1
|
Anderson YC, Wild CEK, Gilchrist CA, Hofman PL, Cave TL, Domett T, Cutfield WS, Derraik JGB, Grant CC. A Multisource Process Evaluation of a Community-Based Healthy Lifestyle Programme for Child and Adolescent Obesity. CHILDREN (BASEL, SWITZERLAND) 2024; 11:247. [PMID: 38397358 PMCID: PMC10887184 DOI: 10.3390/children11020247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
Whānau Pakari is a healthy lifestyle assessment and intervention programme for children and adolescents with obesity in Taranaki (Aotearoa/New Zealand), which, in this region, replaced the nationally funded Green Prescription Active Families (GRxAF) programme. We compared national referral rates from the GRxAF programme (age 5-15 years) and the B4 School Check (B4SC, a national preschool health and development assessment) with referral rates in Taranaki from Whānau Pakari. We retrospectively analysed 5 years of clinical data (2010-2015), comparing referral rates before, during, and after the Whānau Pakari clinical trial, which was embedded within the programme. We also surveyed programme referrers and stakeholders about their experiences of Whānau Pakari, analysing their responses using a multiple-methods framework. After the Whānau Pakari trial commenced, Taranaki GRxAF referral rates increased markedly (2.3 pretrial to 7.2 per 1000 person-years), while NZ rates were largely unchanged (1.8-1.9 per 1000 person-years) (p < 0.0001 for differences during the trial). Post-trial, Taranaki GRxAF referral rates remained higher irrespective of ethnicity, being 1.8 to 3.2 times the national rates (p < 0.001). Taranaki B4SC referrals for obesity were nearly complete at 99% in the last trial year and 100% post-trial, compared with national rates threefold lower (31% and 32%, respectively; p < 0.0001), with Taranaki referral rates for extreme obesity sustained at 80% and exceeding national rates for both periods (58% and 62%, respectively; p < 0.01). Notably, a referral was 50% more likely for referrers who attended a Whānau Pakari training half-day (RR = 1.51; p = 0.009). Stakeholders credited the success of Whānau Pakari to its multidisciplinary team, family-centred approach, and home-based assessments. However, they highlighted challenges such as navigating multidisciplinary collaboration, engaging with families with complex needs, and shifting conventional healthcare practices. Given its favourable referral trends and stakeholder endorsement, Whānau Pakari appears to be a viable contemporary model for an accessible and culturally appropriate intervention on a national and potentially international scale.
Collapse
Affiliation(s)
- Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia
- Telethon Kids Institute, Perth Children's Hospital, Nedlands, WA 6009, Australia
- Child and Adolescent Community Health, Child and Adolescent Health Service, Perth, WA 6009, Australia
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Cervantée E K Wild
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Catherine A Gilchrist
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
- Starship Children's Hospital, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - Tami L Cave
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Tania Domett
- Cogo Consulting, 58 Surrey Crescent, Grey Lynn, Auckland 1141, New Zealand
| | - Wayne S Cutfield
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
- Starship Children's Hospital, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand
| | - José G B Derraik
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Liggins Institute, University of Auckland, Auckland 1142, New Zealand
| | - Cameron C Grant
- Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
- Starship Children's Hospital, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand
| |
Collapse
|
2
|
Lee MD, Wild CEK, Taiapa KJ, Rawiri NT, Egli V, Maessen SE, Anderson YC. Participant and caregiver perspectives on health feedback from a healthy lifestyle check. Health Expect 2024; 27:e13960. [PMID: 39102654 PMCID: PMC10785704 DOI: 10.1111/hex.13960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 12/03/2023] [Accepted: 12/18/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION The usual output following health consultations from paediatric services is a clinical letter to the referring professional or primary care provider, with a copy sent to the patient's caregiver. There is little research on how patients and caregivers perceive the letter content. We aimed to: first understand child, young people and caregiver experiences of and preferences for receiving a health feedback letter about the child/young person's health measures within a healthy lifestyle programme; and second to provide a set of recommendations for designing letters to children, young people and their families within a healthy lifestyle programme. METHODS This qualitative study, informed by Kaupapa Māori principles, included focus groups of children aged 5-11 years and young people aged 12-18 years who were participants in a healthy lifestyle programme in Taranaki, Aotearoa New Zealand and of their respective caregivers (total n = 47). Discussions were audio-recorded, transcribed and analysed using thematic analysis. FINDINGS Key themes were identified: letters sometimes acted as 'discourses of disempowerment'-some participants experienced a lack of safety, depersonalisation with medical jargon and 'feeling like a number'. Participants described the need for acknowledgement and affirmation in written communication-health feedback should include validation, choice regarding content, respectful tone and a strengths-based approach to health messages. INTERPRETATION Letters to referrers, copied to families, can be perceived as disempowering, and participant and caregiver perspectives of content should be considered. This study challenges conventional practice in communicating health feedback with broader implications for written communication in healthcare. We propose separate letters aimed at the child/young person and their caregiver that offer choice in the information they receive. The administrative burden of multiple letters can be mitigated by advances in digital health. PATIENT CONTRIBUTION This study originated in response to feedback from service users that current health feedback was not meeting their needs or expectations. Patient perspectives, especially from children, are rarely considered in the generation of clinic letters from health professionals. Participants were child participants in the community-based clinical service and their caregivers, and care was taken to represent the demographic backgrounds of service users. Collection and interpretation of Māori data were led by researchers who were local community members to ensure prioritisation and preservation of participant voice. Where possible, results are illustrated in the text by direct quotes from participants, whose identities are protected with a pseudonym.
Collapse
Affiliation(s)
- Miranda D. Lee
- Department of PaediatricsTe Whatu Ora TaranakiNew PlymouthTaranakiNew Zealand
| | - Cervantée E. K. Wild
- Department of Paediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | | | - Ngauru T. Rawiri
- Department of Paediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
- Ngāti Mutunga, Ngāti Rāhiri o Te ĀtiawaNgai Tūhoe, Ngāti Ruapani mai Waikaremoana, Ngāti Pāhauwera (iwi)New PlymouthTaranakiNew Zealand
| | - Victoria Egli
- School of Nursing, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Sarah E. Maessen
- Department of Paediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
| | - Yvonne C. Anderson
- Department of Paediatrics: Child and Youth HealthUniversity of AucklandAucklandNew Zealand
- Faculty of Health SciencesCurtin UniversityBentleyWestern AustraliaAustralia
- Telethon Kids InstitutePerth Children's HospitalNedlandsWestern AustraliaAustralia
- Child and Adolescent Community HealthChild and Adolescent Health ServicePerthWestern AustraliaAustralia
| |
Collapse
|
3
|
Cave TL, Derraik JGB, Willing EJ, Maessen SE, Hofman PL, Anderson YC. Changes in referral patterns for weight in association with the preschool Raising Healthy Kids target. J Prim Health Care 2022; 14:310-317. [PMID: 36592769 DOI: 10.1071/hc22076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/21/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The 'Raising Healthy Kids (RHK) health target ' recommended that children identified as having obesity [body mass index (BMI) ≥98th centile] through growth screening at the B4 School Check (B4SC) be offered referral for subsequent assessment and intervention. Aim To determine the impact of the 'RHK health target ' on referral rates for obesity in Aotearoa New Zealand (NZ). Methods A retrospective audit was undertaken of 4-year-olds identified to have obesity in the B4SC programme in Taranaki and nationally in 2015-19. Key outcomes were: 'RHK health target ' rate [proportion of children with obesity for whom District Health Boards (DHBs) applied the appropriate referral process]; Acknowledged referral rate (proportion of children with a referral for obesity whose referral was acknowledged by DHBs); and Declined referral rate (proportion of children offered a referral for obesity who declined their referral). Results Data were audited on 266 448 children, including 7464 in Taranaki. 'RHK health target ' rates increased markedly between 2015-16 and 2016-17 following the health target implementation (NZ: 34-87%; P P Acknowledged referral rates also increased post-target nationally (56-90%; P Declined referral rates across NZ (26-31%) and in Taranaki (although variable: 38-69%). Discussions The 'RHK health target's' focus on referral rather than intervention uptake limited the policy's impact on improving preschool obesity. Future policy should focus on ensuring access to multidisciplinary intervention programmes across NZ to support healthy lifestyle change.
Collapse
Affiliation(s)
- Tami L Cave
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand; and Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Esther J Willing
- Kohatu - Centre for Hauora Maori, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Sarah E Maessen
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Yvonne C Anderson
- Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; and Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia; and Telethon Kids Institute, Perth Children's Hospital, Nedlands, Western Australia, Australia; and Community Health, Child and Adolescent Health Service, Perth, Western Australia, Australia
| |
Collapse
|
4
|
Wild CEK, Wynter LE, Triggs CM, Derraik JGB, Hofman PL, Anderson YC. Five-year follow-up of a family-based multidisciplinary program for children with obesity. Obesity (Silver Spring) 2021; 29:1458-1468. [PMID: 34370401 DOI: 10.1002/oby.23225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/15/2021] [Accepted: 04/25/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study aimed to determine 5-year outcomes from a 12-month, family-based, multidisciplinary lifestyle intervention program for children. METHODS This study was the 5-year follow-up of a randomized clinical trial comparing a low-intensity control group (home-based assessments) with a high-intensity intervention group (assessments plus weekly sessions) in New Zealand. Participants were aged 5 to 16 years with BMI ≥ 98th centile or > 91st centile with weight-related comorbidities. The primary outcome was BMI standard deviation score (BMISDS). Secondary outcomes included various health markers. RESULTS Of the 199 children included in the study at baseline (47% who identified as Māori, 53% who identified as female, 28% in the most deprived quintile, mean age = 10.7 years, mean BMISDS = 3.12), 86 completed a 5-year assessment (43%). BMISDS reduction at 12 months was not retained (control = 0.00 [95% CI: -0.22 to 0.21] and intervention = 0.17 [95% CI: -0.01 to 0.34]; p = 0.221) but was greater in participants aged <10 years versus >10 years at baseline (-0.15 [95% CI: -0.33 to 0.03] vs. 0.21 [95% CI: 0.03 to 0.40]; p = 0.008). BMISDS trajectory favored participants with high attendance (p = 0.013). There were persistent improvements in water intake and health-related quality of life in both groups as well as reduced sweet drink intake in the intervention group. CONCLUSIONS This intervention, with high engagement from those most affected by obesity, did not achieve long-term efficacy of the primary outcome. Attendance and age remain important considerations for future interventions to achieve long-term BMISDS reduction.
Collapse
Affiliation(s)
- Cervantée E K Wild
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
| | - Lisa E Wynter
- Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| | - Christopher M Triggs
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - José G B Derraik
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Yvonne C Anderson
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand
- Tamariki Pakari Child Health and Wellbeing Trust, New Plymouth, New Zealand
- Department of Pediatrics, Taranaki District Health Board, New Plymouth, New Zealand
| |
Collapse
|