Screening tools used in primary health care settings to identify health behaviours in children (birth-16 years); A systematic review of their effectiveness, feasibility and acceptability.

BACKGROUND: Child health behaviour screening tools have potential to enhance the effectiveness of health promotion and early intervention. This systematic review aimed to examine the effectiveness, acceptability and feasibility of child health behaviour screening tools used in primary health care settings. METHODS: A systematic review of studies published in English in five databases (CINAHL, Medline, Scopus, PsycINFO and Web of Science) prior to July 2022 was undertaken. Eligible studies described: 1) screening tools for health behaviours (dietary, physical activity, sedentary or sleep-related behaviours) used in primary health care settings in children birth to 16 years; 2) tool effectiveness for identifying child health behaviours and changing practitioner behaviour; 3) tool acceptability or feasibility from child, caregiver or practitioner perspective and/or 4) implementation of the screening tool. RESULTS: Of the 7145 papers identified, 22 studies describing 14 screening tools were included. Only four screening tools measured all four behaviour domains. Fourteen studies reported changes in practitioner self-reported behaviour, knowledge and practice. Practitioners and caregivers identified numerous benefits and challenges to screening. CONCLUSIONS: Health behaviour screening can be an acceptable and feasible strategy to assess children's health behaviours in primary health care. Further evaluation is needed to determine effectiveness on child health outcomes.

PREVIDE: A Qualitative Study to Develop a Decision-Making Framework (PREVention decIDE) for Noncommunicable Disease Prevention in Healthcare Organisations.

Noncommunicable diseases (NCDs), including obesity, remain a significant global public health challenge. Prevention and public health innovation are needed to effectively address NCDs; however, understanding of how healthcare organisations make prevention decisions is immature. This study aimed to (1) explore how healthcare organisations make decisions for NCD prevention in Queensland, Australia (2) develop a contemporary decision-making framework to guide NCD prevention in healthcare organisations. Cross-sectional and qualitative design, comprising individual semi-structured interviews. Participants (n = 14) were recruited from two organisations: the state public health care system (CareQ) and health promotion/disease prevention agency (PrevQ). Participants held executive, director/manager or project/clinical lead roles. Data were analysed in two phases (1) automated content analysis using machine learning (Leximancer v4.5) (2) researcher-led interpretation of the text analytics. Final themes were consolidated into a proposed decision-making framework (PREVIDE, PREvention decIDE) for NCD prevention in healthcare organisations. Decision-making was driven by four themes: Data, Evidence, Ethics and Health, i.e., data, its quality and the story it tells; traditional and non-traditional sources of evidence; ethical grounding in fairness and equity; and long-term value generated across multiple determinants of health. The strength of evidence was directly proportional to confidence in the ethics of a decision. PREVIDE can be adapted by public health practitioners and policymakers to guide real-world policy, practice and investment decisions for obesity prevention and with further validation, other NCDs and priority settings (e.g., healthcare).

Precision Public Health for Non-communicable Diseases: An Emerging Strategic Roadmap and Multinational Use Cases.

Non-communicable diseases (NCDs) remain the largest global public health threat. The emerging field of precision public health (PPH) offers a transformative opportunity to capitalize on digital health data to create an agile, responsive and data-driven public health system to actively prevent NCDs. Using learnings from digital health, our aim is to propose a vision toward PPH for NCDs across three horizons of digital health transformation: Horizon 1-digital public health workflows; Horizon 2-population health data and analytics; Horizon 3-precision public health. This perspective provides a high-level strategic roadmap for public health practitioners and policymakers, health system stakeholders and researchers to achieving PPH for NCDs. Two multinational use cases are presented to contextualize our roadmap in pragmatic action: ESP and RiskScape (USA), a mature PPH platform for multiple NCDs, and PopHQ (Australia), a proof-of-concept population health informatics tool to monitor and prevent obesity. Our intent is to provide a strategic foundation to guide new health policy, investment and research in the rapidly emerging but nascent area of PPH to reduce the public health burden of NCDs.

Data sources for precision public health of obesity: a scoping review, evidence map and use case in Queensland, Australia.

BACKGROUND: Global action to reduce obesity prevalence requires digital transformation of the public health sector to enable precision public health (PPH). Useable data for PPH of obesity is yet to be identified, collated and appraised and there is currently no accepted approach to creating this single source of truth. This scoping review aims to address this globally generic problem by using the State of Queensland (Australia) (population > 5 million) as a use case to determine (1) availability of primary data sources usable for PPH for obesity (2) quality of identified sources (3) general implications for public health policymakers. METHODS: The Preferred Reporting Items for Systematic Review and Meta-Analyses extension for scoping reviews (PRISMA-ScR) was followed. Unique search strategies were implemented for 'designed' (e.g. surveys) and 'organic' (e.g. electronic health records) data sources. Only primary sources of data (with stratification to Queensland) with evidence-based determinants of obesity were included. Primary data source type, availability, sample size, frequency of collection and coverage of determinants of obesity were extracted and curated into an evidence map. Data source quality was qualitatively assessed. RESULTS: We identified 38 primary sources of preventive data for obesity: 33 designed and 5 organic. Most designed sources were survey (n 20) or administrative (n 10) sources and publicly available but generally were not contemporaneous (> 2 years old) and had small sample sizes (10-100 k) relative to organic sources (> 1 M). Organic sources were identified as the electronic medical record (ieMR), wearables, environmental (Google Maps, Crime Map) and billing/claims. Data on social, biomedical and behavioural determinants of obesity typically co-occurred across sources. Environmental and commercial data was sparse and interpreted as low quality. One organic source (ieMR) was highly contemporaneous (routinely updated), had a large sample size (5 M) and represented all determinants of obesity but is not currently used for public health decision-making in Queensland. CONCLUSIONS: This review provides a (1) comprehensive data map for PPH for obesity in Queensland and (2) globally translatable framework to identify, collate and appraise primary data sources to advance PPH for obesity and other noncommunicable diseases. Significant challenges must be addressed to achieve PPH, including: using designed and organic data harmoniously, digital infrastructure for high-quality organic data, and the ethical and social implications of using consumer-centred health data to improve public health.

Who is responsible for assessing children's weight status? - a qualitative study of health professionals in regional Australia.

BACKGROUND: Currently in Australia there is a lack of clarity regarding routine assessment of primary school aged children's weight status despite it being the first step in the identification of overweight and obesity. The National Health and Medical Research Council Obesity Guidelines recommend primary health care professionals include routine weight status assessment in consultations with children yet research suggests this rarely occurs in practice. This study aimed to determine the views of primary health care professionals regarding routine weight status assessment in primary school aged children and to establish the barriers to assessing children's weight status. METHODS: Using the case study of a regional town, Rockhampton, purposeful sampling was used to represent the key primary health care settings and professional groups. Interviews were conducted with 31 health professionals. Data were collected and analysed guided by two frameworks, the Capability, Opportunity, Motivation and Behaviour and Theoretical Domains Frameworks. RESULTS: Eight themes emerged from data and these were relevant to the three levels of influence on the routine weight status of assessment, system, setting and individual. System level themes related to having a formalised program for the undertaking of routine weight status assessment in primary school aged children, increasing the population's awareness about the importance of the weight status check and limited public health services available for management of childhood overweight and obesity. Setting level theme regarded the location where routine weight status in primary school aged children could be undertaken. Four themes at the individual level of influence on the routine weight status assessment related to the primary health professionals' roles, barriers to assessing children's weight status, methods of weight status assessment and starting a weight related conversations with families. CONCLUSION: The Government, primary health care services, professional organisations and associations as well as health professionals must commit to long-term implementation of the Obesity Guidelines. Immediate action to improve the undertaking of routine weight status assessment in children must be taken by each health service and health professional. Strategies should aim to positively affect motivation to assess children's weight status as it is the central component in creating change in practice.

Parental opinions about the responsibility for assessing children's weight status - a survey of Rockhampton parents.

OBJECTIVES: To explore and analyse parental perspectives regarding the responsibility for routine weight status assessment of primary school-aged children. METHODS: Using a case study of a regional town, Rockhampton, an online survey was used to explore opinions about assessing children's weight status. Data was collected and analysed guided by Capability, Opportunity, Motivation, and Behaviour Framework. RESULTS: Parents recognised their responsibility for assessing children's weight and height and wanted to know their child's risk of being overweight. The majority of participants reported checking their child's weight and height but many never used Body Mass Index or growth charts. Schools were not seen as a setting where this assessment should be undertaken, due to concerns of bullying and effects on self-esteem. CONCLUSIONS: Parents must be better supported in identifying and addressing their child's obesity. Health professionals should use contact with families to provide education on the benefits of early identification of overweight and the steps involved in weight status assessment, and to undertake this check, offer advice and refer families to weight management services. Implications for public health: Increased awareness of parental opinions about the responsibility for assessing children's weight status may lead to change in health professionals' practice and improved health services for the identification and means of addressing childhood obesity.

How is children's weight status assessed for early identification of overweight and obesity? - Narrative review of programs for weight status assessment.

Assessment of a child's weight status is the first step in the management of childhood overweight and obesity. We reviewed routine assessment programs to inform early and routine identification of childhood overweight and obesity to address this global health issue. Twelve electronic databases were searched (Scopus, Web of Science, Wiley, ScienceDirect, PsycINFO, PsycARTICLES, PsycEXTRA, CINAHL, Primary Search, MEDLINE, ERIC, Academic Search Elite) for universal programs for weight status assessment of children aged 4-12 in Organization for Economic Co-operation and Development - countries, which included more than one assessment and parents receiving feedback. Of 1638 papers found via database searches, and 18 additional records identified through other sources, 26 were included. Reference to five countries' programs for weight status assessment was found in the results: Australia, Sweden, the Netherlands, the United Kingdom and the United States. All of these programs were implemented in a school setting. Lack of services, stakeholder collaboration, parental awareness and engagement and government funding need to be improved for this health check to be undertaken as a part of an ongoing program. This review is about the implementation of similar programs. Early identification of risk for overweight and obesity allows families that require help to connect with available health services.

Why do parents enrol in a childhood obesity management program?: a qualitative study with parents of overweight and obese children.

BACKGROUND: Despite the high prevalence of childhood overweight and obesity enrolment to weight management programs remains difficult, time consuming, costly and has limited effectiveness. The aim of this paper was to explore parents' perspectives on factors that influence their decision to enrol in a program to address their child's weight. METHODS: Semi-structured qualitative telephone interviews were undertaken with 21 parents of primary school aged children above the healthy weight range who had enrolled in a healthy lifestyle program. Questions were developed and analysed using the Theory of Planned Behaviour. They addressed parental reasons for enrolment, expectations of the program and apprehensions regarding enrolling. RESULTS: Prior to deciding to enrol, parents tended to be aware of the child's weight status, had attempted to address it themselves and had sought help from a number of people including health professionals. Parental decision to enrol was influenced by their evaluation of their previous attempts and their child's emotional state. CONCLUSIONS: Awareness of their child's weight status is an important first step in parents taking action at this health issue however it is unlikely to be sufficient on its own. Parental decision to join a childhood obesity management program can be complex and is likely to be made after numerous and unsuccessful attempts to address the child's weight. Strategies to encourage parents to enrol in programs should include activities beyond awareness of weight status. Health professionals should use contact time with parents to raise awareness of the child's weight status and to provide encouragement to address overweight and obesity. Parents must be supported in their attempts to address their child's overweight and obesity whether they choose to manage it themselves or within a program.