An exploration of childhood obesity treatment interventions to enhance their long-term effectiveness.

Childhood obesity is a major public health concern. Recent data suggests although childhood obesity prevalence rates appear to be slowing, they are still unacceptably high (Health Survey for England, 2010). To establish a downward trend in childhood obesity rates, effective treatment options are vital. To date, multi-component treatment interventions (MCTIs) incorporating a physical activity, healthy eating and behavioural component and encouraging family involvement appear to be the most promising approach to treat childhood obesity. However, no firm conclusion can be made regarding the sustainability of treatment outcomes (i.e. behavioural & weight related outcomes) (Luutikhuis et al., 2009). This thesis contributed to the evidence base regarding the sustainability of treatment outcomes from MCTIs; considered stakeholder views in the intervention design process and provided an insight into treatment recipient's reasons for attrition from MCTIs.To critically examine the evidence base, Study 1 provided a systematic review of childhood obesity treatment interventions. Results revealed gaps in the evidence in terms of how best to maintain treatment outcomes. Furthermore the study highlighted a need to better consider stakeholder views in intervention design and to fully report treatment fidelity (TF). In Study 2, a qualitative inquiry explored stakeholder perspectives towards childhood obesity treatment and the maintenance of treatment outcomes. Results revealed incongruence between treatment recipients (i.e. parents & children) and treatment deliverers (i.e. health professionals). Treatment recipients suggested they required ongoing support to maintain treatment outcomes. Conversely, treatment deliverers suggested ongoing support is unrealistic and MCTIs should create autonomous individuals who feel confident in their ability to maintain treatment outcomes. Implications included the need to consider maintenance strategies that promote autonomous motivations and perceived competence for behavioural changes in participants with the aim of improving weight maintenance following MCTIs.In light of stakeholder views in Study 2, Study 3A detailed a pilot study to test the efficacy of a maintenance intervention underpinned by Self Determination Theory (Deci & Ryan, 1985; 2000) and that integrated Motivational Interviewing (Miller & Rollnick, 1991; 2002) and cognitive behavioural strategies to improve the sustainability of behavioural and weight related outcomes following a MCTI. A secondary aim of Study 3A was to evaluate TF. Findings supported the potential importance of autonomous motivation and perceived competence in enhancing the maintenance of behavioural and weight related changes. Furthermore this study highlighted a need to explore participants' reasons for attrition from MCTIs. Study 3B provided a qualitative exploration of parents and children's reasons for attrition from MCTIs. Findings underlined the complexity of attrition with several psychological and motivational reasons appearing as the driving source for attrition. Study implications included the need to consider individual families' needs within MCTIs, targeting parents and children's motivations for maintaining a healthy lifestyle and weight differently. The collective implications of the four studies included the need for stakeholders to be involved at all levels of design, implementation and evaluation of MCTIs, the need to assess and report all aspects of TF and the need for MCTIs to develop families' perceived competence and autonomous motivations for health behaviour changes in order to improve the sustainability of weight related outcomes

An exploration of childhood obesity treatment interventions to enhance their long-term effectiveness

Childhood obesity is a major public health concern. Recent data suggests although childhood obesity prevalence rates appear to be slowing, they are still unacceptably high (Health Survey for England, 2010). To establish a downward trend in childhood obesity rates, effective treatment options are vital. To date, multi-component treatment interventions (MCTIs) incorporating a physical activity, healthy eating and behavioural component and encouraging family involvement appear to be the most promising approach to treat childhood obesity. However, no firm conclusion can be made regarding the sustainability of treatment outcomes (i.e. behavioural & weight related outcomes) (Luutikhuis et al., 2009). This thesis contributed to the evidence base regarding the sustainability of treatment outcomes from MCTIs; considered stakeholder views in the intervention design process and provided an insight into treatment recipient's reasons for attrition from MCTIs. To critically examine the evidence base, Study 1 provided a systematic review of childhood obesity treatment interventions. Results revealed gaps in the evidence in terms of how best to maintain treatment outcomes. Furthermore the study highlighted a need to better consider stakeholder views in intervention design and to fully report treatment fidelity (TF). In Study 2, a qualitative inquiry explored stakeholder perspectives towards childhood obesity treatment and the maintenance of treatment outcomes. Results revealed incongruence between treatment recipients (i.e. parents & children) and treatment deliverers (i.e. health professionals). Treatment recipients suggested they required ongoing support to maintain treatment outcomes. Conversely, treatment deliverers suggested ongoing support is unrealistic and MCTIs should create autonomous individuals who feel confident in their ability to maintain treatment outcomes. Implications included the need to consider maintenance strategies that promote autonomous motivations and perceived competence for behavioural changes in participants with the aim of improving weight maintenance following MCTIs. In light of stakeholder views in Study 2, Study 3A detailed a pilot study to test the efficacy of a maintenance intervention underpinned by Self Determination Theory (Deci & Ryan, 1985; 2000) and that integrated Motivational Interviewing (Miller & Rollnick, 1991; 2002) and cognitive behavioural strategies to improve the sustainability of behavioural and weight related outcomes following a MCT!. A secondary aim of Study 3A was to evaluate TF. Findings supported the potential importance of autonomous motivation and perceived competence in enhancing the maintenance of behavioural and weight related changes. Furthermore this study highlighted a need to explore participants' reasons for attrition from MCTIs. Study 3B provided a qualitative exploration of parents and children's reasons for attrition from MCTIs. Findings underlined the complexity of attrition with several psychological and motivational reasons appearing as the driving source for attrition. Study implications included the need to consider individual families' needs within MCTIs, targeting parents and children's motivations for maintaining a healthy lifestyle and weight differently. The collective implications of the four studies included the need for stakeholders to be involved at all levels of design, implementation and evaluation of MCTIs, the need to assess and report all aspects of TF and the need for MCTIs to develop families' perceived competence and autonomous motivations for health behaviour changes in order to improve the sustainability of weight related outcomes.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

‘What’s the point when you only lose a pound?’ Reasons for attrition from a multi-component childhood obesity treatment intervention:a qualitative inquiry

This study explored the causes of drop-out from a community-based multi-component childhood obesity treatment intervention (MCTI), considering parent and child perspectives in order to develop future interventions which manage potential attrition more effectively. Semi-structured interviews explored attrition amongst a sample of children (n = 10) and their parents (n = 10) who dropped out of a community-based MCTI. Parents and children highlighted psychological and motivational issues (e.g. misaligned expectations, lack of desire to make behaviour changes and perceived costs of change outweigh the perceived gains) as the driving factor for their attrition alongside attitudinal, environmental, interpersonal and treatment variables. The complexity and interaction of factors associated with attrition identified in this study points to the challenges associated with reducing drop-out in MCTI’s. The views of families’ should be a key consideration in the design and implementation of treatment interventions to harness and sustain commitment to the treatment process

Rebuilding the workplace to promote young workers' mental health

Purpose Young adults have been particularly adversely affected by COVID-19-related disruptions, especially in relation to industries with an over-representation of young adults. This study, a report, aims to discuss the findings from survey data from young adults who reported poorer mental health comparative to older generations prior to the pandemic. Drawing on the international literature and the research findings, the authors propose recommendations for rebuilding the workplace post-pandemic to support young adult's mental health. Design/methodology/approach Data from 1,999 respondents from 200 organisations in the UK were sought in relation to workplace well-being and mental health through a 15-item multiple choice online survey. Overall, 17% of the sample were senior management, 31% junior management, 37% in non-management roles and a further 15% stated “other”. Exploratory quantitative analyses were undertaken to assess differences in responses to questions between age groups. Findings Participants in the 16–25-year-old age group were more likely than any other age group to report that work adversely affected their mental health, that their mental health challenges influenced their performance at work, that they had witnessed colleagues' employment negatively influenced by mental health challenges and they felt more comfortable citing physical health challenges for absence than mental health difficulties. Originality/value COVID-19-related disruptions meant a large-scale move to remote working for many people. As we return to physical workplaces, we have an exciting opportunity to reform and improve the status quo. The findings, in relation to the mental health of young adults, highlight key risk factors that need to be addressed

Distinguishing factors that influence attendance and behaviour change in family-based treatment of childhood obesity:A qualitative study

Objectives: For the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family-based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)). Design: Focus groups with children and parents/carers as part of a broader mixed-methods evaluation. Methods: Eighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change. Results: Initial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non-judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non-attending significant others. Conclusions: Factors that influence attendance and behaviour change are distinct and may be important at different stages of the family’s change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention