Feasibility study of a childhood obesity risk estimation tool
Research type
Research Study
Full title
Phase one of Wessex FRIEND (Family Risk IdEntificatioN and Decision): Feasibility testing of a Childhood Obesity Risk Estimation tool
IRAS ID
274818
Contact name
Nisreen A Alwan
Contact email
Sponsor organisation
University of Southampton
Duration of Study in the UK
0 years, 11 months, 12 days
Research summary
Research Summary:
Background
Obesity is one of the most pressing health concerns worldwide and childhood obesity is increasing across the UK. Our team has developed an online childhood obesity risk estimation tool, SLOPE CORE (Studying Lifecourse Obesity PrEdictors: Childhood Obesity Risk Estimation).Aim
The aim of this study is to test the feasibility of the SLOPE CORE tool, in a health care setting. This will enable the tool to be refined in preparation for further testing for effectiveness in combination with obesity prevention initiatives and eventual roll out.Methods
This study will utilise mixed methods to undertake feasibility testing of the SLOPE CORE tool, within an enhanced health-visiting programme available across Portsmouth and Southampton cities. Participating Health Visitors (HVs) will recruit families to the study, and then use the tool during one of their routine visits. A System Usability Scale will be used to assess the usability of the tool. Focus groups will then take place with both HVs and families enrolled on the study to gain a more detailed understanding of the feasibility of the tool in this setting. This will include gathering information about the ECHO programme and the relationship that develops between HVs and families.
Implications of the research
This research will test the feasibility of the SLOPE CORE tool. It will highlight any changes needed and allow us to refine the tool and ensure that it is useful in practice. It will help us to better understand the context in which the tool will be used and the impact that the relationships between HVs and families may have on families reaction to the tool. Once this is complete, the next steps would be to test the tool’s effectiveness in combination with an intervention for the prevention of childhood obesity, and then roll out the tool across the health-visiting programmes in our area. This will allow us to undertake further evaluation of the tool and prepare it for potential use nationwide.Summary of Results:
We would like to thank all the parents and health visitors who generously gave their time to take part in this study.
Study title
Phase one of Wessex FRIEND (Family Risk IdEntificatioN and Decision): Feasibility testing of a Childhood Obesity Risk Estimation tool Who carried out the research?
This research was sponsored by the University of Southampton, and carried out by a team based mainly at the University of Southampton, with collaborators from related health and academic institutions. The study was funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Wessex.What public involvement there was in the study?
Patients and members of the public were actively involved in shaping the study. Two contributors were members of the research steering committee and four contributors were recruited during the study. Contributors included people from different ethnic backgrounds and they provided input on:
• How the tool should present risk
• How to communicate results clearly
• What additional support families might need alongside the tool
Where and when did the study take place?
The study took place in an enhanced NHS health visiting service in the south of England (UK). It was conducted between November 2020 and May 2021 Why was the research needed?
Childhood obesity is a major public health issue. Many children who are go on to be overweight in adulthood, which can lead to long-term health problems. Preventing obesity early in life is more effective than trying to treat it later. However, identifying which children are most at risk can be difficult.
The SLOPE CORE tool was developed to estimate a child’s risk of becoming obese using information already collected during pregnancy and early childhood. Before using the tool more widely, it is important to understand whether it is practical, acceptable and easy to use in the real-world.
Factors influencing parent’s dietary choices are complicated. Understanding more about why people choose the foods that they eat could help us to better support families to eat healthy foods. We know that healthy diets are expensive. The Healthy Start scheme aims to help families to afford healthy foods. If we understand more about how families make eating decisions and how the Healthy Start scheme works in real life then we could suggest changes to improve Healthy Start.What were the main questions studied?
The study aimed to find out:
• Is the SLOPE CORE tool feasible to use in routine healthcare?
• Is it acceptable to parents and health visitors?
• Is it easy to use in practice?
• What do parents and health visitors think about the enhance health visiting service?
• What are the barriers and enablers of healthy diets?
• How do parents make food shopping decisions?
• What are the barriers and enablers of the healthy Start Scheme?Who participated in the study?
There were 12 participants in the study, five health visitors and seven parents.What intervention did participants receive?
Health visitors used the SLOPE CORE online tool with parents. The tool calculated a child’s risk of obesity at ages 4–5 years. Results were shown as a percentage and categorised as low, medium or high risk.
What adverse reactions did participants have?
No physical medical problems occurred, but one parent reported that discussing weight in pregnancy could feel uncomfortable or distressing. Health visitors highlighted that conversations about obesity risk can be sensitive and require care.What happened during the study?
Health visitors were trained to use the tool and then they used it during visits with pregnant women and parents of young children. After using the tool, health visitors completed a usability questionnaire and joined focus groups. Parents were invited to interviews to share their experiences. Questions focused on the SLOPE CORE Tool, the health visiting services and the factors that affect families diets.What were the results of the study?
The tool was rated as highly usable, with an average usability score of 84.4 out of 100 (excellent usability). Both parents and health visitors generally found it:
• Easy and quick to use
• Acceptable in practice
Parents said they wanted to know their child’s risk, especially if support was available. Health visitors felt the tool helped start difficult conversations about weight and provided objective evidence, reducing reliance on personal judgement.
Some challenges included:
• Need for internet access
• Time required for sensitive discussions
• Difficulty explaining the concept of risk to some parents
Parents shared several things that make it difficult for them to eat healthy diets.
• Cost and availability of healthy food
• Time for food preparation
• Food preferences of parents and children
Access to cheaper food (Healthy Start, own brand, food banks and food wastage schemes) helped parents to eat healthily.
Health visitors shared what they thought made it difficult for parents to make healthy choices:
• Cost of healthy food
• Availability of shops locally
• Lack of transport options to get to cheaper, larger shops
• Easy access to fast food
• Lacking cooking skills
• Insufficient cooking equipment, facilities or food storage space
• Difficult with forward planningHealth visitors also shared what they thought made it easier for parents to make healthy choices:
• Discounted and free food
• Education around diet and cooking
When talking about Healthy Start health visitors felt that the provision of information and removal of the need for a healthcare professional’s signature enabled parents to access the scheme. They also identified several barriers to the scheme, language barriers, poor understanding of the scheme the strict eligibility criteria which excludes some groups such as asylum seekers. They suggested the following changes to improve the scheme: using electronic cards rather than paper vouchers, providing translators or translated materials, increasing the number of foods included, incentives for breastfeeding mothers and making the eligibility criteria more generous.Parents and health visitors were extremely positive about the enhanced health visiting service. Health visitors felt that the programme gave them the opportunity to support families with preventative advice and health improvement as well as problem solving issues as they came up. They felt that the number of visits was key in creating a good relationship with the family under their care. Health visitors felt that they were able to have a positive impact on the families that they worked with.
On the other hand, health visitors felt that they didn’t always have the time to deliver the programme in the way that they would have liked, and that sometimes they were left to support families with issues that should have been delt with by other services.
Parents generally had low expectations of the service but were pleasantly surprised by the support that they received. They were very positive about their relationship with their health visitor, and trusted them to give good advice. They felt that the frequent visits of the programme and the non-judgemental approach of the health visitors was key in developing this trust.
How has this study helped patients and researchers?
This study found that:The tool could help identify children at higher risk of obesity earlier. It may support healthcare professionals to target limited resources to families who need them most. It could help facilitate important conversations about diet, lifestyle and health. It highlights the importance of combining risk information with support and advice.
There are many factors that affect how families eat, and lots of them are outside of the parent’s control. This can make it difficult for parents to improve their family’s diet without any help. Healthy Start might one thing that could help families to eat more fruit and vegetables, but there are some things that make it difficult to apply for and use the scheme. Making changes to the scheme could help to make it more useful and easier to access for more people.
When thinking about the enhanced health visiting programme, the number and timing of the appointments, as well as the non-judgemental attitude of the health visitors, helped to build a good relationship between the health visitor and the family. Health visitors felt that this helped them to improve outcomes for the families under their care.Details of any further research planned
Further research is needed to:
• Test the tool in larger groups
• Understand how best to integrate it into routine care
• Assess whether using the tool (with support) helps to prevent childhood obesity
Further research is ongoing to better understand the things that affect families diets and how the healthy start scheme could be improved.Where can I learn more about this study?
Part of the study is published in BMC Public Health (2023)DOI: 10.1186/s12889-023-16500-2REC name
South Central - Hampshire A Research Ethics Committee
REC reference
20/SC/0099
Date of REC Opinion
11 May 2020
REC opinion
Further Information Favourable Opinion