Cluster-randomised trial to evaluate the ‘Change for Life’ mass media/ social marketing campaign in the UK

Abstract

BackgroundSocial marketing campaigns offer a promising approach to the prevention of childhood obesity. Change4Life (C4L) is a national obesity prevention campaign in England. It included mass media coverage aiming to reframe obesity into a health issue relevant to all and provided the opportunity for parents to complete a brief questionnaire (‘How are the Kids’) and receive personalised feedback about their children’s eating and activity. Print and online C4L resources were available with guidance about healthy eating and physical activity. The study aims were to examine the impact of personalised feedback and print material from the C4L campaign on parents’ attitudes and behaviours about their children’s eating and activity in a community-based cluster-randomised controlled trial.MethodsParents of 5–11 year old children were recruited from 40 primary schools across England. Schools were randomised to intervention or control (‘usual care’). Basic demographic data and brief information about their attitudes to their children’s health were collected. Families in intervention schools were mailed the C4L print materials and the ‘How are the Kids’ questionnaire; those returning the questionnaire were sent personalised feedback and others received generic materials. Outcomes included awareness of C4L, attitudes to the behaviours recommended in C4L, parenting behaviours (monitoring and modelling), and child health behaviours (diet, physical activity and television viewing). Follow-up data were collected from parents by postal questionnaire after six months. Qualitative interviews were carried out with a subset of parents (n = 12).Results3,774 families completed baseline questionnaires and follow-up data were obtained from 1,419 families (37.6%). Awareness was high in both groups at baseline (75%), but increased significantly in the intervention group by follow-up (96% vs. 87%). Few parents (5.2% of the intervention group) returned the questionnaire to get personalised feedback. There were few significant group differences in parental attitudes or parenting and child health behaviours at follow-up. Physical activity was rated as less important in the intervention group, but a significant group-by-socioeconomic status (SES) interaction indicated that this effect was confined to higher SES families. Similar interactions were also seen for physical activity monitoring and child television time; with adverse effects in higher SES families and no change in the lower SES families. Effects were little better in families that completed the questionnaire and received personalised feedback. At interview, acceptability of the intervention was modest, although higher in lower SES families.ConclusionsThe C4L campaign materials achieved increases in awareness of the campaign, but in this sample had little impact on attitudes or behaviour. Low engagement with the intervention appeared a key issue.Trial registration numberCurrent Controlled Trials ISRCTN00791709.

Ethnic differences in parental attitudes and beliefs about being overweight in childhood

“…It is notable that a national social marketing campaign (Change4Life, [40]) was in its early stages when this study was undertaken, and may not yet have had chance to take effect. Data published since has shown that Change4Life has improved knowledge and awareness of PA in parents of mixed ethnicities, but this does not necessarily translate to changes in behaviour [41].…”

Community-based dietary and physical activity interventions in low socioeconomic groups in the UK: A mixed methods systematic review

“…A recent review found a small effect of community-wide physical activity interventions on physical activity levels in low-SES groups, however again the evidence base was limited (Cleland et al, 2012b). Similarly, a recent evaluation of the 'Change for Life' public health campaign in the UK found little benefit of the intervention on physical activity and dietary behaviours, although engaging with the intervention had a positive impact on low-SES families and a negative impact on high-SES families (Croker et al, 2012).…”

“…Recent research suggests young adults view health promotion messages as unpopular and lack concern for future health (Poobalan et al, 2012). An evaluation of the UK-based 'Change for Life' public health intervention revealed a common perception among people from all SES backgrounds that their existing eating and physical activity behaviours were satisfactory, with the cost of healthier eating seen as a barrier among low-SES families (Croker et al, 2012). Awareness of the impact of financial status on family food choices has also been documented among primary school children (Fairbrother et al, 2012).…”

Scoping the impact of the national child measurement programme feedback on the child obesity pathway: study protocol

“…It is anticipated that there may be a low response rate and response bias towards parents who are more interested and engaged in their child’s health [13]. To address these issues the questionnaire will be distributed to all parents of children enrolled in the NCMP and a number of reminders and incentives will be used.…”