Capítulo 3:Guía integral de actividades a considerar en la fase de desactivación de
3.3 Conclusiones parciales del capítulo 3
Given the aforementioned challenges with existing approaches to childhood weight management, widespread adoption of smartphones and popularity of mobile health apps (mHealth apps), Public Health Warwickshire and Warwickshire County Council (WCC), identified the need to explore the use of a mHealth app to
complement their existing family weight management services. In 2011, the thesis author (KC) conducted voluntary work for the public health department of WCC
11 under the supervision of one of their health psychologists (KB). During this period the thesis author was approached by the Health Improvement Commissioning and Performance Lead, responsible for commissioning family weight management services within Warwickshire, to develop a mHealth app.
After several stakeholder meetings at WCC with the commissioning staff and the Obesity Projects’ Co-ordinating team members, the decision was made to focus on developing a smartphone app that would specifically support parents (with
overweight and very overweight children) in providing healthier food for their children. A contract between WCC and the University of Warwick was drawn up and agreed for a sum of £10,000 from WCC to the University of Warwick to fund the technical development and programming of a mHealth app to support childhood weight management.
In addition to conducting the research, the thesis author’s role also required extensive project management of all elements involved in app development for public health including liaising with: the commercial app company for the design and technical development of the prototype app; the council’s IT and legal staff on licensing and Intellectual Property (IP) issues; and attending quarterly meetings with Public Health Warwickshire staff.
The thesis author considered two local digital media companies who had experience with app development. However, after several meetings it became clear that they were going to exceed the budget and therefore start-up companies in the area of mhealth were sought. One local company was found but lacked the commercial experience required to ensure that the app was engaging and fun to use. Virtually Free Ltd (VF) was finally chosen by the thesis author because they were a start-up
12 company led by two psychiatrists who understood that theory, evidence and research with parents and Change4life advisors were important for informing app
development and would therefore require more time. They were also currently engaged in academic research for their own mHealth app projects and therefore had a good comprehension of the research process. Furthermore, they were partnered with a commercial gaming company who would carry out the design and
programming of the app, applying elements of gamification. Their role in the project was to advise on which functionality (e.g. forums, BMI calculator, notifications), came within the budget, and how certain behaviour change techniques (BCTs) could be operationalised into app features. Interactions with the app company involved several face to face meetings, emails and phone calls with the project team at VF to take the app from the concept stage through to the prototype app.
To provide further context to the project, Warwickshire’s existing weight
management services are described below. These services were also used to recruit research participants to inform app development.
1.5.1 The Change4life Advisors Service
Along with receiving feedback on children’s BMI status from the NCMP, the DoH has also launched the Change4Life programme operating county wide across the UK to provide families with one-to-one support in family weight management. For example, in Warwickshire, after children are measured through the NCMP, letters are sent out to parents to indicate which percentile their child falls into and, in line with best practice guidance from the DoH, families of children falling into the 98th percentile are contacted by local Change4Life advisors to offer families support on weight management (Olander et al., 2011). It should be noted that in Warwickshire, the term “obese” is replaced with “very overweight” when contacting parents.
13 However, the Change4Life programme has been shown to have limited reach within Warwickshire. For example, in 2011, out of the 1620 children in Warwickshire who were identified as either very overweight (32.5%) or overweight (67.5%), only 168 families were contacted by Change4Life advisors from December 2010-July 2011 due to challenges in setting up the service. Furthermore, a large proportion of families who were contacted by Change4Life advisors declined the service. The main reasons given by parents for declining the service, related to their disagreement with the NCMP measurement, or their belief that they had their child’s weight under control (Orlander, Akinson & French, 2011).
1.5.2 Local Family Weight Management Programmes
In addition to the local Change4Life service, since January 2011, Warwickshire County Council (WCC) jointly with NHS Warwickshire (now Public Health
Warwickshire) has commissioned Rugby Borough Council (RBC) and Nuneaton and Bedworth Leisure Trust (NBLT) to set up and manage family weight management programmes. The programmes last for approximately 8-10 weeks in duration and are situated in school and community based settings. The rationale for providing this additional level of weight management service was due to the BMI characteristics of children in those localities. Nuneaton and Bedworth have a higher prevalence of overweight and very overweight children than the national average for both reception and year 6 children as shown in NCMP data summarised in Figure 2. Rugby also has a high rate of overweight and very overweight children that falls in line with the national average. Hence, it was deemed important to offer additional weight management services to children and families in these districts.
14 Figure 2: Map summarising volume of very overweight and overweight
children in Warwickshire.
Source: Warwickshire Observatory, 2012. * Overweight and very overweight are added together.