| 1. |
- Collan, Camilla, et al.
(author)
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To capture the child's interest - nurses experiences of 'Saga stories in health talks'.
- 2024
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In: BMC Nursing. - : BioMed Central (BMC). - 1472-6955. ; 23:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: As unhealthy lifestyle habits have been found to be established early in life and often track into adulthood, early preventive initiatives are important. 'Saga Stories in health talks' is a newly developed material that is intended to be used as a support for nurses at child health care (CHC) centers in their health talks with children and parents in Sweden. The aim of this study is to explore how CHC nurses experience the usability of the 'Saga Stories in health talks' material.METHODS: This study used a qualitative design. The material 'Saga Stories in health talks' was tested by 33 CHC nurses working in 11 CHC centers in three regions in Sweden. All CHC nurses were invited to participate in the interviews and 17 agreed. The interviews were transcribed and analysed using content analysis.RESULTS: Three categories and eight sub-categories emerged. The categories were: (1) An appreciated tool suitable for health talks, (2) Illustrations to capture children's interest in the conversation with families, and (3) Barriers and facilitators. Saga Stories in health talks' was experienced by the CHC nurses as an appreciated tool with content highly relevant to what should be discussed during the health talks. The CHC nurses described the material as well-designed with illustrations that helped them capture the child's interest and increase their participation, while still involving the parents. Support from colleagues, the researchers, and managers were seen as important facilitators. Challenges included structural factors such as how and when to best use the material, especially concerning that the 4-year visit contained many other mandatory parts.CONCLUSIONS: This pilot study show that the material 'Saga Stories in health talks' was highly appreciated by CHC nurses and facilitated their health talks with families in CHC. Important aspects with the material were the relevant content and the focus on healthy living habits, as well as the child friendly illustrations. These findings can be used when similar material is developed to facilitate health talks with families in other contexts. Our results also highlight the importance to adjust the implementation of a new material with already established practice and routines.
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| 2. |
- Delisle Nyström, Christine
(author)
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A web- and mobile phone-based obesity prevention intervention in 4-year-olds : a population-based randomized controlled trial
- 2017
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Doctoral thesis (other academic/artistic)abstract
- Background: Childhood overweight and obesity has increased significantly over the past two decades. Many well-conducted obesity prevention trials have been conducted in pre-school aged children but the majority have not been able to show changes in obesity related markers. These trials have used traditional face-to-face methods to conduct the interventions, which are expensive and difficult to scale up. Therefore, new dissemination methods for intervention studies such as mobile health (mHealth) should be explored. Aims: The overall aim of this thesis was to determine whether a mHealth intervention targeted towards parents could improve obesity markers in pre-school aged children. Paper I: To outline the study design and methodologies utilized in the MINISTOP trial. Paper II: To evaluate the validity of reported energy and food intake assessed using the mobile based Tool for Energy Balance in Children (TECH) against total energy expenditure (TEE) and 24hr dietary recalls, respectively. Paper III: To evaluate the capacity of the wrist-worn ActiGraph wGT3x-BT accelerometer to capture variations in free-living activity energy expenditure (AEE) and to assess wear compliance of the ActiGraph using a seven day 24hr protocol. Paper IV: To assess the effectiveness of the MINISTOP intervention on body composition, intakes of fruits, vegetables, candy, and sweetened beverages, as well as the amount of time spent sedentary and in moderate-to-vigorous physical activity after the 6-month intervention. Paper V: To investigate if the MINISTOP intervention 12-months after baseline improved fat mass index (FMI) and had a maintained effect on a composite score (made up of FMI as well as dietary and physical activity variables). Methods Paper II: A nested validation study including 39 children aged 5.5 years. Energy and food intakes were measured using TECH and compared to TEE assessed using the doubly labelled water method and 24hr dietary recalls, respectively. Paper III: A nested validation study including 40 children aged 5.5 years. TEE was assessed using the doubly labelled water method and AEE was calculated as TEE minus a predicted basal metabolic rate. The ActiGraph was worn on the non-dominant wrist and the utilized outputs were mean of daily filtered vector magnitudes (mean VM total) and mean of awake filtered vector magnitudes (mean VM waking). Papers IV and V: A randomized controlled trial including 315 children aged 4.5 years. After baseline assessments, the children were randomly allocated into the intervention or control group for six months. The intervention group and control group received the MINISTOP app or a pamphlet on dietary and physical activity behaviors for pre-school children, respectively. The outcome measures were FMI (primary) and intakes of fruits, vegetables, candy, and sweetened beverages, as well as time spent sedentary and in moderate-to-vigorous physical activity (secondary). Two composite scores, a seven component (including all primary and secondary outcomes) and a six component (including only secondary outcomes) were computed. Results Paper II: No significant difference between mean energy intake and TEE was found (P = 0.064). For all eight food groups assessed no significant differences in the mean intakes were observed when using TECH and 24hr dietary recalls and all intakes were correlated when using both methods (range for rho: 0.665 to 0.896, all P < 0.001). Paper III: Mean VM total and mean VM waking alone were able to explain 14% (P = 0.009) and 24% (P = 0.001) of the variation in AEE. When adding fat and fat free mass to the models 58% and 62% (P < 0.001) of the variation in AEE was explained, using mean VM total and mean VM waking, respectively. Paper IV: No intervention effect for the primary outcome FMI was observed between the intervention and control group (P = 0.922). At the 6-month follow-up, for the seven component composite score the intervention group significantly increased their score compared to the control group (+0.36 ± 1.47 units vs. -0.06 ± 1.33 units, respectively, P = 0.021 between groups), with the difference being more evident in children with a higher FMI. For the six component composite score the children in the intervention group had a higher odds of increasing their score in comparison to the control group (odds ratio: 1.99; 95% confidence interval: 1.20, 3.30, P = 0.008). Paper V: For FMI there was no significant difference observed between the intervention and control group (P = 0.566) between the 12-month follow-up and baseline. Furthermore, there was no maintained effect observed in the change in the difference in the seven component composite score between the intervention and control group (P = 0.248). Conclusions: The results from this thesis suggest that both TECH and the wrist-worn ActiGraph have the potential to provide useful information in studies where diet and physical activity in young children are assessed. Furthermore, this thesis presents results from the first mHealth obesity prevention study in pre-school aged children. Although no difference between the intervention and control group for FMI was observed, the intervention group showed a significantly higher seven component composite score difference than the control group at the 6-month follow-up, especially in children with a higher FMI. Topics for future research include modifications of the MINISTOP app to more specifically target high risk children as well as further studies on to how maintain behavior changes in mHealth interventions.
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| 3. |
- Delisle Nyström, Christine, et al.
(author)
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Physical activity and screen time in Swedish children and adolescents: The generation pep study 2018–2021
- 2023
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In: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 112:3
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Journal article (peer-reviewed)abstract
- Aim To analyse physical activity and screen time trends annually between 2018 and 2021 in large population-based samples of Swedish children and adolescents. Methods This is a repeated cross-sectional study using data collected over 4years (2018–2021) using simple probability sampling of Swedish children and adolescents aged 4–17years. The web-based questionnaire, including questions on physical activity and screen time, was filled out by a parent if the child was <12years of age and by the adolescents themselves if they were≥12years. Sociodemographic data was collected from the parents. Results No significant difference in physical activity was observed in 2020 and 2021 compared to 2019. However, older children/adolescents and girls have higher odds to be in a lower physical activity category (p-values<0.001). With regards to screen time, there was a significant increase in reported screen time from 2018 to 2021 for children and adolescents, with screen time peaking in 2020 (p-values<0.001). Conclusion This is the first study in Sweden evaluating trends in physical activity and screen time in large population-based samples spanning from pre-school to adolescence. Interventions to promote physical activity, especially in the older age groups and to reduce screen time in a Swedish context are warranted.
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| 4. |
- Delisle Nyström, Christine, et al.
(author)
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Study protocol for an effectiveness-implementation hybrid trial to evaluate a health promotion intervention in parents and their 5-year-old child : Saga Stories in health talks in Swedish child healthcare.
- 2022
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In: BMC Public Health. - : BioMed Central (BMC). - 1471-2458. ; 22:1, s. 2184-
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Journal article (peer-reviewed)abstract
- BACKGROUND: Unhealthy lifestyle behaviours such as a poor diet, inadequate physical activity, and excessive screen time have been shown to be established in childhood and track into adulthood, demonstrating the need for health promotion interventions in the pre-school years. The overall aim of this project is to: (i) evaluate the effectiveness of `Saga Stories in health talks´ within child healthcare (CHC) on parental self-efficacy to promote healthy diet, physical activity, and screen time behaviours in their child; children's intake of key dietary indicators and screen time and (ii) evaluate and explore the implementation of `Saga Stories in health talks´ with regards to acceptability, appropriateness, feasibility, fidelity, adoption, sustainability, satisfaction, and usage.METHODS: A hybrid type I effectiveness-implementation trial will be conducted. A cluster randomized controlled trial will be used to assess the effectiveness of `Saga Stories in health talks´ in 42 CHC centers across six regions in Sweden. `Saga Stories in health talks´ consists of material for CHC nurses to use to facilitate the health talk with both the child and parent(s) and is complemented with take-home material. Parent and child dyads are recruited (n = 450) from participating CHC centers when they attend their 5-year routine visit. The intervention group receives the health talk using Saga Stories and take-home material, whereas the control group receives the standard health talk. The primary outcome is parental self-efficacy to promote healthy diet, physical activity, and screen time behaviours in their child and secondary outcomes include children's intake of key dietary indicators and screen time. All outcomes are assessed at baseline and 2-months post-intervention. The implementation outcomes that will be assessed are: acceptability, appropriateness, feasibility, satisfaction, usage, fidelity, adoption, and sustainability (assessed quantitatively and qualitatively).DISCUSSION: The Swedish National Board of Health and Welfare have identified the need of more material, education, and working methods for promoting healthy lifestyle behaviours in CHC. Following this trial `Saga Stories in health talks´ has great potential to be implemented in CHC across Sweden to aid nurses to promote and support healthy lifestyle behaviours in pre-school children and their families.TRIAL REGISTRATION: ClinicalTrials.gov , NCT05237362 . Registered 2 February 2022.
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| 5. |
- Delisle Nyström, Christine, et al.
(author)
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The paediatric option for BodPod to assess body composition in preschool children: what fat-free mass density values should be used?
- 2018
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In: British Journal of Nutrition. - : CAMBRIDGE UNIV PRESS. - 0007-1145 .- 1475-2662. ; 120:7, s. 797-802
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Journal article (peer-reviewed)abstract
- Air displacement plethysmography utilises a two-component model to assess body composition, which relies on assumptions regarding the density of fat-free mass (FFM). To date, there is no evidence as to whether Lohmans or Wells et al.s FFM density values are more accurate in young children. Therefore, the aims of this study were to compare total body fat percentage (TBF%) assessed using the BodPod with both Lohmans and Wells et al.s FFM density values with TBF% from the three-component (3C) model in forty healthy Swedish children aged 5.5 years. Average TBF% calculated using Lohmans FFM density values underestimated TBF% in comparison with the corresponding value assessed using the 3C model (22.2 (SD 5.7) and 25.1 (SD 5.5)%, respectively; P amp;lt;0.001). No statistically significant difference was observed between TBF% assessed using Wells et al.s FFM density values and the 3C model (24.9 (so 5.5) and 251 (so 5.5)%, respectively; P= 0.614). The Bland and Altman plots for TBF% using both Lohmans and Wells et al.s FFM density values did not show any bias across the range of body fatness (Lohman: r0.056, P= 0.733 and Wells el al.: r-0.006, P= 0.970). These results indicate that Wells Cl al.s FFM density values should be used when assessing body composition with the paediatric option for BodPod in 5-year-old children. However, future studies are needed to confirm these results in other populations, including a wider age range of children.
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| 6. |
- Ek, Anna, et al.
(author)
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A randomized controlled trial for overweight and obesity in preschoolers : the More and Less Europe study – an intervention within the STOP project
- 2019
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 19
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Journal article (peer-reviewed)abstract
- BACKGROUND: Childhood overweight and obesity is a serious public health issue with an increase being observed in preschool-aged children. Treating childhood obesity is difficult and few countries use standardized treatments. Therefore, there is a need to find effective approaches that are feasible for both health care providers and families. Thus, the overall aim of this study is to assess the acceptance and effectiveness of a parent support program (the More and Less, ML) for the management of overweight and obesity followed by a mobile health (mHealth) program (the MINISTOP application) in a socially diverse population of families.METHODS/DESIGN: A two-arm, parallel design randomized controlled trial in 300 2-to 6-year-old children with overweight and obesity from Romania, Spain and Sweden (n = 100 from each). Following baseline assessments children are randomized into the intervention or control group in a 1:1 ratio. The intervention, the ML program, consists of 10-weekly group sessions which focus on evidence-based parenting practices, followed by the previously validated MINISTOP application for 6-months to support healthy eating and physical activity behaviors. The primary outcome is change in body mass index (BMI) z-score after 9-months and secondary outcomes include: waist circumference, eating behavior (Child Eating Behavior Questionnaire), parenting behavior (Comprehensive Feeding Practices Questionnaire), physical activity (ActiGraph wGT3x-BT), dietary patterns (based on metabolic markers from urine and 24 h dietary recalls), epigenetic and gut hormones (fasting blood samples), and the overall acceptance of the overweight and obesity management in young children (semi-structured interviews). Outcomes are measured at baseline and after: 10-weeks (only BMI z-score, waist circumference), 9-months (all outcomes), 15- and 21-months (all outcomes except physical activity, dietary patterns, epigenetics and gut hormones) post-baseline.DISCUSSION: This study will evaluate a parent support program for weight management in young children in three European countries. To boost the effect of the ML program the families will be supported by an app for 6-months. If the program is found to be effective, it has the potential to be implemented into routine care to reduce overweight and obesity in young children and the app could prove to be a viable option for sustained effects of the care provided.
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| 7. |
- Ek, Anna, et al.
(author)
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Effectiveness of a 3-Month Mobile Phone-Based Behavior Change Program on Active Transportation and Physical Activity in Adults : Randomized Controlled Trial.
- 2020
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In: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 8:6, s. 1-15
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Journal article (peer-reviewed)abstract
- BACKGROUND: Active transportation (AT; ie, walking and cycling as a mode for transportation) has been associated with decreased morbidity and mortality; however, low-cost and scalable intervention programs are lacking.OBJECTIVE: The goal of the research was to determine the effectiveness of a 3-month behavior change program delivered via a mobile phone app to promote AT (TravelVu Plus) on time spent in moderate-to-vigorous physical activity (MVPA).METHODS: For this 2-arm parallel randomized controlled trial, we recruited a population-based sample of 254 adults from Stockholm County who were aged 20 to 65 years and had access to a smartphone. On completion of 1-week baseline measures, the 254 participants were randomized to either the control or intervention group (1:1 ratio). Both groups had access to the standard TravelVu app (Trivector AB) for monitoring their AT for 6 months. The intervention group also received a 3-month behavior change program to promote AT (TravelVu Plus app). Assessors of outcomes were blinded to group allocation. Outcomes were objectively measured MVPA at 3 (primary) and 6 months. Secondary outcomes were AT, attitudes toward AT, and health-related quality of life at 3 and 6 months.RESULTS: No effect on MVPA was observed after 3 months (P=.29); however, at 6 months the intervention group had a greater improvement in MVPA than the controls (6.05 minutes per day [95% CI 0.36 to 11.74; P=.04]). A Bayesian analyses showed that there was a 98% probability that the intervention had any effect at 6 months, and a 63% probability that this effect was >5 minute MVPA per day.CONCLUSIONS: No effect on MVPA immediately after the intervention period (at 3 months) was observed; however, there was a delayed effect on MVPA (6 minutes per day) at 6 months, which corresponds to approximately 30% of the weekly MVPA recommendation. Our findings suggest that a behavior change program promoting AT delivered via an app may have a relevant effect on PA.TRIAL REGISTRATION: ClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12889-018-5658-4.
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| 8. |
- Ek, Anna, et al.
(author)
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Physical Activity and Mobile Phone Apps in the Preschool Age: Perceptions of Teachers and Parents
- 2019
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In: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 7:4
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Journal article (peer-reviewed)abstract
- BACKGROUND:Physical activity (PA) is already beneficial at the preschool age. In many countries, young children spend most of their days in the preschool setting, making it a common arena for PA interventions. Mobile health tools are becoming increasingly popular to promote PA in different populations; however, little is known about the interest for and how the preschool setting could incorporate such a tool.OBJECTIVE:This study aimed to examine how teachers and parents perceive PA in preschool-aged children in general and their perceptions of how a mobile phone app could be used to promote PA in the preschool setting.METHODS:Semistructured interviews were conducted with 15 teachers (93%, [14/15] women, mean age 43.5 years, 47%, [7/15] with a university degree and 10 parents [91%, 9/10] women, mean age 38.9 years, all with a university degree) recruited from 2 urban preschools in central Sweden. The interviews were recorded, fully transcribed, coded, and analyzed using thematic analysis by means of an inductive approach.RESULTS:The analysis revealed 4 themes: (1) children are physically active by nature, (2) the environment as a facilitator or a barrier, (3) prerequisites of the adult world, and (4) an app in the preschool setting-challenges and possibilities. Parents and teachers perceived preschoolers as being spontaneously physically active; however, high-intensity PA was perceived as low. The PA was specifically performed during the day in the preschool. Identified facilitators of PA were access to safe and engaging outdoor environments such as forests, spacious indoor areas, and adult involvement. Adult involvement was considered especially important for children preferring sedentary activities. Identified barriers for PA were restricted indoor and outdoor space, rules for indoor activities, and lack of adult involvement because of time constraints. The teachers perceived that they had limited skills and experiences using apps in general, although they also acknowledged the increasing role of technological tools in the curriculum. Thus, the teachers expressed an interest for an app designed as a support tool for them, especially for situations when PA was limited because of perceived barriers. They suggested the app to include accessible information regarding the health benefits of PA in children linked to a library of activities for different settings and seasons. Parents suggested interactive app features including problem-solving tasks and music and dance, but not video clips as they made children passive.CONCLUSIONS:Vigorous PA was perceived as low in preschool-aged children. Future tailoring of interventions in the preschool setting should work around barriers and support facilitators to PA, especially PA of high intensity. In such work, an app could serve as a source of inspiration for PA in different ages, settings, and seasons and thus reduce environmental and structural inequalities in the preschool setting.
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| 9. |
- Ek, Anna, et al.
(author)
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Responding positively to "children who like to eat" : Parents' experiences of skills-based treatment for childhood obesity
- 2020
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In: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 145
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Journal article (peer-reviewed)abstract
- This study aims to understand the challenges parents of preschoolers with obesity face. We assessed parents' experiences of a group treatment program focused on parenting skills; the treatment program was evaluated in a randomized controlled trial in Stockholm County. After completing the program's 10 weekly sessions, parents were invited to participate in a semi-structured interview. The interviews were audio recorded, transcribed and analyzed using thematic analysis. In total, 36 parents (67% mothers, mean age 39 years, 33% foreign background, 50% with university degree) were interviewed. Two main themes were developed: Emotional burden and Skills and strength from others. Emotional burden encompassed the parents' experiences of raising a child with obesity. Parents spoke about the difficulties of managing their child's appetite and of seeking help and treatment, as well as their feelings about the social stigma attached to obesity. Skills and strength from others encompassed the parents' experiences of participating in group treatment. Parents reported that they appreciated the practical behavior change techniques taught, especially those regarding food and how to make everyday life more predictable, and said the focus on parenting skills gave them the confidence to apply the techniques in everyday life. Parents also highlighted the strength of the group setting, saying it enabled them to discuss perceived challenges and learn from other parents. Our findings show that childhood obesity carries social and emotional implications for parents, and that an intervention that provides parents with skill-building and a discussion space can help in negotiating these implications. This suggests that childhood obesity intervention programs benefit from including a parent-based approach which offers training in parenting skills and support in managing socially and emotionally challenging situations.
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| 10. |
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