Parents' evaluation of the IDEFICS intervention: an analysis focussing on socio‐economic factors, child's weight status and intervention exposure

Abstract

Summary Introduction From April 2008 to August 2010 the Identification and prevention of Dietary‐ and lifestyle‐induced health EFfects In Children and infantS (IDEFICS) intervention aimed to encourage healthier diets, higher physical activity levels and lower stress levels among European children and their families. While the intervention was intended to improve children's health, we also wished to assess whether there were unwelcome aspects or negative side‐effects. Therefore all parents of children who participated in the IDEFICS intervention were asked for their views on different aspects of the intervention. Methods A total of 10,016 parents of children who participated in the IDEFICS survey and who were involved in the intervention were invited to complete a questionnaire on positive and negative impacts of the intervention. Responses to each of the statements were coded on a four point Likert‐type scale. Demographic data were collected as part of the baseline (T0) and first follow‐up (T1) surveys; intervention exposure data was also collected in the T1 follow‐up survey. Anthropometric data was collected in the same surveys, and child's weight status was assessed according to Cole and Lobstein. After initial review of the univariate statistics multilevel logistic regression was conducted to analyse the influence of socio‐economic factors, child's weight status and intervention exposure on parental responses. Results In total 4,997 responses were received. Approval rates were high, and few parents reported negative effects. Parents who reported higher levels of exposure to the intervention were more likely to approve of it and were also no more likely to notice negative aspects. Less‐educated and lower income parents were more likely to report that the intervention would make a lasting positive difference, but also more likely to report that the intervention had had negative effects. Parents of overweight and obese children were more likely to report negative effects – above all, that ‘the intervention had made their child feel as if he/she was “fat” or “overweight.”’ Conclusion While the results represent a broad endorsement of the IDEFICS intervention, they also suggest the importance of vigilance concerning the psychological effects of obesity interventions on overweight and obese children.

The IDEFICS intervention trial to prevent childhood obesity: design and study methods

“…Without such behavioural or adiposity effects, it was not surprising that the IDEFICS trial had no impact on insulin resistance or markers of the metabolic syndrome (21). Despite these absent health or behaviour changes, the parents reported many positive effects and four negative effects (33), which might have led to positive effects 5 years later (32). These findings are consistent with the outcomes of other large community-based trials (4,34).…”

Differential outcome of the IDEFICS intervention in overweight versus non‐overweight children: did we achieve ‘primary’ or ‘secondary’ prevention?

“…This finding could be an example of information dissemination paradox or ‘boomerang’ effect , reactive responses in which people might reject or doubt the relevance of information received. Other potential explanations for the outcome based on parental views on the intervention process and on data collected in the extended follow‐up of these families 5 years after the intervention will be considered in future country‐specific analyses.…”

“…Two years after baseline, post‐intervention examinations including anthropometric measurements were conducted in the majority of participating children. Results documenting the effect of the intervention on body mass index (BMI) , describing parental approval of the intervention , and examining longer‐term differences between dietary habits of families in intervention versus control regions are reported separately in this supplement. The present analysis explores whether there is a differential intervention outcome in children with and without prevalent OWOB.…”

The IDEFICS intervention: what can we learn for public policy?

“…Understood in this way, school‐ and community‐level obesity interventions do not simply support parents and children. If thoughtfully designed and implemented, they surely do this – thus the high levels of approval that parents showed for the IDEFICS intervention . At the same time, however, community‐level interventions also ask parents and children to avert risks that systems and infrastructures are imposing on them.…”