Design and methods of the Healthy Kids & Families study: a parent-focused community health worker-delivered childhood obesity prevention intervention.
ABSTRACT: Background:One third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Methods:Participants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child's social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families' needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle. Discussion:A CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact. Trial registration:ClinicalTrials NCT03028233. Registered January 23,2017. The trial was retrospectively registered.
Project description:BACKGROUND:Electronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children. OBJECTIVE:This study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy. METHODS:The Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection. RESULTS:A total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate -1.36, 95% CI -2.27 to -0.45; P=.004), and parents showed improvement in child feeding pressure to eat practices (-0.30, 95% CI 0.06 to -0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). No significant time by group interaction was found for other outcomes. CONCLUSIONS:The trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to improve dietary-related practices and self-efficacy but was not successful in reducing BMI. The target sample size was not achieved, which would have affected statistical power. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ANZCTR12616000119493; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=370030 (Archived by WebCite at http://www.webcitation.org/74Se4S7ZZ).
Project description:OBJECTIVES:To evaluate the impact of the GOALS (Getting Our Active Lifestyles Started) family-based childhood obesity treatment intervention during the first 3?years of implementation. DESIGN:Single-group repeated measures with qualitative questionnaires. SETTING:Community venues in a socioeconomically deprived, urban location in the North-West of England. PARTICIPANTS:70 overweight or obese children (mean age 10.5?years, 46% boys) and their parents/carers who completed GOALS between September 2006 and March 2009. INTERVENTIONS:GOALS was a childhood obesity treatment intervention that drew on social cognitive theory to promote whole family lifestyle change. Sessions covered physical activity (PA), diet and behaviour change over 18 2?h weekly group sessions (lasting approximately 6?months). A Template for Intervention Description and Replication (TIDieR) checklist of intervention components is provided. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome measure was child body mass index (BMI) z-score, collected at baseline, post-intervention and 12?months. Secondary outcome measures were child self-perceptions, parent/carer BMI and qualitative changes in family diet and PA (parent/carer questionnaire). RESULTS:Child BMI z-score reduced by 0.07 from baseline to post-intervention (p<0.001) and was maintained at 12?months (p<0.05). There was no change in parent/carer BMI or child self-perceptions, other than an increase in perceived social acceptance from baseline to post-intervention (p<0.05). Parents/carers reported positive changes to family PA and dietary behaviours after completing GOALS. CONCLUSIONS:GOALS completion was associated with small improvements in child BMI z-score and improved family PA and dietary behaviours. Several intervention modifications were necessary during the implementation period and it is suggested childhood obesity treatment interventions need time to embed before a definitive evaluation is conducted. Researchers are urged to use the TIDieR checklist to ensure transparent reporting of interventions and facilitate the translation of evidence to practice.
Project description:Growing Right Onto Wellness (GROW) is a randomized controlled trial that tests the efficacy of a family-centered, community-based, behavioral intervention to prevent childhood obesity among preschool-aged children. Focusing on parent-child pairs, GROW utilizes a multi-level framework, which accounts for macro (i.e., built-environment) and micro (i.e., genetics) level systems that contribute to the childhood obesity epidemic. Six hundred parent-child pairs will be randomized to a 3-year healthy lifestyle intervention or a 3-year school readiness program. Eligible children are enrolled between ages 3 and 5, are from minority communities, and are not obese. The principal site for the GROW intervention is local community recreation centers and libraries. The primary outcome is childhood body mass index (BMI) trajectory at the end of the three-year study period. In addition to other anthropometric measurements, mediators and moderators of growth are considered, including genetics, accelerometry, and diet recall. GROW is a staged intensity intervention, consisting of intensive, maintenance, and sustainability phases. Throughout the study, parents build skills in nutrition, physical activity, and parenting, concurrently forming new social networks. Participants are taught goal-setting, self-monitoring, and problem solving techniques to facilitate sustainable behavior change. The GROW curriculum uses low health literacy communication and social media to communicate key health messages. The control arm is administered to both control and intervention participants. By conducting this trial in public community centers, and by implementing a family-centered approach to sustainable healthy childhood growth, we aim to develop an exportable community-based intervention to address the expanding public health crisis of pediatric obesity.
Project description:To assess the feasibility and acceptability of family-based group pediatric obesity treatment in a primary care setting, to obtain an estimate of its effectiveness, and to describe participating parents' experiences of social support for healthy lifestyle changes.We adapted an evidence-based intervention to a group format and completed six 12- to 16-week groups over 3 years. We assessed program attendance and completion, changes in child and parent body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and changes in child quality of life in a single-arm before-and-after trial. Qualitative interviews explored social support for implementing healthy lifestyle changes.Thirty-eight parent-child pairs enrolled (28% of the 134 pairs invited). Of those, 24 (63%) completed the program and another 6 (16%) attended at least 4 sessions but did not complete the program. Children who completed the program achieved a mean change in BMI Z-scores (Z-BMI) of -0.1 (0.1) (p < 0.001) and significant improvement in parent-reported child quality of life (mean change = 8.5; p = 0.002). Mean BMI of parents changed by -0.9 (p = 0.003). Parents reported receiving a wide range of social support for healthy lifestyle changes and placed importance on the absence or presence of support.A pilot group program for family-based treatment of pediatric obesity is feasible and acceptable in a primary care setting. Change in child and parent BMI outcomes and child quality of life among completers were promising despite the pilot's low intensity. Parent experiences with lack of social support suggest possible ways to improve retention and adherence.
Project description:Latino preschool children have higher rates of obesity than preschool children from other racial/ethnic groups; however, few effective, culturally appropriate interventions exist targeting this group. The purpose of this study was to test the feasibility of a 10-week, promotora-mediated, home-based intervention to promote a healthy weight in Latino preschool children.Trained promotoras (community health workers) delivered 10, 90-min weekly interactive and tailored sessions to Latino families living in Allegheny County. Participants were recruited through promotoras' own social networks and community gatherings, flyers, and word of mouth. Primary outcome measures included child body mass index (BMI) z-score and percentile. Secondary outcome measures included child objectively measured physical activity and dietary intake, and the home social and physical environment (e.g., parent health behaviors, parent self-efficacy, parental support, physical activity equipment in the home). The final analysis sample included 49 of 51 participants who completed both baseline and follow-up assessments.Participants included mothers (33.5?±?6.1 years old) and their preschool-aged children who were primarily 1st generation immigrants from Mexico (65%). The primary analyses of BMI percentile and z-score showed no change post-intervention. However, there was a significant decrease in child BMI percentile for overweight and obese children from baseline to follow-up (p?<?.05). We also saw significant pre/post increases in child daily fruit and vegetable intake, and parent moderate-to-vigorous physical activity, fruit and vegetable servings per day, and self-efficacy; and significant decreases in child saturated fat and added-sugar intake, and child and parent screen time (p's?<?.05).Despite the short duration of the intervention and follow-up, this pilot study showed promising effects of a promotora-mediated intervention to promote a healthy weight in Latino preschool children.
Project description:The Malian Nutrition Division of the Ministry of Health and Action Against Hunger tested the feasibility of integrating treatment of severe acute malnutrition (SAM) into the existing Integrated Community Case Management package delivered by community health workers (CHWs). This study assessed costs and cost-effectiveness of CHW-delivered care compared to outpatient facility-based care.Activity-based costing methods were used, and a societal perspective employed to include all relevant costs incurred by institutions, beneficiaries and communities. The intervention and control arm enrolled different numbers of children so a modelled scenario sensitivity analysis was conducted to assess the cost-effectiveness of the two arms, assuming equal numbers of children enrolled.In the base case, with unequal numbers of children in each arm, for CHW-delivered care, the cost per child treated was 244 USD and cost per child recovered was 259 USD. Outpatient facility-based care was less cost-effective at 442 USD per child and 501 USD per child recovered. The conclusions of the analysis changed in the modelled scenario sensitivity analysis, with outpatient facility-based care being marginally more cost-effective (cost per child treated is 188 USD, cost per child recovered is 214 USD), compared to CHW-delivered care. This suggests that achieving good coverage is a key factor influencing cost-effectiveness of CHWs delivering treatment for SAM in this setting. Per week of treatment, households receiving CHW-delivered care spent half of the time receiving treatment and three times less money compared with those receiving treatment from the outpatient facility.This study supports existing evidence that the delivery of treatment by CHWs is a cost-effective intervention, provided that good coverage is achieved. A major benefit of this strategy was the lower cost incurred by the beneficiary household when treatment is available in the community. Further research is needed on the implementation costs that would be incurred by the government to increase the operability of these results.
Project description:Childhood iron deficiency anemia (IDA) is an important contributor to under-five mortality in the developing world. There is evidence that Community Health Worker (CHW) delivered programs to increase maternal knowledge of child health practices may decrease childhood IDA. This study reports findings on the association between a long standing CHW intervention and childhood anemia status in rural Haiti.Using structural equations and mediation analyses on data from a household-based survey of 621 mother/child dyads, we tested the hypothesis that CHW would have a direct positive effect on maternal knowledge and an indirect effect on childhood anemia in rural Haiti.CHW contact was significantly associated with maternal knowledge of key child health practices (??=?0.193, SE?=?0.058, p?=?0.001). However, knowledge was not associated with childhood anemia (??=?-0.008, SE?=?0.009, p?=?0.382). Maternal knowledge categories significantly affected by CHW contact included diarrheal prevention knowledge (??=?0.111, SE?=?0.045, p?=?0.013) and signs of malnutrition (??=?0.217, SE?=?0.071, p?=?0.002). There was no significant association with knowledge of vitamin A and iron rich foods (??=?0.057, SE?=?0.032, p?=?0.074), which is the intervention most likely to impact childhood anemia. In all path models tested, we identified the control variables low household socio-economic status, mothers' anemia status, and child's age less than 24 months as significant predictors of childhood anemia.CHWs delivered interventions are associated with improved maternal knowledge of child health practices in rural Haiti; however, this knowledge is not associated with improved childhood anemia. Concurrently with CHW-delivered programs, interventions household poverty are implied to impact childhood health outcomes in resource poor settings.
Project description:BACKGROUND:The Connect for Health study is designed to assess whether a novel approach to care delivery that leverages clinical and community resources and addresses socio-contextual factors will improve body mass index (BMI) and family-centered, obesity-related outcomes of interest to parents and children. The intervention is informed by clinical, community, parent, and youth stakeholders and incorporates successful strategies and best practices learned from 'positive outlier' families, i.e., those who have succeeded in changing their health behaviors and improve their BMI in the context of adverse built and social environments. DESIGN:Two-arm, randomized controlled trial with measures at baseline and 12 months after randomization. PARTICIPANTS:2-12 year old children with overweight or obesity (BMI ? 85th percentile) and their parents/guardians recruited from 6 pediatric practices in eastern Massachusetts. INTERVENTION:Children randomized to the intervention arm receive a contextually-tailored intervention delivered by trained health coaches who use advanced geographic information system tools to characterize children's environments and neighborhood resources. Health coaches link families to community-level resources and use multiple support modalities including text messages and virtual visits to support families over a one-year intervention period. The control group receives enhanced pediatric care plus non-tailored health coaching. MAIN OUTCOME MEASURES:Lower age-associated increase in BMI over a 1-year period. The main parent- and child-reported outcome is improved health-related quality of life. CONCLUSIONS:The Connect for Health study seeks to support families in leveraging clinical and community resources to improve obesity-related outcomes that are most important to parents and children.
Project description:Competency-Based Approaches to Community Health (COACH) is a randomized controlled trial of a family-centered, community-based, and individually-tailored behavioral intervention for childhood obesity among Latino pre-school children. COACH focuses on improving personal agency for health behavior change by tailoring content to overcome contextual barriers. The intervention focuses on diet, physical activity, sleep, media use, and engaged parenting. The content is individually adapted based on routine assessments of competency in specific health behaviors using a mobile health platform and novel measurement tools developed by our team. In response to these regular assessments, health coaches provide tailored health behavior change strategies to help families focus on the areas where they decide to improve the most. The intervention consists of a 15-week group-based intensive phase, with weekly sessions delivered by health coaches in community centers. Following weekly sessions, a 3-month maintenance phase of the intervention consists of twice monthly coaching calls for participants to focus on individual health goals for their families. The primary outcome of the trial is child body mass index trajectory over 1?year. Secondary outcomes include parent body mass index change, child waist circumference, child diet, child physical activity, and other psychosocial mediators of child health behavior change. The control arm consists of a school readiness intervention, delivered by the Nashville Public Library. By applying a personalized approach to child behavior change, in the setting of both family and community, COACH aims to develop sustainable solutions for childhood obesity by supporting healthy childhood growth in low-income, minority preschool children.
Project description:OBJECTIVE:To test the effect of a culturally tailored, family-centered, short-term behavioral intervention on BMI in Latino-American preschool-aged children. METHODS:In a randomized controlled trial, 54 parent-child dyads were allocated to the intervention and 52 dyads were allocated to an alternative school-readiness program as the control condition. Parent-child dyads were eligible if the parent self-defined Latino, was at least 18 years old, had a 2- to 6-year-old child not currently enrolled in another healthy lifestyle program, had a valid telephone number, and planned on remaining in the city for the next 6 months. The Salud Con La Familia (Health with the Family) program consisted of 12 weekly 90-minute skills-building sessions designed to improve family nutritional habits and increase physical activity. Both programs were conducted in a community recreation center serving an urban neighborhood of mostly Spanish-speaking residents. RESULTS:Forty-two percent of participating preschool-aged children were overweight or obese. Controlling for child age, gender, and baseline BMI, the effect of the treatment condition on postintervention absolute BMI was B = -0.59 (P < .001). The intervention effect seemed to be strongest for obese children. CONCLUSIONS:A skills-building, culturally tailored intervention involving parent-child dyads changed short-term early growth patterns in these Latino-American preschool-aged children. Examining long-term effects would be a prudent next step.