Digital technology to facilitate Proactive Assessment of Obesity Risk during Infancy (ProAsk): a feasibility study

Sarah A Redsell, Jennie Rose, Stephen Weng, Joanne Ablewhite, Judy Anne Swift, Aloysius Niroshan Siriwardena, Dilip Nathan, Heather J Wharrad, Pippa Atkinson, Vicki Watson, Fiona McMaster, Rajalakshmi Lakshman, Cris Glazebrook, Sarah A Redsell, Jennie Rose, Stephen Weng, Joanne Ablewhite, Judy Anne Swift, Aloysius Niroshan Siriwardena, Dilip Nathan, Heather J Wharrad, Pippa Atkinson, Vicki Watson, Fiona McMaster, Rajalakshmi Lakshman, Cris Glazebrook

Abstract

Objective: To assess the feasibility and acceptability of using digital technology for Proactive Assessment of Obesity Risk during Infancy (ProAsk) with the UK health visitors (HVs) and parents.

Design: Multicentre, pre- and post-intervention feasibility study with process evaluation.

Setting: Rural and urban deprived settings, UK community care.

Participants: 66 parents of infants and 22 HVs.

Intervention: ProAsk was delivered on a tablet device. It comprises a validated risk prediction tool to quantify overweight risk status and a therapeutic wheel detailing motivational strategies for preventive parental behaviour. Parents were encouraged to agree goals for behaviour change with HVs who received motivational interviewing training.

Outcome measures: We assessed recruitment, response and attrition rates. Demographic details were collected, and overweight risk status. The proposed primary outcome measure was weight-for-age z-score. The proposed secondary outcomes were parenting self-efficacy, maternal feeding style, infant diet and exposure to physical activity/sedentary behaviour. Qualitative interviews ascertained the acceptability of study processes and intervention fidelity.

Results: HVs screened 324/589 infants for inclusion in the study and 66/226 (29%) eligible infants were recruited. Assessment of overweight risk was completed on 53 infants and 40% of these were identified as above population risk. Weight-for-age z-score (SD) between the infants at population risk and those above population risk differed significantly at baseline (-0.67 SD vs 0.32 SD). HVs were able to collect data and calculate overweight risk for the infants. Protocol adherence and intervention fidelity was a challenge. HVs and parents found the information provided in the therapeutic wheel appropriate and acceptable.

Conclusion: Study recruitment and protocol adherence were problematic. ProAsk was acceptable to most parents and HVs, but intervention fidelity was low. There was limited evidence to support the feasibility of implementing ProAsk without significant additional resources. A future study could evaluate ProAsk as a HV-supported, parent-led intervention.

Trial registration number: NCT02314494 (Feasibility Study Results).

Keywords: community child health; preventive medicine; public health.

Conflict of interest statement

Competing interests: None declared.

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Figures

Figure 1
Figure 1
Study regimen.
Figure 2
Figure 2
Therapeutic wheel showing the options to support healthy weight.
Figure 3
Figure 3
Study recruitment flow chart. HV, health visitor; ProAsk, Proactive Assessment of Obesity Risk during Infancy.

References

    1. UNICEF, WHO, The World Bank. Joint Child Malnutrition Estimates - Levels and Trends: Key findings of the 2016 edn.
    1. NHS Digital. National Child Measurement Programme in 2016/2015.
    1. Shrewsbury V, Wardle J. Socioeconomic status and adiposity in childhood: a systematic review of cross-sectional studies 1990-2005. Obesity 2008;16:275–84.10.1038/oby.2007.35
    1. Elks CE, Loos RJ, Hardy R, et al. . Adult obesity susceptibility variants are associated with greater childhood weight gain and a faster tempo of growth: the 1946 British Birth Cohort Study. Am J Clin Nutr 2012;95:1150–6.10.3945/ajcn.111.027870
    1. Dubois L, Ohm Kyvik K, Girard M, et al. . Genetic and environmental contributions to weight, height, and BMI from birth to 19 years of age: an international study of over 12,000 twin pairs. PLoS One 2012;7:e3015310.1371/journal.pone.0030153
    1. Redsell S, Edmonds B, Nathan D, et al. . Systematic review of behavioural and non-behavioural interventions, delivered during infancy and the antenatal period, that reduce the risk of overweight and obesity in childhood. Matern Child Nutr 2015.
    1. Redsell SA, Atkinson P, Nathan D, et al. . Parents' beliefs about appropriate infant size, growth and feeding behaviour: implications for the prevention of childhood obesity. BMC Public Health 2010;10:711.10.1186/1471-2458-10-711
    1. Redsell S, Atkinson PJ, Nathan D, et al. . Preventing childhood obesity during infancy in UK primary care: a mixed-methods study of HCPs’ knowledge. beliefs and practice BMC Family Practice 2011;12:54.
    1. Redsell SA, Swift JA, Nathan D, et al. . UK health visitors' role in identifying and intervening with infants at risk of developing obesity. Matern Child Nutr 2013;9:396–408.10.1111/j.1740-8709.2012.00427.x
    1. Weng SF, Redsell SA, Swift JA, et al. . Systematic review and meta-analyses of risk factors for childhood overweight identifiable during infancy. Arch Dis Child 2012;97:1019–26.10.1136/archdischild-2012-302263
    1. Woo Baidal JA, Locks LM, Cheng ER, et al. . Risk factors for childhood obesity in the first 1,000 Days: a systematic review. American Journal of Preventive Medicine 2016;50:761–79.
    1. Weng S, Redsell SA, Nathan D, et al. . Developing an algorithm to estimate overweight risk in childhood from predictors during infancy. Pediatrics 2013;132:e414–e421.
    1. Elks CE, Loos RJ, Sharp SJ, Langenberg C, et al. . Genetic markers of adult obesity risk are associated with greater early infancy weight gain and growth. PLoS Med 2010;7:e100028410.1371/journal.pmed.1000284
    1. Druet C, Stettler N, Sharp S, et al. . Prediction of childhood obesity by infancy weight gain: an individual-level meta-analysis. Paediatr Perinat Epidemiol 2012;26:19–26.10.1111/j.1365-3016.2011.01213.x
    1. Ekelund U, Ong K, Linné Y, et al. . Upward weight percentile crossing in infancy and early childhood independently predicts fat mass in young adults: the Stockholm Weight Development Study (SWEDES). Am J Clin Nutr 2006;83:324–30.
    1. Hui LL, Schooling CM, Leung SS, et al. . Birth weight, infant growth, and childhood body mass index: Hong Kong's children of 1997 birth cohort. Arch Pediatr Adolesc Med 2008;162:212–8.10.1001/archpediatrics.2007.62
    1. Ong KK, Loos RJ. Rapid infancy weight gain and subsequent obesity: systematic reviews and hopeful suggestions. Acta Paediatr 2006;95:904–8.10.1080/08035250600719754
    1. Baird J, Fisher D, Lucas P, et al. . Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ 2005;331:929.10.1136/bmj.38586.411273.E0
    1. Monteiro PO, Victora CG. Rapid growth in infancy and childhood and obesity in later life--a systematic review. Obes Rev 2005;6:143–54.10.1111/j.1467-789X.2005.00183.x
    1. Redsell SA, Weng S, Swift JA, et al. . Validation, Optimal Threshold Determination, and Clinical Utility of the Infant Risk of Overweight Checklist for Early Prevention of Child Overweight. Child Obes 2016;12:202–9.10.1089/chi.2015.0246
    1. UCL Institute of Education. Centre for Longitudinal Studies: Millenium Cohort Study, 1970.
    1. University of Bristol. Avon Longitudinal Study of Parents and Children (ALSPAC).
    1. Ferguson M, Brandreth M, Brassington W, et al. . A randomized controlled trial to evaluate the benefits of a multimedia educational program for first-time hearing aid users. Ear Hear 2016;37:123–36.10.1097/AUD.0000000000000237
    1. Raaff C, Glazebrook C, Wharrad H. A systematic review of interactive multimedia interventions to promote children's communication with health professionals: implications for communicating with overweight children. BMC Med Inform Decis Mak 2014;14:8.10.1186/1472-6947-14-8
    1. Manning JC, Latif A, Carter T, et al. . 'Our Care through Our Eyes': a mixed-methods, evaluative study of a service-user, co-produced education programme to improve inpatient care of children and young people admitted following self-harm. BMJ Open 2015;5:e009680.10.1136/bmjopen-2015-009680
    1. Widmer RJ, Allison TG, Keane B, et al. . Using an online, personalized program reduces cardiovascular risk factor profiles in a motivated, adherent population of participants. Am Heart J 2014;167:93–100.10.1016/j.ahj.2013.09.019
    1. Glazebrook C, Garrud P, Avery A, et al. . Impact of a multimedia intervention "Skinsafe" on patients' knowledge and protective behaviors. Prev Med 2006;42:449–54.10.1016/j.ypmed.2006.02.007
    1. Gordon D. Breaking Barriers: Management of Cancer-related Pain (Educational CD ROM). Clin J Pain 2009;25:351.10.1097/AJP.0b013e3181862396
    1. Borrelli B, Tooley EM, Scott-Sheldon LA. Motivational interviewing for parent-child health interventions: a systematic review and meta-analysis. Pediatr Dent 2015;37:254–65.
    1. Resnicow K, McMaster F, Bocian A, et al. . Motivational interviewing and dietary counseling for obesity in primary care: an RCT. Pediatrics 2015;135:649–57.10.1542/peds.2014-1880
    1. Craig P, Dieppe P, Macintyre S, et al. . Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:337.
    1. Bugge C, Williams B, Hagen S, et al. . A process for Decision-making after Pilot and feasibility Trials (ADePT): development following a feasibility study of a complex intervention for pelvic organ prolapse. Trials 2013;14:353.10.1186/1745-6215-14-353
    1. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3 edn, 2013.
    1. Edwards EJ, Stapleton P, Williams K, et al. . Building skills, knowledge and confidence in eating and exercise behavior change: brief motivational interviewing training for healthcare providers. Patient Educ Couns 2015;98:674–6.10.1016/j.pec.2015.02.006
    1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987;150:782–6.10.1192/bjp.150.6.782
    1. Spitzer RL KK, Williams JB, et al. . Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA 1999;282:1737–44.
    1. Spitzer RL, Kroenke K, Williams JB, Löwe JBW, et al. . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006;166:1092–7.10.1001/archinte.166.10.1092
    1. World Health Organisation. Child Growth Standards - Weight Velocity.
    1. Redsell SA, Edmonds B, Swift JA, et al. . Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood. Matern Child Nutr 2016;12:24–38.10.1111/mcn.12184
    1. Johnston C, Mash EJ. A Measure of Parenting Satisfaction and Efficacy. J Clin Child Psychol 1989;18:167–75.10.1207/s15374424jccp1802_8
    1. Gilmore L, Cuskelly M. Factor structure of the parenting sense of competence scale using a normative sample. Child Care Health Dev 2009;35:48–55.10.1111/j.1365-2214.2008.00867.x
    1. Baughcum AE, Powers SW, Johnson SB, et al. . Maternal feeding practices and beliefs and their relationships to overweight in early childhood. J Dev Behav Pediatr 2001;22:391–408.10.1097/00004703-200112000-00007
    1. Boyatzis R, Transforming Qualitative Information: Thematic Analysis and Code Development. Thousand Oaks, California: Sage Publications, 1998.
    1. HM Government Department for Communities and Local Government. Income Deprivation Affecting Children Index (IDACI, 2015.
    1. Bowling A. Research Methods in Health: Investigating health and health services. Buckingham: Open University Press, 2002.
    1. Schmitt N. Uses and abuses of coefficient alpha. Psychol Assess 1996;8:350–3.10.1037/1040-3590.8.4.350
    1. Emmel N, Hughes K, Greenhalgh J, et al. . Accessing socially excluded people ó trust and the gatekeeper in the researcher-participant relationship. Sociol Res Online 2007;1210.5153/sro.1512
    1. Parry O, Bancroft A, Gnich W, et al. . Nobody home? Issues of respondent recruitment in areas of deprivation. Crit Public Health 2001;11:305–17.10.1080/09581590110094585
    1. Jennings CG, MacDonald TM, Wei L, et al. . Does offering an incentive payment improve recruitment to clinical trials and increase the proportion of socially deprived and elderly participants? Trials 2015;16:8010.1186/s13063-015-0582-8
    1. Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health 2010;100:1019–28.10.2105/AJPH.2009.159491
    1. Mytton J, Ingram J, Manns S, et al. . The feasibility of using a parenting programme for the prevention of unintentional home injuries in the under-fives: a cluster randomised controlled trial. Health Technol Assess 2014;18:1–184.10.3310/hta18030
    1. Preston NJ FM, Walshe CE , et al. . Strategies designed to help healthcare professionals to recruit participants to research studies: John Wiley & Sons, Ltd, 2016.
    1. Bonevski B, Randell M, Paul C, et al. . Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. BMC Med Res Methodol 2014;14:42.10.1186/1471-2288-14-42
    1. Hughes-Morley A, Young B, Waheed W, et al. . Factors affecting recruitment into depression trials: Systematic review, meta-synthesis and conceptual framework. J Affect Disord 2015;172:274–90.10.1016/j.jad.2014.10.005
    1. NHS Constitution. National Health Visiting Service Specification in 2014/2015.
    1. Ferguson M, Brandreth M, Brassington W, et al. . Information retention and overload in first-time hearing aid users: an interactive multimedia educational solution. Am J Audiol 2015;24:329–322.10.1044/2015_AJA-14-0088
    1. Szeszak S, Man R, Love A, Langmack G, et al. . Animated educational video to prepare children for MRI without sedation: evaluation of the appeal and value. Pediatr Radiol 2016;46:1744–50.10.1007/s00247-016-3661-4

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera