Family-focused obesity prevention program implementation in urban versus rural communities: a case study

Purpose Despite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children. Methods This paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children. Results Community engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery. Discussion When adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally.

1245Culturally-appropriate research supporting a co-designed childhood obesity prevention program tailored for Māori & Pacific Islanders

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.

The Let’s Eat Healthy and Move at School program for adolescents in South Korea: Program design, implementation, and evaluation plan using intervention mapping

Purpose: This study aimed to systematically develop an obesity prevention program for adolescents to promote healthy eating and physical activity in schools.Methods: The development of the Let's Eat Healthy and Move at School program for adolescents followed the six steps of intervention mapping (IM). IM is a widely used protocol for developing systematic and effective interventions based on theories and evidence.Results: To better understand the problem and identify the needs of adolescents, interviews were conducted with teachers, school nurses, and students (step 1). In step 2, the desired behaviors and their determinants were established and combined into a matrix comprising 16 change objectives. In step 3, theoretical methods such as persuasive communication and consciousness-raising were chosen. The program was segmented into three educational activity sessions in step 4. In step 5, an implementation manual was developed for program instructors to ensure effective and accurate implementation. Finally, practices for evaluating the program's effectiveness and procedures were designed in step 6.Conclusion: The Let’s Eat Healthy and Move at School program will provide adolescents with guidelines to promote healthy living and prevent obesity in everyday life using strategies for sustainable adolescent obesity prevention and management.

Effectiveness of a combined obesity prevention program in South Korea for children from low-income families that included primary caregiver participation

Purpose: Obesity among children from low-income families is becoming a social problem. The aim of this study was to evaluate the effectiveness of an obesity prevention program that included physical activity, nutrition education, behavioral modification, and primary caregiver participation components among children from low-income families.Methods: The study analyzed a nonequivalent control group using a pretest-posttest design. A total of 77 children were recruited from six community childcare centers using purposive sampling. For the intervention group (n=40), the pretest was administered before the combined intervention program involving the participants' primary caregivers was conducted for 8 weeks. The posttest was conducted immediately after the program and again four weeks after the program.Results: Flexibility (F=4.64, p=.020), muscular endurance (F=11.22, p<.001), nutritional knowledge scores (F=4.79, p=.010), body image satisfaction scores (F=4.74, p=.012), and self-esteem scores (F=3.81, p=.029) showed significant differences and interactions between group and time for the intervention and control groups.Conclusion: Strategies to actively engage the primary caregivers of low-income families in children's obesity programs are needed. Obesity prevention programs for children based on the program in this study should be routinely developed, and continuing attention should be given to children from low-income families.

Feasibility of a culturally adapted early childhood obesity prevention program among migrant mothers in Australia: a mixed methods evaluation

Introduction Healthy Beginnings is an established nurse-led early childhood obesity prevention program that promotes healthy infant feeding practices and active play in the early years of life. To improve engagement with culturally and linguistically diverse populations, the Healthy Beginnings program delivered by telephone was culturally adapted and implemented with Arabic- and Chinese-speaking mothers in Sydney, Australia. The cultural adaptation process has been published separately. In this article, we aimed to evaluate the feasibility of the culturally adapted program. Methods In 2018–2019, the culturally adapted Healthy Beginnings program was implemented with Arabic- and Chinese-speaking women recruited from antenatal clinics in Sydney. At four staged timepoints (from third trimester until 6 months of age), mothers were sent culturally adapted health promotion booklets and text messages and offered four support calls from bi-cultural child and family health nurses in Arabic and Chinese. A mixed methods evaluation included a) baseline and 6-month telephone surveys, followed by b) semi-structured follow-up interviews with a subset of participating mothers and program delivery staff. Main outcomes of this feasibility study were reach (recruitment and retention), intervention dose delivered (number of nurse support calls completed) and acceptability (appropriateness based on cognitive and emotional responses). Results At recruitment, 176 mothers were eligible and consented to participate. Of 163 mothers who completed the baseline survey, 95% completed the program (n = 8 withdrew) and 83% completed the 6-month survey (n = 70 Arabic- and n = 65 Chinese-speaking mothers). Most mothers (n = 127, 78%) completed at least one nurse support call. The qualitative analysis of follow-up interviews with 42 mothers (22 Arabic- and 20 Chinese-speaking mothers) and 10 program delivery staff highlighted the perceived value of the program and the positive role of bi-cultural nurses and in-language resources. Mothers who completed more nurse support calls generally expressed greater acceptability. Conclusions The culturally adapted Healthy Beginnings program was feasible to deliver and acceptable to Arabic- and Chinese-speaking mothers. Our results highlight the importance of in-language resources and individualised bi-cultural nurse support by telephone for supporting culturally and linguistically diverse migrant families with infant feeding and active play. These findings support the potential for program refinements and progression to an effectiveness trial.