A Healthy School Start – parental support for prevention of obesity in disadvantaged areas in Sweden: Åsa Norman

Background

By focusing on young children and their parents in areas with great health needs, this project aims to improve children’s dietary habits and physical activity contributing to reducing obesity and future risk of chronic diseases. Interventions should ideally start from an early age and target the whole family.

Methods

The parental support programme A Healthy School Start is based on Social Cognitive Theory and includes 3 components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents concerning the child performed by external staff; and 3) Classroom activities performed by teachers. The programme has been evaluated in two cluster-randomised controlled trials in low-income areas in Stockholm County.

Results

Positive effects were found on children’s diet, physical activity in girls, and in BMI among children who were obese at baseline. However, most of the effects were not sustained at 5-months follow up, indicating that the programme needs amplification to give sustained effects. The process evaluation showed that parents perceived the programme as central to family life and that teachers found the provided materials facilitating, rather than burdensome. Increased engagement among parents could be achieved by adapting the intervention components to the abilities of the participating families. Also, cooperation between home and school, positive parenting, and within-family interaction should be targeted in the future.

Conclusions

The Healthy School Start intervention is effective in the short term and acceptable. In order to increase effectiveness and sustainability it needs to be enhanced by focusing even more on parenting and by fully integrating the programme into student health care work routines. This is the objective of A Healthy School Start Plus trial, which has recently started. In the future we aim to make the programme universal and proportionate to needs in different areas.