Optimising preschool obesity intervention: The Whānau Pakari preschool project

Abstract

The rising prevalence of obesity in increasingly younger children prompted the New Zealand government to implement the Raising Healthy Kids (RHK) target in 2016. This was embedded within the national preschool health assessment, the Before School Check (B4SC). In Taranaki, Whānau Pakari (a multi-disciplinary healthy lifestyle programme) became the pathway for preschool children referred via the B4SC in response to the target. Aim: This research aimed to determine the impact of the target, outcomes from engagement in Whānau Pakari, as well as caregivers’ perceptions and experiences, to develop policy and service recommendations for optimising preschool obesity intervention. Methods: A Kaupapa Māori mixed methods approach was utilised. Two audits were undertaken - an audit of B4SC referral data for obesity for Taranaki and nationally, and an audit of data from preschool children who engaged with Whānau Pakari. Qualitative focus groups/interviews were conducted with caregivers of children who were referred from the B4SC to Whānau Pakari. Results: Whilst the RHK target increased referral rates, referrals perceived as mandatory, data accuracy, and the focus on referral rather than intervention uptake limited interpretation of the target’s impact on improving preschool obesity. Whānau Pakari achieved encouraging engagement from at-risk groups, namely Māori and children from the most deprived households, however no change in weight status was observed overall. When contextualised against international population data (given the lack of country-specific population data), this is an age where BMI SDS increases. Focus groups/interviews indicated that the approach of health professionals to discussing weight issues with caregivers was key to engagement with intervention programmes, and that the preschool age was a challenging time to intervene. Conclusions: Future health policy requires a focus on the healthy lifestyle support that eventuates from a referral to achieve change in reducing obesity prevalence in preschool children. Whānau Pakari appears to be acceptable and appropriate to caregivers, including Māori, therefore contributing towards health equity. A focus on determinants upstream of intervention programmes is pivotal to ensuring the health journey of children and whānau/families encourages subsequent engagement in healthy lifestyle support. Programme retention may be improved if offered earlier than four years of age.