Process evaluation of an up-scaled community based child obesity treatment program: NSW Go4Fun®

Abstract

BackgroundCommunity-based obesity treatment programs for children that have a large program reach are a priority. To date, most programs have been small efficacy trials whose findings have yet to be up-scaled and translated into real-world settings. This paper reports on the process evaluation of a government-funded, translated obesity treatment program for children in Australia. It describes the characteristics and reach of children participating in the New South Wales (NSW) Ministry of Health Go4Fun® program.MethodsDelivered across the state of NSW (Australia) by Local Health Districts (LHDs), Go4Fun® is a community-based, multidisciplinary family obesity treatment program adapted from the United Kingdom Mind Exercise Nutrition Do it (MEND) program that targets weight-related behaviours. Children aged 7-13 years with a BMI ≥85th percentile and no co-morbidities were eligible at no cost. Parents/carers self-refer via a toll-free phone number, text messages, online registration or via secondary referrals. LHDs deliver a 16 to 20-session program based on length of school term, holidays and recruitment challenges. Both parent/carer and child attend bi-weekly after school sessions. Parent-reported socio-demographic and measured child weight characteristics are presented using descriptive statistics. Differences between completers (attended at least 75% of sessions) and non-completers were assessed using chi-square tests, independent sample t-tests and adjusted odds ratios. Analyses were adjusted for clustering of programs.ResultsBetween 2009 and 2012, a total of 2,499 children (54.8% girls; mean age [SD]: 10.2 [1.7 years]) participated in the Go4Fun® program. Children were mainly from low-middle socioeconomic status (76.5%), resided in major cities (63.3%), and 5.7% were Aboriginal. At baseline, 96.5% of children were overweight or obese. Mean BMI-z-score was 2.07 (0.41) and 94.5% had a waist-to-height ratio ≥0.5. More than half (57.9%) completed at least 75% of sessions. Amongst completers (N = 1,446), girls (56.8%; p = 0.02), non-Aboriginal children (95.9%; p < 0.01) and children residing in less socially disadvantaged areas (25.9%; p = 0.02) were significantly more likely to complete the program.ConclusionsThe Go4Fun® program successfully reached the targeted population of overweight/obese children at socioeconomic disadvantage and is a rare example of an up-scaled translational program.

Barriers and facilitators to initial and continued attendance at community‐based lifestyle programmes among families of overweight and obese children: a systematic review

“…Screening of titles and abstracts resulted in 78 potentially eligible studies. Of these, 13 peer‐reviewed journal articles met the inclusion criteria . Qualitative methods were employed in five of the studies included (Table ), quantitative methods in six (Table ) while two studies used mixed‐methods to achieve their aim (Table ).…”

“…Five of the included studies reported on the non‐modifiable predictors of attendance (e.g. gender, age and ethnicity) . Of these five, three examined the predictors of initial attendance and four reported on the predictors of continued attendance .…”

“…Three of the four quantitative studies which examined the association between ethnicity and drop‐out reported that those families of ethnic minority were more likely to discontinue care prematurely . Two of the included qualitative studies support this finding with some families dropping out of treatment as a result of language difficulties , or because they felt the programme was ‘ culturally inappropriate ’ .…”

“…Gender influences attendance in weight management programmes. Three of the included quantitative studies reported on the predictors of initial attendance , and all found that families with overweight or obese girls were more likely to enrol in weight management programmes than families with overweight or obese boys. Similarly, out of the three quantitative studies that examined the association between gender and completion, two found that families with overweight or obese girls were also more likely to complete treatment than those of boys .…”

A systematic review of community‐based interventions for the treatment of adolescents with overweight and obesity

“…Scalability needs to be considered with regard to realistic community delivery and resourcing and be balanced with participant need and expectation . Scalability case studies are emerging within the translation research and public health literature; however, most community‐based obesity management programs are for populations of younger children (<13 years) . At present, these case studies are the best evidence to inform community program implementation at scale in adolescents, which includes overcoming such challenges as participant recruitment, engagement and retention, as well as upskilling and training the workforce to deliver these programs as part of, or in addition to, their current practice.…”