The development of the Dutch "National model integrated care for childhood overweight and obesity"

Building space for children's voices: The added value of participatory and creative approaches for child-centred integrated obesity care

BACKGROUND

Paediatric obesity is increasing across the globe. In search for solutions, it is important to engage children, as they have their own unique perspectives on what it means to be a child with obesity within their sociocultural context. Though this is increasingly acknowledged, the question remains how to meaningfully engage children in paediatric obesity care as they are often in an unequal position in relation to adults.

AIM

In this study, we reflect on what can be learned from a participatory research approach to improve child-centred paediatric obesity care.

DESIGN AND METHODS

We reflect on four years of participatory research with children and care professionals to understand the mechanisms that facilitated child participation within the research process. Secondly, we reflect on how these lessons relate to care practices. We conducted qualitative content analysis on the data gathered, including interviews, observations and working sessions with children and care professionals.

RESULTS

We identified three elements that facilitated child participation: (1) adopting a participatory attitude, (2) connecting to children's living environment and (3) doing activities together. This helped to build trusting relationships and gain in-depth understanding of what works well and why.

CONCLUSION

Our findings underscore the significance of building communicative spaces where children's voices can be articulated at their own pace, about issues of their own choice, based on their own experiences.

PRACTICAL IMPLICATIONS

Working together with children as knowledgeable partners in paediatric obesity care can improve care delivery and provide solutions that better reflect their everyday realities and needs.

Development of an action programme tackling obesity-related behaviours in adolescents: a participatory system dynamics approach

System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10-14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice.

Evaluation of Health-Related Quality of Life in Adolescents With Obesity: A Randomized Qualitative Study Among Healthcare Professionals

Adolescent obesity constitutes a disorder with physical and psychosocial implications. Childhood and adolescent obesity rates are constantly increasing worldwide. Since adolescent obesity is a chronic disease, which is part of noncommunicative degenerative diseases, its holistic approach decisively includes the assessment of its impact on quality of life. The use of the tools Pediatric Quality of Life Inventory 4.0 (PedsQL4.0) and The Impact of Weight on Quality of Life for Kids (IWQOL-Kids), the familiarity of health professionals with them, their applicability, and relevance in clinical practice, are a cornerstone in the promotion of health services in adolescent obesity. The present randomized qualitative study aimed to highlight the attitudes and preferences of pediatricians on the assessment of health-related quality of life (HRQoL), among obese adolescents. The sample consists of 120 pediatricians, randomly selected from the totality of municipality-registered pediatricians (Municipality of Thessaloniki, Greece) who were interviewed in a semi-structured way, regarding their attitudes in the assessment of health-related quality of life, as measured by the PedsQL4.0 and IWQOL-Kids tools. The interviews revealed that most participants gained insight into the HRQoL assessment process during the present study interview with the researchers. Only eight (n=8/120) participants were familiar with the explored tools, PedsQL4.0 and IWQOL-KIDS. The remaining sample (n=112/120) was unfamiliar with both the two questionnaires and their content as well. Among the referred barriers to the usage of the tools, lack of time was stated as the pivotal factor hindering the implementation of the tools in clinical practice. There was no consensus on the preferred questionnaire among the participating healthcare professionals. All participants stated that the use of one or both questionnaires would have added significant value to the support and care of adolescents with obesity. Tools assessing HRQoL present low familiarity among pediatricians in real-world data. Focus on the engagement of the healthcare providers in the evaluation of obesity-related quality of life is unequivocal, in order to improve health care status in adolescents with obesity.