Addressing complexity of context: an exploratory study of childhood obesity prevention among diverse ethnic groups in schools and places of worship

Maria Maynard, Graham Baker, Rawlins Emma, Seeromanie Harding

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Abstract / Description of output

The dearth of effective childhood obesity prevention is particularly conspicuous for minority groups. To gain trust, engage families, and sustain culturally appropriate interventions, creative settings warrant consideration. We report on the exploratory phase of the mixed-methods DiEt and Active Living (DEAL) study to assess the potential for obesity prevention among children of diverse ethnic groups in schools and places of worship.

The DEAL study, informed by socioecological perspectives and the principles of the Medical Research Council's framework for development of complex interventions, took place in London, UK, in 2008–10. Target settings were three primary schools, three secondary schools, and six places of worship (churches, mosques, and temples). Key outcomes were recruitment, acceptability, compliance, and intervention delivery processes. An iterative recruitment strategy was used and documented (eg, number of invitations; range of approaches). 13 intervention sessions were designed, informed by thematic analysis of focus group and interview data from children, parents, and grandparents. Sessions were assessed with focus groups and questionnaires centred on enjoyment, appropriateness, and relevance, as perceived by the child participants, and among parents and community representatives seeking their views on the value of potential interventions. Cultural appropriateness and acceptability of validated measures of physical activity and diet were judged by participation and compliance, assessment ratings, and the ability to code and analyse reported dietary components. Participants included 70 children aged 8–13 years, 43 parents, 12 grandparents, and representatives from community groups—a sample small enough for detailed investigation, but precluding statistical inference by individual ethnic group. Standardised, validated methods were used across settings.

One invitation each to 12 schools achieved successful recruitment of five schools (42% response); 181 invitations to 94 places of worship recruited eight organisations (9%). School recruitment was managed by direct telephone contact, whereas individualised methods (telephone contact, mass-mailing, cold-calling by the principal investigator, and engaging with community networks) were needed for places of worship. Intervention sessions were delivered in all five schools but in only three places of worship owing to irregularity of attendance and attendance at more than one place of worship. All 13 sessions were appraised positively in both settings. Participation and completion rates were high for assessment measures (eg, 92% for dietary recalls; 89% for physical activity questionnaires) across schools and places of worship. There were difficulties in coding some foods consumed by ethnic minority groups, which suggests that the adaptation of food composition databases with ethnic-specific foods remains substantial at young ages. Parents and contacts in schools and places of worship overall approved of the intervention, as did wider community representatives, although resources and infrastructure were highlighted as limiting practical support.

Interventions among diverse ethnic and cultural groups carry complex issues around recruitment, cultural frameworks, and sustainability, which can potentially affect all stages of resourcing, development, delivery, and assessment of programmes. Feasibility may be better in schools, but to take advantage of opportunities for culturally specific support in community settings, full awareness of this complexity is needed.
Original languageEnglish
JournalThe Lancet
Issue numberS72
Publication statusPublished - 29 Nov 2013


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