Evaluation of the scale-up and implementation of mind, exercise, nutrition … do it! (MEND) in British Columbia: a hybrid trial type 3 evaluation

Abstract

Background: The Mind, Exercise, Nutrition … Do it! (MEND) childhood obesity intervention was implemented in British Columbia (B.C.), Canada from April 2013 to June 2017. The study objective was: a) to describe and explore program reach, attendance, satisfaction, acceptability, fidelity, and facilitators and challenges during scale-up and implementation of MEND in B.C. while b) monitoring program effectiveness in improving children's body mass index (BMI) z-score, waist circumference, dietary and physical activity behaviours, and psychological well-being. Methods: This prospective, pragmatic implementation evaluation (Hybrid Type 3 design) recruited families with children and adolescents aged 7-13 with a BMI ≥ 85th percentile for age and sex. The 10-week MEND B.C. program was delivered in 27 sites, throughout all five B.C. health regions (Northern, Interior, Island, Fraser, and Vancouver Coastal) over 4 years. Families attended two weekly in-person group sessions aimed to increase physical activity and promote healthy eating. BMI z-score and waist circumference were measured at baseline and follow-up. Dietary and physical activity behaviours and psychological well-being were measured using validated questionnaires. A mixedmethod approach was used to collect and analyze the data. Results: One hundred thirty-six MEND B.C. programs were delivered over 4 years. The program reached 987 eligible participants. 755 (76.5%) children and adolescents completed the program. The average program attendance was 81.5%. Parents reported the program content was easy to understand, culturally suitable, respectful of family's financial situation, and provided adequate information to build a healthy lifestyle. Children achieved significant positive changes across all four evaluation years in BMI z-score (d = − 0.13), nutrition behaviours (d = 0.64), physical activity levels (d = 0.30), hours of screen time per week (d = − 0.38) and emotional distress (d = − 0.21). Challenges to continued program implementation included: recruitment, resource requirement for implementation, and the need to tailor the program locally to be more flexible and culturally relevant.

Evaluating the Effectiveness of a Family-Based Virtual Childhood Obesity Management Program Delivered During the COVID-19 Pandemic in Canada: Prospective Study

“…For example, a previous 12-week family-based childhood obesity management intervention (children aged 8-12 years) showed that MVPA increased by 53 minutes per week and screen time decreased by 34 minutes per day [31]. Similarly, in a previous 10-week family-based intervention (MEND) delivered in British Columbia, children showed an increase in weekly physical activity levels by 2.6 hours per week and a decrease in screen time by 3 hours per week following the intervention [10].…”

“…This may have been due to the lockdown, as parents may have more opportunities to influence children's vegetable intake while they are at home every day [25]. However, previous childhood obesity interventions delivered in-person have reported significant improvements in dietary behaviors [10,11,35,36]. The lack of significant changes in the intake of fruits and sugary drinks may reflect a ceiling effect.…”

“…Family-based lifestyle interventions have been shown to be effective for managing childhood obesity [8][9][10][11]. Family-based interventions encourage the whole family to make lifestyle behavior changes and remove the focus from the child with overweight or obesity.…”

Implementation models and frameworks used to guide community-based physical activity programs for children: a scoping review

“…The included articles were recent in publication, ranging from 2010 to 2021. The 27 articles in this review consisted of 12 case studies [ 21 , 36 – 46 ], 4 study protocol papers [ 47 – 50 ], 3 randomized control trials [ 51 – 53 ], 2 quasi-experimental trials [ 54 , 55 ], 2 longitudinal studies [ 56 , 57 ], 1 prospective evaluation [ 58 ], 1 cross-sectional study [ 59 ], 1 review [ 60 ], and 1 systematic review [ 61 ]. A majority of the articles used mixed methods (e.g., surveys, interviews, workshops, community reports) to report on the implementation of their programs ( n = 13) [ 21 , 38 – 43 , 47 , 51 , 52 , 57 , 58 , 60 ], while the remained focused on quantitative ( n = 10) [ 43 , 45 , 48 – 50 , 53 – 55 , 59 , 61 ] or qualitative measures ( n = 4) [ 36 , 42 , 44 , 56 ].…”

Dose-Response Relationship of a Blended In-Person and Online Family-Based Childhood Obesity Management Program: Secondary Analysis of a Behavior Intervention

“…However, due to the requirements of in-person interventions such as travel to a location or missing work responsibilities, their structures are often limited in flexibility and scalability [ 14 ]. Emerging evidence has indicated the inclusion of digital technologies (eg, smartphones, tablets, computers, and wearables) in conjunction with in-person, family-based interventions, which may allow researchers to increase both program outreach and provide flexibility for families [ 15 , 16 ].…”