The effect of a behaviour change intervention on the diets and physical activity levels of women attending Sure Start Children’s Centres: results from a complex public health intervention

Abstract

ObjectivesThe UK government's response to the obesity epidemic calls for action in communities to improve people's health behaviour. This study evaluated the effects of a community intervention on dietary quality and levels of physical activity of women from disadvantaged backgrounds.DesignNon-randomised controlled evaluation of a complex public health intervention.Participants527 women attending Sure Start Children's Centres (SSCC) in Southampton (intervention) and 495 women attending SSCCs in Gosport and Havant (control).InterventionTraining SSCC staff in behaviour change skills that would empower women to change their health behaviours.OutcomesMain outcomes dietary quality and physical activity. Intermediate outcomes self-efficacy and sense of control.Results1-year post-training, intervention staff used skills to support behaviour change significantly more than control staff. There were statistically significant reductions of 0.1 SD in the dietary quality of all women between baseline and follow-up and reductions in self-efficacy and sense of control. The decline in self-efficacy and control was significantly smaller in women in the intervention group than in women in the control group (adjusted differences in self-efficacy and control, respectively, 0.26 (95% CI 0.001 to 0.50) and 0.35 (0.05 to 0.65)). A lower decline in control was associated with higher levels of exposure in women in the intervention group. There was a statistically significant improvement in physical activity in the intervention group, with 22.9% of women reporting the highest level of physical activity compared with 12.4% at baseline, and a smaller improvement in the control group. The difference in change in physical activity level between the groups was not statistically significant (adjusted difference 1.02 (0.74 to 1.41)).ConclusionsWhile the intervention did not improve women's diets and physical activity levels, it had a protective effect on intermediate factors—control and self-efficacy—suggesting that a more prolonged exposure to the intervention might improve health behaviour. Further evaluation in a more controlled setting is justified.

Developmental Origins of Health and Disease: A Lifecourse Approach to the Prevention of Non-Communicable Diseases

“…These changes were still apparent one year after training [56]. Evaluation showed that women who came into contact with trained staff had significantly smaller declines in their sense of control and self-efficacy than women in the control group, although an effect on diet was not observed [57]. Self-efficacy and sense of control are psychological factors known to be associated with diet quality among disadvantaged women.…”

Knowledge about the Developmental Origins of Health and Disease is independently associated with variation in diet quality during pregnancy

“…Fortunately, the available literature also suggests that these kinds of barriers can be overcome. DOHaD-related concepts have been successfully translated to several hard-to-reach, albeit selected, populations with low levels of health literacy (adolescents in New Zealand and the Cook Islands, adolescents in Uganda, and low SEP women in the United Kingdom; Baird et al, 2014;Bay et al, 2012, 2016a, Bay, Morton, & Vickers, 2016b, Bay, Vickers, Mora, SLoboda, & Morton, 2017a, Bay et al, 2017bMacNab & Mukisa, 2017;Barker et al, 2017). In these selected cohorts, knowledge translation has required development of hands-on curricula and/or deep engagement and cultivation of meaningful relationships with community partners but is proving fruitful (Grace & Bay, 2011;MacNab & Mukisa, 2017).…”

Translating Developmental Origins: Improving the Health of Women and Their Children Using a Sustainable Approach to Behaviour Change

“…Changes to the way staff worked were still evident a year post-training [30]. A non-randomised controlled trial of the effect of exposure to trained staff on diet and physical activity levels in women attending SSCCs showed that the intervention had no measurable effect on women’s diet and physical activity levels, but that it may have protected against a decline in their self-efficacy and perceptions of control over life, factors known to be associated with change in both these health behaviours [31]. …”