Clinical trial NCT02563613: Happy Family Kitchen Movement Project
Official title: Happy Family Kitchen Movement, A Community-based Research to Enhance Family Health, Happiness and Harmony in Hong Kong: A Cluster Randomized Controlled Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Family Health, Happiness and Harmony
Physical Health
Psychosocial Health
Family Communication
Healthy Lifestyle
Keywords: community-based intervention
family holistic health
positive psychology
physical exercise
healthy diet
Lead sponsor: The University of Hong Kong
Sponsor class: OTHER
Collaborators: name: The Hong Kong Council of Social Service
First posted: 2015-09-30
Enrollment: 3419
Sex: ALL
Minimum age (years): 12
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: PREVENTION

Brief summary: In recent years, Hong Kong is undergoing rapid changes together with macro social and economic trends. The increasingly complex and diverse family structure is leading to a major concern in the well-being of families, including their health, happiness and harmony (3Hs). Family life and health education should be strengthened to meet the increasing needs of healthy lifestyle promotion. In light of these concerns, the Happy Family Kitchen Movement (HFKM) project, with a focus on "FAMILY Holistic Health", will be conducted at territory-wide level in Hong Kong. HFKM is a community-based research project to develop, implement and evaluate a community-based family intervention program for improving family well-being. It is expected that participants of the community-based family interventions will gain knowledge on family holistic health and in turn promote a healthy lifestyle for 3Hs.

Detailed description: In 2011, United Nations (UN) gathered to address the prevention and control of non-communicable diseases (NCDs) worldwide. The UN, in its Political Declaration, recognized the critical importance of reducing the level of exposure to the common modifiable risk factors for NCDs, such as physical inactivity and unhealthy diet. In Hong Kong, NCDs are responsible for more than 85% of all deaths and most of these are preventable. FAMILY Project Cohort Study (2014) also found that 88.6% of Hong Kong people had inadequate vegetable and fruit intake, 70.6% had inadequate physical exercise, 26.4% were overweight and 5.4% were obese. Hong Kong, being the most westernized and developed city of China, can take a leading role in promoting and implementing the UN Political Declaration.

Families worldwide are undergoing rapid changes together with macro, social and economic trends. Demographic shifts, economic upheavals, changing societal norms and values, both immigration across national borders and migration within nations are creating new and altered structures, processes, and relationships within families. The increasingly complex and diverse family structure is leading to a major concern in the well-being of families in Hong Kong, including their health, happiness and harmony (3Hs). Family life and health education should be strengthened to meet the increasing needs of healthy lifestyle promotion. The results from the baseline findings of FAMILY Project Cohort Study (2014) revealed that only 27.9% of the participants considered themselves to be 'happy' while 15.6% of the participants were classified as 'unhappy'. Nearly one-third (30.7%) of the participants reported having experienced at least one stressful life event in the previous year due to heavier workload (10.8%), serious health problems of a family member (6.8%), worsening financial situation (6.2%), health problems (5.1%), or death of a family member (4.7%). Furthermore, more than half of the participants (52.5%) reported having some source of dyadic conflict with family members. In response to these family and health challenges, the Happy Family Kitchen Movement (HFKM) project, with a focus on "FAMILY Holistic Health", will be conducted at territory-wide level in Hong Kong.

There are now many definitions and operationally defined terms on family health. On the functional level, the terms family health, family functioning, and healthy family are often used interchangeably (Hanson \& Boyd, 1996). Family health has been described as complex system, interactions, relationships and processes with the potential to enhance both well-being and the entire household's health, and routines in the family may affect family health (Denham, 1999, 2002; Yoshikawa, 2012). Despite the different perspectives in the definitions, family health should be holistically defined, encompass both wellness and illness variables and focus on the interactive, developmental, functional, psychosocial, and health processes of family experience (Anderson \& Tomlinso, 1992). Hence, the HFK Movement project will focus on "FAMILY Holistic Health" which is to emphasize a more comprehensive and wide reaching aim and includes the physical, psychological and social aspects of well-being.

Over the past six years, the FAMILY project has been working on community-based projects to promote 3Hs. Since September 2010, the Happy Family Kitchen I project (HFK) was launched in Yuen Long district, with the mission to promote 3Hs by building capacity for families on positive communication. As a component of the FAMILY Project, the HFK project had demonstrated the impact to build up an effective practice model through collaboration among various project partners. HFK II was an improved version, extended and introduced to Tsuen Wan \& Kwai Tsing districts in April 2012. The School of Public Health, The University of Hong Kong, collaborated with The Hong Kong Council of Social Service in the training, design and implementation, and conducted project evaluations for HFK I \& II projects, which showed that the projects were well received by the family members in Yuen Long, Tsuen Wan and Kwai Tsing districts, with significantly improved 3Hs and intervention-related behaviors. Therefore, the HFKM project is developed based on the strong foundation of the HFK projects in the previous years. In view of the physical health challenges locally and globally, the new phase of FAMILY project will put more emphasis on physical health in the upcoming three years. Following the theme on FAMILY 3Hs, the new work focus is to promote family holistic health with emphasis on the interaction and integration of physical and psychosocial health.

In Hong Kong, most 'health projects' only focus on individual's physical health and usually separate physical from mental or psychosocial health. The focus of this project not only emphasizes on individuals' health but on the family's holistic health. It is aimed to help family members influence each other for healthier lifestyles. The focus on family is a new and unique concept which is an innovative, long-term and highly sustainable at the community level. With the involvement of family members, Hong Kong families can change their lifestyles and make a difference and impact on their health. A family-focused approach will be used and a holistic perspective will be adopted to design a sustainable family holistic health intervention model in the community to meet the global health challenges.

The innovative family holistic health intervention model will emphasize on the interaction and integration of physical health and psychosocial health, based on positive psychology (Seligman, 2002; Seligman, 2011; Seligman \& Csikszentmihalyi, 2000), using physical exercise and healthy diet as the platform to promote finer and fitter families, which will ultimately enhance the 3Hs. Thus, the ultimate objective of the community-based project is family holistic health for 3Hs.

In practice, innovative integrated positive psychology, public health theories and minimal methods will be used to develop brief, simple and cost-effective interventions targeted at families, in collaboration with experienced NGO partners and community stakeholders. Training workshops for the promotion of family holistic health will be conducted for the facilitators of the community-based family intervention programs. Hence, a larger number of people will be able to benefit from the program which can have greater sustainability and wider dissemination as it will be easy to administer and the costs will be low. The community-based family intervention programs will be aimed at promoting a higher level of physical exercise and a healthy diet for people of all ages which will enhance family interaction, pleasure and well-being. The use of positive psychology approach can help families develop positive attitudes and stronger motivation for healthy lifestyles. By working together with family members to have more physical exercise and consume less sugar, the process will be enjoyable with quick and measurable benefits, which will ultimately enhance sustainability within the family and beyond.

The evaluations conducted will be vigorous and evidence generating with quantitative and qualitative methods and follow-ups to assess behavioral changes and improvements in the key components of family well-being. For program development, process evaluation will also be a source for data collection.

This study has two major objectives:

1. To examine the effectiveness of positive psychology and physical exercise intervention (PE) for the promotion of family health, happiness and harmony (3Hs).
2. To examine the effectiveness of positive psychology and healthy diet intervention (HD) for the promotion of family health, happiness and harmony (3Hs).

The community-based family intervention is expected to:

1. improve family health, happiness and harmony
2. promote physical and psychosocial health
3. enhance family communication
4. encourage behaviors on positive psychology, physical exercise and healthy diet

Eligibility criteria: Inclusion Criteria:

* Cantonese speaking
* Intact verbal and hearing abilities for interpersonal communication
* Reading and writing abilities for questionnaire completion
* Willing to participate with 1 or more family members

Exclusion Criteria:

* Participants who fail to meet the inclusion criteria

Primary outcomes:
measure: Changes in family health, happiness and harmony (3Hs) from baseline to 3 months after intervention
timeFrame: Before core session (up to 1 week before), immediately after core session, 1 month after core session (before booster session), 3 months after core session (before follow-up session), 3 months after core session (immediately after follow-up session)
Secondary outcomes:
measure: Changes in behaviors on positive psychology, physical exercise and healthy diet from baseline to 3 months after intervention
timeFrame: Before core session (up to 1 week before), 1 month after core session (before booster session), 3 months after core session (before follow-up session)
measure: Changes in family communication from baseline to 3 months after intervention
timeFrame: Before core session (up to 1 week before), 1 month after core session (before booster session), 3 months after core session (before follow-up session)
measure: Changes in life satisfaction from baseline to 3 months after intervention
timeFrame: Before core session (up to 1 week before), 1 month after core session (before booster session), 3 months after core session (before follow-up session)
measure: Changes in subjective happiness from baseline to 3 months after intervention
timeFrame: Before core session (up to 1 week before), immediately after core session, 1 month after core session (before booster session), 3 months after core session (before follow-up session), 3 months after core session (immediately after follow-up session)
measure: Changes in mental and physical health from baseline to 3 months after intervention
timeFrame: Before core session (up to 1 week before), 1 month after core session (before booster session), 3 months after core session (before follow-up session)
measure: Intention to change after core session
timeFrame: Immediately after core session
measure: Intention to change after follow-up session
timeFrame: 3 months after core session (immediately after follow-up session)
measure: Satisfaction towards core session
timeFrame: Immediately after core session
measure: Satisfaction towards follow-up session
timeFrame: 3 months after core session (Immediately after follow-up session)
measure: The process of community-based intervention program
timeFrame: Up to 3 months
Other outcomes:
measure: Changes in physical fitness (muscle endurance) from baseline to 3 months after intervention
timeFrame: Before core session (up to 1 week before), 1 month after core session (before booster session), 3 months after core session (before follow-up session)
measure: Changes in physical fitness (balance) from baseline to 3 months after intervention
timeFrame: Before core session (up to 1 week before), 1 month after core session (before booster session), 3 months after core session (before follow-up session)
Locations:
city: Wan Chai
country: China
facility: The Hong Kong Council of Social Service
state: Hong Kong
Study officials:
affiliation: The University of Hong Kong
name: Henry C. Y. Ho, PhD
role: PRINCIPAL_INVESTIGATOR
affiliation: The University of Hong Kong
name: Tai Hing Lam, MD
role: STUDY_CHAIR
affiliation: The University of Hong Kong
name: Agnes YK Lai, DN
role: STUDY_DIRECTOR
References:
citation: Anderson KH, Tomlinson PS. The family health system as an emerging paradigmatic view for nursing. Image J Nurs Sch. 1992 Spring;24(1):57-63. doi: 10.1111/j.1547-5069.1992.tb00700.x.
citation: Denham SA. Family routines: a structural perspective for viewing family health. ANS Adv Nurs Sci. 2002 Jun;24(4):60-74. doi: 10.1097/00012272-200206000-00010.
citation: Denham, S. A. (1999). Part I: The definition and practice of family health. Journal of Family Nursing, 5(2), 133-159.
citation: Hanson, S. M., & Boyd, S. T. (1996). Family nursing: An overview. In S. M. Hanson & S. T. Boyd (Eds.), Family health care nursing: Theory, practice, and research (pp. 5-37). Philadelphia: F. A. Davis.
citation: Seligman, M. E. P. (2002). Authentic happiness: Using the new positive psychology to realize your potential for lasting fulfilment. New York: Free Press.
citation: Seligman, M. E. P. (2011). Flourish: A visionary new understanding of happiness and well-being. New York, NY: Free Press.
citation: Seligman ME, Csikszentmihalyi M. Positive psychology. An introduction. Am Psychol. 2000 Jan;55(1):5-14. doi: 10.1037//0003-066x.55.1.5.
citation: The FAMILY Project. (2014). FAMILY project cohort study: Baseline findings. Hong Kong Jockey Club Charities Trust Fund and the School of Public Health, The University of Hong Kong.
citation: United Nations. (2011). Political declaration of the high-level meeting of the general assembly on the prevention and control of non-communicable diseases. Retrieved from http://ncdalliance.org/sites/default/files/rfiles/UN%20HLM%20Political%20Declaration%20English.pdf
citation: Yoshikawa H. Integrating methods in the science of family health: new directions from an institute of medicine workshop report. Arch Pediatr Adolesc Med. 2012 Jul 1;166(7):659-61. doi: 10.1001/archpediatrics.2012.510. No abstract available.
citation: Guo N, Ho HCY, Wang MP, Lai AY, Luk TT, Viswanath K, Chan SS, Lam TH. Factor Structure and Psychometric Properties of the Family Communication Scale in the Chinese Population. Front Psychol. 2021 Nov 12;12:736514. doi: 10.3389/fpsyg.2021.736514. eCollection 2021.
citation: Ho HCY, Mui MW, Wan A, Yew CW, Lam TH. A cluster randomized controlled trial of a positive physical activity intervention. Health Psychol. 2020 Aug;39(8):667-678. doi: 10.1037/hea0000885. Epub 2020 May 14.