Behavior change is not one size fits all: psychosocial phenotypes of childhood obesity prevention intervention participants

Abstract Variability in individuals’ responses to interventions may contribute to small average treatment effects of childhood obesity prevention interventions. But, neither the causes of this individual variability nor the mechanism by which it influences behavior are clear. We used qualitative methods to characterize variability in students’ responses to participating in a childhood obesity prevention intervention and psychosocial characteristics related to the behavior change process. We interviewed 18 students participating in a school-based curriculum and policy behavior change intervention. Descriptive coding, summary, and case-ordered descriptive meta-matrices were used to group participants by their psychosocial responses to the intervention and associated behavior changes. Four psychosocial phenotypes of responses emerged: (a) Activated—successful behavior-changers with strong internal supports; (b) Inspired—motivated, but not fully successful behavior-changers with some internal supports, whose taste preferences and food environment overwhelmed their motivation; (c) Reinforced—already practiced target behaviors, were motivated, and had strong family support; and (d) Indifferent—uninterested in behavior change and only did target behaviors if family insisted. Our findings contribute to the field of behavioral medicine by suggesting the presence of specific subgroups of participants who respond differently to behavior change interventions and salient psychosocial characteristics that differentiate among these phenotypes. Future research should examine the utility of prospectively identifying psychosocial phenotypes for improving the tailoring of nutrition behavior change interventions.

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A cluster RCT and process evaluation evaluating the effectiveness of an optimisation intervention to promote parental engagement in a childhood obesity prevention programme: Results of the Optimising Family Engagement in HENRY (OFTEN) trial

10.21203/rs.3.rs-188964/v1 ◽

2021 ◽

Author(s):

Maria Bryant ◽

Wendy Burton ◽

Michelle Collinson ◽

Amanda Farrin ◽

Jane Nixon ◽

...

Keyword(s):

Childhood Obesity ◽

Process Evaluation ◽

Obesity Prevention ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Parental Engagement ◽

Childhood Obesity Prevention ◽

Prevention Intervention ◽

The Impact ◽

Children’S Centres

Abstract Background Low parental participation reduces the impact and sustainability of public health childhood obesity prevention programmes. Using data from a focused ethnography, we developed a multi-level, theory-based implementation optimisation intervention. The optimisation intervention aimed to support local authorities and children’s centres to adopt behaviours to promote engagement in ‘HENRY (Health Exercise Nutrition for the Really Young)’, a UK community obesity prevention intervention. Methods We evaluated the effectiveness of the optimisation intervention on programme enrolment and completion over a 12 implementation period in a cluster randomised controlled trial. We randomised 20 local government authorities (with 126 children’s centres) to HENRY plus the optimisation intervention or to HENRY alone. Primary outcomes were (1) the proportion of centres enrolling at least eight parents per programme and (2) the proportion of centres with a minimum of 75% of parents attending at least five of eight sessions per programme. Trial analyses adjusted for stratification factors (pre-randomisation implementation of HENRY, local authority size, deprivation) and allowed for cluster design. A parallel mixed-methods process evaluation used qualitative interview data and routine monitoring to explain trial results. Results Neither primary outcome differed significantly between groups; 17.8% of intervention centres and 18.0% of control centres achieved the parent enrolment target (adjusted difference -1.2%; 95%CI: -19.5%, 17.1%); 17.1% of intervention centres and 13.9% of control centres achieved the attendance target (adjusted difference 1.2%; 95%CI: -15.7%, 18.1%). Unexpectedly, the trial coincided with substantial national service restructuring, including centre closures and reduced funds. Some commissioning and management teams stopped or reduced implementation of both HENRY and the optimisation intervention due to competing demands. Thus, at follow up, HENRY programmes were delivered to approximately half the number of parents compared to baseline (n=433 vs. 881). Conclusions During a period in which services were reduced by policies outside the realm of this research, this first definitive trial found no evidence of effectiveness for an implementation optimisation intervention promoting parent engagement in an obesity prevention intervention. Trial registration: ClinicalTrials.gov Identifier: NCT02675699 registered 4th February 2016. https://clinicaltrials.gov/ct2/show/NCT02675699

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Healthy Habits, Happy Homes Scotland (4HS) feasibility study: Translation of a home-based early childhood obesity prevention intervention evaluated using RE-AIM framework

Public Health in Practice ◽

10.1016/j.puhip.2020.100026 ◽

2020 ◽

Vol 1 ◽

pp. 100026

Author(s):

Jenny Gillespie ◽

Adrienne R. Hughes ◽

Ann-Marie Gibson ◽

Jess Haines ◽

Elsie M. Taveras ◽

...

Keyword(s):

Early Childhood ◽

Childhood Obesity ◽

Feasibility Study ◽

Obesity Prevention ◽

Childhood Obesity Prevention ◽

Prevention Intervention ◽

Healthy Habits ◽

Home Based ◽

Early Childhood Obesity

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Supporting healthy lifestyle behaviours in families attending community playgroups: parents’ perceptions of facilitators and barriers

BMC Public Health ◽

10.1186/s12889-019-8041-1 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Andrea B. Fuller ◽

Rebecca A. Byrne ◽

Rebecca K. Golley ◽

Stewart G. Trost

Keyword(s):

Childhood Obesity ◽

Focus Group ◽

Young Children ◽

Obesity Prevention ◽

Parenting Practices ◽

Qualitative Content Analysis ◽

Self Regulation ◽

Barriers And Facilitators ◽

Childhood Obesity Prevention ◽

Prevention Intervention

Abstract Background Establishing healthy nutrition, activity, and sleep behaviours early in life is a key strategy in childhood obesity prevention. Parents are the primary influence on the development and establishment of obesity-related behaviours in young children. There is evidence that autonomy supporting parenting practices are crucial for the development of self-regulation and the internalisation of healthy behaviours in children. It is therefore imperative that parenting practices are targeted as part of an obesity prevention intervention. However, there is limited understanding of barriers and facilitators to parents using autonomy supporting parenting practices with their children aged 0–5 years. Therefore, the aim of the study was to identify barriers and facilitators to using autonomy supporting parenting practices. A secondary aim was to determine parent preferences in respect to an intervention program to be delivered in community playgroups. Methods Parents were recruited through Playgroup Queensland (PGQ), a not-for-profit organisation in Brisbane, Australia, to attend a focus group during their usual playgroup session. The focus group interview guide was designed to promote discussion among the participants in respect to their shared experiences as parents of young children. The focus group transcripts were coded and analysed using qualitative content analysis. Five focus groups with parents (n = 30) were conducted in May 2018. Most of the participants were mothers [1], and the majority (76%) had a child at playgroup aged between 2 and 4 years. Results The support and guidance received from other parents at playgroup was a facilitator to autonomy supporting parenting practices. Barriers included beliefs around the need to use rewards to encourage child eating, beliefs around the need for screens as babysitters, and feeling disempowered to change sleep behaviours. Parents were enthusiastic about a potential program that would leverage off the existing playgroup support networks, but they did not want to be “educated”, or to lose their “playgroup time” to an intervention. Rather they wanted strategies and support to deal with the frustrations of food, screen and sleep parenting. Conclusion These results will be used to inform the development of a childhood obesity prevention intervention to be delivered in a community playgroup setting.

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A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners

International Journal of Behavioral Nutrition and Physical Activity ◽

10.1186/s12966-021-01082-2 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

James Nobles ◽

Carolyn Summerbell ◽

Tamara Brown ◽

Russell Jago ◽

Theresa Moore

Keyword(s):

Childhood Obesity ◽

Obesity Prevention ◽

Cochrane Review ◽

Secondary Analysis ◽

Determinants Of Health ◽

Future Research ◽

Childhood Obesity Prevention ◽

Mapping Tool ◽

Cochrane Reviews ◽

Randomised Controlled

Abstract Background Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens. Methods We conducted a secondary analysis of the interventions included in the Cochrane Review on “Interventions for Preventing Obesity in Children”, published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity. Results The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0–5 years, 6–12 years, 13–18 years). Conclusions This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity.

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