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van Sluijs EMF, Brown HE, Coombes E, Hughes C, Jones AP, Morton KL, Guagliano JM. An online family-based self-monitoring and goal-setting intervention to improve children’s physical activity: the FRESH feasibility trial and three-arm pilot RCT. PUBLIC HEALTH RESEARCH 2021. [DOI: 10.3310/phr09090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Family-based physical activity promotion presents a promising avenue for promoting whole-family physical activity, but high-quality research is lacking.
Objectives
To assess the feasibility, acceptability and preliminary effectiveness of FRESH (Families Reporting Every Step to Health), a child-led online family-based physical activity intervention; and to identify effective and resource-efficient family recruitment strategies.
Design
The project consisted of (1) a randomised feasibility trial, (2) a randomised controlled pilot trial and (3) a systematic review and Delphi study.
Setting
Norfolk/Suffolk counties, UK.
Participants
Families, recruited from schools, workplaces and community settings, were eligible to participate if one child aged 7–11 years and one adult responsible for their care provided written consent; all family members could participate.
Interventions
The FRESH intervention, guided by self-determination theory, targeted whole families and was delivered via an online platform. All family members received pedometers and were given website access to select family step challenges to ‘travel’ to target cities around the world, log steps, and track progress as they virtually globetrotted. Families were randomised to FRESH intervention, pedometer-only or control arm.
Main outcome measures
Physical (e.g. blood pressure), psychosocial (e.g. family functioning) and behavioural (e.g. device-measured family physical activity) measures were collected at baseline and at 8- and 52-week follow-up. A mixed-methods process evaluation assessed the acceptability of the intervention and evaluation.
Data sources review
Systematic search of four databases (Cochrane Library, PubMed, PsycINFO and SCOPUS).
Review methods
Articles were screened in duplicate, and data extraction was fully checked. Academic experts participated in the three-round Delphi study. Data were combined to identify effective and resource-efficient family recruitment strategies.
Inclusion criteria
Included generally healthy school-aged children and at least one adult; intervention attempted to change physical activity, sedentary behaviour, screen use, diet, or prevent overweight/obesity in multiple family members; presented relevant measure of effect in children and adults.
Results
The feasibility study (12 families, 32 participants; 100% retention at 8 weeks) demonstrated the feasibility and acceptability of FRESH, but highlighted that adaptations were required. Of 41 families recruited in the pilot study (149 participants), 98% and 88% were retained at the 8-week and 52-week follow-up, respectively. More children in the FRESH arm self-reported doing more family physical activity, and they thought that FRESH was fun. There were no notable between-group differences in children’s outcomes. Change in moderate to vigorous physical activity at 8 weeks favoured FRESH intervention adults [vs. control: 9.4 minutes/week (95% confidence interval 0.4 to 18.4) vs. pedometer only: 15.3 (95% confidence interval 6.0 to 24.5)], and was stronger in fathers, but this was not maintained. In 49 included studies, apart from recruitment settings and strategies used (reported in 84% and 73% of the studies, respectively), recruitment details were scarce. School-based recruitment was predominant. The Delphi study identified a wide range of recruitment settings and strategies.
Limitations
Recruitment was the main limitation of the FRESH studies; generalisability of the proposed recruitment strategies may be limited.
Conclusions
This study has demonstrated the feasibility and acceptability of the FRESH intervention. However, we failed to recruit the target sample size and were unable to demonstrate a signal of effectiveness. Future research should employ a multifaceted recruitment approach.
Future work
Further refinements to intervention delivery and recruitment methods should be investigated.
Study registration
Current Controlled Trials ISRCTN12789422 and PROSPERO CRD42019140042.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 9, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Esther MF van Sluijs
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Helen E Brown
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Emma Coombes
- Norwich Medical School and Centre for Diet and Activity Research (CEDAR), University of East Anglia, Norwich, UK
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Andrew P Jones
- Norwich Medical School and Centre for Diet and Activity Research (CEDAR), University of East Anglia, Norwich, UK
| | - Katie L Morton
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Justin M Guagliano
- Centre for Diet and Activity Research (CEDAR) and MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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Michaelson V, Pilato KA, Davison CM. Family as a health promotion setting: A scoping review of conceptual models of the health-promoting family. PLoS One 2021; 16:e0249707. [PMID: 33844692 PMCID: PMC8041208 DOI: 10.1371/journal.pone.0249707] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/23/2021] [Indexed: 12/02/2022] Open
Abstract
Background The family is a key setting for health promotion. Contemporary health promoting family models can establish scaffolds for shaping health behaviors and can be useful tools for education and health promotion. Objectives The objective of this scoping review is to provide details as to how conceptual and theoretical models of the health promoting potential of the family are being used in health promotion contexts. Design Guided by PRISMA ScR guidelines, we used a three-step search strategy to find relevant papers. This included key-word searching electronic databases (Medline, PSycINFO, Embase, and CINAHL), searching the reference lists of included studies, and intentionally searching for grey literature (in textbooks, dissertations, thesis manuscripts and reports.) Results After applying inclusion and exclusion criteria, the overall search generated 113 included manuscripts/chapters with 118 unique models. Through our analysis of these models, three main themes were apparent: 1) ecological factors are central components to most models or conceptual frameworks; 2) models were attentive to cultural and other diversities, allowing room for a wide range of differences across family types, and for different and ever-expanding social norms and roles; and 3) the role of the child as a passive recipient of their health journey rather than as an active agent in promoting their own family health was highlighted as an important gap in many of the identified models. Conclusions This review contributes a synthesis of contemporary literature in this area and supports the priority of ecological frameworks and diversity of family contexts. It encourages researchers, practitioners and family stakeholders to recognize the value of the child as an active agent in shaping the health promoting potential of their family context.
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Affiliation(s)
- Valerie Michaelson
- Department of Health Sciences, Brock University, St. Catharines, Canada
- * E-mail:
| | - Kelly A. Pilato
- Department of Health Sciences, Brock University, St. Catharines, Canada
| | - Colleen M. Davison
- Department of Public Health Sciences, Queen’s University, Kingston, Canada
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Guagliano JM, Morton KL, Hughes C, van Sluijs EMF. Effective and resource-efficient strategies for recruiting families in physical activity, sedentary behavior, nutrition, and obesity prevention research: A systematic review with expert opinion. Obes Rev 2021; 22:e13161. [PMID: 33331106 PMCID: PMC7613433 DOI: 10.1111/obr.13161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 01/13/2023]
Abstract
We systematically identified effective and resource-efficient strategies for recruiting families into health promoting intervention research. Four databases were searched for reviews. Interventions were extracted from included reviews. Additionally, a Delphi study was conducted with 35 experts in family-based research. We assessed extracted data from our review and Delphi participants' opinions by collating responses into overarching themes based on recruitment setting then recruitment strategies to identify effective and resource-efficient strategies for recruiting families into intervention research. A total of 64 articles (n = 49 studies) were included. Data regarding recruitment duration (33%), target sample size (32%), reach (18%), expressions of interest (33%), and enrollment rate (22%) were scarcely reported. Recruitment settings (84%) and strategies (73%) used were available for most studies. However, the details were vague, particularly regarding who was responsible for recruitment or how recruitment strategies were implemented. The Delphi showed recruitment settings, and strategies fell under six themes: school-based, print/electronic media, community settings-based, primary care-based, employer-based, and referral-based strategies. Underrecruitment in family-based trials is a major issue. Reporting on recruitment can be improved by better adherence to existing guidelines. Our findings suggest a multifaceted recruitment approach targeting adults and children with multiple exposures to study information.
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Affiliation(s)
- Justin M Guagliano
- MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Katie L Morton
- MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit & Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
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Bestle SMS, Christensen BJ, Trolle E, Biltoft-Jensen AP, Matthiessen J, Gibbons SJ, Ersbøll BK, Lassen AD. Reducing Young Schoolchildren's Intake of Sugar-Rich Food and Drinks: Study Protocol and Intervention Design for "Are You Too Sweet?" A Multicomponent 3.5-Month Cluster Randomised Family-Based Intervention Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:9580. [PMID: 33561071 PMCID: PMC7767356 DOI: 10.3390/ijerph17249580] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 12/15/2022]
Abstract
A high consumption of sugar-rich discretionary food and drinks has several health implications, which have been traced from childhood into adulthood. Parents act as primary mediators shaping children's dietary habits, and interventions that engage parents have shown to result in positive outcomes. Further, collaboration with local school health nurses and dentists provides an effective structural frame to support behaviour change and anchor new initiatives. The multicomponent 3.5-month cluster randomised family-focused intervention "Are you too Sweet?" aims to evaluate the effectiveness of communicating new Danish guidelines for sugar-rich discretionary food and drinks for school starters (5-7 years). This paper describes the development, outcomes and process evaluation of the intervention that includes three main components: extended dialogue during a school health nurse consultation, a box with home-use materials, and a social media platform to facilitate interaction among participants. Children (n = 160) and their parents were scheduled for a baseline interview at six different schools. The intervention was developed to increase self-efficacy, knowledge about guidelines, observational learning and reduce impediments for behavioural change. The desired primary outcome was a reduction in intake of sugar-rich food measured through a 7-day dietary record. The results contribute to the evidence on effective health promotion strategies.
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Affiliation(s)
- Sidse Marie Sidenius Bestle
- Division of Food Technology, National Food Institute, Technical University of Denmark, Kemitorvet Building 201, 2800 Kongens Lyngby, Denmark; (B.J.C.); (E.T.); (A.P.B.-J.); (J.M.); (S.J.G.); (A.D.L.)
| | - Bodil Just Christensen
- Division of Food Technology, National Food Institute, Technical University of Denmark, Kemitorvet Building 201, 2800 Kongens Lyngby, Denmark; (B.J.C.); (E.T.); (A.P.B.-J.); (J.M.); (S.J.G.); (A.D.L.)
| | - Ellen Trolle
- Division of Food Technology, National Food Institute, Technical University of Denmark, Kemitorvet Building 201, 2800 Kongens Lyngby, Denmark; (B.J.C.); (E.T.); (A.P.B.-J.); (J.M.); (S.J.G.); (A.D.L.)
| | - Anja Pia Biltoft-Jensen
- Division of Food Technology, National Food Institute, Technical University of Denmark, Kemitorvet Building 201, 2800 Kongens Lyngby, Denmark; (B.J.C.); (E.T.); (A.P.B.-J.); (J.M.); (S.J.G.); (A.D.L.)
| | - Jeppe Matthiessen
- Division of Food Technology, National Food Institute, Technical University of Denmark, Kemitorvet Building 201, 2800 Kongens Lyngby, Denmark; (B.J.C.); (E.T.); (A.P.B.-J.); (J.M.); (S.J.G.); (A.D.L.)
| | - Sarah Jegsmark Gibbons
- Division of Food Technology, National Food Institute, Technical University of Denmark, Kemitorvet Building 201, 2800 Kongens Lyngby, Denmark; (B.J.C.); (E.T.); (A.P.B.-J.); (J.M.); (S.J.G.); (A.D.L.)
| | - Bjarne Kjær Ersbøll
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800 Kongens Lyngby, Denmark;
| | - Anne Dahl Lassen
- Division of Food Technology, National Food Institute, Technical University of Denmark, Kemitorvet Building 201, 2800 Kongens Lyngby, Denmark; (B.J.C.); (E.T.); (A.P.B.-J.); (J.M.); (S.J.G.); (A.D.L.)
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Guagliano JM, Armitage SM, Brown HE, Coombes E, Fusco F, Hughes C, Jones AP, Morton KL, van Sluijs EMF. A whole family-based physical activity promotion intervention: findings from the families reporting every step to health (FRESH) pilot randomised controlled trial. Int J Behav Nutr Phys Act 2020; 17:120. [PMID: 32962724 PMCID: PMC7510101 DOI: 10.1186/s12966-020-01025-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 01/02/2023] Open
Abstract
Introduction This study assessed the feasibility and acceptability of FRESH (Families Reporting Every Step to Health), a theory-based child-led family physical activity (PA) intervention delivered online. We also assessed the preliminary effectiveness of the intervention on outcomes of interest and whether pre-specified criteria were met to progress to a full-scale definitive trial. Methods In a three-armed randomised pilot trial, 41 families (with a 7–11-year-old index child) were allocated to a: ‘family’ (FAM), ‘pedometer-only’ (PED), or a no-treatment control (CON) arm. The FAM arm received access to the FRESH website, allowing participants to select step challenges to ‘travel’ to target cities around the world, log their steps, and track progress as families virtually globetrot. FAM and PED arms also received family sets of pedometers. All family members could participate in the evaluation. Physical (e.g., fitness, blood pressure), psychosocial (e.g., social support), behavioural (e.g., objectively-measured PA), and economic (e.g., expenditure for PA) data were collected at baseline, 8- and 52-weeks. Results At 8- and 52-weeks, 98 and 88% of families were retained, respectively. Most children liked participating in the study (> 90%) and thought it was fun (> 80%). Compared to the PED (45%) and CON (39%) arms, a higher percentage of children in the FAM (81%) arm reported doing more activities with their family. Adults agreed that FRESH encouraged their family do more PA and made their family more aware of the amount of PA they do. No notable between-group differences were found for childrens’ minutes in moderate-to-vigorous PA. Sizeable changes of 9.4 (95%CI: 0.4, 18.4) and 15.3 (95%CI: 6.0, 24.5) minutes in moderate-to-vigorous PA was found for adults in the FAM group compared to those in the PED or CON groups, respectively. No other notable differences were found. Conclusion This study demonstrates feasibility and acceptability of the FRESH intervention. All progression criteria were at least partially satisfied. However, we failed to recruit the target sample size and did not find a signal of effectiveness on PA particularly long-term or in children. Further refinements are required to progress to a full-scale trial. Trial registration This study was prospectively registered (ISRCTN12789422) on 16/03/2016.
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Affiliation(s)
- Justin M Guagliano
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK.
| | - Sofie M Armitage
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Helen Elizabeth Brown
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Emma Coombes
- Norwich Medical School and Centre for Diet and Activity Research, University of East Anglia, Norwich, UK
| | - Francesco Fusco
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Claire Hughes
- Centre for Family Research, University of Cambridge, Cambridge, UK
| | - Andrew P Jones
- Norwich Medical School and Centre for Diet and Activity Research, University of East Anglia, Norwich, UK
| | - Katie L Morton
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
| | - Esther M F van Sluijs
- MRC Epidemiology Unit and Centre for Diet and Activity Research, University of Cambridge, Cambridge, UK
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