Evaluation of the preventive care chain for overweight in children

Background of the study:

In 2016, 11 % of the children in 's-Hertogenbosch were overweight. Overweight children in the Netherlands not always receive
optimal, coordinated care. Improving integrated care for overweight is a priority in many Dutch municipalities. An integrated
preventive care chain for children 4-12 years has been developed in 's-Hertogenbosch and this innovative approach is implemented
in three neighborhoods: Noord, Maaspoort en Zuidoost. The approach is focused on self management of the family and is based on
principles of stepped and matched care. There is close local collaboration between schools and all kinds of (health)professionals.
Youth health care professionals function as coördinators and linking pins in the local network. With this approach we expect to reach
more children and parents. By matching care with needs of parents and children and through the optimal use of strong local
networks, we expect to achieve durable effects on quality of life of overweight children and self management of their families.



Objective of the study:

Get insight in the implementation and effectiveness of the integrated preventive care chain for overweight children in 's-
Hertogenbosch.

With the results we can optimize the support for overweight children and their parents.



Study design:

The (PhD) research project runs from 2017 to 2020 and consists of an implementation and effectiveness study.
In the implementation study we evaluate the degree of implementation of the integrated preventive care chain (use of principles,
tools as described) in the three neighborhoods in 's-Hertogenbosch as well as determinants of implementation (facilitating and/or
impeding factors). In addition, we describe experiences of professionals and parents, as well as the flow of children (numbers
reached, drop outs) in the new approach.

Based on documents about the preventive care chain in 's-Hertogenbosch and in consultation with professionals, we draw up a
checklist to measure the extent to which youth health care professionals work according to the principles of the new approach. We
make use of the MIDI-model (measuring instrument for determinants of Innovations) (Fleuren 2012) to determine potential
determinants for implementation, such as characteristics of youth health care nurses, characteristics of participants and
characteristics of the local network.

To determine these characteristics and to discuss experiences of professionals with the new approach, semi-structured interviews
are held with all youth health care nurses (± 12), all youth health care physicians (± 6), a number of general practitioners (± 6), a
number of pediatricians (± 2) and a number of other professionals (+ 6) working in the three neighborhoods. Interviews are also held
with 10-15 parents (if possible with children) to discuss their experiences with the support they received for their overweight
child(ren).

To picture the flow of children in the preventive care chain, we document the number of children identified with overweight (at
school, or by GP or YHC professionals). We also count how many children receive support by YHC professionals, how many
children accomplish care and how many children drop out. Simple registries are kept by the professionals who are involved.



In the effectiveness study, 120 overweight children in 's-Hertogenbosch are followed and compared with 60 overweight children
outside 's-Hertogenbosch who receive care as usual. Our primary outcome is the development in quality of life of the child.
Secondary outcomes are developments in BMI, physical activity, nutrition, psychosocial problems of the child and empowerment of
the parents. Parents fill out digital questionnaires at the start, after three months and after approximately one year of YHC
involvement. Measurements are aligned with regular contacts with youth health care nurses. After a year we ask parents which
professional support for overweight they received (including life style interventions). We also ask them to rate the support they
received (both from YHC as in general). Information on BMI and referrals are subtracted from regular YHC files of the child.

With this approach we expect to reach
more children and parents. By matching care with needs of parents and children and through the optimal use of strong local
networks, we expect to achieve durable effects on quality of life of overweight children and self management of their families.

0, 3, 12 months

The preventive care chain for overweight children emphasizes self-managment of the family and
is based on stepped and matched care principles in a strong multidisciplinairy local network.



Important aspects:

- Key role of the Youth Health Care (YHC) nurse:

Coach, coordinator, linking pin

- Local alignment/cooperation between schools, GP’s, YHC and other (health) professionals

- Shared vision: BMI as a symptom

- Stepped and matched care (lifestyle interventions, referrals etc)