Healthy families in a healthy system

Samenvatting Kinderen in achterstandswijken hebben vaak gezondheidsachterstanden en een grotere kans op overgewicht dan kinderen uit betere wijken. Deze verschillen zijn al op de voorschoolse leeftijd zichtbaar. Momenteel is er echter weinig aandacht voor overgewichtpreventie bij peuters. Het doel van dit project is het evalueren van een integrale aanpak van leefstijl en overgewicht bij jonge gezinnen, die aangeboden wordt in achterstandswijken in Sittard-Geleen. De doelgroep wordt bereikt via de peuterspeelzaal, de thuisomgeving, en de wijk. De verwachting is dat de aanpak beter werkt in de wijken met de meeste achterstand, hierdoor worden gezondheidsverschillen verkleind. Een tweede doel van het project is het inzicht verkrijgen in waarom de integrale aanpak werkt. Het eindproduct is een evaluatie van de multi-component interventie ter verbetering van de gezondheid van jonge gezinnen. De studie verschaft inzicht in de werkzaamheid, borging en relevante contextuele factoren van de interventie. Summary Children and adults in deprived areas often have a greater chance to develop overweight, compared to people living in non-deprived areas. These differences are already present in preschool-aged children. Moreover, the preschool period is a crucial period: weight status at this age is the strongest predictor for the development of overweight at a later age. However, few interventions to prevent overweight are aimed in this age group are currently too fragmented and isolated in order to result in sustained effects. The aim of the current project is to evaluate an integrated systems approach aimed at the prevention of overweight in preschoolers and their families. Such an integrated systems approach, in which interventions in multiple settings are aligned, can create synergistic effects, resulting in effects above and beyond the effects of existing single-setting interventions. However, there is a need to gain more insight in working mechanisms of systems approaches in the prevention of overweight. We have developed an integrated approach in order to reach low SES families through three settings: the neighborhood, preschools and the home environment. At preschool, teachers are offered a training regarding physical activity, nutrition, and parenting, as well as on the job coaching to help them put their newly acquired knowledge and skills into practice. In addition, parents of families with an overweight family member (either the child or the parents themselves), receive a family intervention focusing on the same topics as the preschool intervention, combined with sessions together with their child focused on enjoying physical activity together as a family. In the neighborhood, the link between the preschool and the community is strengthened, for instance by organizing activities for the community at the preschools, and by the preschools going into the community to use existing resources and facilities to be active, for instance. The aim of this intervention is to promote a healthy lifestyle, resulting in a healthier weight status and a better positive health in young families. This approach is offered in low socio-economic status (SES) areas in the municipality Sittard-Geleen. Main intervention components are aimed at changing the social and physical environments in order to promote healthy diets and physical activity. The objective of the proposed project is to evaluate effects and working mechanisms of the integrated systems approach. We will use a quasi-experimental design with a matched control condition. We have 3 main hypotheses: 1. The integrated systems approach will result in a healthier weight status and a better perceived health in the intervention areas, compared to the matched control areas. 2. The integrated systems approach will reduce health inequalities between communities, i.e. the positive effects of the intervention are expected to be stronger in lower SES areas. 3. The effects of the integrated systems approach on weight status and health are mediated by interactions between changed in the physical and social environmental features. The current project includes a rigorous effect and process evaluation of an integrated systems approach aimed at improving the health status of young families. Outcome measures of the effect evaluation include positive health of the preschoolers and parents, as perceived by the parents, and preschoolers’ and parents’ measured weight status. In addition, preschoolers’ dietary intake and physical activity, as well as changes in the social and physical environment, are assessed to provide insight in the working mechanisms of this systems approach. The process evaluation will be based on RE-AIM. The project pays specific attention to knowledge transfer and the maintenance and further dissemination of the intervention after the project period. Involved organizations have already consented to their role in this.