Title: Healthy Dads, Healthy Kids UK: a cultural adaptation and feasibility study of a weight management programme for fathers of younger children
Funder: Department of Health and Social Care

Abstract: DESIGN Two phases informed by the MRC complex interventions framework.[25] PHASE 1: INTERVENTION ADAPTATION The Healthy Dads, Healthy Kids (HDHK) intervention is a 9 session group-based weight management and healthy lifestyle programme for fathers and their children (aged 4-11 years) delivered in community settings.[5,6,27] The intervention will be adapted to an ethnically diverse UK population using principles for adapting behaviour change interventions for multi-ethnic groups[26] and information from focus groups and semi-structured interviews with overweight fathers and their partners from ethnically and socio-economically diverse groups. Manuals and resources for the facilitators and participants will be adapted. PHASE 2: FEASIBILTY STUDY The feasibility aims to test the delivery and acceptability of the adapted programme, recruitment and retention; additional aims will test the feasibility of components of the proposed RCT to determine the feasibility of the protocol. SETTING Birmingham, an ethnically diverse city. Weight management services for adults currently have an under-representation of men (<15%). The service will be funded by the local authority (LA) and group facilitators recruited from Change4Life Champions, teachers and local authority fitness coaches. A further site will be selected from Sandwell or Wolverhampton. STUDY POPULATION: Obese fathers (BMI>=30kg/m2/27.5kg/m2 for minority ethnic groups) of children (aged 4-11) identified through schools, religious organisations, jobcentres and workplaces. DESIGN: Feasibility RCT with 90 fathers randomised (stratified by ethnicity) 2:1 to intervention (described above) or control group (fathers provided with information about local opportunities for physical activity and voucher for a single free attendance for the family at a leisure centre). OUTCOME MEASURES: Intervention acceptability by attendance at programme. Uptake and adherence rates. Interviews and focus groups will be used to explore programme providers, fathers’, children’s and mothers'/partners' views of the programme, and reasons for non-completion. The feasibility of a future definitive trial will be assessed by recruitment rates, willingness to be randomised, follow-up rates at 3 and 12 months and level of questionnaire completion. OUTCOME MEASURES TO INFORM FULL TRIAL at 3 and 12 months to test feasibility of data collection: Fathers’ weight change at 3 and 12 months; % losing 5% or more body mass, self-reported and objectively measured physical activity, self-reported dietary intake and involvement of father in parenting. Children’s BMI z-score change, % body fat, objectively measured physical activity, self-reported dietary intake, attainment data collected from schools. Quality of life measures and costs of taking part to inform future economic study. Fathers, mothers/partners and children will be interviewed at 3 and 12 months to explore their views on intervention acceptability, ability to sustain behaviour change, changes to food purchasing and cooking practices and family relationships. Fidelity of delivery of HDHK programme from observations of sessions and focus groups with facilitators. SAMPLE SIZE: To achieve feasibility objectives and estimate of fathers’ weight change at 6 months and standard deviation to inform sample size of full trial. PROJECT LENGTH: 27 months. 12 months adaptation; 12 months feasibility RCT, 3 months analyses and write-up.

Lay abstract: Nearly half of men aged 35-44 are overweight and a quarter are obese. Obesity is a major cause of long-term disease such as diabetes and heart disease and losing 5% of body weight reduces the risk of these diseases, but few men attend weight management services. Children are increasingly overweight, with 1 in 3 children aged 10/11 years overweight or obese. Whilst there are weight loss programmes for overweight children, the drop-out from these services is high. We propose to adapt a programme developed in Australia (Healthy Dads, Healthy Kids) which aims to help fathers lose weight and be positive role models for their children in their eating habits and physical activity. Fathers together with their primary school aged children attend 9 group sessions where information is provided and discussed, and fun physical activities are done together. Mothers/partners are invited to attend 2 sessions. In a research study in Australia, fathers and the children both lost weight, with fathers losing 3½kgs 3 months from the study start. The programme has not been tested in diverse ethnic groups or socio-economically disadvantaged communities, or outside Australia. An initial review of the programme booklet used in Australia for the fathers suggests that some changes would be needed to make it suitable for ethnically and socio-economically diverse populations in the UK. We plan to discuss the Australian programme booklets with people from a range of communities in Birmingham; then to adapt the programme to make it acceptable to different UK ethnic and social groups. We will also ask fathers how they would like to be approached to join such a programme. Next we will test out the modified fathers’ programme and the methods of our research study. To do this, we plan to enrol 90 fathers categorised as ‘obese’, with their children aged 4-11 years, via schools, workplaces, and religious organisations. We will visit them at home to weigh them and to fill out questionnaires. They will then be allocated by chance with 2/3 receiving Healthy Dads, Healthy Kids and 1/3 receiving one free family leisure centre visit and information about opportunities for physical activity in their local area (the control group). We will interview the fathers, children and the Healthy Dads, Healthy Kids session leaders to find out their experience of the programme and test whether fathers are willing to take part, attend the programme and agree to be seen at 3 months and 1 year. At 3 and 6 months we will evaluate measurements and questionnaires that we plan to use in a full trial. These include body weight, amount of physical activity and type and frequency of foods eaten. Fathers and children will each wear a monitor (like a watch) to measure their activity in the previous week. We will also measure fathers’ involvement in the family and in supporting physical activity and explore whether we can collect information about how the children are doing academically at school. Quality of life will be measured by questionnaire and programme costs collected. We will combine the information about whether the families found the programme acceptable, their willingness to take part, to be followed up and complete the questionnaires, and how well the sessions were delivered to inform a decision on whether or not to seek additional funding for a large trial. A group of fathers have commented on this proposal and will continue to advise on study methods.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE