Scoping the impact of NCMP feedback on the child obesity pathway – Study results Falconer, C;...
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Transcript of Scoping the impact of NCMP feedback on the child obesity pathway – Study results Falconer, C;...
Scoping the impact of NCMP feedback on the child obesity pathway – Study resultsFalconer, C; Park, MH; Croker, H; Skow, A; Black, J; Saxena, S; Kessel, A;Morris, S; Karlsen, S; Viner, R; and Kinra, S.
Improving health worldwide www.lshtm.ac.uk
1. To increase public understanding of child weight issues;
2. To engage families with the issue of healthy weight in children;
3. To offer information, advice and services which provide an opportunity for families to make healthy lifestyle choices.
Aims of NCMP feedback
Study Aims
1. To estimate the impact of NCMP feedback on parental risk perceptions, parental acceptance of the feedback and associated behaviour change and health service use;
2. To identify barriers and levers to behaviour change and health service use, particularly among deprived/ethnic minority groups;
3. To determine which feedback approach (letter versus pro-active) has the greatest positive impact.
Methods
• Parents of children enrolled in the NCMP in 5 PCTS (N=18,000):– Redbridge– Islington,– West Essex,– Bath and North East Somerset (BANES) – Sandwell PCT
• Questionnaire surveys at three time points– Baseline– One month, 6 months and 1 year post feedback
• Interviews with parents of 52 overweight and very overweight children
Time-line
Results
• 1,844 parents completed a questionnaire at baseline and follow-up
• Weight status:– 9.7% overweight – 5.7% very overweight
• Ethnicity:– 66% white – 15.7% Asian– 5.5% Black– 12.8% mixed/other
• Comparable to NCMP population
Participants
• Parental knowledge was high? – Baseline 72.5%– Follow-up 79.7%
• Assessed parents’ knowledge of future health risks associated with child overweight
Aim 1: Public awareness of child overweight
• Parental acceptance of child’s overweight category– Baseline 22%– Follow-up 38%
• Parental perception of their child’s weight as a health risk– Baseline 21%– Follow-up 27%
• BUT these changes were not as big as you would expect
Aim 2: Engage families with overweight children
Disagreement with feedback“I look at him and I see puppy fat. I don’t see overweight fat. I think
they’re two different things”
Parents view their child in terms of their physical and emotional functioning and not their weight
“If she’s not active I would be worried. Yes but she’s active, she runs she do all of them things so I’m not worried about her health”
Comparisons to other children“He honestly doesn’t look overweight to me so you see children in the
street and they’re little round puddings. He’s not one of them”
Rationalising – failed attempts before?
Why?
• 36.6% parents sought further help or information following NCMP feedback
Aim 2: Engage families with overweight children
0 5 10 15 20
Contact no. on the letter
School or school nurse
Dietician/pharmacist
Other parents/ family or …
NHS Choices
Change 4 life
Other internet sites
A GP
Proportion of parents
Help seeking
Very overweight
Overweight
Lack of knowledge“I don’t think I need to go to the GP unless she’s ill or something. I don’t
know. What would you suggest?”
Mis-information“He said ‘Looking at her she looks perfectly healthy so I wouldn’t be too
concerned about that side of things’. It gave me reassurance”
“Sometimes I used to check with the doctor, GP, whether his height and weight is normal. The doctor when he sees him, ‘I think he’s normal’, and they didn’t find him as overweight”
Aim 2: Engage families with overweight children
• After NCMP feedback:–Dietary behaviour was unchanged–Physical activity was unchanged
(increased in very overweight only)–Screen-time increased
Aim 3: Encourage behaviour change
Lack of knowledge“I do give fish fingers and I don’t know whether it’s healthy or not…If I
can get proper guidance of what I should give her”
Availability/access to services“At the local sports centre they have things going on but things are so
expensive to pay for that is a lot…I always keep thinking, oh I want him to do another thing, but we just don’t have the funds to do that”
Perceived healthy lifestyleThen actually I threw the letter away because I thought I’m not going to
alter her diet. She eats, as far as I’m concerned a healthy diet. She does sport”
Why?
• After NCMP feedback– Frequency of weight-related teasing remained
unchanged• 10% overweight children• 2% healthy weight children
– Frequency of bouts of low self-esteem remained unchanged • 4% overweight children• 1% healthy weight children
Does it cause any harm?
• Emotions reported after NCMP feedback in parents of overweight children:– 22.8% upset– 15.4% guilty – 14.8% angry
BUT:• 87.2% of parents found the feedback to be somewhat or very
helpful• 70% would encourage future participation in the NCMP• Only 1.8% would withdraw their child in the future
Parental experience of NCMP feedback
• Parents of non-white children:– Lower knowledge of the health risks of child
overweight– Greater change in recognition of the health risks
following weight feedback– More likely to seek help
• Parents of older children– More recognised overweight and associated health
risks
Effect of population characteristics on the impact of NCMP feedback
• Pro-active feedback:– More accepted the feedback result• 10% change with letter• 32% change with pro-active
– No additional impact on behaviour• But– Additional cost• Letter: £1.24/child• Pro-active: £9.50/child for phone call and £41/child for
appointment• Parents prefer the letter
Effect of feedback type on the impact of NCMP feedback
Recommendations
• Feedback letter is moderately effective and well received by parents
• Suggested actions: – Continue to provide routine letter feedback to all parents of children
participating in the NCMP
• Proactive feedback offered some additional benefit but comes at an additional cost and is less preferred by parents
• Suggested actions:– Re-think the best use of the additional costs.
• Consider investing these resources in:– Providing additional contacts to parents– Increasing the capacity of local services– Improving the capability of staff delivering interventions
Feedback
• Parents are willing to seek help, but may not be finding the best information
• Suggested actions:– Make it easier for parents to access the right information• Make high quality information more accessible• NCMP champions at schools
– Ensure that the capacity of local services is sufficient to deal with any increased help-seeking
– Engage with GPs
Provision of information and help-seeking
Thanks for listening
• PROMISE Research– http://www.promiseresearch.org.uk
• HELP trial– http://helptrial.org.uk
Help seeking by ethnicity
Help seeking by SES