Parenting, Eating and Activity for Child Health (PEACH) Queensland: the trial of universal childhood obesity management program for families of primary school aged children

The TRIM kids project trialled the universal availability of a childhood obesity management service in Queensland, Australia. It was the upscaled implemention of the Parenting, Eating and Activity for Child Health (PEACH) program. The aims of the project were to increase the capacity of families who participated to adopt healthy lifestyles (eating and physical activity and to promote healthy weight through sustainable behavior change. Objectives of the project were to: 1: Successfully deliver the program to 1400 children state-wide. 2: Refine the PEACH model to ensure maximum retention of participants and further deploy the program to maximise participation state-wide (including regional and rural Queensland). 3: Document new models utilised to deliver the program. 4: Enhance the currently limited evidence-base on the effectiveness of paediatric treatment programs, in particular, in their use with culturally and linguistically diverse (CALD) and Aboriginal and Torres Strait Islander populations. 5: Contribute to the Department of Health’s vision through contributing to the early detection and appropriate treatment of childhood obesity and secondary prevention of obesity related conditions. 6: Leverage the funding opportunity to invest in the sustainability beyond the project lifecycle. PEACH targeted families of children aged 5-11 years who were above the healthy weight range for age. PROCEDURES AND MATERIALS PEACH was a group-based, 6 month family-focussed lifestyle intervention. PEACH consisted of nine 90-minute face-to-face sessions (fortnightly or weekly), followed by a final tenth session at 6-months after session one. Between sessions nine and ten, facilitators made three individualised phone calls (duration varied according to family need). At each session, content was delivered by the facilitator to a group of parents, emphasising the role of peer-support in behaviour change. Sessions were held outside of school hours in a variety of tertiary and community based settings, predominantly school venues. Topics included parenting styles, nutrition skills, and physical activity. Each of the ten parent sessions had defined objectives, take home messages and a small homework task. Parents were encouraged to set one or two family family-specific goals to work on between sessions, utilising the goal setting and action planning worksheet templates and the planning ahead template (PAT). Enrolled families received a Parent Handbook and provided additional one-on-one parent facilitator time support via three phone calls between sessions 9 and 10 at a time each parent had identified as convenient for them. Parents received appointment reminder SMS messages before each face-to-face session and twelve weekly motivational messages between sessions 9 and 10 e.g. "routines help children to move from one activity to th enext smoothly and calmly. why not use a PAT to set a healthy routine? Concurrently with parent sessions, Children attended separate sessions with a child facilitator during which they participated in games and activities. Each child session included a brief healthy eating component based on the content corresponding parent session to facilitate family discussion at home. Children sessions were supported with a Child workbook which encouraged ‘at home’ activities. Siblings of enrolled children were encouraged to participate in the child sessions. WORKFORCE Facilitators were health professionals recruited from around Queensland via call for expressions of interest. Training workshops were conducted via a 2-day face-to-face workshop in Brisbane, Queensland or teleconference meeting in special circumstances. Workshops comprised program information including the background to PEACH and its key objectives, session content role-plays as well as information on the role of the facilitator in program delivery and collection of evaluation data from participants. ADHERENCE AND MODIFICATIONS Data regarding fidelity of the intervention was collected using session monitoring booklets. Facilitators recorded the duration of each session and their adherence to the session’s key content. The project was implemented over five geographical time limited waves during which one program cycle (ie 6months) was delivered. The number of programs being run increased incrementally with each wave with services from previous waves expected to continue to offer the program in subsequent waves. Data was reviewed at the end of each wave and informed subsequent waves. Two key changes were made as a results: After wave 2, the QUT Project Implementation Team undertook a review of the program design and content, and as a consequence of this the intervention was adapted in order to improve retention and engagement. Some of this adaptations were: changed intervention frequency from fortnightly to weekly sessions, within a school term, reviewed program design and content to better align with families concerns and reasons for enrolment, Introduced SMS reminder messages before sessions, focused on using schools as ideal venues to reduce stigma, and sent motivational SMS messages to families between sessions 9 and 10. Following wave 4, eligibility criteria were changed to include healthy weight children.