Embed Size (px)
Citation preview
Santosh KhanalSenior Evaluation Officer*
Christine Innes-HughesManager, NSW Healthy Children Initiative*
*NSW Office Preventive Health
Go4FunNSW Healthy Children Initiative
Acknowledgement: Deb Welsby,Local Health District Teams, Better Health Company,
Policy and funding context 2006 The Australian Better Health Initiative
NSW Parenting Program
2008 Pilot of the MEND program
2011 National Partnership Agreement on Preventive Health Go4Fun in all Local Health
Districts
2014 NSW Healthy Eating and Active Living Strategy
2015 NSW Government election commitment Go4Fun as part of type 2 diabetes
prevention effort
Current delivery context
NSW Office of Preventive Health - Healthy Children Initiative programs in children’s settings:
Early Childhood Munch and Move
Primary schools Live Life Well @ School,
Crunch & Sip
Junior Community Finish With The Right Stuffsport
Community Go4Fun
Evidence base
Demonstrated effectiveness through randomised control trials of MEND program in UK 1,2
Process evaluation of Go4Fun demonstrated that we are reaching our target group3
Scalability demonstrated while maintaining program fidelity and outcomes 4,5
References
1.Randomized Controlled Trial of the MEND Program: A Family-based Community Intervention for Childhood Obesity. Obesity 2012.Paul M. Sacher, Maria Kolotourou, Paul M. Chadwick, Tim J. Cole, Margaret S. Lawson, Alan Lucas and Atul Singhal
2. Outcomes Following the MEND 7–13 Child Weight Management Program Childhood Obesity June 2015 Volume 11, Number 3 Maria Kolotourou, Duncan Radley, Catherine Gammon, Lindsey Smith, Paul Chadwick, DClinPsy and Paul M. Sacher
3. Process evaluation of an up-scaled community based child obesity treatment program: NSW Go4Fun, BMC Public Health 2014, 14:140. Welsby D, Nguyen B, O’Hara B, Innes-Hughes C, Bauman A and Hardy LL.
4. From trial to population: a study of a family-based community intervention for childhood overweight implemented at scale International Journal of Obesity (2014) 38, 1343–1349 J Fagg1, P Chadwick, TJ Cole, S Cummins, H Goldstein, H Lewis, S Morris, D Radley, P Sacher and C Law
5. Translational research: are community-based child obesity treatment programs scalable? BMC Pubic Health 2015. Louise L. Hardy, Seema Mihrshahi, Joanne Gale, Binh Nguyen, Louise A. Baur and Blythe J. O’Hara
A community-based child obesity treatment program (secondary prevention)
AIM: to improve health, fitness, self esteem and confidence in overweight and obese children.
Program eligibility:
Aged 7 to 13 years
Overweight or obese (≥ 85th BMI percentile for age and gender)
Parent/carer available to attend each session
Go4Fun Program Overview
Program design
10 weeks
2 sessions per week (until 2014)
2 hours per session.
Multidisciplinary including:
- Family involvement
- Practical education in nutrition and diet
- Increasing physical activity
- Behaviour change goal setting
Model of Service Delivery
Funding and performance agreement with service delivery partnerBetter Health Company (private public partnership)
Referral line
Resources and equipment
Data and data management system
Reporting
Quality framework
Quality improvements
Model of Service DeliveryService Level Agreement - Ministry of Health and Local Health Districts
Local Health Districts (LHDs)Prevalence based targets (July 2011 to June 2015)
Currently targets based on indicative number of programs
Dedicated positions funded within LHDs
Oversight NSW Office Preventive Health
State level coordination, performance monitoring, evaluation, marketing and communications
Evaluation and monitoring
Monitoring - routine business processProgram Reach (July 2011 to July 2015)
Number of programs: 652
Total children enrolled: 6,178
Total children completed: 5,301
Evaluation and monitoring
Program outcomes (mean)BMI: -0.6 kg/m2
Waist circumference: -1.5cm
Physical activity: +3.6hours per week
Sedentary behaviours: -2.8hours per week
Self esteem: statistically significant improvements
Fruit and vegetable intake: statistically significant improvements
Monitoring by disadvantage
Household characteristics
AboriginalityHealth care card status
mother
Service improvement study
Background
A 2012 program review found twice per week attendance requirement for families a barrier to participation
A once per week delivery model was developed in partnership with the Better Health Company
It needed to be ensured that the reduced program frequency would not disadvantage participants
Service improvement study
Aims
To compare the effectiveness of the once per week model with the standard twice per week at program completion and six months follow up Health: BMI z-score Behavioural: Physical and sedentary activities Psychosocial: Global self-esteem
To compare the program attendance between the once per week and twice per week delivery approaches
Service improvement study
Methods
Cluster randomised controlled trial: rigorous
Pragmatic design: real world implementation
53 sites across 11 Local Health Districts
494 families
Measurements at program start and completion and six months follow up
Service improvement study
The pragmatic design
Service improvement study
Results
Once per week delivery model was equally effective to the twice per week model
Attendance patterns were similar between the two delivery models
Service improvement study
Implications
Once per week delivery model was made the standard delivery approach for the program
Program has become more accessible to families with work and other commitments
Cost efficiency has been achieved with no compromises to program outcomes
Important contribution to academic knowledge about program frequency for childhood obesity
Future systems improvements and efficiency gains
Incentivisation trial with Department of Premier and Cabinet
Flexible, non face to face delivery
Enhanced post program support model– Particularly around maintaining physical activity
Go4Fun for Aboriginal Families
Questions?
