Title: Development of a culturally adapted weight management programme for children of Pakistani and Bangladeshi origin
Funder: Department of Health (England)

Abstract: We will undertake two work packages (WPs) informed by the MRC complex interventions framework.WP1 (Theoretical and modelling phase): Development of a childrens weight management programme that is culturally adapted for Bangladeshi and Pakistani (BP) families but is suitable to be delivered in a diverse community encompassing multiple ethnic groups.WP2 (exploratory phase): A feasibility study to evaluate the acceptability of the developed weight management programme and to assess the feasibility of a future definitive trial.The setting for the study is Birmingham; a diverse city with 44% of children from minority ethnic groups (MEGs) and 20% from BP communities. The NHS offers a group-based community weight management programme for parents of children aged 4-11 years (First Steps) targeting all ethnic groups. Parents are invited to attend 7 sessions with the children attending the first and last sessions. Sessions are interactive and practical covering nutrition education behaviour change and physical activity promotion. After completion families are invited to attend quarterly follow up events. Currently initial uptake of the programme by BP families is high but completion rates are lower than in other ethnic groups. The programme is delivered by Birmingham Community Healthcare NHS Trust and is commissioned by Birmingham City Council. This existing infrastructure will be used for the study. WP1 consists of three strands of work to inform development of the culturally adapted childrens weight management programme.1) We will review the existing programme against the current evidence for effective childrens weight management interventions and identify common behaviour change techniques included in effective programmes using the CALO-RE taxonomy for behaviour change techniques.2) We will recruit 3 groups of BP parents to participate in interviews and FGs to explore barriers and facilitators to participation in the existing programme and potential modifications to enhance participation and sustained engagement. These groups will comprise parents/carers who were offered the First Steps programme but declined to attend (n=15) parents/carers who attended but did not complete the programme (n=15) and parents/carers who completed the programme (n=20-30).3) We will use our previous experience existing literature and a framework for the adaptation of health promotion interventions for MEGs4 to guide the programme adaptation process.Accompanying manuals will be developed for the adapted programme. Much of the content will be generic but will include tailored content specific to BP families. The tailored content will provide a template for adaptation to other communities enabling future transferability and tailoring to different populations.In WP2 we will undertake a feasibility study with the primary aim of assessing the proportion of BP families completing the adapted intervention programme. We will also assess the proportion of families of all ethnicities completing the adapted programme. In addition the feasibility study will inform design of a future RCT to determine effectiveness of the modified programme.Study population: Families in Birmingham with an overweight/obese child aged 4-11 years. Families referred to the existing service will be invited to participate. Purposive sampling will be undertaken to achieve over representation of BP families (60% of the study sample)Health technology: The culturally adapted weight management programme for children aged 4-11 years modified from the existing First Steps programme. Structure content and delivery will be determined in WP1. The programme will be delivered over 7-8 weeks followed by post-intervention support.Study design: Families will be randomised to intervention or standard care arms with a 2:1 ratio. The standard care arm will be offered the existing First Steps programme.Outcome measures: For the primary outcome measure we will estimate the proportion of BP families completing the programme in the intervention arm. We will assess intervention acceptability and success of programme adaptation. For each outcome interviews FGs and questionnaires will be used to explore the views of programme providers children and parents in relation to the adapted programme and reasons for non-completion. Sociodemographic data will be collected and measures taken on children and parents at baseline. Follow up measures will be taken immediately post-intervention and 6 months after the intervention. Data will be collected by researchers through home visits (with interpreters if required). Anthropometric diet physical activity and psychosocial outcomes will be collected and compared between the two groups. Methods for collecting cost data on intervention and standard care will be developed to inform a future economic evaluation.Sample size: We will recruit 120 families (60% BP) and randomise to intervention and usual care arms with a 2:1 ratio (n=80 in intervention arm n=40 in usual care arm). We will stratify randomisation by BP ethnicity (48 and 24 BP families in intervention and usual care arms respectively).The project length will be 30 months in total.


Research activity codes: 5.7 PHYSICAL;6.7 PHYSICAL
Health categories: STROKE;CANCER AND NEOPLASMS;METABOLIC AND ENDOCRINE;CARDIOVASCULAR;ORAL AND GASTROINTESTINAL