Healthier Together: Implementation and evaluation of a co-designed, culturally tailored childhood obesity community prevention program for Maori and Pacific Islander children and families.

ISSUE ADDRESSED: Co-designed and culturally tailored preventive initiatives delivered in childhood have high potential to close the cross-cultural gap in health outcomes of priority populations. Maori and Pacific Islander people living in Australia exhibit a higher prevalence of overweight and obesity and higher rates of multimorbidity, including heart disease, cancer and diabetes. METHODS: This mixed-methods, pilot implementation and evaluation study, aimed to evaluate the implementation of a community-based, co-designed and culturally tailored childhood obesity prevention program, using quantitative (pre-post anthropometric measurement, pre-post health behaviour questionnaire) and qualitative (semi-structured interview) methods. Sessions relating to healthy eating, physical activity and positive parenting practices were delivered to families residing in Brisbane (Australia) over 8-weeks. RESULTS: Data were collected from a total of 66 children (mean age 11, SD 4) and 38 parents (mean age 40, SD 8) of Maori and Pacific Islander background, from July 2018 to November 2019. Anthropometric changes included a reduction in Body Mass Index (BMI) z-score among 59% of children (median change -0.02, n = 38, p = 0.17) and BMI among 47% of adults (median change +0.06 kg/m2 , n = 18, p = 0.64). Significant improvements (p < 0.05) in self-reported health behaviours from pre- to post-program included increased vegetable consumption among children, decreased discretionary food intake of children, decreased discretionary drink consumption among both children and adults, increased minutes of daily physical activity among adults and increased parental confidence in the healthy diets of their children. Qualitative data revealed participants valued the inclusion of all family members, learning of practical skills and cultural tailoring delivered by the Multicultural Health Coaches. CONCLUSIONS: This study provides preliminary evidence that the Healthier Together program improved self-reported health behaviours and physical activity levels among Maori and Pacific Islander children and their families in the short-term; however, due to the small sample size, these results must be interpreted carefully. The program empowered change via cultural tailoring and accessibility; however, long-term implementation and evaluation with a larger cohort is needed to validate the observed health behaviour improvements and their sustainability. SO WHAT?: The co-design framework that informed program development and key learnings of implementation will provide guidance to health practitioners, health workers, public health professionals and policy makers to develop inclusive and pragmatic co-design solutions for priority cultural populations in Australia. Health outcomes will improve as a result, promoting health equity for future generations.

What Do Health Professionals and Parents Want as Part of an Online Childhood Obesity Prevention Program?

Background: There are limited evidence-based programs for children living in Queensland, Australia, who are at risk of overweight or obesity. Despite the known importance of prevention initiatives, an online, locally relevant program supporting sustainable health behaviors does not exist. This study aimed to understand the perspectives of parents/guardians and health professionals regarding important aspects of an online childhood obesity prevention program. Methods: This pragmatic, mixed-methods study was conducted from March to December 2020. Recruitment included participants from two groups involved with children aged 2-17 years, health professionals, and parents/guardians. Phase 1 involved dissemination of an online survey. Questions addressed program structure, content delivery (including nutrition, physical activity, and parenting practices), program evaluation, and information dissemination. Descriptive statistics were used to describe survey data to inform the delivery of Phase 2, where two focus groups further explored the topics. Thematic analysis was used to investigate the qualitative data. Results: Twenty-eight health professionals and 11 parents/guardians completed the survey, and 14 health professionals and 6 parents/guardians participated in the focus groups. Participants believed that the most beneficial approach would target younger children with family-based interventions, via a nontraditional structure. There was a strong preference for interactive content, gamification, and practical resources to translate knowledge into practice. Parents emphasized that there should be no assumption of basic knowledge, and that decision fatigue is a barrier to engagement. Conclusion: Participants provided clear direction regarding key aspects for future development of an online prevention program, highlighting the importance of codesign to tailor the program to identified needs.

Healthier Together: Co-design of a culturally tailored childhood obesity community prevention program for Maori & Pacific Islander children and families.

ISSUE ADDRESSED: Children of Maori & Pacific Islander descent living in Australia have a greater prevalence of overweight/obesity and an increased risk of adverse health outcomes. This study aimed to co-design Healthier Together, a community-based, childhood overweight/obesity prevention program tailored to Maori & Pacific Islander cultures. METHODS: Co-design involved a three-phase, iterative, participatory and experience-based process, guided by the Te Ara Tika: Guidelines for Maori Research Ethics to promote respect and equity. Following traditional oratory customs of Maori & Pacific Islander cultures, "talanoa" facilitated the collaborative program design with recruited Maori & Pacific Islander consumers, cultural advisors and health professionals. Co-design formulated program objectives, session plans, resources and evaluation tools. RESULTS: Co-design developed a 9-week community-based childhood overweight/obesity prevention program providing culturally tailored education across four themes: (a) nutrition (b) physical activity (c) positive parenting practices (d) culture and health. Strong community engagement developed a program highly tailored to the local Maori & Pacific Islander population. CONCLUSIONS: Co-design methodology promotes equity and inclusion of all stakeholders, acknowledges and caters to diversity and creates a medium for openness, respect and shared purpose. Community-led participatory approaches are pivotal to engaging and empowering communities to successfully improve health behaviours, particularly in tackling childhood overweight/obesity. SO WHAT?: Healthier Together is culturally significant to ensure relevance, effectiveness and sustainability. It is relevant and potentially adaptable to other priority populations across Australia and globally. Ultimately, the delivery of culturally tailored health care will contribute to a reduction in the health inequity experienced amongst priority populations.