Background Behavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia. Methods The cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program. Results Program structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials). Conclusions This cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness.
Summary Interventions for obesity prevention can effectively reduce obesity‐related behaviors in young children. Understanding how to leverage and adapt evidence‐based interventions is needed to improve reach among culturally and linguistically diverse families. This systematic review aimed to synthesize the approaches and outcomes of culturally adapted early childhood obesity‐related behavioral prevention interventions. Multiple electronic databases were systematically searched in March 2021. All study designs were included if they reported cultural adaptations of an intervention targeting at least one obesity‐related behavior (infant feeding, nutrition, physical activity, and/or sleep) among children aged 0–5 years. Studies that only conducted language translations or that developed new interventions were excluded. Two authors independently conducted critical appraisals using the Mixed Method Appraisal Tool. Findings were synthesized narratively, based on the Stages of Cultural Adaptation theoretical model and the Framework for Reporting Adaptations and Modifications‐Enhanced. Twelve interventions met the inclusion criteria, with varied study designs. Few reported all aspects of cultural adaptation processes, and the cultural adaptation strategies documented varied. The results suggest that cultural adaptation of obesity‐related behavioral prevention interventions targeting young children increases acceptability among target cultural groups, yet effectiveness is inconclusive due to a lack of trials. More detailed reporting of cultural adaptation processes and further effectiveness trials are needed to evaluate future work.
Aim: The present study explored whether existing tools measuring parenting could be combined to assess an expanded parenting definition, specifically to include co‐participation in food‐related activities and teaching children about nutrition. The relationships between parenting, child dietary intake and weight outcomes were explored. Methods: The sample included 93 children aged 4–13 years and their parent/caregiver. Child outcomes were dietary intake and body mass index z‐score. Parent measures included demographics, nutrition knowledge and parenting practices. Exploratory factor analysis was used to identify underlying dimensions of parenting. Hierarchical linear regression was used to investigate the independent effects of parenting on child outcomes (body mass index z‐score, fruit and vegetable, fibre, saturated and total fat) after adjustment for covariates. Results: Five factors were extracted, accounting for 44% of the total variance (α= 0.77–0.87). The regression model for kilojoules explained 31% of the variance (P= 0.001), with a significant independent contribution from construct ‘guide and reward’ (β=−0.249, P= 0.027). For child body mass index z‐score, the model explained 25% of variance, and parenting constructs ‘guide and reward’ (β= 0.274, P= 0.015) and ‘concern about intake’ (β=−0.273, P= 0.008) made significant contributions. Conclusions: The present study adds to our understanding of parenting influences on children's dietary intake and weight status. Results support the inclusion of parenting strategies in obesity prevention interventions. Future research should explore the range of ways parenting influences children's diet and risk of obesity, preferably longitudinally.
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