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Title: Feasibility evaluation and long-term follow up of a family-based behaviour change intervention for overweight children (GOALS)
Author: Watson, Paula
ISNI:       0000 0004 2740 5470
Awarding Body: Liverpool John Moores University
Current Institution: Liverpool John Moores University
Date of Award: 2012
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Childhood obesity is the most serious public health challenge of the 21st century. Whilst evidence supports a family-based lifestyle approach to childhood obesity treatment, research is needed to understand how interventions work and how practitioners can effectively support families to sustain behavioural changes in the long-term. This thesis evaluated the feasibility of a family-based behaviour change intervention for overweight children (GOALS) and explored the psychosocial process of long-term behavioural change in families with overweight children. Study 1 measured the impact of GOALS on the body composition, lifestyle behaviours and self-perceptions of children and parents who completed the intervention. A complete case analysis (n=70) showed a significant 6-month reduction in child BMI SOS (-0.07, p < 0.001) that was maintained at 12-month follow up. There was a significant year-on-year increase in the proportion of children reducing BMI SOS (42.9% year 1, 62.5% year 2, 80% year 3, p < 0.05) and a strong positive relationship between parent and child BMI change (r = .479, p < 0.001). Parents reported positive changes to their own and their children's physical activity and diet. BMI SOS reduction during the intervention was associated with improved global self-esteem and perceived physical appearance at 12 months. Study 2 explored the experiences of families six weeks into the 18-session intervention through focus groups with parents and children. Motivators to attend GOALS included the non-judgemental approach, being in the same boat as others and child enjoyment. The whole family approach was perceived positively and families used BCTs both as a core component of GOALS and to facilitate their behaviour change at home. As well as the challenges of living with childhood overweight, families described a lack of support from extended family members and a perceived need for on-going professional support. Study 3 followed up 15 families 3-5 years after they attended GOALS. Child and parent BMI was collected and parents took part in a semi-structured interview to explore their perceptions of "success" and their experiences of changing physical activity and eating behaviours. Mean child BMI SOS change from baseline was -0.47 for the 14 families who had completed GOALS. The majority of families perceived positive long-term outcomes, but these were not always aligned with actual child weight change. The most "successful" families placed a priority on changing child weight-related behaviours and parents took responsibility for these changes. While weight-control was a conscious process for these families, it was not necessarily made a "big issue" and parents used practices of an authoritative nature to facilitate change. Physical activity had become a way of life for the children, and mothers had reached a stage of feeling in control of their own weight. This is the first UK childhood obesity treatment study to follow children up beyond 12 months, and the first known study worldwide to employ qualitative methods to explore parental perceptions of long-term success. Findings provided a unique insight into the process of long-term behavioural change for overweight children and raised questions about the way "success" is defined following participation in childhood obesity treatment. Recommendations are made to enhance the delivery of family-based childhood obesity treatment and policy-makers are urged to adopt a multilevel approach to tackling childhood obesity, with child weight management care pathways that recognise the heterogeneity of familial needs. Further research is required to substantiate the impact of GOALS, and to prospectively explore the process of behavioural change in overweight children and the familial factors that serve as moderators in this process.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: GV Recreation Leisure ; TX341 Nutrition. Foods and food supply ; RA0421 Public health. Hygiene. Preventive Medicine ; RJ101 Child Health. Child health services