Introduction
Methods
Search strategy and identification of included articles
Inclusion and exclusion criteria
Data extraction and synthesis
Quality assessment and risk of bias
Results
Identification of included articles
Quality assessment and risk of bias
Authors & Country | Design | Downs and Black scorea | Study quality |
---|---|---|---|
Anderson, C.Y et al. (2017) [22] (New Zealand) | RCT (Treatment) | 20 | Good |
Chansavang, Y. et al. (2015) [23] (New Zealand) | Pre/post mixed methods (Treatment) | 16 | Fair |
Gittelsohn, J. et al. (2010) [24] (USA - Hawaii) | Pre/post with control (Prevention) | 17 | Fair |
Maddison, R. et al. (2014) [27] (New Zealand) | RCT (Treatment) | 19 | Fair |
Rush, E. et al. (2012) [26] (New Zealand) | RCT (Prevention) | 23 | Good |
Rush, R. et al. (2014) [25] (New Zealand) | RCT (Prevention) | 19 | Fair |
Study participants
Study characteristics
Authors & Country | Design | Participants and retention | Intervention Characteristics | Control | Outcome Measure/s | Main Findings | ||
---|---|---|---|---|---|---|---|---|
Setting | Description | Dose | ||||||
Anderson, C.Y et al. [22] (2017) (NZ) | RCT (Treatment) | n = 103 (I: n = 69; C: n = 69); aged 5–16 y with overweight/ obesity and comorbidities; 49% female; 45% Māori Retention: 69% (31% dropout) | Community sporting venues (intervention); Home (assessments) | “Whānau Pakari Program” Multidisciplinary program, delivered by a physical activity coordinator, dietitian, and psychologist. Sessions focused on an introduction to sports, making sustainable healthy lifestyle change and dietary education. | 12-month, weekly group sessions. 6- and 12-month follow-up with home visits, assessments, and advice | Physical assessments and advice bi-annually for 2 years | (1) Anthropometry: BMI SDS change, baseline − 12 mo. (2) Psychological: quality of life (HR-QOL); psychological characteristics (CBCL); Cardiometabolic: PA (steps/day; PA intensity); CV fitnessa; glycated hemoglobin; fasting insulin; Behavioural: screen time | No difference in BMI SDS reduction after 12 mo in Māori participants. CV fitness and HR-QOL sig. Improved in Māori participants. Attendance of ≥70% sessions sig. Increased BMI SDS reduction, CV fitness, parent HR-QOL and CBCL score. |
Chansavang, Y. et al. [23] (2015) (NZ) | Pre/post mixed methods (Treatment) | n = 18; “less-active adolescents”, mean age 16.3 y; 78% female; 72% Pacific; 28% Māori Retention: 89% (11% dropout) | Recreation Centre (after-school) | Group-based exercise and lifestyle intervention program. Sessions focused on a variety of physical activities, with dietary and lifestyle education delivered post-session. Text message support was provided, containing health-related quotes. | 6-week, 3 × 1.5 h per week sessions; follow-up at intervention conclusion | None | (1) Cardiometabolic: VO2max; insulin resistance (2) Cardiometabolic: glycated hemoglobin; fasting plasma glucose; fasting lipid profile; PA levels (IPAQ); Anthropometry: BMI, waist circumference; Behavioural (qualitative): session attendance; comments on program feasibility | Significant improvements in VO2max, systolic BP, weekly vigorous and moderate PA; however, waist circumference sig. Increased. No change in BMI or weight. Feasibility comments were positive, related to sport participation and helpfulness of texts. |
Gittelsohn, J. et al. [24] (2010) (USA - Hawaii) | Pre/post with control (Prevention) | n = 117 (I: n = 64; C: n = 53) child-caregiver pairs; mean child age 9.8 y; 65% Native Hawaiian or Pacific Islander; 50% female (child); 95% female (caregiver) Retention: 67% (33% dropout) | Five stores in two communities in Oahu and the Big Island. Population size: Oahu (n = 10,506); Big Island (n = 5748) | “Healthy Foods Hawaii” Increase availability of healthy foods in community stores. Intervention phases targeted: (1) Healthier beverages; (2) Healthier snacks; (3) Healthier condiments; and (4) Healthier meals. Educational and labelling materials were promoted in-store. Cooking demonstrations performed 4–6 times per phase. | Four phases, 6–8 weeks each, with 1–2 week break intervals. | Two communities on each island with no intervention | (1) Adult caregiver psychosocial factor and food-related behaviours (CIQ); Child psychosocial factors, food-related behaviours and food intake (CCIQ) | Mostly no differences overall; however, significant caregiver improvement in perceiving healthy foods as convenient, and significant child improvement in overall dietary score, particularly water and grain consumption. |
Maddison, R. et al. [27] (2014) (NZ) | RCT (Treatment) | n = 251 (I: n = 127; C: n = 124); aged 9–12 years with overweight/ obesity; 43% female; 13% Māori, 53% Pacific Retention: 95% (5% dropout) | Home environment with complementary digital intervention avenues | “SWITCH” Reducing all leisure-based screen-time activities in the home. Three elements offered to families: (1) Behaviour change strategies; (2) Budgeting media time; (3) Activity pack for children. | 20 weeks, initial face-to-face, then monthly digital resources. Follow-up at 24 week post-randomisation (4 weeks post-intervention) | Usual behaviour | (1) Anthropometry: BMI z-score (2) Anthropometry: BMI, weight (kg), WC, %BF; Cardiometabolic: PA frequency & intensity; Behavioural: total sedentary time (mins), sleep, dietary intake, enjoyment of PA and sedentary behaviour | No significant differences. |
Rush, E. et al. [26] (2012) (NZ) | RCT (Prevention) | n = 926 (I: n = 492; C: n = 434); aged 5–7 y; 51% female; 23% Māori n = 446 (I: n = 200; C: n = 226); aged 10–12 y; 51% female; 33% Māori Retention: Aged 5-7y - 80% (20% dropout) Aged 10-12y − 57% (43% dropout) | 124 primary schools | “Project Energize” Assignment of a dedicated healthy lifestyle champion - “Energizer” - to each school. Energizers were “agents of change” and integrated physical activity, healthy eating and educational initiatives into daily class activities. Parental nutrition education sessions were delivered. | 2 years, no specific dose. Assessments at baseline and 2 years. | Schools - no intervention with no restrictions on self-directed initiatives | (1) Anthropometry: body composition (BMI; %BF); Cardiometabolic: BP; | No significant differences in Māori population. |
Rush, R. et al. [25] (2014) (NZ) | RCT (Prevention) | n = 2959 (I: n = 2474; C: n = 485); aged 6–8 y; 52% female; 36% Māori n = 3670 (I: n = 2330; C: n = 1340); aged 9-11y; 54% female; 37% Māori Retention (number of schools): 82% (18% dropout) | 193 primary schools | As above | Months (n) of engagement with each school | Historical comparison with 2012 RCT control group [26] | (1) Cardiometabolic: BP; CV fitnessa; Anthropometry: body composition (BMI; %BF) | Overweight/obesity prevalence 31 and 15% lower in younger and older “Energized” children compared to historical comparison, respectively. BMI lower by 3 and 2.4%, respectively. Physical fitness also higher. |
Prevention
Treatment
Intervention effectiveness
Prevention
Authors & Country | Study type | Sub-group analysis of MPI participants | Effectiveness on intervention outcomes | |||
---|---|---|---|---|---|---|
Improved anthropometry | Improved cardiometabolic | Improved psychological | Improved behavioural | |||
Anderson, C.Y et al. [22] (2017) (NZ) | Treatment | Yes (cardiometabolic only) | × (BMI, WC)a | × (HbA1c, fasting insulin, CV fitnessb, PA levels/intensity) ✓ CV fitnessa | ✓ (HR-QOL, overall psychological profile)a | × (Screen time) |
Chansavang, Y. et al. [23] (2015) (NZ) | Treatment | Participants were exclusively of MPI descent | × (BMI, WC)a | ✓ (VO2max, BP, HbA1c)a × (fasting insulin)a | – | – |
Gittelsohn, J. et al. [24] (2010) (USA - Hawaii) | Prevention | No | – | – | ✓ (Parent food knowledge) | ✓ (Overall child dietary intake) |
Maddison, R. et al. [27] (2014) (NZ) | Treatment | No | × (BMI, %BF, FFM, FM, WC) | – | – | × (Screen time, sedentary time, sleep, PA enjoyment, sedentary behaviour enjoyment) |
Rush, E. et al. [26] (2012) (NZ) | Prevention | Yes | × (BMI, %BF)a | × (BP)a | – | – |
Rush, R. et al. [25] (2014) (NZ) | Prevention | No | NRc | NR‡ | – | – |
Treatment
Intervention optimisation for Māori and Pacific islander participants
Discussion
Main findings
Cultural optimisation of interventions
Cultural optimisation of system approaches
Strengths and limitations of included articles
Strengths and limitations of review
Conclusions
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Cultural-tailoring of interventions, preferably utilising a co-design approach, with adequate methodological reporting;
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Implementation of interventions that exclusively target Māori and Pacific Islander children and adolescents; fostering community engagement, leadership and ownership at every stage of the proposed intervention i.e. from conception to evaluation;
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Performing intervention sub-group analysis on Māori and Pacific Islander participants in mixed-population studies; and
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Integrating and evaluating, where possible, long-term, mixed-methods interventions within an existing healthcare system to maximise reach and sustainability for policy- and population-level impact