A Multisource Process Evaluation of a Community-Based Healthy Lifestyle Programme for Child and Adolescent Obesity
Author:
Anderson Yvonne C.12345ORCID, Wild Cervantée E. K.1ORCID, Gilchrist Catherine A.1ORCID, Hofman Paul L.56, Cave Tami L.5, Domett Tania7, Cutfield Wayne S.56ORCID, Derraik José G. B.15ORCID, Grant Cameron C.16ORCID
Affiliation:
1. Department of Paediatrics: Child and Youth Health, Grafton Campus, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand 2. Curtin Medical School, Faculty of Health Sciences, Curtin University, Bentley, WA 6102, Australia 3. Telethon Kids Institute, Perth Children’s Hospital, Nedlands, WA 6009, Australia 4. Child and Adolescent Community Health, Child and Adolescent Health Service, Perth, WA 6009, Australia 5. Liggins Institute, University of Auckland, Auckland 1142, New Zealand 6. Starship Children’s Hospital, Auckland District Health Board, 2 Park Road, Grafton, Auckland 1023, New Zealand 7. Cogo Consulting, 58 Surrey Crescent, Grey Lynn, Auckland 1141, New Zealand
Abstract
Whānau Pakari is a healthy lifestyle assessment and intervention programme for children and adolescents with obesity in Taranaki (Aotearoa/New Zealand), which, in this region, replaced the nationally funded Green Prescription Active Families (GRxAF) programme. We compared national referral rates from the GRxAF programme (age 5–15 years) and the B4 School Check (B4SC, a national preschool health and development assessment) with referral rates in Taranaki from Whānau Pakari. We retrospectively analysed 5 years of clinical data (2010–2015), comparing referral rates before, during, and after the Whānau Pakari clinical trial, which was embedded within the programme. We also surveyed programme referrers and stakeholders about their experiences of Whānau Pakari, analysing their responses using a multiple-methods framework. After the Whānau Pakari trial commenced, Taranaki GRxAF referral rates increased markedly (2.3 pretrial to 7.2 per 1000 person-years), while NZ rates were largely unchanged (1.8–1.9 per 1000 person-years) (p < 0.0001 for differences during the trial). Post-trial, Taranaki GRxAF referral rates remained higher irrespective of ethnicity, being 1.8 to 3.2 times the national rates (p < 0.001). Taranaki B4SC referrals for obesity were nearly complete at 99% in the last trial year and 100% post-trial, compared with national rates threefold lower (31% and 32%, respectively; p < 0.0001), with Taranaki referral rates for extreme obesity sustained at 80% and exceeding national rates for both periods (58% and 62%, respectively; p < 0.01). Notably, a referral was 50% more likely for referrers who attended a Whānau Pakari training half-day (RR = 1.51; p = 0.009). Stakeholders credited the success of Whānau Pakari to its multidisciplinary team, family-centred approach, and home-based assessments. However, they highlighted challenges such as navigating multidisciplinary collaboration, engaging with families with complex needs, and shifting conventional healthcare practices. Given its favourable referral trends and stakeholder endorsement, Whānau Pakari appears to be a viable contemporary model for an accessible and culturally appropriate intervention on a national and potentially international scale.
Funder
Health Research Council of NZ Royal Australasian College of Physicians Maurice and Phyllis Paykel Trust Taranaki Medical Foundation Lotteries Health Research
Reference40 articles.
1. Commission on Social Determinants of Health (2008). Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health—Final Report of the Commission on Social Determinants of Health, World Health Organization. 2. World Health Organisation (2016). Report of the Commission on Ending Childhood Obesity, World Health Organization. 3. Ministry of Health (2022). Annual Update of Key Results 2020/2021: New Zealand Health Survey, Ministry of Health. 4. Smylie, J., Adomako, P., Crengle, S., Freemantle, J., Gallaher, G., McAullay, D., Kelly McShane, K., and Taualii, M. (2009). Indigenous Children’s Health Report: Health Assessment in Action, University of Toronto. 5. Effectiveness of weight management interventions in children: A targeted systematic review for the USPSTF;Whitlock;Pediatrics,2010
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