a childhood obesity intervention developed by families for families: results from a pilot study
DESCRIPTION
A Childhood obesity intervention developed by families for families: Results from a Pilot study. Presented by: Emily Macieiski Dietetic Intern. Background. 1 in 10 infants & 1 in 4 toddlers and preschoolers- overweight or obese Prevention of obesity starts with parents and/or caregivers - PowerPoint PPT PresentationTRANSCRIPT
Presented by:Emily MacieiskiDietetic Intern
A CHILDHOOD OBESITY INTERVENTION DEVELOPED BY FAMILIES FOR FAMILIES: RESULTS FROM A PILOT STUDY
Background
1 in 10 infants & 1 in 4 toddlers and preschoolers- overweight or obese
Prevention of obesity starts with parents and/or caregivers High family dropout rates (27-73%) in low-income
This study presents a new approach to family-centered childhood obesity prevention
Communities for Healthy Living (CHL)- developed in collaboration with low-income parents/caregivers of preschool aged children and representatives from community organizations.
Community-based participatory research (CBPR) approach- utilized to ensure that parents and organizations were actively engaged in the design, implementation, and evaluation.
This study introduces a PARENT CENTERED approach Parents make up majority of decision making body
Methods
Guided by the Family-centered Action Model of Intervention Layout and Implementation (FAMILI) and its foundations in nutrition, child development, and public health*
Based on the Family Ecological Model (FEM)- A family centered development theory
Also based by Empowerment Theory- understanding forces and controlling them by using resources-
Help parents actively participate in the research an eye opening to the causes and risks of obesity
Help them identify ways to live healthy lifestyles with their children
Setting
CHL developed and tested in 5 Head Start centers 423, 2-5 y.o in N.Y. exposed to intervention
Head Start selected as focal setting due to its mission of parent involvement
Demographics:Parent avg age- 31 y.o, Child avg age- 3.59 y.o55% children were femaleRespondents to child- 88% mothers, 6% fathers, 6%
grandmothers17% married, 13% divorced, 44% single, 25% member of
unmarried couple68% parents overweight, 36% parents obese44% children overweight, 20% children obese
Intervention development and Implementation
Development of CHL program fall 2009- summer 2010Implementing of intervention of CHL program fall 2010- spring 2011
Community Advisory Board (CAB) was the foundation of participatory processParents (majority of board members) recruited*Large pediatric provider and Head Start staff20 CAB members recruited, while 17 participated after 1st
meetingHeld 1-2 x/month during 1st 6 months of project25 total meetings over 2 years
CAB had a process of engaging parents*
Conducting Community Assessment
Methods of assessment:Self-report surveys examined roles of parents and older children
in household, utilization of community programs, parents viewpoints on childhood obesity
Focus groups examined impact of having children over wide age range on food, PA, and screen-related parenting
Photovoice documented by camera the chronic and acute stressors
Windshield surveys parents led on driving tour of neighborhood and answered open-ended questions about perceived social, economic, and environmental conditions of their neighborhood and effect on daily activities, parenting, and well-being
The final CHL program was developed utilizing results from this community assessment, and feedback/discussions from the 2 community forums with CAB
Primary Objectives and Intervention Components
Primary objectives:Promote parenting practices supportive of healthy lifestyles*Increase children’s healthy lifestyle behaviors*Reduce children’s BMI and rates of obesity
Key intervention components:Health communication campaign- over 3 months (Jan-March 2011)-
increase parent awareness of child’s weight status; dispel myths; Posters displayed in all Head Start centers
Revised BMI letters (sent home 2x in fall and spring)- explained how to interpret results and prevent/treat overweight
Family nutrition counseling (8 sessions)- graduate students provided samples of healthy foods and answered questions about weight and nutrition
Parents’ connect for Healthy Living Program and Child Program (2x in fall and spring)- addressed skills parents interested in gaining, examples about healthy living, workshops by local organizations; mini workshops run for the kids by local org (dance studios, karate)
Evaluation Design
Families with a child >2 years or older enrolled in target Head Start centers eligible to participate in evaluation.
Families recruited through posters displayed in centers and flyers sent home with children
Parents agreed to complete self-report survey at baseline and follow-up.
Gave permission for investigators to extract child’s BMI data from Head Start records
$20 gift card at baseline and follow-up 154 parents at baseline, 35 didn’t follow-up
24-hour diet recall and accelerometry protocol $20 gift card for each at baseline and $30 at follow-up 55 parents at baseline for 24 hr recall, 22 didn’t follow up 83 parents at baseline for accelerometry protocol, 26 didn’t follow
up
Measures
Weight status obtained from Head Start in fall 2010 and spring 2011 and entered into database to extract BMI z-scores and percentiles
Dietary intake estimated using 24 hr recall; 2 recalls (one weekday and weekend) pre and post intervention, conduced via phone by staff as Purdue Univ. Intake averaged across the 2 days to estimate avg kcals, macros, and food groups
Physical activity Measured using GT3X accelerometer, worn around waist for 7 days. 83 kids met min 10 min/day x 4 days of monitoring
TV viewing time min/day
Parent Outcomes
Self-efficacy to provide healthy foods using 3 items 1=not at all confident to 5=very confidentResults: Pre (4.61) vs Post (4.80) intervention
Freq of offering fruits/veg with min 2 items 1=less than 1x/wk to 6=3x or more/dayResults: Pre (4.51) vs Post (4.69) intervention
Freq family eats fast food 0=never to 5=every dayResults: Pre (1.19) vs Post (1.14) intervention
Support for PA, family participation 1=strongly disagree to 4=strongly agreeResults: Pre (3.33) vs Post (3.51) intervention
Monitoring screen time to 2 hrs 1=strongly disagree to 4= strongly agreeResults: Pre (3.29) vs Post (3.27) intervention
TV on during dinner 1=never to 5=alwaysResults: Pre (1.24) vs Post (1.07) intervention
TV in child’s bedroom Results: Pre (64%) vs Post (62%) intervention
Pre-Post differences
BMI z-score lowered and Obese % decreased from 18.413.9% by post intervention
Children recorded significantly greater min/hr in light PA by post intervention
TV viewing time decreased from 142 min/day 72 min/day
Marginally lower mins/hr of sedentary activity (33 32 min/hr) and greater mins/hr of moderate activity (4.6 5.0 min/hr) by post intervention
Decreased kcals (1593 1404 ) and macros by post intervention
No changes in screen-related parenting (monitoring TV time, TV on during dinner, or TV in child’s bedroom)
Conclusion
This program centered around families’ needs and interests, built on strengths, responded to their weaknesses, and helped them utilize resources in their communities.
One of first studies to use CBPR to engage low-income parents in development, implementation, and evaluation of a family-centered obesity prevention program.
Advantages: This approach was parent centered and engaged parents as part of the
CAB members. Built on pre-existing Head Start resources such as BMI reporting and
Family Fun Days for family outreach. Parents were trained to be leaders for the Parents’ Connect program and
created involvement Disadvantages:
Lack of control group- not feasible in short time frame Threat to internal validity- relied on parents’ report and improvements in
children’s obesity risk behaviors could be seasonal effects