A weight management programme for fathers of children aged 4–11 years: cultural adaptation and the Healthy Dads, Healthy Kids UK feasibility RCT

Abstract

Background More men than women in the UK are living with overweight or obesity, but men are less likely to engage with weight loss programmes. Healthy Dads, Healthy Kids is an effective Australian weight management programme that targets fathers, who participate with their primary school-aged children. Behavioural interventions do not always transfer between contexts, so an adaptation of the Healthy Dads, Healthy Kids programme to an ethnically diverse UK setting was trialled. Objectives To adapt and test the Australian Healthy Dads, Healthy Kids programme for delivery to men in an ethnically diverse, socioeconomically disadvantaged UK setting. Design Phase 1a studied the cultural adaptation of the Healthy Dads, Healthy Kids programme and was informed by qualitative data from fathers and other family members, and a theoretical framework. Phase 1b was an uncontrolled feasibility trial. Phase 2 was a randomised controlled feasibility trial. Setting Two ethnically diverse, socioeconomically disadvantaged UK cities. Participants In phase 1a, participants were parents and family members from black and minority ethnic groups and/or socioeconomically deprived localities. In phases 1b and 2, participants were fathers with overweight or obesity and their children aged 4–11 years. Interventions The adapted Healthy Dads, Healthy Kids intervention comprised nine sessions that targeted diet and physical activity and incorporated joint father–child physical activity. Healthy Dads, Healthy Kids was delivered in two programmes in phase 1b and four programmes in phase 2. Those in the comparator arm in phase 2 received a family voucher to attend a local sports centre. Main outcome measures The following outcomes were measured: recruitment to the trial, retention, intervention fidelity, attendance, feasibility of trial processes and collection of outcome data. Results Forty-three fathers participated (intervention group, n = 29) in phase 2 (48% of recruitment target), despite multiple recruitment locations. Fathers’ mean body mass index was 30.2 kg/m2 (standard deviation 5.1 kg/m2); 60.2% were from a minority ethnic group, with a high proportion from disadvantaged localities. Twenty-seven (63%) fathers completed follow-up at 3 months. Identifying sites for delivery at a time that was convenient for the families, with appropriately skilled programme facilitators, proved challenging. Four programmes were delivered in leisure centres and community venues. Of the participants who attended the intervention at least once (n = 20), 75% completed the programme (attended five or more sessions). Feedback from participants rated the sessions as ‘good’ or ‘very good’ and participants reported behavioural change. Researcher observations of intervention delivery showed that the sessions were delivered with high fidelity. Conclusions The intervention was well delivered and received, but there were significant challenges in recruiting overweight men, and follow-up rates at 3 and 6 months were low. We do not recommend progression to a definitive trial as it was not feasible to deliver the Healthy Dads, Healthy Kids programme to fathers living with overweight and obesity in ethnically diverse, socioeconomically deprived communities in the UK. More work is needed to explore the optimal ways to engage fathers from ethnically diverse socioeconomically deprived populations in research. Trial registration Current Controlled Trials ISRCTN16724454. 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. 8, No. 2. See the NIHR Journals Library website for further project information.

Cultural adaptation of ‘Healthy Dads, Healthy Kids’ for Hispanic families: applying the ecological validity model

“…Similar to this study, they engaged representatives of the target population in interviews and focus groups, in addition to formative data from other ongoing studies to inform their adaptation of HDHK. The resulting adaptations included changes in the recruitment and follow-up procedures, program delivery and program content, primarily at a surface structural level [44]. After two feasibility trials of the adapted HDHK-UK program, the researchers concluded that despite the program being delivered with high fidelity and well received among participants, there were significant challenges in recruiting overweight or obese men and low follow up rates, resulting in the adapted program not being evaluated in an efficacy trial.…”

A systematic review examining socioeconomic factors in trials of interventions for men that report weight as an outcome

“…Consultation methods undertaken to inform the intervention design process varied across studies, including focus groups, workshops, survey data, and various patient and public involvement activities. Of the nine studies that consulted men, four specifically reported engaging with lower socioeconomic groups 99–102 . In the cultural adaptation of the Healthy Dads Healthy Kids intervention for men and children from low‐income Hispanic communities in the United States, family members participated in focus groups, online surveys, and interviews with findings reviewed by stakeholder experts to inform the adaptation 101 .…”

Reporting of patient involvement: A mixed-methods analysis of current practice in health research publications

“…The group encouraged the research team to be fully open about the challenges faced in delivering the HDHK programme and the research study." [28] Discussion and conclusions Comment on the extent to which PPI influenced the study overall. Describe positive and negative effects.…”