Dataset Information

Cultural adaptation of a children's weight management programme: Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study.

ABSTRACT:

Background

Childhood obesity prevalence continues to be at high levels in the United Kingdom (UK). South Asian children (mainly Pakistani and Bangladeshi origin) with excess adiposity are at particular risk from the cardiovascular consequences of obesity. Many community-based children's weight management programmes have been delivered in the UK, but none have been adapted for diverse cultural communities. The aim of the Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study, was to culturally adapt an existing children's weight management programme for children aged 4-11?years so that the programme was more able to meet the needs of families from South Asian communities.

Methods

The adaptation process was applied to First Steps, an evidence informed programme being delivered in Birmingham (a large, ethnically diverse city). A qualitative study was undertaken to obtain the views of South Asian parents of children with excess weight, who had fully or partially attended, or who had initially agreed but then declined to attend the First Steps programme. The resulting data were integrated with current research evidence and local programme information as part of a cultural adaptation process that was guided by two theoretical frameworks.

Results

Interviews or focus groups with 31 parents in their preferred languages were undertaken. Themes arising from the data included the need for convenient timing of a programme in a close familiar location, support for those who do not speak English, the need to focus on health rather than weight, nutritional content that focuses on traditional and Western diets, more physical activity content, and support with parenting skills. The data were mapped to the Behaviour Change Wheel framework and Typology of Cultural Adaptation to develop an intervention programme outline. The research evidence and local programme information was then used in the detailed planning of the programme sessions.

Conclusions

The process of cultural adaptation of an existing children's weight management programme resulted in a theoretically underpinned programme that is culturally adapted at both the surface and deep structural levels.

Trial registration

ISRCTN81798055 , registered: 13/05/2014.

SUBMITTER: Pallan M

PROVIDER: S-EPMC6599293 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Cultural adaptation of a children's weight management programme: Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study.

Pallan Miranda M Griffin Tania T Hurley Kiya K Lancashire Emma E Blissett Jacqueline J Frew Emma E Gill Paramjit P Griffith Laura L Jolly Kate K McGee Eleanor E Parry Jayne J Thompson Janice L JL Adab Peymane P

BMC public health 20190628 1

<h4>Background</h4>Childhood obesity prevalence continues to be at high levels in the United Kingdom (UK). South Asian children (mainly Pakistani and Bangladeshi origin) with excess adiposity are at particular risk from the cardiovascular consequences of obesity. Many community-based children's weight management programmes have been delivered in the UK, but none have been adapted for diverse cultural communities. The aim of the Child weigHt mANaGement for Ethnically diverse communities (CHANGE) ...[more]

PMID: 31253113

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Project description:BackgroundCommunity-based programmes for children with excess weight are widely available, but few have been developed to meet the needs of culturally diverse populations. We adapted an existing children's weight management programme, focusing on Pakistani and Bangladeshi communities. We report the evaluation of this programme to assess feasibility of programme delivery, acceptability of the programme to participants from diverse communities, and feasibility of methods to inform a future trial.MethodsA cluster-randomised feasibility trial was undertaken in a large UK city. Children's weight management programmes (n?=?24) were randomised to be delivered as the adapted or the standard programme (2:1 ratio). Routine data on participant attendance (n?=?243) at the sessions were used to estimate the proportion of families completing the adapted and standard programmes (to indicate programme acceptability). Families planning to attend the programmes were recruited to participate in the feasibility study (n?=?92). Outcome data were collected from children and parents at baseline, end of programme, and 6 months post-programme. A subsample (n?=?24) of those attending the adapted programme participated in interviews to gain their views of the content and delivery and assess programme acceptability. Feasibility of programme delivery was assessed through observation and consultation with facilitators, and data on costs were collected.ResultsThe proportion of Pakistani and Bangladeshi families and families of all ethnicities completing the adapted programme was similar: 78.8% (95% CI 64.8-88.2%) and 76.3% (95% CI 67.0-83.6%) respectively. OR for completion of adapted vs. standard programme was 2.40 (95% CI 1.32-4.34, p?=?0.004). The programme was feasible to deliver with some refinements, and participant interview data showed that the programme was well received. Study participant recruitment was successful, but attrition was high (35% at 6 months). Data collection was mostly feasible, but participant burden was high. Data collection on cost of programme delivery was feasible, but costs to families were more challenging to capture.ConclusionsThis culturally adapted programme was feasible to deliver and highly acceptable to participants, with increased completion rates compared with the standard programme. Consideration should be given to a future trial to evaluate its clinical and cost-effectiveness.Trial registrationISRCTN81798055, registered: 13/05/2014.

Project description:Purpose: Health care disparities exist for people from culturally and linguistically diverse (CALD) communities. Addressing the cultural competence of health care providers could limit these disparities. The aim of this study was to improve cultural knowledge of and humility regarding pain in a CALD community. Method: This interpretive description qualitative study used focus group discussions (FGDs) to generate ideas about how South Asian culture could influence how health care providers manage pain. A total of 14 people with pain and of South Asian background (6 women and 8 men, aged 28-70 y) participated. Two investigators independently analyzed the data. This process involved repeatedly reading the transcripts, then manually sorting the key messages into categories. The investigators compared their categorizations and resolved differences through discussion. Next, similar categories and concepts were grouped into ideas (potential themes). These ideas, along with supporting categories and verbatim quotes, were presented to the full research team for feedback. After compiling the feedback, the ideas formed the thematic representation of the data. Results: The data from the FGDs revealed how pain management could be culturally adapted. The FGDs generated four themes about South Asian cultural perspectives that could influence the pain management experience for people living with pain: (1) cultural and linguistic impediments to communication, (2) understanding of pain in terms of the extent to which it interferes with function and work, (3) nurturing or personal attention as a marker of good care, and (4) value attributed to traditional ideas of illness and treatment. Conclusion: This study demonstrates how engaging with CALD people living with pain can lead to improved cultural knowledge and humility that can form the basis for adapting pain management. Through this process, it is more likely that a meaningful and client-centred pain management plan can be developed.

Project description:BACKGROUND:Evidence used to guide the current Institute of Medicine (IOM) gestational weight gain (GWG) recommendations is largely derived from studies of European descent, and as such the guidelines are the same for all races and ethnicities. The guidelines are also the same for prepregnancy obesity classes I through III. OBJECTIVE:Considering these literature gaps, we aim to (1) determine the association between the IOM GWG guidelines and three common pregnancy complications: preeclampsia, gestational diabetes mellitus, and cesarean delivery in a racially and ethnically diverse population; and (2) assess whether the association between GWG and pregnancy complications differs by race/ethnicity or prepregnancy body mass index (BMI) categories, particularly obesity classes I through III. METHODS:To address these aims, we analyzed data from the Boston Birth Cohort. We calculated GWG using data from electronic medical records or, when missing, from a postdelivery questionnaire. We examined GWG continuously and categorically using the IOM formula. RESULTS:Of the 5,568 women included, 54.5% met the IOM criterion for excessive GWG. Compared to women who had adequate GWG, women who gained excessive weight had 1.65 (95% confidence interval [CI] 1.27-2.14) times greater odds of preeclampsia; 1.68 (95% CI 1.15-2.46) times greater odds of gestational diabetes; and no significant change in odds of cesarean delivery (odds ratio [OR]?=?1.14, 95% CI 0.99-1.31). Associations did not differ by race, ethnicity, or prepregnancy BMI categories including comparisons of obesity class I versus II or III (all p-values for interaction >0.05). CONCLUSIONS:In this racially and ethnically diverse population, excessive GWG was associated with higher odds of preeclampsia, gestational diabetes, and nonsignificantly, with cesarean delivery. Associations did not differ appreciably by race, ethnicity, or prepregnancy BMI categories. Our results support the relevance of the IOM GWG recommendations in racially and ethnically diverse populations, and in women in the higher prepregnancy obesity classes.

Project description:BackgroundAfter childbirth, most women do not lose the extra weight gained during pregnancy. This is important because postnatal weight retention contributes to the development of obesity in later life. Research shows that postnatal women living with overweight would prefer to weigh less, are interested in implementing weight loss strategies, and would like support. Without evidence for the benefit of weight management interventions during pregnancy, postnatal interventions are increasingly important. Research has focused on intensive weight loss programmes, which cannot be offered to all postnatal women. Instead, we investigated the feasibility of a brief intervention delivered to postnatal women at child immunisation appointments. This qualitative study explored the views of women who received the intervention and healthcare professionals who delivered it.MethodsThe intervention was delivered within the context of the national child immunisation programme. The intervention group were offered brief support encouraging self-management of weight when attending general practices to have their child immunised at two, three and four months of age. The intervention involved motivation and support from practice nurses to encourage women to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. Nurses provided external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a weight record card. Nested within this trial, semi-structured interviews explored the experiences of postnatal women who received the intervention and nurses who delivered it.ResultsThe intervention was generally acceptable to participants and child immunisation appointments considered a suitable intervention setting. Nurses were hesitant to discuss maternal weight, viewing the postnatal period as a vulnerable time. Whilst some caveats to implementation were discussed by nurses, they felt the intervention was easy to deliver and would motivate postnatal women to lose weight.ConclusionsParticipants were keen to lose weight after childbirth. Overall, they reported that the intervention was acceptable, convenient, and, appreciated support to lose weight after childbirth. Although nurses, expressed concerns about raising the topic of weight in the early postnatal period, they felt the intervention was easy to deliver and would help to motivate women to lose weight.

Project description:Childhood obesity is a global problem, disproportionately affecting children in low-to-middle income countries (LMIC). Despite this evidence, no previous study has adapted instruments measuring children's movement behaviors and associated parenting practices for use in LMIC families. This study reports the results of a cross-cultural adaptation of previously validated measures of children's movement behaviors and parenting practices in economically disadvantaged Brazilian families. Study 1 involved translation of the instruments from English to Portuguese. A team of translators (fluent in both English and Portuguese) and researchers followed established procedures for translating measurement scales, identifying problematic items, and reaching consensus on discrepancies. Study 2 involved cognitive interviews with 24 parents from urban and rural North-eastern Brazil addressing the format, content, and clarity of the items. Half the parents provided feedback on the first 33 items of the questionnaire, with the remaining parents providing feedback on the final 29 items. Notes were recorded during the interview and parents' feedback summarized in a report. In the translation and back-translation, 15 discrepancies were identified. These were mostly due to multiple Portuguese words having the same meaning in English. The research team discussed these discrepancies and consensus was reached to ensure that the concepts depicted in the Portuguese version were consistent with the English version. In the cognitive interviews, parents identified minor problems with item comprehension resulting in minor adaptations to response options, recall period, and format of the questionnaire. The process of translation and cognitive interviews conducted in Brazilian families resulted in an appropriate cultural adaptation of scales measuring children's movement behaviors and parenting practices. Future studies should evaluate the validity and reliability of the measures in LMIC families.

Dataset Information

Cultural adaptation of a children's weight management programme: Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study.

Background

Methods

Results

Conclusions

Trial registration

Publications

Cultural adaptation of a children's weight management programme: Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study.

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