PEACH™ QLD Final Report

Childhood overweight and obesity is a priority health issue throughout the world including Queensland. In response to this, in 2008 the National Partnership Agreement on Preventive Health (NPAPH) Healthy Children’s Initiative was announced. Within this agreement, in September 2011 the Queensland Government called for tenders for a Targeted Risk Modification Kids Program (TRIM Kids) for children who were already overweight or obese. An agreement was signed in March 2013 with the Queensland University of Technology (QUT) for the up-scaled state-wide implementation of the PEACH™ Program. The project was known as PEACH™ QLD. PEACH™ QLD trialled the universal availability of a childhood obesity management service in Queensland.The overall aim was to increase the capacity of families who participate to adopt healthy lifestyles (eating and activity) and promote healthy weight through sustainable behaviour change. This report details the findings of this trial for participants, and for health care services. In includes key reflections and implications for practice for future universal childhood healthy lifestyle programs

Key learnings of the PEACH™ program in Queensland

PEACH™ (Parenting, Eating and Activity for Child Health) is a healthy lifestyle community program targeting Queensland families with overweight primary school children. PEACH™ aims to assist parents to build knowledge, skills and confidence around health eating and physical activity. The program implements an evidenced-based intervention consistent with clinical practice guidelines. Methods were designed with the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework in mind and the following data are collected: Reach: Family demographics Effectiveness: Changes in parental knowledge, skills and confidence; child anthropometry, diet and activity behaviours; attendance rates and satisfaction with program resources Adoption: Facilitator demographics and services involved Implementation: No. facilitators delivering groups; Adherence to program protocol Maintenance: Workforce capacity change; funding committed; long -term family impact Preliminary results: 104 groups across 47 sites including rural and remote areas. Mean (±SD) age of enrolees was 9 (±1.8) years, 45% were male and 78% were obese. Single-parent households comprised 21% of cohort. Number of children meeting fruit and veg guidelines increased (fruit; 49 to 61%, NS ; veg; 3 to 9%, p PEACH™ is successful for those families who engage. Recruitment and retention are issues that need to be addressed. Clarity is needed regarding service delivery and funding responsibilities of various parts of the health system before services to families can be universally offered

A narrative account of implementation lessons learnt from the dissemination of an up-scaled state-wide child obesity management program in Australia: PEACH™ (Parenting, Eating and Activity for Child Health) Queensland

Abstract Background PEACH™QLD translated the PEACH™ Program, designed to manage overweight/obesity in primary school-aged children, from efficacious RCT and small scale community trial to a larger state-wide program. This paper describes the lessons learnt when upscaling to universal health coverage. Methods The 6-month, family-focussed program was delivered in Queensland, Australia from 2013 to 2016. Its implementation was planned by researchers who developed the program and conducted the RCT, and experienced project managers and practitioners across the health continuum. The intervention targeted parents as the agents of change and was delivered via parent-only group sessions. Concurrently, children attended fun, non-competitive activity sessions. Sessions were delivered by facilitators who received standardised training and were employed by a range of service providers. Participants were referred by health professionals or self-referred in response to extensive promotion and marketing. A pilot phase and a quality improvement framework were planned to respond to emerging challenges. Results Implementation challenges included engagement of the health system; participant recruitment; and engagement. A total of 1513 children (1216 families) enrolled, with 1122 children (919 families) in the face-to-face program (105 groups in 50 unique venues) and 391 children (297 families) in PEACH™ Online. Self-referral generated 68% of enrolments. Unexpected, concurrent and, far-reaching public health system changes contributed to poor program uptake by the sector (only 56 [53%] groups delivered by publicly-funded health organisations) requiring substantial modification of the original implementation plan. Process evaluation during the pilot phase and an ongoing quality improvement framework informed program adaptations that included changing from fortnightly to weekly sessions aligned with school terms, revision of parent materials, modification of eligibility criteria to include healthy weight children and provision of services privately. Comparisons between pilot versus state-wide waves showed comparable prevalence of families not attending any sessions (25% vs 28%) but improved number of sessions attended (median = 5 vs 7) and completion rates (43% vs 56%). Conclusions Translating programs developed in the research context to enable implementation at scale is complex and presents substantial challenges. Planning must ensure there is flexibility to accommodate and proactively manage the system changes that are inevitable over time. Trial registration ACTRN12617000315314. This trial was registered retrospectively on 28 February, 2017

Parent engagement and attendance in PEACH™ QLD – an up-scaled parent-led childhood obesity program

Abstract Background Parenting, Eating and Activity for Child Health (PEACH™) is a multicomponent treatment program delivered over ten group sessions to parents of overweight/obese primary school-aged children. It has been shown to be efficacious in an RCT and was recently translated to a large-scale community intervention funded by the Queensland (Australia) Government. Engagement (enrolment and attendance) was critical to achieving program outcomes and was challenging. The purpose of the present study was to examine sample characteristics and mediating factors that potentially influenced program attendance. Methods Data collected from parents who attended at least one PEACH™ Queensland session delivered between October 2013 and October 2015 (47 programs implemented in 29 discrete sites), was used in preliminary descriptive analyses of sample characteristics and multilevel single linear regression analyses. Mediation analysis examined associations between socio-demographic and parent characteristics and attendance at group sessions and potential mediation by child and parent factors. Results 365/467 (78%) enrolled families (92% mothers) including 411/519 (79%) children (55% girls, mean age 9 ± 2 years) attended at least one session (mean 5.6 ± 3.2). A majority of families (69%) self-referred to the program. Program attendance was greater in: advantaged (5.9 ± 3.1 sessions) vs disadvantaged families (5.4 ± 3.4 sessions) (p < 0.05); partnered (6.1 ± 3.1 sessions) vs un-partnered parents (5.0 ± 3.1 sessions) (p < 0.01); higher educated (6.1 ± 3.0 sessions) vs lower educated parents (5.1 ± 3.3 sessions) (p = 0.02); and self-referral (6.1 ± 3.1) vs professional referral (4.7 ± 3.3) (p < 0.001). Child (age, gender, pre-program healthy eating) and parent (perceptions of child weight, self-efficacy) factors did not mediate these relationships. Conclusions To promote reach and effectiveness of up-scaled programs, it is important to identify ways to engage less advantaged families who carry higher child obesity risk. Understanding differences in referral source and parent readiness for change may assist in tailoring program content. The influence of program-level factors (e.g. facilitator and setting characteristics) should be investigated as possible alternative mediators to program engagement

What are the service and system enablers for childhood obesity management services?

The rising prevalence of overweight and obesity among Australian children, and associated health risks and economic burden to the health care system, continues to raise concerns. While the urgent need for coherent and comprehensive strategies for effective prevention is acknowledged globally, the implementation of appropriate management approaches at scale are lacking for children already above a healthy weight. This research investigated factors affecting the implementation of two evidence-based weight management programs targeting families of primary aged children (7-13 years) across NSW and Queensland. Interviews were conducted with a broad range of program stakeholders, representative of geographical location, stakeholder role and variation in program implementation across the states. Forty seven stakeholders were interviewed across 14 sites about their experiences in implementing Go4Fun (NSW) or PEACH (QLD). The Consolidated Framework for Implementation Research (CFIR) was used to structure collection and analysis of data. Findings will be reported against the 31 CFIR constructs assessed identifying those constructs that strongly or weakly influenced implementation effectiveness between sites with low versus high program implementation effectiveness. Such learnings are paramount to guide future investment in the implementation and scale-up of evidence based strategies to address childhood obesity management