C.H.A.M.P. Families: Feasibility of educating parents to treat obesity in their children

Feasibility of the pilot intervention using the RE-AIM Framework.
The RE-AIM Framework, a planning and evaluation tool for community-based health interventions (Estabrooks & Glasgow, 2006; Glasgow, Vogt, & Boles, 1999) will be used to determine the feasibility of the C.H.A.M.P. Families pilot intervention via an in-depth examination of five broad dimensions:
1. Reach: Family (parent and child) demographics will be compared to census demographics in London, Ontario, Canada to determine the reach of C.H.A.M.P. Families. In addition, records of participant and/or non-participant inquiries into the program will be used to analyze: (a) participate rate; (b) reasons for participating; (c) reasons for declining to participate; and (d) the most effective recruitment methods.
2. Effectiveness: In the present study, effectiveness will be measured via the short-term (i.e. baseline to mid- and/or post-intervention) measurements of the secondary outcomes described below (i.e. child outcomes: BMI-z, physical activity levels and sedentary time, parent- and self-reported health-related quality of life, overall perceptions of the program; parent outcomes: BMI, family cohesion, satisfaction, and communication, parental self-efficacy for engaging children in healthy behaviours, overall perceptions of the program). Short-term attrition will be explored, and reasons for drop out will be reported. Qualitative data were collected via focus groups held during the last session of the program with both parents and children (separately) to explore the effectiveness of the program via participants’ experiences and perceptions of the intervention; these data will also be analyzed and reported.
3. Adoption (staff and setting levels): Data pertaining to and detailed descriptions of (e.g. roles, credentials, demographic information, and/or representativeness where applicable) delivery settings (YMCA, community organizations) and intervention agents (researchers, setting staff, guest speakers) who were invited to participate and/or delivered aspects of the program will be provided.
4. Implementation: Records detailing anticipated and actual planned intervention activities and components were kept and will be used to determine whether the C.H.A.M.P. Families program was delivered as it was intended (i.e. fidelity to study protocol). Adaptations to the intervention protocol (e.g., changes to assessment tools, measures, information sessions, and/or homework/resources) will also be reported. Additionally, completion of participant worksheets and goal setting logs (i.e. the at-home activities) will be assessed and reported. All costs associated with the development, implementation, and delivery of the program will also be reported (including in-kind contributions).
5. Maintenance (individual and setting levels): Individual-level maintenance will be assessed using the same secondary outcomes outlined in the effectiveness dimension of RE-AIM, but will be evaluated at 6 months post-intervention (Dzewaltowski et al., 2004; Glasgow et al., 1999). Long-term attrition will be measured via participant drop-out between post-intervention (i.e. Week 13) and 6-month follow-up (i.e. June 2018). The use of qualitative data obtained through focus groups with parents and children will be used to further contextualize differences between families that completed and those who did not complete follow-up assessments. Setting-level maintenance will be assessed using a follow-up mixed-methods questionnaire delivered to participating staff and organizations (e.g. YMCA, Heart and Stroke Foundation, etc.) at approximately 6 months post-intervention to assess their perceptions of the program and to determine their level of interest and potential participation in future interventions.

As noted above, there were several secondary outcomes assessed in the C.H.A.M.P. Families research project, which represent the "Effectiveness" and "Maintenance-Individual" dimensions of RE-AIM discussed above. Data collection took place in the home of each participant to ensure the privacy and comfort of participants during the four measurement timepoints: baseline (≤4 weeks pre-intervention), mid-intervention (Week 6), post-intervention (≤2 weeks post intervention), and 6-month follow-up (June 2018). All of the secondary outcomes were assessed during each home visit, with the exception of the focus groups, which took place at the YMCA during the last group-based session of the intervention (Week 13). The following provides an overview of the secondary outcomes.

Child outcomes:
1. Children’s Health-Related Quality of Life assessed using the Pediatric Quality of Life Inventory 4.0 (PEDS-QL 4.0; Varni, Seid, & Rode, 1999). This valid and reliable measure includes a self-report component (n = 23 items) completed by the child as well as a proxy report component (n = 23 items) completed by the parent/guardian based on his or her perceptions of the child’s health-related quality of life (Varni, Seid, & Kurtin, 2001).
2. Children’s General Health and Wellbeing assessed via parent reports using The Child Health Questionnaire – Parent Form 50 (Landgraf et al., 1998), a valid and reliable survey designed to measure the quality of life of children aged 5-18 years (HealthActCHQ Inc., 2016).
3. Children’s Physical Activity and Sedentary Time measured objectively using Actical™ accelerometers (MiniMitter, Bend, Oregon). These small, lightweight devices collect information on the frequency, duration, and intensity of activity (i.e. sedentary, light, moderate, vigorous), and have been shown to be a valid and reliable predictor of physical activity in children (Evenson et al., 2008; Puyau et al., 2004). Children were asked to wear the device during waking hours (i.e. from wake time to bed time) for 7 consecutive days at each of the four assessment points. Children were instructed to wear the device on their right hip (secured on an adjustable elastic and Velcro belt), and to keep a daily log of the times the device was put on and taken off (as well as reasons for removing the device throughout the day if applicable). Parents were also provided with information regarding the wear-time logs and use and placement of the devices.
4. Children’s Standardized Body Mass Index (BMI-z) calculated using researcher assessed height and weight, sex, date of birth, and date of measurement. Height (nearest 0.1 cm) and weight (nearest 0.1 kg) were measured on a firm, flat surface using a Seca 214 portable stadiometer and digital glass bathroom scale. Participants were instructed to remove shoes and heavy clothing while measurements were conducted. Calculations were performed using an online tool called “BMI Percentile Calculator for Child and Teen” developed by The Centers for Disease Control and Prevention (CDC; https://nccd.cdc.gov/dnpabmi/Calculator.aspx).
5. Children’s Perceptions of the Program and Perceived Impact on Family Health and Wellbeing. The purpose of the single 60-minute focus group held for children (n = 7) on the last day of the formal intervention (Week 13) was to explore their experiences in the study (e.g. data collection, researcher home visits, parental involvement, etc.), as well as their perceptions of the program's impact on their family’s communication, cohesion, and/or health behaviours.

Parent outcomes:
6. Parental Body Mass Index (BMI). Researcher-assessed weight and height was used to calculate parents’ BMI. Height (nearest 0.1 cm) and weight (nearest 0.1 kg) were measured on a firm, flat surface using a Seca 214 portable stadiometer and digital glass bathroom scale. Participants were instructed to remove shoes and heavy clothing while measurements were conducted. An online tool ( "Adult BMI Calculator") developed by the CDC was used to perform these calculations (https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html).
7. Parent-Reported Family Cohesion, Communication, and Satisfaction measured via the FACES IV Package (Olson, 2011). This package is a valid and reliable tool consisting of six Family Cohesion scales (n = 42 items), one Family Communication scale (n = 10 items), and one Family Satisfaction scale (n = 10 items). This package of instruments is reliable and valid for both parents and children aged 12 years or older, although in the current study, only parents completed these scales.
8. Parental Self-Efficacy for Supporting Children’s Health Behaviours assessed using the Parental Self-Efficacy Questionnaire, a valid and reliable 34-item questionnaire that assesses parental self-efficacy related to supporting children’s healthy dietary and physical activity behaviours (Decker, 2012). Four additional scales (n = 4 items each) were administered to parents, measuring parental self-efficacy for:
8.1. helping their child get at least 60 minutes of moderate intensity physical activity per day
8.2. helping their child consume five servings of fruits and vegetables per day
8.3. limiting sugary drinks to once a week
8.4. limiting consumption of fruit juice to 6 ounces per day
These scales have been found to be valid and reliable for parents of children aged 4 to 10 (Wright et al., 2014).
9. Parents’ Perceptions of the Program and Perceived Impact on Family Health and Wellbeing. Two 60-minute focus groups were held for parents (n = 6 in each group) during the last session of the program (Week 13) to explore their experiences and perspectives of the program, as well as perceptions of its impact on family health, health behaviours, communication, cohesion, and general satisfaction/wellbeing. Objectives of the focus groups for parents were to identify: which program components were perceived as impactful and useful; which aspects of the program could be improved in the future; the barriers and facilitators parents perceived in relation to implementing healthy behaviour changes in their homes; and the program’s potential impact on parenting as well as family cohesion, communication, and satisfaction.