Development and feasibility testing of an interactive, educational programme to facilitate Proactive Assessment of Obesity Risk during Infancy: ProAsk

Lead Research Organisation: Anglia Ruskin University
Department Name: Fac of Health, Social Care & Education

Abstract

Children who are above healthy weight are more likely to be ill and to miss time off school. Being overweight in childhood can also sow the seeds for health problems in later life such as heart disease and diabetes. Most overweight children become overweight adults.
One solution is to try to prevent children becoming overweight by intervening very early in life. Researchers have looked at some of the factors which suggest that a baby may be at greater risk of becoming overweight compared to other babies without these risk factors. We have developed a questionnaire which asks parents about these risk factors such as whether their baby was heavy at birth and how quickly their baby is gaining weight. As with all such questionnaires there is a risk that some babies might be identified as at greater risk of becoming overweight children when they are not.
This research project will design a computer-based interactive educational programme to enable health visitors to present this questionnaire to parents, calculate a baby's risk and feed that risk back to parents. Where necessary, health visitors will also present some possible solutions, such as additional help around feeding.
However, the question remains as to whether parents would like to know about their baby's risk of overweight and what they could do to keep their child healthy. We also need to know how health visitors feel about giving this sort of information to parents so the project will ask both health visitors and parents for their views. Parents will also be asked if they would be willing to enter a future study that calculates their baby's overweight risk score and, if this is high, offers additional health visiting support with diet, feeding and physical activity.

Technical Summary

Childhood obesity risk can be identified during infancy and risk models have been developed with moderately good levels of predictability. The Infant Risk of Obesity Checklist (IROC) [1] is a screening tool that can be used with infants at 4 months. However, the impact of implementing risk prediction models into clinical practice has not been explored. This study will design and develop a computer-based educational programme, using interactive multimedia digital technologies, which will sensitively contextualise the problem of childhood obesity and facilitate communication between health practitioners and parents about obesity risk and prevention during infancy. The Proactive Assessment of Obesity Risk during Infancy (ProAsk) programme will be theoretically grounded in the Expanded Health Belief Model (EHBM) [2] and include the IROC [1] and strategies to improve parental feeding behaviour, infant diet and physical activity. A feasibility study will assess parents' and health practitioners' views about obesity risk communication and use a causal model [3] to determine the fit between the intervention strategies and outcome measures, ascertain recruitment and retention rates, determine the availability of data and data collection methods to inform the design of a future definitive trial to evaluate the benefits and harm of ProAsk compared with current practice.
1. Weng S, Redsell, SA, Nathan, D, Swift, JA, Yang, M, Glazebrook, C: Developing an algorithm to estimate overweight risk in childhood from predictors during infancy. Pediatrics, 2013, Published on-line 15th July 2013 doi: 10.1542/peds.2012-3858.
2. Strecher V, Rosenstock I: The Health Belief Model. San Francisco, CA: Jossey-Bass; 1997.
3. Hardeman W, Sutton S, Griffin S, Johnston M, White A, Wareham NJ, Kinmonth AL: A causal modelling approach to the development of theory-based behaviour change programmes for trial evaluation. Health education research 2005, 20(6):676-687.
 
Description All Party Parliamentary Group on Infant Feeding and Inequalities
Geographic Reach National 
Policy Influence Type Participation in a advisory committee
 
Description Proactive Assessment of Obesity Risk during Infancy; the role of health professionals and health technology, talk for British Nutrition Foundation Conference, New perspectives on first foods, complementary feeding and obesity, London 28th April 2015. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Sarah Redsell was invited to give a talk to the British Nutrition Foundation (BNF) Conference. The audience spanned academic, practitioners, students, NGOs and some Industry/Business. The talk was streamed to a wider audience who had signed up in advance. Reach was approximately 90 people. Sarah was interviewed by a member of staff from the BNF using some focused questions. The video was made available on the British Nutrition Foundation website. Furthermore, Sarah was invited to help contribute to nutrition training for health visitors. This work will take place later in 2016. In addition the BNF have agreed to support further research bids in this area.
Year(s) Of Engagement Activity 2015
 
Description Redsell SA on behalf of the ProAsk team. ProActive Assessment of Obesity Risk during Infancy (ProAsk). Presented at Food Matters Live, 23rd November 2016, London, Excel. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Invited speaker at Food Matters Live, 23rd November 2016, London, Excel, I also chaired the session on infant feeding and nutrition.
At least 90 people were in attendance including baby food manufacturers, members of the public, academics and professionals. Questions were limited because of time.
Year(s) Of Engagement Activity 2016
 
Description Rose J, Redsell ProAsk Health Visitor's feedback & engagement session, St Ann's Health Centre, Nottingham, 7th November 2016 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact This session feedback the results of the ProAsk project to health visitors involved in the project and others in their teams. We asked:
What do you think the Pros and Cons are for families of health visitors using the ProAsk tool to identify obesity risk during infancy?
They said: Pros: improved outcomes, enables/empowers parents towards more healthy lifestyles for their children, evidence base to see which areas have more overweight and how to support them, student and many mothers like the device, evidence base to promote with parents,
Cons: people might feel judged, sensitive subject to discuss with parents, need to be diplomatic, device is difficult to use, too jumpy, need better IT skills, delivering at 3-4 months. This isn't a targeted review so we won't be seeing parents.
Do you think ProAsk is something health visitors would find useful in practice?
They said: good for understanding, yes, yes, yes, should be a specialist health visitor role for this, good opportunity to advise families before children start having food, interventions are good if they are targeted and not an extra visit for the health visitor.
Have you changed the way you practice since being involved in the ProAsk study?
They said: ongoing motivational interviewing, assessment of readiness to change, probably made more awareness of the risk/dangers of rapid growth, multifactorial approach. I talk to parents about diet and diet concerns when doing reviews but I wasn't involved in the study.
Do you believe it is appropriate for health visitors to talk to parents about overweight risk?
They said: yes it is, being overweight is emotionally and psychologically concerning, yes, but sensitively, concerned it could lead to underfeeding or reduction in maternal mental health, yes, though it can be hard at times due to language culture. yes, though its hard a times due to it being a sensitive issue, yes - role of public health nurse (x2), yes we have a responsibility to search for health care needs and should communicate risk with parents, therefore providing them with the information needed to make informed choices.
Year(s) Of Engagement Activity 2016
 
Description Rose J, Redsell ProAsk Health Visitor's feedback & engagement session, Young People's Centre, March, Cambridgeshire, 18th October 2016 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Professional Practitioners
Results and Impact This session feedback the results of the ProAsk project to the health visitors involved and others in the region. Practitioners were asked:
Do you believe it is appropriate to communicate overweight risk to parents of infants?
They said: Parents need to be educated, yes, yes, yes, but a difficult conversation, very sensitive topic for some parents, consider the most appropriate time, not just after birth, need to establish a relationship, education in groups when introducing solids, I advise parents of infants under one not to have fat free, low fat food so this would send a mixed message to them, yes but some parents might take offence.
Do you think ProAsk is useful for health visitor practice?
They said: Already using it, not sure, unsure if it is useful for School Nursing, would like to see evidence of effectiveness and data on future outcomes
Have you changed the way your practice since being involved in ProAsk? If so, how?
They said: Supports practice, one of high impact areas on 4-5-6 model, raised awareness of risk factors in babies from a very young age, motivational interviewing now used in a management capacity to help with difficult conversations, supports our practice as diet/weaning is pertinent to our role but not changed yet, not relevant for my role.
What are the Pros and Cons of ProAsk for families:
They said: Pros - using an app/visual cue can be positive, has been shown to reduce long term health conditions (i.e. enuresis), supports conversations. Cons - it should be inclusive, wider family involvement not just mother, families may disengage, find it offensive, time and staff capacity.
Year(s) Of Engagement Activity 2016
 
Description Rose J, Redsell ProAsk parents feedback & engagement session Chatteris Children's Centre, 24th May 2016 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact This session feedback the results of the ProAsk project to the parents involves.
Year(s) Of Engagement Activity 2016
 
Description Rose J, Redsell ProAsk parents feedback & engagement session Whittlesey Children's Centre, 23rd May 2016 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact This session feedback the results of the ProAsk project to the parents involved. There was also a discussion about further work and two parents offered to be involved as PPI.
Year(s) Of Engagement Activity 2016