Abstract
BackgroundBehavioural interventions for the early prevention of childhood obesity mostly focus on English-speaking populations in high-income countries. Cultural adaptation is an emerging strategy for implementing evidence-based interventions among different populations and regions. This paper describes the initial process of culturally adapting Healthy Beginnings, an evidence-based early childhood obesity prevention program, for Arabic and Chinese speaking migrant mothers and infants in Sydney, Australia.MethodsThe cultural adaptation process followed the Stages of Cultural Adaptation theoretical model and is reported using the Framework for Reporting Adaptations and Modifications-Enhanced. We first established the adaptation rationale, then considered program underpinnings and the core components for effectiveness. To inform adaptations, we reviewed the scientific literature and engaged stakeholders. Consultations included focus groups with 24 Arabic and 22 Chinese speaking migrant mothers and interviews with 20 health professionals. With input from project partners, bi-cultural staff and community organisations, findings informed cultural adaptations to the content and delivery features of the Healthy Beginnings program.ResultsProgram structure and delivery mode were retained to preserve fidelity (i.e. staged nurse calls with key program messages addressing modifiable obesity-related behaviours: infant feeding, active play, sedentary behaviours and sleep). Qualitative analysis of focus group and interview data resulted in descriptive themes concerning cultural practices and beliefs related to infant obesity-related behaviours and perceptions of child weight among Arabic and Chinese speaking mothers. Based on the literature and local study findings, cultural adaptations were made to recruitment approaches, staffing (bi-cultural nurses and project staff) and program content (modified call scripts and culturally adapted written health promotion materials).ConclusionsThis cultural adaptation of Healthy Beginnings followed an established process model and resulted in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers. This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness.
Highlights
Behavioural interventions for the early prevention of childhood obesity mostly focus on Englishspeaking populations in high-income countries
This paper reports the process of culturally adapting Healthy Beginnings delivered by telephone among Arabic and Chinese speaking migrant mothers in Sydney, Australia and summarises the adapted intervention
Studies find that migrant mothers in high-income English-speaking countries commonly experience being ‘between cultures’ when accessing maternity care [60, 61] and making infant feeding decisions [62]
Summary
Behavioural interventions for the early prevention of childhood obesity mostly focus on Englishspeaking populations in high-income countries. Nutrition and physical activity in the first 2000 days of a child’s life - from conception until 5 years - are important predictors of healthy weight during childhood and later life [1, 2]. This critical period for childhood obesity prevention is a global priority for establishing lifelong health [3]. Diverse ethnic and cultural minority populations experience higher childhood obesity prevalence rates and show differences in early life behavioural risk factors [5, 6]. Cultural feeding practices and traditional foods can be protective of obesity development [9]
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