A Scale-Out Study of an Evidence-Based Family Meals Program Delivered in the Head Start Setting: Results,Challenges,and Opportunities

Abstract

Background:

There is need to identify evidence-based early childhood obesity prevention programs that are feasible and demonstrate cost-effectiveness for a broader health impact. This scale-out study leveraged community-engaged principles to compare the feasibility and cost-effectiveness of three delivery modes of a childhood obesity prevention family meals program (Simple Suppers) that demonstrated positive impacts on child and caregiver diet/nutritional health-related outcomes in a previous experimental trial tested among elementary-aged children.

Methods:

This three-arm (in-person, online, hybrid) pre-(T0) and post-(T1)-test study included families recruited from Head Start. Forty-five families (45 caregivers; 55 children) completed the study. The program was adapted to families with younger children (3–5 years). During the 8-week program, participants received weekly group education and meals through in-person, online, or hybrid format. Feasibility outcomes were attendance, acceptability (post-test survey; focus groups), fidelity, and cost (food; staff). Participant outcomes were related to diet/nutritional health. Kruskal–Wallis test was used to compare T0 to T1 differences in participant outcomes across delivery modes. Qualitative data were analyzed using thematic analysis. Cost-effectiveness was calculated as the net-cost of the program by changes in outcomes.

Results:

Overall attendance was 51.2%, and higher for in-person (72.0%) and hybrid (59.7%). Program satisfaction rate was highest for hybrid (93.0%), as well as program fidelity (96.7%). Focus group results revealed areas of program improvement, behavior change, and program approval. Cost was lowest for hybrid ($17.09/family). Children in the hybrid group had a reduced waist circumference (p = 0.02) versus in-person and online groups.

Conclusion:

The hybrid mode of Simple Suppers demonstrated the greatest scaling potential for a broader public health impact.

Get full access to this article

View all access options for this article.

References

Barlow

, Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 2007; 120 Suppl 4:S164–S92.

Fulkerson

, Rydell

, Kubik

, et al. Healthy home offerings via the mealtime environment (HOME): Feasibility, acceptability, and outcomes of a pilot study. Obesity (Silver Spring), 2010; 18 Suppl 1:S69–S74.

Fulkerson

, Neumark-Sztainer

, Story

, et al. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus study: Design and methods. Contemp Clin Trials, 2014; 38(1):59–68.

Rogers

, Anderson

, Dollahite

, et al. Methods and design of a 10-week multi-component family meals intervention: A two group quasi-experimental effectiveness trial. BMC Public Health, 2017; 17(1):50.

Fink

, Racine

, Mueffelmann

, et al. Family meals and diet quality among children and adolescents in North Carolina. J Nutr Educ Behav, 2014; 46(5):418–422.

Gable

, Chang

, Krull

. Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children. J Am Diet Assoc, 2007; 107(1):53–61.

Rollins

, Belue

, Francis

. The beneficial effect of family meals on obesity differs by race, sex, and household education: The national survey of children’s health, 2003-2004. J Am Diet Assoc, 2010; 110(9):1335–1339.

Woodruff

, Hanning

, McGoldrick

, et al. Healthy eating index-C is positively associated with family dinner frequency among students in grades 6-8 from Southern Ontario, Canada. Eur J Clin Nutr, 2010; 64(5):454–460.

Gunther

, Rogers

, Holloman

, et al. Child diet and health outcomes of the simple suppers program: A 10-week, 2-group quasi-experimental family meals trial. BMC Public Health, 2019; 19(1):1657.

10.

Hopkins

, Holloman

, Webster

, et al. Caregiver nutritional health outcomes of the simple suppers study: Results from a 10 week, two-group Quasi-experimental family meals intervention. Nutrients, 2022; 14(2):250.

11.

Aarons

, Sklar

, Mustanski

, et al. “Scaling-out” evidence-based interventions to new populations or new health care delivery systems. Implement Sci, 2017; 12(1):111.

12.

US Department of Health and Human Services. Office of Head Start [Internet]. [cited 2021 Feb 12]. Available from: https://www.acf.hhs.gov/ohs/about/head-start

13.

Birch

, Fisher

. Development of eating behaviors among children and adolescents. Pediatrics, 1998; 101(3 Pt 2):539–549.

14.

Deal

, Huffman

, Binns

, et al. Perspective: Childhood obesity requires new strategies for prevention. Adv Nutr, 2020; 11(5):1071–1078.

15.

Prevalence of Overweight, Obesity, and Severe Obesity Among Children and Adolescents Aged 2–19 Years: United States, 1963–1965 Through 2017–2018 [Internet]. National Center for Health Statistics (U.S.); 2021 Jan [cited 2024 Sep 29]. Available from: https://www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf

16.

Bowen

, Kreuter

, Spring

, et al. How we design feasibility studies. Am J Prev Med, 2009; 36(5):452–457.

17.

Dalziel

, Segal

. Time to give nutrition interventions a higher profile: Cost-effectiveness of 10 nutrition interventions. Health Promot Int, 2007; 22(4):271–283.

18.

Weiner

, Lewis

, Stanick

, et al. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci, 2017; 12(1):108.

19.

Blumberg

, Bialostosky

, Hamilton

, et al. U.S. household food security survey module: Six-item short form. Am J Public Health, 1999; 89(8):1231–1234.

20.

Bohman

, Nyberg

, Sundblom

, et al. Validity and reliability of a parental self-efficacy instrument in the healthy school start prevention trial of childhood obesity. Health Educ Behav, 2014; 41(4):392–396.

21.

Centers for Disease Control and Prevention. National Health and Nutrition Examinatory Survey (NHANES): Anthropometry Procedures Manual. Centers for Disease Control and Prevention: Atlanta, GA; 2007.

22.

Block Kids Food Screener - Last Week (age 2-17), Parent Version [Internet]. NutritionQuest; [cited 2024 Sep 29]. Available from: https://www.nutritionquest.com/assessment/list-of-questionnaires-and-screeners/

23.

Lohman

, Roache

, Martorell

. Anthropometric standardization reference manual. Med Sci Sports Exerc, 1992; 24(8):952.

24.

Centers for Disease Control and Prevention NC for HS. CDC growth charts: United States. 2010.

25.

High Blood Pressure | National Heart, Lung, and Blood Institute (NHLBI) [Internet]. [cited 2018 Aug 12]. Available from: https://www.nhlbi.nih.gov/health-topics/high-blood-pressure

26.

Jilcott Pitts

, Jahns

, Wu

, et al. A non-invasive assessment of skin carotenoid status through reflection spectroscopy is a feasible, reliable and potentially valid measure of fruit and vegetable consumption in a diverse community sample. Public Health Nutr, 2018; 21(9):1664–1670.

27.

Anonymous. Designing and conducting cost-effectiveness analyses in medicine and health care. Int J Health Care Qual Assur, 2002; 15(4); doi: 10.1108/ijhcqa.2002.06215dae.003/full/html

28.

Let’s Move: America’s Move to Raise a Healthier Generation of Kids [Internet]. [cited 2024 Sep 29]. Available from: https://letsmove.obamawhitehouse.archives.gov/

29.

White House Task Force on Childhood Obesity Report [Internet]. [cited 2024 Sep 29]. Available from: https://letsmove.obamawhitehouse.archives.gov/white-house-task-force-childhood-obesity-report-president

30.

Lincoln

, Blanche

. [D-AR]. Healthy, Hunger-Free Kids Act of 2010 [Internet]. 3307 Dec 13, 2010. Available from: https://www.congress.gov/bill/111th-congress/senate-bill/3307

31.

Nutrition and Childhood Obesity Science White Paper [Internet]. U.S. Department of Agriculture; 2012 Jul [cited 2024 Sep 29]. Available from: https://www.usda.gov/sites/default/files/documents/nutrition-childhood-obesity-science-white-paper.pdf

32.

Fraser

, Whelan

, Brown

, et al. System approaches to childhood obesity prevention: Ground up experience of adaptation and real-world context. Public Health Nutr, 2023; 26(4):886–889.

33.

Heerman

, Schludnt

, Harris

, et al. Scale-out of a community-based behavioral intervention for childhood obesity: Pilot implementation evaluation. BMC Public Health, 2018; 18(1):498–411.

34.

Bérubé

, Gélinas

, Feeley

, et al. A hybrid web-based and in-person self-management intervention aimed at preventing acute to chronic pain transition after major lower extremity trauma: Feasibility and acceptability of iPACT-E-Trauma. JMIR Form Res, 2018; 2(1):e10323.

35.

Powell

, Dalton

, Lawrence-Bourne

, et al. Co-creating community wellbeing initiatives: What is the evidence and how do they work? Int J Ment Health Syst, 2024; 18(1):28.

36.

Yamanaka

, Davis

, Wilkens

, et al. Determination of child waist circumference cut points for metabolic risk based on acanthosis nigricans, the children’s healthy living program. Prev Chronic Dis, 2021; 18:E64.

37.

Schwandt

. Defining central adiposity in terms of clinical practice in children and adolescents. Int J Prev Med, 2011; 2(1):1–2.

38.

Daniels

, Khoury

, Morrison

. Utility of different measures of body fat distribution in children and adolescents. Am J Epidemiol, 2000; 152(12):1179–1184.

39.

Freedman

, Kompaniyets

, Daymont

, et al. Weight gain among US adults during the COVID ‐19 pandemic through May 2021. Obesity (Silver Spring), 2022; 30(10):2064–2070.

40.

Zeigler

. COVID-19 Self-quarantine and weight gain risk factors in adults. Curr Obes Rep, 2021; 10(3):423–433.

41.

Berge

, Hazzard

, Larson

, et al. Are there protective associations between family/shared meal routines during COVID-19 and dietary health and emotional well-being in diverse young adults? Prev Med Rep, 2021; 24:101575.

42.

Gunther

, Banna

, Jones

, et al. Adolescent independent eating occasions, dietary intake, and parenting practices during the COVID-19 pandemic: A qualitative study of parents and adolescents from households with low income. J Nutr Educ Behav, 2023; 55(9):634–643.

43.

Titis

. Parental perspectives of the impact of COVID-19 lockdown on food-related behaviors: Systematic review. Foods, 2022; 11(18):2851.

44.

Otterbach

, Mena

, Greene

, et al. Community-based childhood obesity prevention intervention for parents improves health behaviors and food parenting practices among Hispanic, low-income parents. BMC Obes, 2018; 5(1):1–0.

45.

Dietz

. We need a new approach to prevent obesity in low-income minority populations. Pediatrics, 2019; 143(6):e20190839.

46.

Cloutier

, Wiley

, Kuo

C‐L

, et al. Outcomes of an early childhood obesity prevention program in a low‐income community: A pilot, randomized trial. Pediatr Obes, 2018; 13(11):677–685.

47.

Kumanyika

. Getting to equity in obesity prevention: A new framework [Internet]. [cited 2017 Jan 18]. Available from: https://nam.edu/ getting-to-equity-in-obesity-preventiona- new-framework/

48.

Bleich

, Dupuis

, Seligman

. Food is medicine movement—key actions inside and outside the government. JAMA Health Forum, 2023; 4(8):e233149.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB