Integrating an effective obesity prevention program into existing home visiting services: The Healthy Beginnings Program

Abstract

Background/Aim : The establishment of effective and sustainable programs to promote healthy weight gain in the first years of life is a public health priority given the elevated rates of childhood overweight and obesity worldwide. Healthy Beginnings (HB) was a world-first randomised control trial to demonstrate the effectiveness of an intensive (eight sessions), home-based early obesity prevention intervention delivered by nurses from the third trimester until two years of age. The HB intervention targeting first-time mothers was effective in improving infant feeding practices, reducing TV viewing time and child body mass index (BMI) at two years. However, the program was not cost effective or sustainable without integrating with existing services. The aim of this study is to explore how the HB program has been integrated into existing on-going home-visiting services within New South Wales. Method/Results : In 2016, a steering committee was established by the Chief Executive of the Sydney Local Health District (SLHD) to instigate the integration of the HB program in existing home-visiting services in SLHD. The Healthy Families Healthy Children program, a sustained health home-visiting program targeting vulnerable families in SLHD and the HB team contributed to the development of an addendum. The addendum provided an overview of the service including eligibility criteria to engage families, the modules covered in the program (including behaviours targeted in the HB program), the program schedule (including the integration of the eight HB sessions over two years) and data collection (including expected HB outcomes). The nurses delivering the home visits were provided with a visit checklist containing standard minimum information as well as resources to support key messages developed from the HB Trial. For the purpose of this study a mixed methods approach will be used to explore the barriers, facilitators and effectiveness of integrating the HB program into the sustained health home-visiting program targeting vulnerable families in SLHD. Qualitative interviews will be conducted with higher, middle and program managers aimed at exploring their thoughts and experiences with integrating HB. Focus groups will be conducted with nurses delivering the HB sessions in order to explore their experiences with implementation. The researcher will observe the HB sessions delivered during home-visits and explore clients’ experiences and satisfaction with the sessions. Further, to measure the effectiveness of the integration, the data collected from the electronic medical record on infant feeding behaviours of the clients involved in the home-visits will be analysed. Conclusions/implications : The findings of this study will inform the integration of HB across other Local Health Districts in NSW. More broadly, this study will provide insight into the translation of an evidence-based health promotion program into a real-world setting.