The impact of active stakeholder involvement on recruitment, retention and engagement of schools, children and their families in the cluster randomised controlled trial of the Healthy Lifestyles Programme (HeLP): a school-based intervention to prevent obesity

J Lloyd,C Mchugh,J Minton,K Wyatt,H Eke

doi:10.1186/s13063-017-2122-1

Abstract

BackgroundRecruitment and retention of participants is crucial for statistical power and internal and external validity and participant engagement is essential for behaviour change. However, many school-based interventions focus on programme content rather than the building of supportive relationships with all participants and tend to employ specific standalone strategies, such as incentives, to improve retention. We believe that actively involving stakeholders in both intervention and trial design improves recruitment and retention and increases the chances of creating an effective intervention.MethodsThe Healthy Lifestyles Programme, HeLP (an obesity prevention programme for children 9–10 years old) was developed using intervention mapping and involved extensive stakeholder involvement in both the design of the trial and the intervention to ensure that: (i) delivery methods were suitably engaging, (ii) deliverers had the necessary skills and qualities to build relationships and (iii) the intervention dovetailed with the National Curriculum. HeLP was a year-long intervention consisting of 4 multi-component phases using a range of delivery methods. We recruited 1324 children from 32 schools from the South West of England to a cluster-randomised controlled trial to determine the effectiveness of HeLP in preventing obesity. The primary outcome was change in body mass index standard deviation score (BMI SDS) at 24 months post randomisation. Secondary outcomes included additional anthropometric and behavioural (physical activity and diet) measures at 18 and 24 months.ResultsAnthropometric and behavioural measures were taken in 99%, 96% and 94% of children at baseline, 18 and 24 months, respectively, with no differential follow up between the control and intervention groups at each time point. All children participated in the programme and 92% of children and 77% of parents across the socio-economic spectrum were considered to have actively engaged with HeLP.ConclusionsWe attribute our excellent retention and engagement results to the high level of stakeholder involvement in both trial and intervention design, the building of relationships using appropriate personnel and creative delivery methods that are accessible to children and their families across the social spectrum.Trial registrationInternational Standard Randomised Controlled Trials Register, ISRCTN15811706. Registered on 1 May 2012.

Highlights

Recruitment and retention of participants is crucial for statistical power and internal and external validity and participant engagement is essential for behaviour change
This paper presents how we embedded meaningful stakeholder involvement in both the design of the trial and the intervention in order to develop successful strategies in the Healthy Lifestyles Programme (HeLP) cluster Randomised controlled trial (RCT) to maximise recruitment, uptake of the intervention, completeness of follow-up data and the engagement of schools, children and their families across the socio-economic spectrum
Learning was based on the relationship between fiction and reality, allowing children to role-play real-life situations

Summary

Introduction

Recruitment and retention of participants is crucial for statistical power and internal and external validity and participant engagement is essential for behaviour change. Evidence suggests that in industrialised countries low socio-economic status (SES) groups are at higher risk of becoming overweight/obese [5] It is important, that behavioural trials to treat and prevent obesity are able to recruit, retain and engage children and their families across the social spectrum and report on any differences by socio-economic group. That behavioural trials to treat and prevent obesity are able to recruit, retain and engage children and their families across the social spectrum and report on any differences by socio-economic group Recent reviews of both obesity prevention and management trials have highlighted low participation, and high rates of dropout and loss to follow up [6,7,8,9]; few studies discuss the problems experienced with recruiting and retaining children and families or the strategies and/or approaches employed that were helpful [10, 11]

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