The impact of HENRY on parenting and family lifestyle: A national service evaluation of a preschool obesity prevention programme

Abstract

Objectives

One in five children in England are overweight/obese at school entry. Tackling obesity is therefore a priority. Right from the Start with HENRY is a widely-commissioned programme delivered by trained facilitators to small groups of parents over eight weekly sessions. It is designed to provide parents of infants and preschool children with the skills, knowledge and confidence required for a healthier family lifestyle. The aim of this work was to investigate programme impact using data collected routinely for quality control purposes.

Study design

Analysis of routinely collected pre-post data from programmes delivered in the UK from January 2012 to February 2014.

Methods

Data were analysed from 144 programmes, including questionnaires relating to parenting, family eating behaviours, dietary intake, and physical activity/screen time.

Results

Over 24 months, 1100 parents attended programmes running in 86 locations. 788 (72%) completed >5 sessions of whom 624 (79%) provided baseline and completion questionnaires. Parents reported increases in healthiness of family lifestyle, parenting attributes, and emotional wellbeing following attendance (all P < .001). Both parents and children were reported to have increased their daily fruit/vegetable consumption, and reduced their consumption of high fat/sugar foods (both P < .001). There were also positive changes in eating behaviours, physical activity (P < .001) and children's screen time (P < .001).

Conclusions

Significant changes were reported in all domains similar to those reported in a previous, smaller study in locations selected for experience and quality. The HENRY approach appears to have a beneficial impact even when delivered at scale in non-selected locations. Such changes, if maintained, may serve to protect against later obesity.

Introduction

One in five children are already overweight or obese by the time they start school at the age of five years,¹ making it increasingly clear that efforts to combat obesity must be directed towards preschool children.² Moreover, the gap is widening sociodemographically, placing disadvantaged children at greater risk.¹ By comparison with programmes for school-aged children, interventions targeting babies and younger children remain in their infancy.3, 4, 5, 6, 7, 8, 9, 10

Health Exercise Nutrition for the Really Young (HENRY) 11, 12, 13, 14, 15 is a widely-commissioned, theory-based initiative (see Box 1). Drawing upon evidence regarding risk and protective factors in the early years,² it aims to tackle childhood obesity through training community and health practitioners to work more effectively with families with young children. Early evaluation has indicated success in improving the way practitioners work with families, with additional benefit to their own lives and work settings.¹⁵

Alongside practitioner training, HENRY has an eight-week programme that offers parents – as the primary agents for change – the skills and knowledge needed to provide a healthier family lifestyle. It takes a broad approach: healthy eating is considered equally important to parenting skills, physical activity and emotional wellbeing, together with developing a positive attitude to change and enhancing self-esteem¹³ (Box 1). It is currently delivered in 33 local authorities and over 5000 parents have participated since 2009. A previous evaluation followed a cohort of 71 parents completing the programme at nine selected locations.¹⁴ Data were collected at the beginning and end of the programme, and eight weeks after completion. Significant increases in parental self-efficacy and the ability to encourage good behaviour were found, together with positive changes in food and drink consumption, family mealtimes and reduced screen time. While the results were encouraging, the locations had been selected for their good record, both in terms of attracting and retaining participants and the quality and experience of the facilitators. We were therefore interested to examine outcomes in a larger, more representative national cohort across all local authorities delivering the HENRY programme between January 2012 and February 2014. Analysing data collected by HENRY for quality assurance purposes and reporting to service commissioners, we aimed to ascertain if HENRY offers similar benefits to families when it is delivered routinely and at scale.