Scoping the impact of NCMP feedback on the child obesity pathway – Study resultsFalconer, C; Park, MH; Croker, H; Skow, A; Black, J; Saxena, S; Kessel, A;Morris, S; Karlsen, S; Viner, R; and Kinra, S.

Improving health worldwide www.lshtm.ac.uk

1. To increase public understanding of child weight issues;

2. To engage families with the issue of healthy weight in children;

3. To offer information, advice and services which provide an opportunity for families to make healthy lifestyle choices.

Aims of NCMP feedback

Study Aims

1. To estimate the impact of NCMP feedback on parental risk perceptions, parental acceptance of the feedback and associated behaviour change and health service use;

2. To identify barriers and levers to behaviour change and health service use, particularly among deprived/ethnic minority groups;

3. To determine which feedback approach (letter versus pro-active) has the greatest positive impact.

Methods

• Parents of children enrolled in the NCMP in 5 PCTS (N=18,000):– Redbridge– Islington,– West Essex,– Bath and North East Somerset (BANES) – Sandwell PCT

• Questionnaire surveys at three time points– Baseline– One month, 6 months and 1 year post feedback

• Interviews with parents of 52 overweight and very overweight children

Time-line

Results

• 1,844 parents completed a questionnaire at baseline and follow-up

• Weight status:– 9.7% overweight – 5.7% very overweight

• Ethnicity:– 66% white – 15.7% Asian– 5.5% Black– 12.8% mixed/other

• Comparable to NCMP population

Participants

• Parental knowledge was high? – Baseline 72.5%– Follow-up 79.7%

• Assessed parents’ knowledge of future health risks associated with child overweight

Aim 1: Public awareness of child overweight

• Parental acceptance of child’s overweight category– Baseline 22%– Follow-up 38%

• Parental perception of their child’s weight as a health risk– Baseline 21%– Follow-up 27%

• BUT these changes were not as big as you would expect

Aim 2: Engage families with overweight children

Disagreement with feedback“I look at him and I see puppy fat. I don’t see overweight fat. I think

they’re two different things”

Parents view their child in terms of their physical and emotional functioning and not their weight

“If she’s not active I would be worried. Yes but she’s active, she runs she do all of them things so I’m not worried about her health”

Comparisons to other children“He honestly doesn’t look overweight to me so you see children in the

street and they’re little round puddings. He’s not one of them”

Rationalising – failed attempts before?

Why?

• 36.6% parents sought further help or information following NCMP feedback

Aim 2: Engage families with overweight children

0 5 10 15 20

Contact no. on the letter

School or school nurse

Dietician/pharmacist

Other parents/ family or …

NHS Choices

Change 4 life

Other internet sites

A GP

Proportion of parents

Help seeking

Very overweight

Overweight

Lack of knowledge“I don’t think I need to go to the GP unless she’s ill or something. I don’t

know. What would you suggest?”

Mis-information“He said ‘Looking at her she looks perfectly healthy so I wouldn’t be too

concerned about that side of things’. It gave me reassurance”

“Sometimes I used to check with the doctor, GP, whether his height and weight is normal. The doctor when he sees him, ‘I think he’s normal’, and they didn’t find him as overweight”

Aim 2: Engage families with overweight children

• After NCMP feedback:–Dietary behaviour was unchanged–Physical activity was unchanged

(increased in very overweight only)–Screen-time increased

Aim 3: Encourage behaviour change

Lack of knowledge“I do give fish fingers and I don’t know whether it’s healthy or not…If I

can get proper guidance of what I should give her”

Availability/access to services“At the local sports centre they have things going on but things are so

expensive to pay for that is a lot…I always keep thinking, oh I want him to do another thing, but we just don’t have the funds to do that”

Perceived healthy lifestyleThen actually I threw the letter away because I thought I’m not going to

alter her diet. She eats, as far as I’m concerned a healthy diet. She does sport”

Why?

• After NCMP feedback– Frequency of weight-related teasing remained

unchanged• 10% overweight children• 2% healthy weight children

– Frequency of bouts of low self-esteem remained unchanged • 4% overweight children• 1% healthy weight children

Does it cause any harm?

• Emotions reported after NCMP feedback in parents of overweight children:– 22.8% upset– 15.4% guilty – 14.8% angry

BUT:• 87.2% of parents found the feedback to be somewhat or very

helpful• 70% would encourage future participation in the NCMP• Only 1.8% would withdraw their child in the future

Parental experience of NCMP feedback

• Parents of non-white children:– Lower knowledge of the health risks of child

overweight– Greater change in recognition of the health risks

following weight feedback– More likely to seek help

• Parents of older children– More recognised overweight and associated health

risks

Effect of population characteristics on the impact of NCMP feedback

• Pro-active feedback:– More accepted the feedback result• 10% change with letter• 32% change with pro-active

– No additional impact on behaviour• But– Additional cost• Letter: £1.24/child• Pro-active: £9.50/child for phone call and £41/child for

appointment• Parents prefer the letter

Effect of feedback type on the impact of NCMP feedback

Recommendations

• Feedback letter is moderately effective and well received by parents

• Suggested actions: – Continue to provide routine letter feedback to all parents of children

participating in the NCMP

• Proactive feedback offered some additional benefit but comes at an additional cost and is less preferred by parents

• Suggested actions:– Re-think the best use of the additional costs.

• Consider investing these resources in:– Providing additional contacts to parents– Increasing the capacity of local services– Improving the capability of staff delivering interventions

Feedback

• Parents are willing to seek help, but may not be finding the best information

• Suggested actions:– Make it easier for parents to access the right information• Make high quality information more accessible• NCMP champions at schools

– Ensure that the capacity of local services is sufficient to deal with any increased help-seeking

– Engage with GPs

Provision of information and help-seeking

Thanks for listening

• Catherine.falconer@lshtm.ac.uk

• PROMISE Research– http://www.promiseresearch.org.uk

• HELP trial– http://helptrial.org.uk

Help seeking by ethnicity

Help seeking by SES