Lifestyle Screening Tools for Children in the Community Setting: A Systematic Review

Abstract

Screening of children’s lifestyle, including nutrition, may contribute to the prevention of lifestyle-related conditions in childhood and later in life. Screening tools can evaluate a wide variety of lifestyle factors, resulting in different (risk) scores and prospects of action. This systematic review aimed to summarise the design, psychometric properties and implementation of lifestyle screening tools for children in community settings. We searched the electronic databases of Embase, Medline (PubMed) and CINAHL to identify articles published between 2004 and July 2020 addressing lifestyle screening tools for children aged 0–18 years in the community setting. Independent screening and selection by two reviewers was followed by data extraction and the qualitative analysis of findings. We identified 41 unique lifestyle screening tools, with the majority addressing dietary and/or lifestyle behaviours and habits related to overweight and obesity. The domains mostly covered were nutrition, physical activity and sedentary behaviour/screen time. Tool validation was limited, and deliberate implementation features, such as the availability of clear prospects of actions following tool outcomes, were lacking. Despite the multitude of existing lifestyle screening tools for children in the community setting, there is a need for a validated easy-to-administer tool that enables risk classification and offers specific prospects of action to prevent children from adverse health outcomes.

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

“…Practitioners identified training needs to support implementation and intervention success and highlighted the importance of integration of a screening tool into electronic medical records, staff roles and capacity and practitioner resources such as decision support charts, examples of specific behaviour change strategies and follow up consultations. This aligns with the findings of Krijger and colleagues 29 who identified the importance and need for specific actions following screening that extend beyond counselling to address target behaviours, such as repeating screening after a certain time and referral to multidisciplinary team members. Qualitative literature also suggests engagement, open discussions and buy‐in from PHC practitioners as vital to support adoption of new practices in PHC settings 64 .…”

“…This highlights a need for high‐quality, rigorously developed, and validated screening tools that measure all four behaviour domains to enable health practitioner and caregiver conversations that can positively impact child health behaviours. Similar to previous reviews examining health behaviour measurement tools, 28,29 few tools focused on child sleep, indicating that sleep behaviours remain a comparatively novel area for early screening and intervention compared with diet and activity behaviours. This review demonstrated the effectiveness of screening tools in changing practitioner knowledge, attitudes, and practice; but given that all studies used practitioner self‐report measures, more robust evaluation of effectiveness are necessary to corroborate these findings.…”

“…This highlights a need for high-quality, rigorously developed, and validated screening tools that measure all four behaviour domains to enable health practitioner and caregiver conversations that can positively impact child health behaviours. Similar to previous reviews examining health behaviour measurement tools, 28,29 acceptability and feasibility of screening from the current body of literature. For successful and sustained implementation of health behaviour screening in PHC settings, acceptability needs to be carefully evaluated from multiple perspectives including practitioners, support staff, practice managers, caregivers, and children.…”

“…Thus, their suitability for application in this setting is unknown. Further tools were identified in a recent systematic review by Krijger and colleagues, which described 41 unique screening tools to measure lifestyle behaviours in children aged 0–18 years in community settings 29 . However, the tools described in this review ranged in length, with several tools >25 items in length, impacting their suitability for use in the time poor PHC setting.…”

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

“…While four screening tools measured all four domains of diet, physical activity, sedentary behaviour and sleep, none were tested for validity or reliability. Similar to previous reviews examining health behaviour measurement tools 28,29 , few tools focused on child sleep, indicating that sleep behaviours remain a comparatively novel area for early screening and intervention compared to diet and activity behaviours. This review demonstrated the effectiveness of screening tools in changing practitioner knowledge, attitudes and practice; but given that all studies used practitioner self-report measures, more robust evaluation of effectiveness are necessary to corroborate these findings.…”