Mixed methods feasibility and usability testing of a childhood obesity risk estimation tool

Abstract

Background: A Childhood Obesity Risk Estimation tool (SLOPE CORE) has been developed based on prediction models using routinely available maternity and early childhood data to estimate risk of childhood obesity at 4-5 years. This study aims to test the feasibility, acceptability and usability of SLOPE CORE within an enhanced health visiting (EHV) service in the UK, as one context in which this tool could be utilised.

Methods: A mixed methods approach was used to assess feasibility of implementing SLOPE CORE. Health Visitors (HVs) were trained to use the tool, and in the processes for recruiting parents into the study. HVs were recruited using purposive sampling and parents by convenience sampling. HVs and parents were invited to take part in interviews or focus groups to explore their experiences of the tool. HVs were asked to complete a system usability scale (SUS) questionnaire.

Results: Five HVs and seven parents took part in the study. HVs found SLOPE CORE easy to use with a mean SUS of 84.4, (n = 4, range 70-97.5) indicating excellent usability. Five HVs and three parents took part in qualitative work. The tool was acceptable and useful for both parents and HVs. Parents expressed a desire to know their child's risk of future obesity, provided this was accompanied by additional information, or support to modify risk. HVs appreciated the health promotion opportunity that the tool presented and felt that it facilitated difficult conversations around weight, by providing 'clinical evidence' for risk, and placing the focus of the conversation onto the tool result, rather than their professional judgement. The main potential barriers to use of the tool included the need for internet access, and concerns around time needed to have a sensitive discussion around a conceptually difficult topic (risk).

Conclusions: SLOPE CORE could potentially be useful in clinical practice. It may support targeting limited resources towards families most at risk of childhood obesity. Further research is needed to explore how the tool might be efficiently incorporated into practice, and to evaluate the impact of the tool, and any subsequent interventions, on preventing childhood obesity.

Keywords: Childhood obesity; Early years; Health inequalities; Health visiting; Mixed methods; Pregnancy; Prevention; Risk prediction.

Fig. 1

SLOPE CORE online data collection page. This screenshot depicts the data collection page of SLOPE CORE, as viewed through an administrator account for illustration purposes. When using the live tool, the user enters the required data before pressing ‘calculate’ and being taken to a results page. Data required for the tool is routinely collected at healthcare appointments, and should be available in the mother’s clinical records, and the child’s red book

Fig. 2

Example of a green risk score results page in SLOPE CORE. The screenshot depicts an example of a low-risk results page (< 20% risk that a child will be obese at age 4–5 years), as viewed through an administrator account for illustration purposes. The risk is conveyed as a percentage and a natural frequency

Fig. 3

Example of a yellow risk score results page in SLOPE CORE. The screenshot depicts an example of a medium-risk results page (≥ 20 < 30% risk that a child will be obese at age 4–5 years), as viewed through an administrator account for illustration purposes. The risk is conveyed as a percentage and a natural frequency

Fig. 4

Example of an amber risk score results page in SLOPE CORE. The screenshot depicts an example of a high-risk results page (≥ 30% risk that a child will be obese at age 4–5 years), as viewed through an administrator account for illustration purposes. The risk is conveyed as a percentage and a natural frequency