A Child-Centred Health Dialogue for the prevention of obesity : Feasibility and evaluation of a structured model for the promotion of a healthy lifestyle in preschool children and their families in the Swedish Child Health Services

Sammanfattning: Prevention of childhood obesity with its effects on children’s mental and physical health and well-being is an international public health priority and is suggested to be effective when started early. As Child Health Services lack an evidence-based model, there is the need for development of a low-intensive health promotion model that is feasible and cost-effective in preventing obesity in preschool children.The overall aim of this study was to develop an evidence-based child-centred multicomponent model that can be used in the Child Health Services with the aim of promoting a healthy lifestyle in families and preventing obesity in preschool children. The Medical Research Council’s guidelines for developing complex interventions were used to design two studies. A feasibility study was set up with a quasi-experimental cluster design comparing usual care with a structured Child-Centred Health Dialogue (CCHD). A total of 203 children at three Child Health Centres received the intervention and were compared to a register-control group at eight matched centres consisting of 582 children. The results showed that both the universal and the targeted part of CCHD were feasible. Training and recurrent tutorial sessions with room for reflection strengthened nurses’ confidence and security in executing CCHD.In a cluster-randomised controlled trial including an economic evaluation, 37 Child Health Centres were randomly assigned to deliver usual care or CCHD. A total of 6,047 children with a mean age of 4.1 years [SD=0.1] were included, consisting of 4,598 children with normal weight and 490 children with overweight. At follow‐up, at a mean age of 5.1 years [SD=0.1], there was no intervention effect on zBMI‐change for children with normal weight. In children with overweight the intervention effect on zBMI‐change was -0.11(95% CI: -0.24 to 0.01; p=0.07). The estimated additional costs for children with overweight were 167 euros per child with overweight.Qualitative interviews and non-participatory observations exploring the experiences of 21 children who participated in CCHD showed that children participated as social actors and wanted to understand the meaning of the health information. The study revealed that 4-year-old children given the opportunity to speak for themselves interpreted some of the illustrations, developed by adults differently from the intended meaning.Parents of 1,197 children, including 1,115 mothers and 869 fathers, responded to a survey that measured perceived parental self-efficacy. Mothers showed an intervention effect on perceived self-efficacy in promoting physical activity of 0.5 (95% CI: 0.04 to 1.0; p=0.046). A subgroup of mothers with increased self-efficacy showed an intervention effect on zBMI-change in normal weight children of -0.13 (95% CI: -0.26 to -0.01; p=0.04) and a decreasing tendency in zBMI-change of -0.50 (95% CI: -1.08 to 0.07; p=0.08) in children with overweight or obesity. To conclude, the intervention performed in a real-life setting did not show an effect on zBMI in children with normal weight, but demonstrated a decreasing tendency in zBMI in children with overweight 12 months after the intervention, albeit statistically uncertain. The additional costs for the provision of CCHD and the training of health professionals in the model could be considered a cost-effective investment in the future health of children with overweight. This thesis supports the view that children are capable of making health information meaningful and can take an active role in their health. It demonstrates the importance of a child-centred approach, respecting children as social actors in the context of their families and using tools that strengthen the child’s and the family’s health literacy.