• Development of an evidence-based practice guideline for UK public health nurses (health visitors) to use with parents of infants at risk of obesity.

      REDSELL, S.A.; EDMONDS, B.E.; GLAZEBROOK, C.; SWIFT, J.; NATHAN, D.; SIRIWARDENA, A.N.; WENG, S.F.; Atkinson, Pippa; WATSON, V.; Anglia Ruskin University; et al. (Elsevier BV, 2014-03-31)
      Evidence about effective interventions that reduce obesity risk during infancy is needed. A systematic review of Randomised Controlled Trials (RCTs) of behavioural and non-behavioural interventions which address potential risk factors for childhood overweight and obesity was undertaken to inform a guideline for UK health visitors. The National Institute for Health and Clinical Excellence (NICE) guidelines were followed. The findings were used to develop a guideline which was reviewed internally by a multi-professional Guideline Development Group (GDG) and externally by national experts and practitioners. We identified 35 RCTs reporting behavioural and non-behavioural interventions delivered antenatally and/or during infancy that included infant weight outcomes (e.g. weight-for-length, weight-for-age, weight-for-BMI) or outcomes related to obesity risk (breastfeeding, physical activity, timing of weaning). A number of on-going trials were identified. Good evidence exists for breastfeeding promotion and support interventions. Evidence exists for parental education around responsive feeding, aspects of infant diet and soothing/sleep expectations. These behavioural components informed the guideline, which is freely available on the UK Institute for Health Visiting website. There was equivocal evidence that infants fed lower protein (compared to higher protein) formula milk gained less weight, and this was not incorporated into the guideline. Further research is needed to establish clinically effective interventions for obesity prevention during infancy. Continuous dialogue between commissioners, policy makers, health visitors and parents is essential to inform obesity prevention strategies in the first year of life.
    • Digital technology to facilitate proactive assessment of obesity risk during infancy (ProAsk): a feasibility study

      Redsell, Sarah A; Rose, Jennie; Weng, Stephen; Ablewhite, Joanne; Swift, Judy Anne; Siriwardena, Aloysius Niroshan; Nathan, Dilip; Wharrad, Heather J; Atkinson, Pippa; Watson, Vicki; et al. (BMJ, 2017-09-06)
      To assess the feasibility and acceptability of using digital technology for Proactive Assessment of Obesity Risk during Infancy (ProAsk) with the UK health visitors (HVs) and parents. Multicentre, pre- and post-intervention feasibility study with process evaluation. Rural and urban deprived settings, UK community care. 66 parents of infants and 22 HVs. ProAsk was delivered on a tablet device. It comprises a validated risk prediction tool to quantify overweight risk status and a therapeutic wheel detailing motivational strategies for preventive parental behaviour. Parents were encouraged to agree goals for behaviour change with HVs who received motivational interviewing training. We assessed recruitment, response and attrition rates. Demographic details were collected, and overweight risk status. The proposed primary outcome measure was weight-for-age z-score. The proposed secondary outcomes were parenting self-efficacy, maternal feeding style, infant diet and exposure to physical activity/sedentary behaviour. Qualitative interviews ascertained the acceptability of study processes and intervention fidelity. HVs screened 324/589 infants for inclusion in the study and 66/226 (29%) eligible infants were recruited. Assessment of overweight risk was completed on 53 infants and 40% of these were identified as above population risk. Weight-for-age z-score (SD) between the infants at population risk and those above population risk differed significantly at baseline (−0.67 SD vs 0.32 SD). HVs were able to collect data and calculate overweight risk for the infants. Protocol adherence and intervention fidelity was a challenge. HVs and parents found the information provided in the therapeutic wheel appropriate and acceptable. Study recruitment and protocol adherence were problematic. ProAsk was acceptable to most parents and HVs, but intervention fidelity was low. There was limited evidence to support the feasibility of implementing ProAsk without significant additional resources. A future study could evaluate ProAsk as a HV-supported, parent-led intervention.
    • Using interactive digital technology to predict and prevent childhood overweight

      Atkinson, Pippa; University of Nottingham; Anglia Ruskin University; University of Lincoln; Nottingham University Hospitals Trust (Wiley, 2017-11-12)
      Obesity risk factors can be identified during infancy, providing an opportunity for early intervention. ProAsk is an interactive digital intervention that supports health professionals to quantify and communicate an infant's overweight risk status, prompting discussion of parental strategies to reduce future risk. To investigate user experiences of an interactive digital intervention that assesses overweight risk during infancy and supports motivational behaviour change by parents to reduce their infants' future risk. The study was conducted in four economically deprived localities in the UK. Qualitative data on user experiences of ProAsk were collected at the end of a feasibility study of the intervention in which health visitors (public health nurses) used ProAsk with parents when the infants were three months old. Semi-structured interviews with parents (N = 12) and health visitors (N = 15) were conducted when the infants were 6 months old. Interview data were transcribed and analysed thematically using an inductive, interpretative approach. The analysis identified four key themes: engaging and empowering with digital technology; unfamiliar technology presents challenge and opportunity; trust in the risk score; resistance to targeting. Interactive, digital technology was found to actively engage parents, and enabled them to take ownership of the process of seeking strategies to reduce infant risk of overweight. However, cognitive and motivational biases that prevent effective overweight risk communication represent barriers to targeting the intervention at those infants most at risk of becoming overweight.