Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis

Legrand, Karine; Lecomte, Édith; Langlois, J.; Muller, Laurent; Saez, Laura; Quinet, Marie-Hélène; Böhme, Philip; Spitz, Élisabeth; Omorou, Abdou Y.; Briançon, Serge; Lavenne, Rozenn De; Gailliard, Cécile; Pourcher, Céline; Toussaint, Brigitte

doi:10.1016/j.conctc.2017.05.010

Cited by 16 publications

(15 citation statements)

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“…Specifically and according to Marmot, 30 interventions should be universal and proportionate (i.e., with a scale and intensity that is proportionate of the level of disadvantage). For example, Legrand et al 31 conducted a universal and proportionate intervention to reduce WSG among adolescents. Specifically, a standard-care management was proposed for all adolescents, whereas a strengthened-care management was proposed for only adolescents from low socioeconomic group.…”

Section: Discussionmentioning

confidence: 99%

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Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents

et al. 2019

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Background: Differences in weight status by socioeconomic position occur during adolescence and is known as weight social gradient (WSG). The PRALIMAP (Promotion de l'ALIMentation et de l'Activité Physique) trial highlighted that a universal intervention was effective in reducing overweight and obesity prevalence among adolescents. However, its ability to reduce the WSG is unclear. This study aimed to evaluate the impact of the PRALIMAP intervention on the WSG among adolescents. Methods: Data were obtained from 3504 adolescents who participated in the school-based PRALIMAP trial between 2006 and 2009. The PRALIMAP study consisted of three interventional strategies: educational, environmental, screening and care. Weight status was assessed by body mass index (BMI) z-score and overweight and obesity prevalence. The ''indice de position sociale des élèves'' was used to measure adolescents' socioeconomic status. Linear regression and hierarchical models were used to assess the WSG and its evolution, respectively. Results: Among all adolescents (14-18 years old), significant WSG was identified at baseline: BMI z-score (b =-0.06; p < 0.0001), overweight and obesity prevalence (b =-2.86; p < 0.0001). Overall, the intervention conferred no significant reduction in the WSG: BMI z-score (b =-0.01 [-0.02 to 0.01], p = 0.48), overweight and obesity prevalence (b =-0.01 [-0.07 to 0.05], p = 0.73). Similar results were observed for adolescents whatever the interventional strategy they benefited from in the PRALIMAP trial. Conclusions: This study provided no evidence that the PRALIMAP universal intervention was effective in reducing the socioeconomic inequalities in weight status among adolescents. Different interventions that account for social differences should be considered to tackle these inequalities.

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Section: Discussionmentioning

confidence: 99%

“…: the Family Affluence Scale). 22,31 Despite these limitations, our study has several strengths. First, our results are derived from data of a trial with a long follow-up and a large sample size.…”

Section: Study Limitations and Strengthsmentioning

confidence: 97%

Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents

et al. 2019

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“…This study was carried out during the 2013-2014 academic year within a larger research program running over a 3-year period for the prevention of overweight and obesity aimed at overweight and obese adolescents aged between 13 and 18 years attending grades 9 and 10 in 33 state-run middle-schools and high-schools in the Vosges department (north-eastern France). The full protocol of the PRALIMAP-INÈS (Promotion de l’ALIMentation et l’Activité Physique-INEgalité de Santé) trial is described elsewhere [ 39 ]. A letter was sent to adolescents’ home addresses, and they were included in the study unless their parents or legal guardian returned a refusal slip.…”

Section: Methodsmentioning

confidence: 99%

“…Both were embedded in the PRALIMAP-INÈS general assessment: the 2012-2103 follow-up session and the 2013-2014 inclusion session. Both were organized through close collaboration between the school and research teams [ 39 ]. All eligible adolescents were, therefore, invited to participate in the interviews if they attended these sessions.…”

Section: Methodsmentioning

confidence: 99%

Reach and Acceptability of a Mobile Reminder Strategy and Facebook Group Intervention for Weight Management in Less Advantaged Adolescents: Insights From the PRALIMAP-INÈS Trial

Saez¹,

Langlois²,

Legrand³

et al. 2018

JMIR Mhealth Uhealth

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BackgroundAlthough information and communication technology interventions appear to be a promising means of reducing the health inequality gap in overweight and obesity prevention, research on information and communication technology interventions is lacking outside the Anglo-Saxon world.ObjectiveThe aim of this study was to assess the reach and acceptability of 2 information and communication technology interventions delivered as part of a French nutritional program: an SMS text messaging (short message service, SMS) attendance-reminder for collective sessions strategy and a Facebook challenge group.MethodsThis study sample comprised 262 socially less advantaged overweight adolescents aged between 13 and 18 years. The information and communication technology interventions were carried out during the 2013-2014 academic year in 33 French state-run schools. For the SMS attendance-reminder for collective sessions strategy, at the start of the academic year, adolescents were asked to give their mobile number. SMS attendance-reminders were sent shortly before each of the 5 collective sessions. For the Facebook challenge group, adolescents were invited to join a closed Facebook group in which challenges on physical activity and on diet were posted weekly. Process data and 2 sets of face-to-face interviews were also used to interpret participation rates and access to Facebook. Appreciation for both interventions was evaluated by a questionnaire at the end of the academic year.ResultsOf the recruited adolescents, 79.0% (207/262) gave their mobile number, reflecting high access to a mobile phone. Giving a number was significantly more likely for girls (odds ratio [OR] 2.1, 95% CI 1.1-3.9; P=.02) and adolescents in a vocational or general high school as opposed to middle school (OR 1.0, 95% CI 0.4-2.7; OR 0.2, 95% CI 0.1-0.5; P<.001). Indicating a mobile number at the start of the year was not significantly associated with participation in collective sessions. Of the adolescents seen at the start-of-year face-to-face interviews, 78.1% (153/196) declared an interest in the Facebook challenge group, which implies having a Facebook account or being able to have access to one. However, only 21 adolescents went through the process of joining the group. Although there was satisfaction with the Facebook group among the participants, the low participation rate in the Facebook group does not allow conclusions to be drawn with confidence.ConclusionsThe results are in line with the claim that using information and communication technologies in health programs is unlikely to widen health inequalities. However, in this population of French adolescents, mobile phone strategies seem more adapted to a high school context, and caution should be exercised with a younger audience. Although there is positive appreciation of the SMS attendance-reminders and a Facebook intervention is initially highly appealing to less advantaged adolescents, no evidence of impact could be demonstrated. These results highlight the difficulty in assessing the im...

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“…The study protocol of PRALIMAP-INÈS has been described in detail elsewhere. 30 Briefly, PRALIMAP-INÈS is a mixed quasi-experimental and experimental prospective trial aimed at overweight and obese adolescents aged 13–18 attending grade 9 in state-run middle schools (last year of ‘collège’ in France) and grade 10 in high schools (first year of ‘lycée’ in France) in the Vosges department (north-eastern France). At the beginning of the school year, a screening process was carried out in the school setting (T0).…”

Section: Methodsmentioning

confidence: 99%

Using facilitator–receiver peer dyads matched according to socioeconomic status to promote behaviour change in overweight adolescents: a feasibility study

et al. 2018

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ObjectiveTo evaluate the feasibility of an innovative peer intervention promoting healthy eating and physical activity, which purposefully selected peer facilitators according to socioeconomic status to target less-advantaged overweight receivers.SettingNine high schools, two middle schools.ParticipantsOne hundred and fifty-six adolescents were approached to become facilitators, of whom 18 were trained. Thirty-two of 56 potential receivers agreed to participate.InterventionThe peer intervention was carried out in 2013–2014 and embedded in a larger trial: PRALIMAP-INÈS (Promotion de l’ALIMentation et l’Activité Physique-INEgalité de Santé). Facilitanoators were selected and trained to organise weight-control activities with specific peer receivers participating in the programme.Primary and secondary outcome measuresDifferent types of data were collected to assess demand, acceptability, implementation and practicality of the intervention. For the facilitators, this included 6 training sessions, 11 mid-programme interviews, 4 end-of-programme sessions, telephone notes and text message exchanges. All six potential receivers in one school were also interviewed. Sociodemographic and health characteristics were also analysed.ResultsAgreeing to participate was more likely when asked by a peer compared with a professional (51.2% discordant pairs; p<0.02). Twelve activities, mostly based on physical activity and implemented during weekends or holidays, were carried out. The mean age of active receivers was 16 and their body mass index was higher than other participants. For both facilitators and active receivers, there were more participating girls. Qualitative analysis reveals key implementation challenges for facilitators. Interviews with the receivers highlight social difficulties, with most feeling bad about their appearance and wanting to lose weight. Those who participated in peer activities were very positive about the experience especially social support.ConclusionsThe present study suggests the peer intervention is feasible provided organisational difficulties are addressed. Good practice recommendations are formulated, including a longer training session, organising a joint meeting with the facilitators and receivers, matching dyads on place of residence and multiplying modes of contact.Trial registration numberNCT01688453.

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Reducing social inequalities in access to overweight and obesity care management for adolescents: The PRALIMAP-INÈS trial protocol and inclusion data analysis

Cited by 16 publications

References 56 publications

Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents

Universal School-Based Intervention Does Not Reduce Socioeconomic Inequalities in Weight Status among Adolescents

Reach and Acceptability of a Mobile Reminder Strategy and Facebook Group Intervention for Weight Management in Less Advantaged Adolescents: Insights From the PRALIMAP-INÈS Trial

Using facilitator–receiver peer dyads matched according to socioeconomic status to promote behaviour change in overweight adolescents: a feasibility study

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