Data Analysis

Describe about the Family-Based Behavioural Treatment of Childhood Obesity.

Childhood obesity has been developing as a menace in the UK in recent times and is so anticipated that 25% of the children in the country aged under 16 will be prone to obesity by 2050. The National Health Service is presumed to increase by seven folds by 2050, which can also be a contributory factor to this public health concern (Wilkie et al. 2016). The health survey conducted in England suggested that 12.9% of the girls and 15.4% of the boys are overweight and 15.3% of the girls and 16.1% of the boys are obese in the age group of two to fifteen. So a Randomised Controlled Trial (RCT) was performed was performed to implement and determine the effectiveness of Healthy Lifestyle Program (HeLP) in school going children to tackle childhood obesity (Wyatt et al. 2013).

Data analysis method primarily involved statistical analysis. Emphasis was on the estimation of the data rather than the hypothesis of the study. Hypothesis test results accounted for the 5% levels of the secondary and primary outcomes and 1% for the terms of interaction. The CONSORT guidelines were followed for reporting as it is followed with RCTs. The analysis of the primary comparatives was conducted based on the intention-to-treat. Baseline differences in the measures of outcome and demographics were analysed by descriptive statistics (Karnik and Kanekar 2015). The outcome measure comparison involved all the available measures. The binary outcomes comparison were expressed at the confidence intervals of 95% and odd ratios. The continuous outcomes comparisons were expressed as the mean differences along with the confidence intervals of 95%. Regression analysis was used for the comparison of between groups. Sensitivity analysis was conducted as missing data imputation models. The study design was of hierarchical nature and the adjustment was based on the socio-economic class, availability of school meals at free of cost, school size, income values, etc (Wang et al. 2013).

The study involved the cluster RCT followed by evaluation of the process including 32 schools of UK. The study will help to determine the cost effectiveness and effectiveness of HeLP in the prevention of childhood obesity. Children aged 9 to 10 years were selected as the participants. Randomized sequencing to intervene did the school allocation and the control of the study was done by a stratified method. This included the consideration of the factors like the proportion of the free meal eligibility of the children and the size of the school.

The Healthy Lifestyle Program

The program had the objective of encouraging the children to select proper activities and replacing their diets for the maintenance of their energy balance. HeLP employed Behaviour Change Techniques (BCT) for enhancing the motivation, relevant information and the skills of behaviour. Engaging and accessible delivery methods were utilized which were aligned with the curriculum of the school and provided the parents with opportunities to be engaged in the program activities (Fagg et al. 2014). The prime hypothesis of the study was based on the fact that motivation, behavioural skills and targeting information will guide the participants towards better physical activities and improved diets. This will ultimately prevent in the gaining of the excessive weight by the children and the problem of childhood obesity can be tackled. However, the moderators of these processes were weight status, gender, school size and socioeconomic circumstances (Druet et al. 2012)

The terms of interaction were examined for the investigation of the differences in the effects of the intervention on the outcome based on baseline BMI, gender, etc.

The engagement intensity of the individual child was estimated and a comparison was drawn between the children who did and did not meet the criteria.

The mediational analysis was done to determine the effectiveness of the intervention on the secondary and primary outcomes mediated by attitudes, norms, knowledge social support, self-efficacy and perceived environment.

The regulation behaviours and techniques, which are related to the diet and physical activities utilizing the analytic framework for RCTs, were employed (Martin, Chater and Lorencatto 2013).

HeLP is a four phase multi-component program, which has the primary objective of encouraging a healthy lifestyle. The four phases are as follow.

Creation of a supportive context: The objective of this phase is to create the awareness and develop the relationship for establishing the foundation of the program and ensuring the success of the remaining phases.

Week of a healthy lifestyle: This is an intensive phase, which involved the interactive drama and sessions of education lessons. The drama portion involved the theatrical performances and activities.

Setting of the personal goals: This phase deals with the understanding of the messages of HeLP along with the parents of the children.

Reinforcement: This phase deals with the fortification of the knowledge and messages achieved from the program and subsequent understanding through activities.

The Economic evaluation was done for the estimation of the cost-effectiveness of the program. In comparison with the usual practice and from the perspective of the payers like the third party and NHS the economic analysis was performed for the cost-effectiveness of the program in the long term. 

Economic Evaluation

Analyses of within trial provided a robust estimation of the costs and uses of the resources, which have been incurred in the delivery of the intervention of HeLP. This was performed on a regular basis by reporting the use of the resources by the personnel who were involved in the delivering and hosting of the intervention. The long-term assessment of the cost effectiveness was done by an evaluation which was model based. The framework of the model connected the weight status to the effectiveness outcomes to determine the outcomes of the future health over time (Showell et al. 2013)

The analysis of the qualitative data was done on the basis of focus groups and interviews which were recorded as transcribed verbatim and audio tapes. NVivo software was employed for managing the transcribed data, which also supported the analytical and coding process. The transcripts were thoroughly read for understanding the experiences and views of the participants. The interpretation and analysis of the emerging themes were done was approached by the framework analysis.

The efficiency of statistical analysis was enhanced by the analysis of BMI SDS by adjusting the values of the baseline phase. The calculation of the sample size employed conservative estimates. The standard deviation values for the participants ranged from 0.14 to 0.25 units.

Various research studies have been performed by research organizations from where statistical data can be obtained regarding the childhood obesity conditions in UK. Some of these statistical data representations have been provided below.

Image 1: Prevalence of childhood obesity

Source: gov.scot

Image 2: Childhood obesity in Middlebrough

Source: teesjsna.org.uk

Image 3: Childhood obesity in England

Source: health.org.uk

The study objective was to prevent childhood obesity by the application of a school-based intervention. The childhood obesity prevalence has increased from 5% to 17%, which is approximately a three-fold increase in the past three decades. This prevalence has lead to several health disorders. One third of the children in England are obese in the age limit of 10 to 11 years and gradually it is increasing. This problem of childhood obesity has got significant psychological and physical adverse effects which may continue in the adulthood as well. The behavioural treatments have shown little effectiveness in solving the problem. So it has become very important to prevent the unhealthy behaviour among all the children to prevent the childhood obesity, even if they are not suffering from obesity (Pallan et al. 2013).

Qualitative Data Analysis

For these reasons, HeLP has been piloted and developed for evaluating and developing the complex interventions. It is based on the skill model of Information Motivation Behavior (IMB), which works on the principle that motivation, behavioural skills, and adequate information are required for bringing the change in the behaviour of the children. This system has been exclusively developed and implemented in the population of UK by working with the children, parents and the teachers to understand the delivery methods and the techniques of behaviour change. The behaviour change can be brought about by creating an atmosphere at the home and school that supports the change. The change should be brought about at the different levels of the lives of the children. Therefore, the study engulfed the students, teachers and their families in the program to create the environment of behavioural change by engaging all of them with multiple approaches.

The systematic application of HeLP will allow to understand the operation of mediators and effects of moderators with respect to the outcomes. The variables related to behaviour and psychology describes the weight status outcomes. The process evaluation of HeLP provides the details associated with the success of the intervention program and the experience that the participants gathered can be determined. The clear understandings of these factors will further enable the program to undergo any remodelling or modifications for its enhancement in effectiveness.

The intervention fidelity was based on three manuals. These manuals described the program components in the different phases of the program. There was also a separate trainer’s manual designed for the personnel involved in delivery. The checklist for intervention delivery was recorded in another separate manual. Documentation for the activities of the schools affecting the physical activity and diet was done and recorded for both the intervention and control schools. There were the baseline, questionnaire and post-baseline phases during the study period where different data were collected for analysis. The study period extended for twelve months (Ramasubramaniam, Lane and Rahman 2013).

The attrition rates were quite low throughout the study, which involved 201 children. It was about 8% of the total strength of the children from the intervention and control schools. The method employed to prevent attrition was building up of relationships based on trust, which will encourage the participants to remain engaged in the process of research, and providing them with suitable incentives (Croker et al. 2012). In case of extension of the study periods, suitable benefits and remunerations were provided to the participants along with the intervention materials. The incentive value was determined after consultation with the children during the pilot study phase.

Prevalence of Childhood Obesity

The measure for primary outcome for HeLP was carried out by BMI SDS evaluation in the post-baseline period. The children as they get promoted in the school might effect the studies. Therefore, the timing of the study has been chosen keeping in mind this factor. As the population distribution of the class changes, the shape of the population remains the same. Therefore, the approach of the study focuses on the entire population distribution rather than focussing on a single child to prevent obesity of the entire population.

The result of this study provided enough evidence regarding the cost-effectiveness and efficacy of HeLP, a novel intervention. This intervention aims to create the environments in the schools and home, which are supportive of the prevention of obesity in the school going children (Hollinghurst et al. 2014).

A dearth has been noticed among the health professionals in the UK to show confidence while working with childhood obesity. The traditional methods of management of childhood obesity have been found to be unhelpful. Therefore, there has been a for an approach development which is suitable for the young children and can be equally supportive of the parents and health professionals. HeLP was developed with this objective for the successful management of childhood obesity among the school-going children of UK.

References

Croker, H., Viner, R.M., Nicholls, D., Haroun, D., Chadwick, P., Edwards, C., Wells, J.C. and Wardle, J., 2012. Family-based behavioural treatment of childhood obesity in a UK National Health Service setting: randomized controlled trial. International Journal of Obesity, 36(1), pp.16-26.

Druet, C., Stettler, N., Sharp, S., Simmons, R.K., Cooper, C., Davey Smith, G., Ekelund, U., Lévyâ€ÂMarchal, C., Jarvelin, M.R., Kuh, D. and Ong, K.K., 2012. Prediction of childhood obesity by infancy weight gain: an individualâ€Âlevel metaâ€Âanalysis. Paediatric and perinatal epidemiology, 26(1), pp.19-26.

Fagg, J., Cole, T.J., Cummins, S., Goldstein, H., Morris, S., Radley, D., Sacher, P. and Law, C., 2014. After the RCT: who comes to a family-based intervention for childhood overweight or obesity when it is implemented at scale in the community?. Journal of epidemiology and community health, pp.jech-2014.

Gov.scot. (2016). Health scotland, community care. [online] Available at: https://www.gov.scot/Topics/Health [Accessed 21 Mar. 2016].

Health.org.uk. (2015). Research and policy analysis | The Health Foundation. [online] Available at: https://www.health.org.uk/collection/research-and-policy-analysis [Accessed 21 Mar. 2016].

Hollinghurst, S., Hunt, L.P., Banks, J., Sharp, D.J. and Shield, J.P., 2014. Cost and effectiveness of treatment options for childhood obesity. Pediatric obesity, 9(1), pp.e26-e34.

Karnik, S. and Kanekar, A., 2015. Childhood obesity: a global public health crisis. Int J Prev Med, 2012. 3 (1), pp.1-7.

Martin, J., Chater, A. and Lorencatto, F., 2013. Effective behaviour change techniques in the prevention and management of childhood obesity.International journal of obesity, 37(10), pp.1287-1294.

Pallan, M., Parry, J., Cheng, K.K. and Adab, P., 2013. Development of a childhood obesity prevention programme with a focus on UK South Asian communities. Preventive medicine, 57(6), pp.948-954.

Ramasubramanian, L., Lane, S. and Rahman, A., 2013. The association between maternal serious psychological distress and child obesity at 3 years: a crossâ€Âsectional analysis of the UK Millennium Cohort Data. Child: care, health and development, 39(1), pp.134-140.

Showell, N.N., Fawole, O., Segal, J., Wilson, R.F., Cheskin, L.J., Bleich, S.N., Wu, Y., Lau, B. and Wang, Y., 2013. A systematic review of home-based childhood obesity prevention studies. Pediatrics, 132(1), pp.e193-e200.

Teesjsna.org.uk. (2016). Middlesbrough. [online] Available at: https://www.teesjsna.org.uk/middlesbrough/ [Accessed 21 Mar. 2016].

Wang, Y., Wu, Y., Wilson, R.F., Bleich, S., Cheskin, L., Weston, C., Showell, N., Fawole, O., Lau, B. and Segal, J., 2013. Childhood obesity prevention programs: comparative effectiveness review and meta-analysis.

Wilkie, H.J., Standage, M., Gillison, F.B., Cumming, S.P. and Katzmarzyk, P.T., 2016. Multiple lifestyle behaviours and overweight and obesity among children aged 9–11 years: results from the UK site of the International Study of Childhood Obesity, Lifestyle and the Environment. BMJ open, 6(2), p.e010677.

Wyatt, K.M., Lloyd, J.J., Abraham, C., Creanor, S., Dean, S., Densham, E., Daurge, W., Green, C., Hillsdon, M., Pearson, V., Taylor, R.S., Tomlinson, R. & Logan, S. 2013, “The Healthy Lifestyles Programme (HeLP), a novel school-based intervention to prevent obesity in school children: study protocol for a randomised controlled trial”, Trials, vol. 14, no. 1, pp. 95-95.