Feasibility of tackling obesity

prevalence in low and middle income

countries using mobile health
Lessons learned and strategies from Australian
prevention programs

Sarah Taki

Health Promotion Unit, Sydney Local Health District

NHMRC Centre of Research Excellence in the Early Prevention of Obesity in
Childhood
School of Public Health, University of Sydney

October 2018
Presentation Outline

 Global prevalence of obesity

 Healthy Beginnings program

 COMmunicating Healthy Beginnings Advice by Telephone

 Using mHealth to deliver obesity prevention programs in

low and middle income countries

 Recommendations
 Ending Childhood Obesity
By World Health Organisation

Rate of childhood overweight & obesity

• GLOBALLY: 6.0% (38.3 million) children under 5 were categorised as overweight or obese (2017)
• SOUTH EAST ASIA: 7.2% of children under 5 years were overweight
• AUSTRALIA: 20% of children between 2-3 years of age are overweight or obese (2016)
What is Healthy Beginnings?
 Staged home-based early obesity intervention trial delivered by community
nurses to primiparous mothers from 3rd trimester to children aged 24
months.
 Provided 8 home visits - once before the birth, and at 1, 3, 5, 9, 12, 15, 24
months by a trained nurse – plus usual care.

Key intervention messages:

• Breast is best
• No solids for me until 6 months
• Only water in my cup
• I am part of an active family
• TV away – let’s go play
• I eat a variety of fruit and vegetable every day
 Although expensive and not sustainable in the longer term, the intervention
effectively improved infant feeding practices and child body mass index
(BMI) at 2 years.

For more details, please visit Healthybeginnings.net.au

The Communicating Healthy Beginnings
Advice by Telephone (CHAT) study
 The CHAT study is a TRG funded project to determine the effectiveness of
using telephone and SMS support to prevent childhood obesity.

Usual care
n=385

Total SMS
n=1155 n=384

Telephone support
n=386
Healthy Beginnings staged booklets
SMS and telephone support with Healthy
Beginnings

SMS Support Telephone Support

• 2 SMSs/wk for 4 weeks • 1 telephone call/milestone by a Child Family Health Nurse
in each milestone • Maximum of 10 attempted calls per milestone
• RedCAP software is used to schedule, monitor and record notes
To date achievements:
Telephone support SMS support
(n= 386) (n= 384)
Intervention SMS sent
n=18,399

SMS replies to
participant enquiries
n=1018

SMS received from

participants
n=2433

Average of 4 calls for

1 successful call
 Co-benefits of telephone support
 Compliments existing services
– Health service referral

 Targeted hard to reach populations

• Socially isolated:
 Rural
 New into the country (no family support)

• Culturally And Linguistically Diverse backgrounds

• Financially disadvantaged

• Lack of awareness and confidence to access other services

Co-benefits of telephone support
 Opportunistic moment to address health and social
challenges

• Provide information on the latest evidence based practice for

healthy infant feeding, sleeping and active play

• Challenging unhealthy practices

• Feeding behaviours (e.g. force feeding)
• Unhealthy food choices (e.g. commercial food, camomile
tea)
• Using screen-time
• Supporting mother’s wellbeing
• Managing mental health crisis
mHealth programs to deliver obesity prevention
programs in low and middle income countries
MYANMAR (Hmone, M.P, 2017)
Study: RCT using mobile phone short messages to improve breastfeeding and reduce
adverse infant feeding practices

Criteria: Pregnant women 28-34 weeks gestation, owned a mobile phone and literate in
Myanmar language

Mode of delivery: SMS on breastfeeding or maternal and child health care messages,
from recruitment till postpartum six months. Messages were tailored for gestation in
pregnancy and the child’s age.

Findings:

 N=353, 80% completed the 6 month program

 The intervention group had significantly higher EBF rate at 1 to 6 months’ of age

 At 6 months, the intervention group had almost tripled EBF rates (43%) compared to
the control group (15%).
Recommendations
– Needs assessment to explore interest in using mobile phones for
promotion
– Conduct research to understand the disparity of
overweight/underweight across Indonesia including:
 Map out policies across each province to identify current
strategies implemented to address the double burden
– Leverage off existing successful obesity programs implemented in
developed countries and other low middle income countries
 Educate parents on healthy infant feeding behaviours
(Pregnancy- beyond)
 Use of increasing rates of technology
Thank you and Acknowledgements

Members of the committee

Funding Sources:

NHMRC #393112, #1003780 #1028555, and #1101675

NSW TRGS 2016 round one #200

SLHD
Websites:
http://www.healthybeginnings.net.au

http://www.earlychildhoodobesity.com/