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Cultural adaptation of an existing children's weight management programme: the CHANGE intervention and feasibility
Miranda Pallan1, Tania Griffin1, Kiya L Hurley1
1Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Insights
Culturally adapting children's weight management programs improved completion rates for Pakistani and Bangladeshi families. The adapted program was feasible and acceptable, but future trials need to address data collection and attrition.
Area of Science:
- Public Health
- Pediatric Obesity Management
- Health Disparities
Background:
- Excess weight in children is a significant health concern.
- Community-based weight management programs show some success but have lower completion rates among minority ethnic families.
- Existing programs lack cultural adaptation for diverse communities.
Purpose of the Study:
- To culturally adapt an existing children's weight management program for Pakistani and Bangladeshi communities.
- To evaluate the feasibility and acceptability of the adapted program and its delivery methods for a future trial.
Main Methods:
- Phase I: Cultural adaptation of a weight management program using formative research and theoretical frameworks.
- Phase II: Cluster-randomised feasibility study comparing the adapted program with the standard program.
- Participants included children aged 4-11 with excess weight and their families in Birmingham, UK.
Main Results:
- Completion rates for the adapted program were 78.8% for Pakistani and Bangladeshi families and 76.3% for all families.
- The adapted program was feasible to deliver with refinements and well-received by participants.
- Data collection feasibility was noted, but participant burden and attrition (35% overall, higher in the comparator arm) were significant challenges.
Conclusions:
- The culturally adapted weight management program demonstrated high acceptability across ethnicities.
- Future trials should evaluate clinical and cost-effectiveness.
- Trial designs must address data collection logistics, participant burden, and attrition to ensure robust evaluation.
Background:
Excess weight in children is a continuing health issue. Community-based children's weight management programmes have had some effect in promoting weight loss. Families from minority ethnic communities are less likely to complete these programmes but, to date, no programmes have been culturally adapted to address this.
Objectives:
We aimed to (1) culturally adapt an existing weight management programme for children aged 4-11 years and their families to make it more suited to Pakistani and Bangladeshi communities but inclusive of all families and (2) evaluate the adapted programme to assess its feasibility and acceptability, as well as the feasibility of methods, for a future full-scale trial.
Design:
In phase I, a cultural adaptation of a programme that was informed by formative research and guided by two theoretical frameworks was undertaken and in phase II this adapted programme was delivered in a cluster-randomised feasibility study (for which the clusters were the standard and adapted children's weight management programmes).
Setting:
Birmingham: a large, ethnically diverse UK city.
Participants:
In phase I, Pakistani and Bangladeshi parents of children with excess weight, and, in phase II, children aged 4-11 years who have excess weight and their families.
Interventions:
A culturally adapted children's weight management programme, comprising six sessions, which was delivered to children and parents, targeting diet and physical activity and incorporating behaviour change techniques, was developed in phase I and delivered in the intervention arm to 16 groups in phase II. The eight groups in the comparator arm received the standard (unadapted) children's weight management programme.
Main Outcome Measures:
The primary outcome was the proportion of Pakistani and Bangladeshi families completing (attending ≥ 60% of) the adapted programme. Secondary outcomes included the proportion of all families completing the adapted programme, the feasibility of delivery of the programme, the programme's acceptability to participants, the feasibility of trial processes and the feasibility of collection of outcome and cost data.
Results:
The proportion of Pakistani and Bangladeshi families and all families completing the adapted programme was 78.8% [95% confidence interval (CI) 64.8% to 88.2%] and 76.3% (95% CI 67.0% to 83.6%), respectively. The programme was feasible to deliver with some refinements and was well received. Ninety-two families participated in outcome data collection. Data collection was mostly feasible, but participant burden was high. Data collection on the cost of programme delivery was feasible, but costs to families were more challenging to capture. There was high attrition over the 6-month follow-up period (35%) and differential attrition in the two study arms (29% and 52% in the intervention and comparator arms, respectively).
Limitations:
The study was not designed to address the issue of low participant uptake of children's weight management programmes. The design of a future trial may include individual randomisation and a 'minimal intervention' arm, the acceptability of which has not been evaluated in this study.
Conclusions:
The theoretically informed, culturally adapted children's weight management programme was highly acceptable to children and families of all ethnicities. Consideration should be given to a future trial to evaluate clinical effectiveness and cost-effectiveness of the adapted programme, but the design of a future trial would need to address the logistics of data collection, participant burden and study attrition.
Trial Registration:
Current Controlled Trials ISRCTN81798055.
Funding:
This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 33. See the NIHR Journals Library website for further project information. Kate Jolly is part-funded by the Collaboration for Leadership in Applied Health Research and Care West Midlands.
