Designing new UK‐WHO growth charts: implications for health staff use and understanding of charts and growth monitoring

Abstract

New pre-school UK charts have been produced incorporating the new World Health Organization growth standards based on healthy breastfed infants. This paper describes the process by which the charts and evidence-based instructions were designed and evaluated, and what it revealed about professional understanding of charts and growth monitoring. A multidisciplinary expert group drew on existing literature, new data analyses and parent focus groups as well as two series of chart-plotting workshops for health staff. The first series explored possible design features and general chart understanding. The second evaluated an advanced prototype with instructions, using plotting and interpretation of three separate scenarios on the old charts, compared with the new charts. The first plotting workshops (46 participants) allowed decisions to be made about the exact chart format, but it also revealed widespread confusion about use of adjustment for gestation and the plotting of birthweight. In the second series (78 participants), high levels of plotting inaccuracy were identified on both chart formats, with 64% of respondents making at least one major mistake. Significant neonatal weight loss was poorly recognized. While most participants recognized abnormal and normal growth patterns, 13-20% did not. Many respondents had never received any formal training in chart use. Growth charts are complex clinical tools that are, at present, poorly understood and inconsistently used. The importance of clear guidelines and formal training has now been recognized and translated into supporting educational materials (free to download at http://www.growthcharts.rcpch.ac.uk).

Advances in Growth Chart Design and Use: The UK Experience

“…An example of this was the question of adjustment for preterm gestation. It was clear in the evaluation groups that staff found this confusing and were inconsistent in applying it [10]. The working group thus identified a consistent and simple approach -the 'arrow drawn back' method ( fig.…”

“…Charts that may appear simple to the expert enthusiast, can be confusing to non-expert staff, so formal testing and consultation is essential. In designing the UK-WHO charts, a mixture of discussion and formal testing with plotting exercises was used [10]. The aids described above were much improved as result, but others design ideas were abandoned altogether.…”

“…These need to be well evidenced, rather than relying on consensus from within what may be a quite narrow group. We drew on existing publications, but also undertook new analyses and collected our own evidence via specially convened focus groups [10].…”

Sensitivity (Se) and Specificity (Sp) Anthropometric Wall Chart (Awc) Tb/U for Detecting Stunting on Children Aged 6-12 Years

“…Some countries have developed and modified growth charts based on the WHO growth standard following the conditions of children in these countries [11][12][13][14][15][16]. Some developments of growth charts are also intended to facilitate understanding of data interpretation in the growth chart [17,18], because there are still many who do not comprehend the data presented in growth charts to monitor children's growth [19]. One of the tools developed for screening ICHP nutritional status in children aged 6-12 years and is a development of WHO (2005) standard growth chart so that it is easy to understand and fast to use is Height-for-age Anthropometric Wall Chart (AWC TB/U) [20].…”

‘Now I understand’: consulting parents on chart design and parental information for the UK‐WHO child growth charts

“…The full design process and the resulting charts have been described elsewhere (Wright et al . 2010, 2011).…”