk of infection in at least 128 countries. Despite the promising results of EcoHealth and community mobilization approaches to Aedes reduction, more evidence of their efficacy on reducing dengue risk is needed. The principal research question is to determine if interventions based upon community mobilization reduce the risk of dengue virus infection among children 3 to 9 years old compared to usual dengue control practice in Fortaleza, Brazil. Methods The present study will follow a pragmatic cluster randomized controlled trial (cRCT) design with randomization at the census tract level with equal allocation to the two arms. In each arm, there will be 34 clusters of 86 children between 3 to 9 years old for an expected total of 5848 children enrolled in the study, assuming a risk reduction of 29.5% based upon findings from a previous multi-site cRCT. The primary outcomes are rates of anti-dengue Immunoglobulin G (IgG) seroconversion and adult female Aedes density. The intervention is based upon a participatory health research approach, Socializing Evidence for Participatory Action (SEPA), where the research evidence is used to foster community engagement and ownership of the health issue and solution. Following allocation, intervention communities will develop and implement their own solutions that will likely include a wide variety of collective events and media approaches. Data collection activities over a period of 3 years include household visits for blood collection, household surveys, and entomological surveys; and qualitative activities including focus groups, in-depth interviews, and document analysis to evaluate the process, acceptability, fidelity, and sustainability of the intervention. Study participants will be aware of their assignment and all research staff will be blinded although the intervention assignment will likely be revealed to field staff through interaction with participants. Discussion The results of our study will provide evidence on community mobilization as an intervention for dengue control. We anticipate that if community mobilization is effective in Fortaleza, the results of this study will help develop evidence-based vector control programs in Brazil, and also in other countries struggling with Aedes-transmitted diseases. Trial registration ISRCTN66131315, registration date: 1 October 2018.
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Affiliation(s)
- Kate Zinszer
- School of Public Health, University of Montreal, Montréal, Québec, Canada. .,Québec Public Health Research Centre, Montréal, Canada. .,Québec Population Health Research Network, Montréal, Canada.
| | - Andrea Caprara
- Québec Population Health Research Network, Montréal, Canada
| | - Antonio Lima
- Fortaleza Municipal Health Secretariat, Fortaleza, Brazil.,University of Fortaleza, Fortaleza, Brazil
| | | | - Monica Zahreddine
- School of Public Health, University of Montreal, Montréal, Québec, Canada
| | | | | | - Katia Charland
- School of Public Health, University of Montreal, Montréal, Québec, Canada
| | | | | | | | - Florence Fournet
- French Institute for Research on Sustainable Development, Paris, France
| | - Emmanuel Bonnet
- French Institute for Research on Sustainable Development, Paris, France
| | - Denis Pérez
- School of Public Health, University of Montreal, Montréal, Québec, Canada.,Pedro Kourí Tropical Medicine Institute, Havana, Cuba
| | | | - Christian Dagenais
- School of Public Health, University of Montreal, Montréal, Québec, Canada
| | | | - Neil Andersson
- McGill University, Montréal, Canada.,Universidad Autonomy De Guerrero, Acapulco, Mexico
| | - Valéry Ridde
- French Institute for Research on Sustainable Development, Paris, France
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Jolly K, Griffin T, Sidhu M, Adab P, Burgess A, Collins C, Daley A, Entwistle A, Frew E, Hardy P, Hurley K, Jones L, McGee E, Pallan M, Sun Y, Young M, Morgan P. A weight management programme for fathers of children aged 4–11 years: cultural adaptation and the Healthy Dads, Healthy Kids UK feasibility RCT. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
More men than women in the UK are living with overweight or obesity, but men are less likely to engage with weight loss programmes. Healthy Dads, Healthy Kids is an effective Australian weight management programme that targets fathers, who participate with their primary school-aged children. Behavioural interventions do not always transfer between contexts, so an adaptation of the Healthy Dads, Healthy Kids programme to an ethnically diverse UK setting was trialled.
Objectives
To adapt and test the Australian Healthy Dads, Healthy Kids programme for delivery to men in an ethnically diverse, socioeconomically disadvantaged UK setting.
Design
Phase 1a studied the cultural adaptation of the Healthy Dads, Healthy Kids programme and was informed by qualitative data from fathers and other family members, and a theoretical framework. Phase 1b was an uncontrolled feasibility trial. Phase 2 was a randomised controlled feasibility trial.
Setting
Two ethnically diverse, socioeconomically disadvantaged UK cities.
Participants
In phase 1a, participants were parents and family members from black and minority ethnic groups and/or socioeconomically deprived localities. In phases 1b and 2, participants were fathers with overweight or obesity and their children aged 4–11 years.
Interventions
The adapted Healthy Dads, Healthy Kids intervention comprised nine sessions that targeted diet and physical activity and incorporated joint father–child physical activity. Healthy Dads, Healthy Kids was delivered in two programmes in phase 1b and four programmes in phase 2. Those in the comparator arm in phase 2 received a family voucher to attend a local sports centre.
Main outcome measures
The following outcomes were measured: recruitment to the trial, retention, intervention fidelity, attendance, feasibility of trial processes and collection of outcome data.
Results
Forty-three fathers participated (intervention group, n = 29) in phase 2 (48% of recruitment target), despite multiple recruitment locations. Fathers’ mean body mass index was 30.2 kg/m2 (standard deviation 5.1 kg/m2); 60.2% were from a minority ethnic group, with a high proportion from disadvantaged localities. Twenty-seven (63%) fathers completed follow-up at 3 months. Identifying sites for delivery at a time that was convenient for the families, with appropriately skilled programme facilitators, proved challenging. Four programmes were delivered in leisure centres and community venues. Of the participants who attended the intervention at least once (n = 20), 75% completed the programme (attended five or more sessions). Feedback from participants rated the sessions as ‘good’ or ‘very good’ and participants reported behavioural change. Researcher observations of intervention delivery showed that the sessions were delivered with high fidelity.
Conclusions
The intervention was well delivered and received, but there were significant challenges in recruiting overweight men, and follow-up rates at 3 and 6 months were low. We do not recommend progression to a definitive trial as it was not feasible to deliver the Healthy Dads, Healthy Kids programme to fathers living with overweight and obesity in ethnically diverse, socioeconomically deprived communities in the UK. More work is needed to explore the optimal ways to engage fathers from ethnically diverse socioeconomically deprived populations in research.
Trial registration
Current Controlled Trials ISRCTN16724454.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Tania Griffin
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Manbinder Sidhu
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Clare Collins
- School of Health Sciences, Faculty of Health and Medicine, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia
| | - Amanda Daley
- School of Sport, Exercise and Health Sciences, University of Loughborough, Loughborough, UK
| | | | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Pollyanna Hardy
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kiya Hurley
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Laura Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Eleanor McGee
- Birmingham Community Health Care NHS Foundation Trust, Birmingham, UK
| | - Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Yongzhong Sun
- Birmingham Clinical Trials Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Myles Young
- School of Education, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia
| | - Philip Morgan
- School of Education, and Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia
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Lemstra M, Rogers M. The Healthy Kids Initiative: Results from the First 2000 Participants. Patient Prefer Adherence 2020; 14:2347-2355. [PMID: 33293797 PMCID: PMC7718988 DOI: 10.2147/ppa.s284511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/31/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The comprehensive and free Healthy Kids Initiative (HKI) was developed with key features including social support, family support, and cognitive behavior education in order to promote program completion and improve health outcomes among youth. The first objective was to determine program completion rates and independent risk indicators for non-completion. The second objective was to determine the 12-week impact of the Healthy Kids Initiative on aerobic fitness, depressed mood and health-related quality of life. PATIENTS AND METHODS Obese youth (ages 10-17) were referred to a community-based, multidisciplinary, free program by their doctor or pediatrician. Each participant was requested to attend the program with a "buddy" and complete three social support contracts with family and friends to support their behavioral modifications. The program duration was 12 weeks with physical activity, dietary, and cognitive behavior education sessions. Those who completed the program, and those who did not, were compared across socioeconomic variables, age, gender, depressed mood and aerobic fitness. RESULTS Across five cohorts, 1789 of 1995 youth completed the program (89.7% completion rate). Five referred youth never started. Independent risk indicators associated with non-completion included older age (OR 3.07, 95% CI 2.26-4.17; p<0.001), mother with a non-professional occupation (OR 1.84, 95% CI 1.22-2.78; p=0.004), and living in a low-income neighborhood (OR 9.37, 95% CI 5.61-15.65; p<0.001). There were significant improvements from baseline for aerobic fitness (mCAFT score 35.84 to 55.72 mL × kg -1 × min-1; p<0.001), depressed mood (mean CES-D 12 score 21.47 to 17.40; p<0.001), and health-related quality of life (mean SF-12 score 23.4 to 33.8; p<0.001). CONCLUSION The HKI program had high completion rates and early success in improving outcomes. Knowing the independent risk indicators for non-completion will allow for program revision to help at-risk participants complete the program.
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Affiliation(s)
- Mark Lemstra
- Alliance Wellness and Rehabilitation Inc., Moose Jaw, Saskatchewan, Canada
| | - Marla Rogers
- The Canadian Hub for Applied and Social Research, University of Saskatchewan, Saskatoon, Canada
- Correspondence: Marla Rogers Canadian Hub for Applied and Social Research, University of Saskatchewan, Saskatoon, SKS7N 5A5, Canada Email
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Mears R, Jago R, Sharp D, Patel A, Kipping R, Shield JPH. Exploring how lifestyle weight management programmes for children are commissioned and evaluated in England: a mixed methodology study. BMJ Open 2019; 9:e025423. [PMID: 31848157 PMCID: PMC6937081 DOI: 10.1136/bmjopen-2018-025423] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To assess how lifestyle weight management programmes for children aged 4-16 years in England are commissioned and evaluated at the local level. DESIGN This was a mixed-methods study comprising an online survey and semistructured telephone interviews. SETTING An online survey was sent to all local authorities (LAs) in England regarding lifestyle weight management services commissioned for children aged 4-16 years. Online survey data were collected between February and May 2016 and based on services commissioned between April 2014 and March 2015. Semistructured telephone interviews with LA staff across England were conducted between April and June 2016. PARTICIPANTS Commissioners or service providers working within the public health department of LAs. MAIN OUTCOME MEASURES The online survey collected information on the evidence base, costs, reach, service usage and evaluation of child lifestyle weight management services. The telephone interviews explored the nature of child weight management contracts commissioned by LAs, the type of outcome data collected and whether these data were shared with other LAs or organisations, the challenges faced by these services, and the perceived 'markers of success' for a programme. RESULTS The online survey showed that none of the participating LAs was aware of any peer-reviewed evidence supporting the effectiveness of their specific commissioned service. Despite this, the telephone interviews revealed that there was no national formal sharing of data to enable oversight of the effectiveness of commissioned services across LAs in England to help inform future commissioning decisions. Challenges with long-term data collection, service engagement, funding and the pressure to reduce the prevalence of obesity were frequently mentioned. CONCLUSIONS Robust, independent, cost-effectiveness analyses of obesity strategies are needed to determine the appropriate allocation of funding to lifestyle weight management treatment services, population-level preventative approaches or development of whole system approaches by an LA.
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Affiliation(s)
- Ruth Mears
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Russ Jago
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Deborah Sharp
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anamica Patel
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Ruth Kipping
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Population Health Sciences, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Bristol, UK
| | - Julian P H Shield
- NIHR Bristol Biomedical Research Centre, Nutrition Theme, University of Bristol, Bristol, UK
- Faculty of Health Sciences, University of Bristol, Bristol, UK
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Schroeder K, Van Allen J, Dhurandhar E, Lancaster B, Heidari Z, Cazenave K, Boone D, Erdman P. Riding into Health: A Case Study on an Equine-Assisted Childhood Obesity Intervention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234835. [PMID: 31805713 PMCID: PMC6926900 DOI: 10.3390/ijerph16234835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/18/2019] [Accepted: 11/23/2019] [Indexed: 12/16/2022]
Abstract
In this article, we present an exploratory case study that describes the initial outcomes of the Equine-Assisted Positively Fit (EAPF) program. Children with obesity and their caregivers were recruited to participate in the eight-session program. Results indicated that treatment completers (n = 2) had a decrease in fat mass and fat mass percentage and an increase in fat-free mass and fat-free mass percentage. Moreover, results from accelerometer measurements of physical activity indicated that participants increased their moderate to vigorous physical activity, as well as reported increased self-efficacy for physical activity. Qualitative data from the post-intervention focus group suggested children perceived the treatment acceptable and enjoyable. Findings from this study provide support for future investigations on the feasibility and potential efficacy of pairing children and their caregivers with horses to accomplish health-related goals.
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Affiliation(s)
- Katy Schroeder
- Department of Animal and Food Sciences, College of Agricultural and Natural Resources, Texas Tech University, Lubbock, TX 79409, USA;
- Correspondence:
| | - Jason Van Allen
- Department of Psychological Sciences, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA (B.L.); (Z.H.); (D.B.)
| | - Emily Dhurandhar
- Department of Kinesiology and Sports Management, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA;
| | - Brittany Lancaster
- Department of Psychological Sciences, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA (B.L.); (Z.H.); (D.B.)
| | - Zohal Heidari
- Department of Psychological Sciences, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA (B.L.); (Z.H.); (D.B.)
| | - Kandis Cazenave
- Department of Animal and Food Sciences, College of Agricultural and Natural Resources, Texas Tech University, Lubbock, TX 79409, USA;
| | - Dianna Boone
- Department of Psychological Sciences, College of Arts and Sciences, Texas Tech University; Lubbock, TX 79409, USA (B.L.); (Z.H.); (D.B.)
| | - Phyllis Erdman
- Department of Kinesiology and Educational Psychology, College of Education, Washington State University; Pullman, WA 99164, USA;
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47
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Wittmeier K, Brockman GH, Garcia AP, Woodgate RL, Ball GDC, Wicklow B, Sellers E, Jong G', Sibley KM. Access to Multidisciplinary Care for Pediatric Weight Management: Exploring Perspectives of the Health Care Team within Canada and the United States. Child Obes 2019; 15:363-370. [PMID: 31099587 DOI: 10.1089/chi.2019.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background: In Canada and the United States, most families referred for pediatric weight management services do not start treatment. Of families who initiate care, many discontinue before the program ends. Parents and youth have reported difficulties in accessing services as an important barrier to starting or completing programming. The purpose of this study was to understand barriers and identify potential solutions related to access to care from the perspective of health care team members from Canada and the United States. Methods: Qualitative description method guided the study design. Participants were health care team members, purposefully recruited through Canadian and US-based pediatric weight management program registries. Telephone interviews were conducted with participants between February and May 2017. Interviews were transcribed verbatim and analyzed using content analysis. Results: Eighteen individuals from 16 sites participated (n = 8 Canada, n = 8 United States). Access barriers and potential solutions were related to: (1) referral and eligibility, (2) wait lists and program capacity, (3) logistics and costs, and (4) stigma and weight bias. Barriers were similar between Canadian and US sites, with the exception of cost-related barriers. Conclusions: Health care providers from Canada and the United States reported multiple societal, organizational, service, and family-level barriers to accessing multidisciplinary pediatric weight management care. Proposed solutions suggest that service providers can play a key role alongside families to improve access to appropriate care. Further research is needed to demonstrate the feasibility and effectiveness of proposed solutions.
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Affiliation(s)
- Kristy Wittmeier
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Gwenyth H Brockman
- 3George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Arnaldo Perez Garcia
- 4Department of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Roberta L Woodgate
- 2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,5College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Geoff D C Ball
- 6Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Brandy Wicklow
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Sellers
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Geert 't Jong
- 1Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,2Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kathryn M Sibley
- 3George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.,7Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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48
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Povey RC, Cowap LJ, Scholtens K, Forshaw MJ. 'She's not obese, she's a normal 5-year-old and she keeps up with the other kids': families' reasons for not attending a family-based obesity management programme. Perspect Public Health 2019; 140:148-152. [PMID: 31409189 DOI: 10.1177/1757913919868509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS To discover the reasons behind invited families' lack of engagement with a family-based childhood obesity programme in a deprived area. METHODS Interviews were conducted with 10 families who were invited to join the programme, but declined to engage. There were two distinct subgroups of participants: those who had no interest in attending the programme and those who showed initial interest yet did not continue attending. The two subgroups were analyzed separately using inductive thematic analysis, and then compared. RESULTS Analysis identified eight themes overall. For both groups, when the service was perceived to be not needed ('I didn't see how that would help'), the families disengaged with it. For both groups, this perception was partly related to the perceived appearance of their children: either that they were not obese ('I didn't think my son was overweight') or that they were growing into their size. There was also a similarity in both groups that they perceived that they were already following healthy lifestyles. In addition, several of the themes arising from the families who had no initial interest were related to the impact of the letter that parents received detailing the result of their child being weighed and measured at school. This angered parents ('I was disgusted'), and there was a feeling that the approach was too generic. CONCLUSION This study identified a number of potential reasons behind why families may decline to engage with a childhood obesity programme in a deprived area. Across all families, if the programme was perceived as not needed, they would disengage. For those who did not engage at all, the initial communication of the child's body mass index (BMI) is crucial. Recommendations include taking a more personal and tailored approach for the initial communication and shifting the focus of the programmes onto healthier lifestyles.
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Affiliation(s)
- R C Povey
- Staffordshire Centre for Psychological Research, Science Centre, Staffordshire University, Leek Road, Stoke-on-Trent ST4 2DF, Staffordshire, UK
| | - L J Cowap
- Staffordshire Centre for Psychological Research, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - K Scholtens
- Staffordshire Centre for Psychological Research, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - M J Forshaw
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK
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Pallan M, Griffin T, Hurley K, Lancashire E, Blissett J, Frew E, Gill P, Griffith L, Jolly K, McGee E, Parry J, Thompson JL, Adab P. Cultural adaptation of a children's weight management programme: Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study. BMC Public Health 2019; 19:848. [PMID: 31253113 PMCID: PMC6599293 DOI: 10.1186/s12889-019-7159-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/12/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Childhood obesity prevalence continues to be at high levels in the United Kingdom (UK). South Asian children (mainly Pakistani and Bangladeshi origin) with excess adiposity are at particular risk from the cardiovascular consequences of obesity. Many community-based children's weight management programmes have been delivered in the UK, but none have been adapted for diverse cultural communities. The aim of the Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study, was to culturally adapt an existing children's weight management programme for children aged 4-11 years so that the programme was more able to meet the needs of families from South Asian communities. METHODS The adaptation process was applied to First Steps, an evidence informed programme being delivered in Birmingham (a large, ethnically diverse city). A qualitative study was undertaken to obtain the views of South Asian parents of children with excess weight, who had fully or partially attended, or who had initially agreed but then declined to attend the First Steps programme. The resulting data were integrated with current research evidence and local programme information as part of a cultural adaptation process that was guided by two theoretical frameworks. RESULTS Interviews or focus groups with 31 parents in their preferred languages were undertaken. Themes arising from the data included the need for convenient timing of a programme in a close familiar location, support for those who do not speak English, the need to focus on health rather than weight, nutritional content that focuses on traditional and Western diets, more physical activity content, and support with parenting skills. The data were mapped to the Behaviour Change Wheel framework and Typology of Cultural Adaptation to develop an intervention programme outline. The research evidence and local programme information was then used in the detailed planning of the programme sessions. CONCLUSIONS The process of cultural adaptation of an existing children's weight management programme resulted in a theoretically underpinned programme that is culturally adapted at both the surface and deep structural levels. TRIAL REGISTRATION ISRCTN81798055 , registered: 13/05/2014.
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Affiliation(s)
- Miranda Pallan
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Tania Griffin
- Department for Health, University of Bath, University of Bath, Bath, BA2 7AY UK
| | - Kiya Hurley
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Emma Lancashire
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Jacqueline Blissett
- School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET UK
| | - Emma Frew
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Paramjit Gill
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Laura Griffith
- School of Social Policy, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Kate Jolly
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Eleanor McGee
- Birmingham Community Healthcare NHS Trust, 1 Priestley Wharf, Holt Street, Birmingham, B7 4BN UK
| | - Jayne Parry
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Janice L. Thompson
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Peymane Adab
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
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50
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Esdaile E, Hernandez E, Moores CJ, Vidgen HA. Enrolment of families with overweight children into a program aimed at reducing childhood obesity with and without a weight criterion: a natural experiment. BMC Public Health 2019; 19:756. [PMID: 31200674 PMCID: PMC6570944 DOI: 10.1186/s12889-019-6894-y] [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: 12/20/2018] [Accepted: 04/25/2019] [Indexed: 11/10/2022] Open
Abstract
Background Difficulties engaging families with overweight children to enrol into programs aimed at reducing childhood obesity have been well documented. During the implementation of the Parenting, Eating and Activity for Child Health Program (PEACH™) over a large geographical area (Queensland (QLD), Australia), a natural experiment developed. This experiment provided an opportunity to observe if there was a difference in enrolment for families with overweight children with a weight criterion (referred to as the period with a Targeted Eligibility Criterion (TEC)) compared to when a weight criterion was removed (the period referred to as Universal Eligibility Criterion (UEC)). We also examined the eligibility criterion’s relationship with attendance, parental concern about their child’s weight, estimation of overweight and obesity from parent-reported data. Methods A secondary analysis of baseline data from 926 overweight/obese children from 817 families enrolled in PEACH™ QLD was performed. Analyses were adjusted to control for the presence of clustered data. Bivariate statistics were performed using Pearson chi-square test with the second-order Rao-Scott correction, and Mann–Whitney U-test for non-parametric continuous variables. Generalized Estimating Equations (GEE) explored the association between weight status-based eligibility criteria and enrolment of overweight children. GEE were adjusted for sex, age and socioeconomic index and stratified for weight category. Results Compared to obese children, overweight children were almost twice as likely to be enrolled when the program did not have weight status-based eligibility criteria (during UEC period) (OR = 1.90 (CI 95% 1.35–2.68, p < 0.001)). Parents of overweight children enrolled during the UEC period were more likely to regard their child’s weight as less of a concern than during the TEC period (UEC 67% vs. TEC 45%, p = 0.036). Children whose parent-reported data underestimated their weight category were more likely to be enrolled while the program did not have weight-related eligibility criteria OR = 2.27 (CI 1.38–3.70, p < 0.01). Program session attendance did not appear to be impacted by the changes in eligibility criteria. Conclusions The omission of weight criteria for healthy lifestyle programs is a consideration for health professionals and decision-makers alike when encouraging the enrolment of children who are overweight into healthy lifestyle programs. Trial registration ACTRN12617000315314. Retrospectively registered 28 February 2017. Electronic supplementary material The online version of this article (10.1186/s12889-019-6894-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Esdaile
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland, Qld 4059, Australia.
| | - Emely Hernandez
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland, Qld 4059, Australia
| | - Carly Jane Moores
- Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Helen Anna Vidgen
- School of Exercise & Nutrition Sciences, Faculty of Health, Queensland University of Technology, Level 4, A Wing, O Block, Kelvin Grove, Brisbane, Queensland, Qld 4059, Australia
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