Who is change for life aimed at

Parents a were recruited from 40 state-funded primary schools across England selected to represent a mix of school types faith vs. Randomisation was carried out by a statistician and researchers enrolled participants. They were ranked by school size and this was used as a blocking factor; each block comprised two schools and within blocks, schools were randomly allocated to intervention or control conditions. Parents in the intervention group were sent the C4L materials available as part of the national campaign and the HTK questionnaire.

Due to the nature of the intervention, it was not possible to blind participants to group allocation. It was considered appropriate to amend the study protocol in response to non-participation with the HTK questionnaires since this reflected typical population-based behaviour, hence was a realistic evaluation of how the campaign was received by families in the UK. This deviation from the study protocol was implemented during the study; it was not planned a priori, but was agreed by the study team and Department of Health.

All parents were sent a follow-up questionnaire after six months, with two reminders if it was not returned. Parental education used as the measure of SES [ 17 ]. Categorical variables were dichotomised for analysis: white vs.

Parents reported their weight and height, from which BMI was calculated and weight status was determined using World Health Organisation cut-offs [ 18 ]. Awareness of a new initiative Start4Life , designed for a younger age group and launched after C4L, was additionally included at follow-up.

Questions on a number of other health promotion initiatives were asked as distracters. Validated measures were used where possible but the majority were created for the study.

A summary of the outcomes included and how these relate to the C4L targets is provided in Table 1 and more detailed information regarding questionnaire scoring is available in the Additional file 1 : Table S1. These comprised eight dietary behaviours and two physical activity behaviours outlined in Table 1.

Parents were asked to rate how important and how easy it was to achieve each behaviour. Higher scores indicated greater importance and ease. Parents were asked whether they intended to encourage their child to do these ten behaviours over the following three months. Higher scores indicated greater intention. An overall healthy eating score was calculated using the mean of the scores with a higher score indicating healthier eating.

For analysis, an average of the daily hours of activity and of the daily hours of media viewing was calculated. Higher scores indicated more monitoring and modelling. The correlation for the questions about TV watching was 0.

The correlation for the questions relating to modelling of physical activity was 0. This indicated that the questions performed adequately. We based this on the monitoring scale of the CFQ [ 19 ] since it has been validated for the age group in the study and reference data were available in similar populations. The sample size calculation assumed a difference between the means in the intervention and control groups of 0. Based on a relatively conservative estimated intra-class correlation ICC of 0.

The actual ICC in the study was 0. Several families had more than one child in the same school, and to avoid duplication of responses, parents were asked to complete the questionnaire for the older child. Baseline characteristics were compared in those returning responders and not returning non-responders the follow-up questionnaire.

Independent samples t-tests were used for continuous outcomes and chi-squared tests for categorical outcomes. The main analyses were carried out on the sample of families for whom follow-up data were available responders. Differences between randomisation groups in awareness of C4L were tested at baseline and follow-up and of Start4Life at follow-up, using chi-squared tests. For attitudinal and behavioural outcomes, complex samples general linear model GLM analyses were used to test for between group differences and interactions with SES with adjustment for clustering by school.

There were six attitudinal outcomes importance, ease and intention for healthy child diet and activity behaviours , four parenting outcomes monitoring and modelling of healthy eating and physical activity , and three child behaviour outcomes: overall healthiness of diet composite score of snack, fruit, vegetable, and sugary drink intake , physical activity days per week active , and television viewing hours per day.

Randomisation group and parent education university vs. Covariates included in all models were parent age, BMI, and ethnicity, and child age and gender. Baseline levels were included as covariates where there were similar items, but these were not available for monitoring or modelling. Outcomes and covariates were assumed to be linear, apart from covariates which were categorical child gender or which had been dichotomised for analysis ethnicity and education.

Further analyses were conducted to examine the impact of C4L materials on families who actively participated in the campaign by returning the HTK questionnaire. Baseline characteristics of the sample are outlined in Table 2 and a flowchart of participants through the study is shown in Figure 1. Children were on average 8. Participant flow through trial. This was not known at baseline; subsequent analyses included only one child per family hence numbers are presented for families rather than individual children.

Compared with parents who did not respond at follow-up, those who returned this questionnaire were older, had a lower BMI, and were proportionally more white and better educated. There were substantial differences between randomisation groups for ethnicity and education see Table 2 with parents in the intervention group being less well-educated and proportionally less white.

These results are outlined in Table 4 and Figure 2. There was a near-significant interaction between SES and group for rating of physical activity importance, with adverse effects of the intervention only being seen for the higher SES families, and virtually no group differences in the lower SES families. There were also significant interactions with SES for dietary monitoring and TV hours showing the same pattern, with the intervention group doing worse than the control group in the higher SES group and no differences in the lower SES group.

A summary of the feedback from the qualitative interviews is presented in Table 5 ; quotes are grouped to reflect the main outcomes of the study. There were varying views about the campaign itself with several families, lower and higher SES, considering that they already did the recommended behaviours, and one parent feeling that the recommendations were unrealistic. Most parents were positive about the materials themselves, especially those aimed at children, although some higher SES parents considered them patronising.

Overall 5. Baseline characteristics of the engaged and non-engaged sub-groups of the intervention group are shown in Table 6. These are shown in Figure 3. The team would advise others contemplating such a programme to:. Skip to main content. Results Change4Life exceeded all of its first year targets, including: The campaign reached 99 per cent of targeted families , families joined Change4Life in the first 12 months Over 44, families were believed to still be involved with Change4Life after 6 months Over 1.

Getting Started. Aims and objectives The social marketing programme aims to: Create a societal movement in which everyone plays their part, helping to create fundamental changes to those behaviours that can lead to people becoming overweight and obese Create a segmentation model that would allow resources to be targeted to those individuals most in need of help i.

The focus of the social marketing programme is on: The 1. The research programme consisted of five phases: Review of the existing evidence base in both academic and market research Quantitative segmentation of families of children aged 2 to 10 using the TNS Family Food Panel and bespoke surveys Qualitative research by 2CV into current behaviours and attitudes and opportunities for intervention focusing on those families identified as a priority in the segmentation Proposition research by 2CV to identify the most effective ways of tackling the issue of family diet and activity levels and promoting behaviour change Qualitative research with six ethnic minority communities — Pakistani, Bangladeshi, Black African, Gujarati Hindu, Punjabi Sikh and Black Caribbean communities Segmentation Analysis of the quantitative data showed that participating families could be grouped into six clusters according to their attitudes and behaviours relating to diet and physical activity.

The team believed the programme would need two stages: 1. Creating the right preconditions for behaviour change Before behaviour change could be achieved on any significant scale, people would need to: Be concerned that weight gain has health consequences Recognise their families are at risk and take responsibility for reducing that risk Know what they need to do to change Believe that change is possible 2.

Supporting people on a behaviour change journey Consultation and dialogue would need to play a central role and include the following elements: Ask — Use a variety of mechanisms to ask as many families as possible about their own behaviours Benchmark — Use mass media to bring results to life and tell people how they and their neighbours stand in relation to the nation Create practical goals — Allow families to select a behaviour to change, based on their own needs and aspirations Record — Provide a mechanism for individuals to record their own behaviour Report back — Tell the nation how we are doing.

Pre-stage: Mobilising the network Rather than taking a top-down approach, the campaign set out to use marketing as a catalyst for a broader societal movement in which everyone who had an interest in preventing obesity could play a part. Phase one: Reframing the issue The campaign would launch with advertising explaining the link between weight gain and illness and reduced life expectancy, positioning this as an issue that could affect the majority of families in the future.

Phase two: Personalising the issue The next phase would help people recognise that their own families may be at risk of developing obesity because of their current behaviours. Phase three: Rooting the behaviours In consultation with the Healthy Weight, Healthy Lives Expert Advisory Group and policy team, the Chief Medical Officer CMO and key stakeholders including the Food Standards Agency , the campaign team defined the behaviours that parents should encourage their children to adopt if they are to achieve and maintain a healthy weight: To make the behaviours real for people, partner agencies created user-friendly, memorable language for describing them, supplied tips that translated each behaviour into real situations to which target audiences could relate, and created a mechanism for promoting the behaviours as a set.

Phase five: Supporting people as they change All campaign materials would give at-risk families the opportunity to sign up to an ongoing CRM programme that supports behaviour change.

Phase one: Reframing the issue In January , Change4Life was launched officially to the public with television and print advertising, an information line and a campaign website. Phase three: Rooting the behaviours People who responded to the campaign were sent a welcome pack of materials, including a handbook for Healthy Happy Kids, a wall chart detailing target behaviours and stickers for their children.

Phase four: Inspiring change From June to September , Amra which represents over regional newspapers used locally sourced case study material to showcase local activity and reported on upcoming and relevant events that fitted the Change4Life movement. Phase five: Supporting change , at-risk families who joined Change4Life were entered into a CRM programme, which comprised 4 separate packs of information and resources, designed around the calendar of family life and delivered to their homes.

Governance A Change4Life Board was created to review progress against campaign objectives, advise on future direction and adjudicate on any disputes arising under the partnership terms of engagement. There are three high-level themes to the evaluation programme: Monitoring campaign exposure and visibility to the target audience Investigating the impact on families Tracking the development of a social movement Approach Tracker study — Conducted by the British Market Research Bureau BMRB , this study aims to measure campaign awareness and track intent to change and self-reported behaviour.

Every month mothers with children aged 0 to 11 are interviewed face-to-face in their homes. Fieldwork began in December to provide a baseline. Academic study — University College London is using a combination of quantitative and qualitative approaches and a randomised design and control group to gauge the impact of Change4Life marketing materials on family behaviour.

Basket analysis — To understand whether Change4Life might be beginning to have a measurable impact on the food that at-risk audiences were buying, retail media group dunnhumby was commissioned to analyse data from the Tesco Clubcard database to track actual shopping behaviour.

Key findings In February , the Government published a full evaluation report of the first year of Change4Life. This equates to over one million mothers claiming to have made changes in response to the campaign The number of mothers claiming their children do all 8 behaviours increased from 16 per cent at the baseline to 20 per cent by quarter 4 The proportion of families having adopted at least four of the behaviours has increased, suggesting the campaign has persuaded people with much less healthy lifestyles to make an effort to improve their health Basket analysis found differences in the purchasing behaviour of 10, families who were most engaged with Change4Life relative to a control group.

Follow Up. Additional audiences The programme has produced targeted interventions and materials for pregnant women and parents of children under the age of two under the Start4Life sister brand, which launched to the public in January , for ethnic minority communities a bespoke campaign launched in late and for middle-aged adults a campaign targeting to year-olds launched in February Home Health and social care Public health. Press release New Change4Life campaign encourages families to make sugar swaps.

This early analysis yielded surprising results: on average the families were consuming g of sugar a day at the beginning of the challenge their sugar intake was reduced to g per day when making sugar swaps this meant an average daily saving of g of sugar per family each day or 49 sugar cubes Professor Kevin Fenton, National Director of Health and Wellbeing at Public Health England, comments: Reducing sugar intake is important for the health of our children both now and in the future.

Dr Daniel Lamport, Research Fellow at the University of Reading and Challenge data collection coordinator, comments: It is fantastic to see that the sugar swaps resulted in a reduction in sugar intake for these families.

Cathy Court, founder of Netmums said: We know that mums want to provide a healthy diet for their children but balancing a number of competing priorities, including healthy eating, can be tricky. Case studies are available. October The diets of these 50 families were analysed in terms of sugar content both before and during the Change4Life Sugar Swaps campaign, October 23 to 4 December This is an early analysis and full results are expected in due course.

It does this through world-class science, knowledge and intelligence, advocacy, partnerships and the delivery of specialist public health services. PHE is an operationally autonomous executive agency of the Department of Health. Website: www. Share this page Share on Facebook Share on Twitter. Brexit Check what you need to do. But that's where Change4Life comes in, helping families with fun ideas to help kids stay healthy, whether with easy recipes for busy weeknights, great sugar swaps, Disney-inspired games to get kids moving or help in understanding food labels.

Change4Life was launched in as part of a national ambition set out in the government's Healthy Weight, Healthy Lives Its purpose has been to inspire a social movement, through which government, the NHS, local authorities, businesses, charities, schools, families and community leaders can all play a part in improving children's diets and physical activity levels. If a member of your family has special dietary requirements, medical needs, an eating disorder or requires specialised nutrition advice — for example, if your child is underweight or very overweight — we recommend you seek guidance from a registered healthcare professional.

Want to have a chat? If you have some more specific questions in mind, get in touch with Public Health England by emailing enquiries phe. Our offices are open from 9am to 8pm every day. If you need help or advice about a medical problem, visit NHS online or call free from any phone. We have a single aim: to motivate and support millions more people to make and sustain changes that will improve their health.

It's a big task.