Next phase of CHErIsH study gets underway this month

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The CHErIsH (Choosing Healthy Eating for Infant Health) team are delighted to be commencing the next phase of their HRB-funded research on a pioneering intervention aimed at promoting healthy early infant feeding practices in primary care. This next phase seeks to explore the feasibility of the intervention, which will begin at the state-of-the-art Mallow Primary Healthcare Centre (MHPC) – one of the leading centres for primary healthcare in Ireland.

To mark the beginning of this exciting new phase of research, a special launch event was organised by the CHErIsH team at its feasibility site in Mallow. The event, held last week on Tuesday 12th March, featured a ‘launch lunch’, which was attended by healthcare practitioners (GPs and nurses) from the MPHC who will be involved in rolling out the intervention. Launching the event was Professor Patricia Kearney from the School of Public Health at UCC, who is Principal Investigator for the study, and Dr Tony Heffernan, a GP at the MPHC who is leading the study. Also attending the launch were members of the CHErIsH team – Dr Elaine Toomey from NUIG and Dr Caragh Flannery, Dr Kate O’Neill and Susan Calnan from UCC’s School of Public Health.

The feasibility study marks the latest phase of development and implementation of the CHErIsH intervention, which has been designed by a team of researchers from UCC, NUIG and Trinity College Dublin (TCD) – in partnership with practitioners at the MPHC, led by Dr Heffernan, the HSE Nurture Programme, and parents and primary caregivers from the CHErIsH public and patient involvement group. The multi-component intervention seeks to improve early infant (aged 0–2 years) feeding practices, such as breastfeeding and the introduction of solid foods, to improve health outcomes and reduce the risk of overweight and obesity in childhood and later life.

Speaking about this latest phase of the research, CHErIsH team member, Dr Elaine Toomey of NUIG, commented: ‘We are so delighted to be at this exciting stage of the CHErIsH study. It’s been a real honour to have worked so closely with the excellent team in Mallow and the HSE Nurture programme, to develop something that we think has the potential to make a valuable contribution to child health. We are really looking forward to learning as much as we can from this testing to inform the next steps of research’.  

Results from the study will help to determine the feasibility of the intervention, which will informing further testing to determine the effectiveness of the intervention in other primary care sites. The CHErIsH team look forward to updating readers on more news about this pioneering intervention over the coming months.

By Susan Calnan

 

‘Exploring intervention fidelity in trials of interventions to change infant feeding behaviours – are we testing what we think we’re testing?’

CHErIsH researcher Dr Elaine Toomey has recently written a blog post for the SPHeRE (Structured Population and Health-Services Research Education) programme on one of the CHErIsH study research papers.

Find the original blog here, or read on below:

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The first two years of life represent an important stage in a child’s development. In particular, how and what a child is fed during this time has an important influence on their subsequent development. For example, infant feeding behaviours such as the early or inappropriate introduction of solid foods into a child’s diet have been associated with the later development of childhood obesity [1, 2]. Childhood obesity is an urgent global concern, with serious health, economic and social implications both for the individual and the wider health system. Therefore infant feeding behaviours represent a potential target for the prevention of childhood obesity and a worthwhile focus for behaviour change intervention research.

To date, studies have found that the effectiveness of infant feeding interventions to prevent childhood obesity to be somewhat variable and inconsistent [3, 4]. However, little is known about the actual implementation of the interventions within these trials, and the ‘fidelity’ with which they were put into practice. Intervention fidelity refers to the extent to which an intervention is actually implemented as intended by the researchers who designed it [5]. For example, are all aspects of the intervention delivered by the providers as planned? Do participants actually attend or engage with the intervention, do they receive or use intervention materials or resources as intended? Intervention fidelity is an important methodological aspect of behavioural studies, as without knowledge of intervention fidelity we are only really assuming that the intended intervention is being tested.

In a recent systematic review [6], we explored the use and reporting of different strategies to enhance and assess intervention fidelity within trials of infant feeding interventions delivered by healthcare professionals to prevent childhood obesity. We also explored the associations between fidelity score and study quality, intervention effectiveness and publication year. Using a systematic search strategy we identified 10 trials represented in 16 papers. Across these studies, the average use and/or reporting of strategies to enhance (e.g. training manuals/protocols) and/or assess intervention fidelity (e.g. delivery checklists) was moderate (54%), ranging from 28.9% to 76.7%. No patterns were observed between levels of fidelity reporting/use and study quality, effectiveness or publication year. Interestingly, although six studies reported using a method to assess fidelity of intervention delivery, only 2 studies explicitly reported the results of this fidelity assessment.

The moderate use/reporting of fidelity strategies within trials of infant feeding interventions identified in our review suggest that previous findings of inconsistent effectiveness may not fully reflect the intended interventions. As a result, our study identified a number of recommendations that could improve the methodological quality of future trials of infant feeding interventions, to ensure that these trials are a more accurate test of the intervention in question. These include 1) ensuring adequate focus on how intervention providers are trained and the knowledge and skills needed to deliver the intervention as intended, 2) ensuring adequate focus on the fidelity of treatment within comparator or control groups and 3) ensuring better reporting across all aspects of fidelity, in particular the results of fidelity assessments. In doing so, improved intervention fidelity will facilitate better interpretation and understanding of the findings of such trials, and provide more information to support the translation of successful interventions into policy and practice.

 

  1. Woo Baidal JA, Locks LM, Cheng ER, Blake-Lamb TL, Perkins ME, Taveras EM: Risk Factors for Childhood Obesity in the First 1,000 Days: A Systematic Review. Am J Prev Med. 2016;50:761-779.
  2. Pluymen LPM, Wijga AH, Gehring U, Koppelman GH, Smit HA, van Rossem L: Early introduction of complementary foods and childhood overweight in breastfed and formula-fed infants in the Netherlands: the PIAMA birth cohort study. Eur J Nutr. 2018;57:1985-1993.
  3. Matvienko-Sikar K, Toomey E, Delaney L, Harrington J, Byrne M, Kearney PM: Effects of healthcare professional delivered early feeding interventions on feeding practices and dietary intake: A systematic review. Appetite. 2018;123:56-71.
  4. Redsell SA, Edmonds B, Swift JA, Siriwardena AN, Weng S, Nathan D, Glazebrook C: Systematic review of randomised controlled trials of interventions that aim to reduce the risk, either directly or indirectly, of overweight and obesity in infancy and early childhood. Maternal & Child Nutrition. 2016;12:24-38.
  5. Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, Ogedegbe G, Orwig D, Ernst D, Czajkowski S: Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004;23:443-451.
  6. Toomey E, Matvienko-Sikar K, Heary C, Delaney L, Queally M, B Hayes C, M Kearney P, Byrne M, Choosing Healthy Eating for Infant Health study t: Intervention Fidelity Within Trials of Infant Feeding Behavioral Interventions to Prevent Childhood Obesity: A Systematic Review. Annals of Behavioral Medicine. 2018:kay021-kay021

Fresh faces in CHErIsH!

Lots of changes and new updates for the CHErIsH study team over the last while! Our wonderful CHErIsH post-docs Dr Michelle Queally and Dr Karen Matvienko-Sikar have both taken up new positions and will continue to work on CHErIsH in an advisory capacity. Michelle has started a post-doctoral research position with CÚRAM, the Centre for Research in Medical Devices working on recruitment to clinical trials, while Karen will be starting her HRB Applying Research into Policy and Practice fellowship in January 2019! We wish them both the best of luck in their new endeavours and will be looking forward to hearing their updates!
Coming onto the CHErIsH team, we are delighted to welcome Dr Kate O’Neill and Dr Caragh Flannery! Kate has a background in Public Health and Health Promotion, Epidemiology and Health Economics, and will join us to work with Michelle on our health economics evaluation. Kate recently passed her viva under the supervision of Prof Patricia Kearney and Dr Sheena McHugh in UCC. Kate’s PhD, which focused on the cost of diabetes in Ireland in 2013. Caragh recently passed her viva under the supervision of Prof Molly Byrne in NUI Galway. Caragh was part of the HRB SPHeRE PhD programme in Population Health and Health Service Research and her PhD focused on health behaviour change in the area of pregnancy and gestational diabetes.
We are so thrilled to have such a growing team with fantastic expertise. CHErIsH is currently in the third phase of development and will be starting to explore the feasibility of the intervention with our partners in the Mallow Primary Healthcare Centre in the upcoming months. Watch this space for more project updates coming soon! 🙂

CHErIsH researcher delivers webinar for Primary Care Trials Network Ireland

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Dr Elaine Toomey delivered the first webinar of the Autumn 2018 series for the Primary Care Trials Network Ireland (PCTNI). The HRB Primary Care Clinical Trials Network Ireland is a collaborative partnership that brings together key people in Ireland to run clinical trials in primary care, that is, through general practices or primary care centres and in the community. Dr Toomey gave a webinar on the current progress of the CHErIsH study entitled “The Choosing Healthy Eating for Infant Health (CHErIsH) Study“. The talk focused on childhood obesity in Ireland, the role of infant feeding behaviours in childhood obesity, current infant feeding best practice recommendations and guidance, and an update on the Choosing Healthy Eating for Infant study and how primary care practitioners can get involved.

To watch the webinar, click hereImage 2

Research snapshot of review of fidelity of infant feeding interventions

Our review of fidelity of trials of infant feeding interventions was published in February in Annals of Behavioral Medicine – available here.

Our study found that the moderate use and/or reporting of strategies to improve and assess fidelity within trials of infant feeding interventions suggests that previous findings of inconsistent effectiveness may not fully reflect the intended interventions.

This research snapshot was created by Rebekah Roy, a HRB Trials Methodology Research Network summer student working with Dr Elaine Toomey over the summer, in an attempt to make our study more accessible and informative!

Research Snapshot_ 1 page A4research snapshot

CHErIsH researcher wins award for obesity research

AMM-180125-7136CHErIsH post-doctoral researcher, Dr Elaine Toomey was recently awarded the ‘Irish Canadian University Foundation James M Flaherty Early Career Researcher Award’. Dr Toomey received the award to conduct further research on the adaptation of ‘Football Fans in Training’ (FFIT), an effective health behaviour change intervention developed by Prof Kate Hunt, Prof Sally Wyke and Dr Cindy Gray that used Scottish professional football clubs to engage with overweight and obese men. The ‘Hockey Fit’ intervention was recently developed by Dr Rob Petrella and Dr Dawn Gill in Western University, Ontario to adapt the FFIT project to ice-hockey, within a Canadian context.

Elaine’s award will enable her to visit Western University and explore the Canadian ‘Hockey Fit’ intervention with a specific focus on how FFIT components were adapted to suit a different sporting and cultural context, and inform how this might be used in an Irish context. Dr Toomey will also spend time in the Centre for Implementation Research in the Ottawa Hospital Research Institute to maximise how knowledge from her visit to Western University can be used to inform adaptation and translation into an Irish setting, using a structured and theory-based approach.

Elaine was interviewed on Thursday 15th February about this award and also about the work of the CHErIsH study on the ‘Limerick Today’ programme on Limerick’s Live 95fm. Radio host Joe Nash, was particularly interested in the work of the CHErIsH study into how infant feeding behaviours could be changed to prevent childhood obesity. Listen back to the interview podcast here!

 

We need you! Get involved with CHErIsH!

Work has recently gotten underway on the next stage of our project, to get you, parents, mothers and fathers, aunts, uncles and grandparents of children involved with us in our research! We want to create an energetic partnership between you and Team CHErIsH so that the infant feeding insights, views and experiences of parents, grandparents, aunts and uncles will guide the development of our research, influence the planning and delivery of infant feeding support services in ways that are accessible and meaningful to the public.

This is called PPI, or public and patient involvement, and tries to make sure our research is relevant and beneficial to patient and public needs. As such it is a really important part of our project. We have recently created a dedicated page to our PPI –https://cherishstudy.com/home/public-patient-involvement/ If you, or anyone you know, would like to help out (even in a small way) please get in touch using our contact page!

Involvement

This part of our project is being led by CHErIsH researcher Dr. Michelle Queally.

For more information on how to get involved please click the link to our PPI page: https://cherishstudy.com/home/public-patient-involvement/