Lloyd Jenny J, Wyatt Katrina M
Institute for Health Research, University of Exeter Medical School, University of Exeter, Exeter, UK.
BMC Public Health. 2014 Jun 9;14:578. doi: 10.1186/1471-2458-14-578.
Approximately one third of 10-11 year olds in England are now overweight or obese suggesting that population approaches are urgently required. However, despite the increasing number of school-based interventions to prevent obesity, results continue to be inconsistent and it is still unclear what the necessary conditions are that lead to the sustained behaviour change required to affect weight status. The Healthy Lifestyles Programme is a theoretically informed four phase multi-component intervention which seeks to create supportive school and home environments for healthy behaviours.
A process evaluation has run alongside the exploratory trial of the Healthy Lifestyles Programme to ascertain the feasibility and acceptability of; the trial design (including the trial outcomes) and the HeLP Programme and whether it is able to engage schools, children and their families. Data was collected using interviews with teachers (n = 12) and parents (n = 17) and six focus groups with children (n = 47) and a questionnaire for parents of children in the intervention schools. Interview and focus group data relating to the intervention was analysed using framework analysis.
Four schools and 201 children participated in the exploratory trial. The data showed that the trial design was feasible and acceptable for schools and children. Three themes emerged for the data in relation to the acceptability and feasibility of the HeLP Programme (value, compatibility with the curriculum and enjoyment) and two themes emerged in relation to engagement ('knowledge and awareness' and 'taking messages on board'). The latter could be broken down into 4 subthemes ('initiating discussion with family and friends', 'acceptance of family rules', 'increased responsibility' and 'the importance of the mode and agent of delivery'). The use of highly inclusive and interactive delivery methods where the children were encouraged to identify with and take ownership of the healthy lifestyle messages were identified as important factors in motivating the children to take the messages home, seek parental support and initiate family lifestyle behaviour change.
The process evaluation of the exploratory trial has not only provided evidence of the feasibility and acceptability of the Programme, it has also allowed an understanding of how HeLP engages schools, children and their families. These findings have informed the process evaluation for the definitive trial.
目前，英格兰10至11岁的儿童中约有三分之一超重或肥胖，这表明迫切需要采取面向全体人群的措施。然而，尽管学校为预防肥胖开展的干预措施越来越多，但其效果仍不一致，目前仍不清楚影响体重状况所需的持续行为改变的必要条件是什么。健康生活方式计划是一项基于理论的四阶段多成分干预措施，旨在为健康行为营造支持性的学校和家庭环境。
在健康生活方式计划的探索性试验过程中进行了一项过程评估，以确定试验设计（包括试验结果）和健康生活方式计划的可行性和可接受性，以及该计划是否能够让学校、儿童及其家庭参与进来。通过与教师（n = 12）和家长（n = 17）进行访谈，并与儿童开展六个焦点小组讨论（n = 47），以及向干预学校的儿童家长发放问卷来收集数据。使用框架分析法对与干预相关的访谈和焦点小组数据进行分析。
四所学校和201名儿童参与了探索性试验。数据表明，试验设计对学校和儿童来说是可行且可接受的。关于健康生活方式计划的可接受性和可行性的数据出现了三个主题（价值、与课程的兼容性和趣味性），关于参与度的数据出现了两个主题（“知识与意识”和“接受信息”）。后者可细分为4个子主题（“与家人和朋友展开讨论”、“接受家规”、“增强责任感”以及“传递方式和传递者的重要性”）。使用高度包容和互动的传递方式，鼓励儿童认同并自主接受健康生活方式信息，被确定为激励儿童将信息带回家、寻求家长支持并引发家庭生活方式行为改变的重要因素。
探索性试验的过程评估不仅提供了该计划可行性和可接受性的证据，还让人了解了健康生活方式计划如何让学校、儿童及其家庭参与进来。这些发现为确定性试验的过程评估提供了参考。
