Child-Centred Health Dialogue in Child Health Services
Condition: Child, Only; Child Obesity; Parents
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      Aims: The principal aim of this study is to evaluate a model of Child Centred Health Dialog
      (CCHD) in Child Health Services (CHS) aiming to promote a healthy lifestyle in families and
      prevent overweight and obesity in preschool children. The specific aims are to compare CCHD
      with usual care and to evaluate the effectiveness and cost-effectiveness of the CCHD for all
      children and specifically for children with overweight at the age of 4 years and to compare
      parents self-efficacy and feeding practices in families that received either CCHD or usual
      care Methods: A clustered non-blinded Randomised Control Trial was set up comparing usual
      care with a structured multicomponent child-centred health dialogue consisting of two parts:
      1) a universal part directed to all children and 2) a targeted part for families where the
      child is identified with overweight.
    

Detailed description: 
      Obesity in childhood challenges our global health as it affects children's immediate health,
      educational achievements and quality of life. Research shows that obesity has its roots in
      the preschool years and that children with obesity are very likely to remain obese as adults
      and are at risk of developing adult morbidity. Therefore, primary prevention and lifestyle
      interventions are important in order to promote healthy lifestyle and reduce the likelihood
      of later obesity. The evidence is strong that the first years of life are critical in
      establishing good nutrition and physical activity behaviours.

      The principal aim of the study is to evaluate a model of Child Centred Health Dialog (CCHD)
      in Child Health Services (CHS) aiming to promote a healthy lifestyle in families and prevent
      overweight and obesity in preschool children. Specific aims are to compare CCHD with usual
      care and to evaluate the effectiveness of the CCHD for all children and specifically for
      children with overweight at the age of 4 years and to compare parents self-efficacy and
      feeding practices in families that received either CCHD or usual care and to analyse the cost
      and cost effectiveness of CCHD, compared to usual care

      The study is guided by the Medical Research Councils framework for complex interventions
      consisting of four key elements: development, feasibility/piloting, evaluation and
      implementation. In the feasibility phase CCHD proved to be feasible and fewer normal-weight
      4-year-olds in the intervention group had developed overweight at the age of 5 compared to
      the control group and none had developed obesity one year after the intervention. Qualitative
      interview studies showed that nurses felt more comfortable using the illustrations in the
      conversation about healthy food habits. The nurses described the children more talkative and
      more involved when the illustrations were used. Parents felt that they received support,
      confirmation and guidance on various issues in the health dialogue. Four-year-old children
      liked to participate actively in CCHD, expressed their views based on their daily life but
      needed to understand the meaning of the information with which they interacted.

      The Swedish Child Health Services (CHS) are free of charge and attended by nearly all
      families with young children, irrespective of social position or ethnicity. CHS provide a
      package of health care universally to all children aged 0-5 years and extra health visits are
      offered according to need. Overweight is a condition, par excellence, that exemplifies the
      need for this approach. However, evidence-based models that can be used in CHS for the
      prevention of overweight and the prevention of obesity in case of identified overweight are
      lacking.

      The intervention CCHD was developed based on the following theories: the child's perspective,
      which puts the child as part of a family in the centre of thinking and practice and health
      literacy, meaning how people access, understand and use health information in ways which
      promote and maintain good health.
    

Intervention name(s): Child Centred Health Dialog (CCHD)
Intervention type(s): Behavioral
Intervention description(s): The universal part of CCHD means a structured dialogue between the nurse and the child in presence of its parents using eight illustrations based on the most important practices associated with overweight in preschool children: fruit and vegetables consumption, intake of sweetened beverages and portion size, physical activity, sedentary behaviour tooth brushing and sleep routines. The health dialog is completed by demonstrating the BMI-growth chart to show BMI development to give parents an accurate weight perception, identify overweight and support parental readiness towards a healthy lifestyle.
When the child is identified with an overweight or obesity, the entire family is invited to participate in the targeted part of CCHD: the Family Guidance, a family consultation based on the evidence based Standardized Obesity Family Therapy (Nowicka, 2011).
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: A clustered non-blinded randomised controlled trial (RCT) with two arms to determine the effectiveness (including costs and cost effectiveness) of 1) usual care (n = 3015 children) and 2) CCHD (n = 3032 children). The RCT includes 35 Child Health Centres (CHCs), located both in the country side as well as in 2 of the major cities, including areas with diverse social-economic settings.
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Child nutrition; Child physical activity; Child sleeping routines; Child toothbrushing; Parental feeding practices; Parental self-efficacy