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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.
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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
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Brauer P, Desroches S, Dhaliwal R, Li A, Wang Y, Conklin AI, Klein D, Drouin-Chartier JP, Robitaille J, Horne J, Ponta ML, Burns R, Harding SV, Hosseini Z, Santosa S. Modified Delphi Process to Identify Research Priorities and Measures for Adult Lifestyle Programs to Address Type 2 Diabetes and Other Cardiometabolic Risk Conditions. Can J Diabetes 2022; 46:411-418. [DOI: 10.1016/j.jcjd.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 11/26/2022]
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Mulchandani R, Chandrasekaran AM, Shivashankar R, Kondal D, Agrawal A, Panniyammakal J, Tandon N, Prabhakaran D, Sharma M, Goenka S. Effect of workplace physical activity interventions on the cardio-metabolic health of working adults: systematic review and meta-analysis. Int J Behav Nutr Phys Act 2019; 16:134. [PMID: 31856826 PMCID: PMC6923867 DOI: 10.1186/s12966-019-0896-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 12/04/2019] [Indexed: 02/02/2023] Open
Abstract
Background Adults in urban areas spend almost 77% of their waking time being inactive at workplaces, which leaves little time for physical activity. The aim of this systematic review and meta-analysis was to synthesize evidence for the effect of workplace physical activity interventions on the cardio-metabolic health markers (body weight, waist circumference, body mass index (BMI), blood pressure, lipids and blood glucose) among working adults. Methods All experimental studies up to March 2018, reporting cardio-metabolic worksite intervention outcomes among adult employees were identified from PUBMED, EMBASE, COCHRANE CENTRAL, CINAHL and PsycINFO. The Cochrane Risk of Bias tool was used to assess bias in studies. All studies were assessed qualitatively and meta-analysis was done where possible. Forest plots were generated for pooled estimates of each study outcome. Results A total of 33 studies met the eligibility criteria and 24 were included in the meta-analysis. Multi-component workplace interventions significantly reduced body weight (16 studies; mean diff: − 2.61 kg, 95% CI: − 3.89 to − 1.33) BMI (19 studies, mean diff: − 0.42 kg/m2, 95% CI: − 0.69 to − 0.15) and waist circumference (13 studies; mean diff: − 1.92 cm, 95% CI: − 3.25 to − 0.60). Reduction in blood pressure, lipids and blood glucose was not statistically significant. Conclusions Workplace interventions significantly reduced body weight, BMI and waist circumference. Non-significant results for biochemical markers could be due to them being secondary outcomes in most studies. Intervention acceptability and adherence, follow-up duration and exploring non-RCT designs are factors that need attention in future research. Prospero registration number: CRD42018094436.
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Affiliation(s)
- Rubina Mulchandani
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India
| | | | | | - Dimple Kondal
- Centre for Chronic Disease Control, New Delhi, India
| | - Anurag Agrawal
- CSIR Institute of Genomics and Integrative Biology, New Delhi, India
| | - Jeemon Panniyammakal
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Government Medical College, Thiruvananthapuram, Kerala, India.,Public Health Foundation of India, Gurgaon, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, Delhi, India
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, New Delhi, India.,Public Health Foundation of India, Gurgaon, India
| | | | - Shifalika Goenka
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Gurgaon, India. .,Centre for Chronic Disease Control, New Delhi, India.
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Abstract
The aim of this review is to discuss the state of the art regarding the field of health promotion in the context of childhood obesity prevention in order to learn how we can better prevent childhood obesity. Challenges have been identified that exist within the different steps of health promotion programme development and implementation. Important steps forward include studying behaviours and determinants of behaviours as clusters, upgrading the importance of distal environmental factors in modelling determinants and understanding determinants as a dynamic system: a complex of interacting elements. An important note is that the process of implementation and the analysis thereof should more often come before the analysis of behaviours and the determinants of behaviour. In applied research, the expertise from the 'real world' practitioners should be used in an early stage to find out whether the answers on research questions really help us in preventing childhood obesity.
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Affiliation(s)
- Tommy L S Visscher
- Research Centre for the Prevention of Overweight, Zwolle Windesheim University of Applied Sciences and VU University Amsterdam, PO Box 10090, 8000GB, Zwolle, The Netherlands.
| | - Stef P J Kremers
- Department of Health Promotion, NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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