Healthier Together: Co‐design of a culturally tailored childhood obesity community prevention program for Māori & Pacific Islander children and families

Abstract Background Children of Māori & Pacific Islander descent living in Australia experience higher rates of obesity, increasing their risk of developing life diminishing chronic diseases. However, community-based, childhood obesity prevention programs, tailored to the Māori & Pacific Islander population are lacking, further escalating the rates of health inequity. Methods Program co-design involved a three-phase, iterative, participatory and experienced-based process, guided by the Te Ara Tika: Guidelines for Māori Research Ethics, promoting respect and equity. Following traditional oratory customs of Māori & Pacific Islander cultures, “talanoa” facilitated the collaborative program design with consumers, cultural advisors and health professionals. Results Co-design developed an 8-week community-based childhood overweight/obesity prevention program, providing culturally-tailored education across nutrition, physical activity and parenting practices. Maximum engagement demonstrated life-changing improvements across the life course; 72% of children and 67% of parents reduced their sugar sweetened beverage consumption and 60% of children and 47% of adults increased their vegetable consumption. Resultingly, BMI z-score decreased among 59% of children and BMI decreased among 47% of parents. Conclusions Endorsing a bottom-up approach, via a co-design methodology, significantly improves culturally-tailored health care delivery. An evidence-based framework developed holds significant potential to be scaled to additional cultural groups. A consumer-led approach is pivotal to sustaining engagement and improving health outcomes, addressing health inequity among Australia’s priority populations. Key messages Co-design empowered consumers to formulate program objectives, session plans, resources and evaluation tools. Co-designed quality improvement practices ensure relevance of the program to sustainably address community needs, tackling the complexities of obesity over generations.

Download Full-text

The process of culturally adapting the Healthy Beginnings early obesity prevention program for Arabic and Chinese mothers in Australia

BMC Public Health ◽

10.1186/s12889-021-10270-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sarah Marshall ◽

Sarah Taki ◽

Penny Love ◽

Yvonne Laird ◽

Marianne Kearney ◽

...

Keyword(s):

Childhood Obesity ◽

Obesity Prevention ◽

Cultural Adaptation ◽

Prevention Program ◽

Delivery Mode ◽

Evidence Based ◽

Cultural Adaptations ◽

Local Study ◽

Culturally Adapted ◽

Obesity Prevention Program

Abstract Background Behavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia. Methods The cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program. Results Program structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials). Conclusions This cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness.

Download Full-text