Abstract
BackgroundOne third of U.S. children and two thirds of adults are overweight or obese. Interventions to prevent obesity and thus avert threats to public health are needed. This paper describes the design and methods of the Healthy Kids & Families study, which tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity.MethodsParticipants were English or Spanish-speaking parent-child dyads (n = 247) from nine elementary schools (grades K-6) located in racial/ethnically diverse low-income communities in Worcester, Massachusetts. Using a quasi-experimental design with the school as the level of allocation, the study compared the lifestyle intervention vs. an attention-control comparison condition. The lifestyle intervention was guided by social cognitive theory and social ecological principles. It targeted the child’s social and physical home environment by intervening with parental weight-related knowledge, beliefs, and skills for managing child obesogenic behaviors; and addressed families’ needs for community resources supportive of a healthy lifestyle. The two-year CHW-delivered intervention was structured based on the 5As model (Agenda, Assess, Advise, Assist, Arrange follow up) and included two in person sessions and two telephone follow-ups per year with the parent, with a personalized letter and print materials sent after each contact. Parents also received quarterly newsletters, Facebook messages, and invitations to community events. The attention-control comparison condition used the same format and contact time as the intervention condition, but targeted positive parenting skills. Measurements occurred at baseline, and at 6-, 12-, 18- and 24-month follow-up. Assessments included anthropometrics, accelerometry, global positioning system (GPS), and self-report surveys. The primary outcome was child body mass index (BMI) z score. Secondary outcomes were parent BMI; and parent and child diet, physical activity, sedentariness, and utilization of community resources supportive of a healthy lifestyle.DiscussionA CHW-delivered parent-focused lifestyle intervention may provide a translatable model for targeting the high priority public health problem of childhood obesity among low-income diverse communities. If demonstrated effective, this intervention has potential for high impact.Trial registrationClinicalTrials NCT03028233. Registered January 23,2017. The trial was retrospectively registered.
Highlights
One third of U.S children and two thirds of adults are overweight or obese
This paper describes the design and methods of Healthy Kids & Families, a community-based quasi-experimental trial of a parent-focused community health worker (CHW)-delivered intervention for childhood obesity prevention, in accordance with the Transparent Reporting of Evaluations with Nonrandomized Designs (TREND) guidelines [50]
Study objectives The aim of this community-based study was to test the effectiveness of Healthy Kids & Families, a parent-focused CHW-delivered intervention to promote and assist a healthier lifestyle to prevent childhood obesity among low-income and minority families
Summary
Study design This quasi-experimental study was conducted in Worcester, Massachusetts through a partnership between the UMass Worcester Prevention Research Center, the Worcester Public Schools and Oak Hill Community Development Corporation. The family-centered intervention [56] delivery protocol was structured based on the 5As model, which includes setting a shared Agenda for all sessions; Assessing parent/ family’s health-related values, beliefs and motivations for behavior change, history of prior change attempts and monitoring of progress; brief and personalized Advising regarding diet, physical activity and sedentary behaviors; Assisting parents with setting goals and developing an action plan for goal achievement including problem-solving anticipated challenges for change; and Arranging follow up [56,57,58] This model was implemented using motivational interviewing principles that included open-ended questions, a non-judgmental attitude, understanding and working with ambivalence to change, and strategies to reduce resistance [59]. Planned analyses included beginning to assess the sustainability of the intervention
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