Implementing a family-based intervention to promote healthy family routines in deprived neighborhoods - a feasibility study from Bremen, Germany.

backgroundThe prevalence of overweight and obesity among children in Europe is high. Particularly ethnic minority and low-income families are at increased risk. This highlights the need for effective family-based interventions addressing multiple obesity-related behaviors tailored to socially deprived families. Addressing this issue, our study aimed to adapt the North American ‘Healthy Habits, Happy Homes’ program to socially deprived neighborhoods in Bremen, Germany, and to test the feasibility of its implementation by using the RE-AIM model.

methodsThis single-arm intervention study was conducted between 2022 and 2023, including a process evaluation and a pre-post outcome assessment. Families with children aged 3–10 received 4 intervention visits from a health educator over a period of 3–9 months. The implementation fidelity was assessed via an intervention logbook. The acceptability and maintenance of intervention was assessed via feedback questionnaire filled out by parents and through qualitative data collected from parents, intervention staff and local stakeholders. The pre-post outcome assessment was conducted to evaluate its acceptability and to estimate changes in weight status of parents and children, and the children’s dietary habits, physical activity, sleep duration, screen time and behavioral problems.

resultsIn total, 23 caregivers and 33 children participated in the intervention study, and 87% of the families reported at least one indicator of social deprivation. Recruitment proved to be challenging; active recruitment methods, i.e. approaching families personally, were more effective than passive ones. The program implementation demonstrated good fidelity and acceptability. Language barriers were perceived as obstacles in program delivery. 78% of the families completed the outcome measurement. Descriptive analysis revealed positive trends over time in increased physical activity, reduced screen time, and behavioral problems, but no changes in BMI, dietary habits, or sleep duration. Stakeholders recommended integrating the intervention into existing structures like kindergartens for long-term implementation.

conclusionThis study highlights the program’s acceptability and potential benefits for families in deprived neighborhoods of a German city, while acknowledging recruitment challenges. Further adaptations are needed to address barriers and integrate the intervention into wider community efforts to combat childhood obesity.