Co-Fam project
Co-Fam is a partnership model for health promotion and early prevention and treatment of obesity. This project aims to co-design and evaluate a coherent model of family support that combines actions in school and primary health care to promote health and prevent and manage overweight and obesity in children 6-12 years.
A coherent model for family support
National guidelines recommend comprehensive behavioral interventions and structured family support for younger children and their parents in cases of unhealthy habits and obesity. However, Sweden currently lacks an evidence‑based family support program for children aged 6–12 years.
The aim of the Co-Fam project is to co-design and evaluate a coherent model for family support for school, primary healthcare and pediatric clinics to promote healthy behaviors and prevent and treat overweight and obesity. The goal is to offer support to all children and their families according to needs at an early stage to reduce the risk of obesity and chronic diseases in the long term.
The Co-Fam model
The Co-Fam model combines the universal family support program A Healthy School Start and the targeted parental support program More and Less (in Swedish). The model emphasizes the importance of close collaboration and feedback between school health services, primary healthcare and pediatric clinics, with the family in the center.
The arrows represent referrals for children with overweight or obesity between school health services, primary healthcare and the pediatric clinic. In case of obesity, the school health service refers the family to the pediatric clinic. When children have overweight, the school health service can refer the family to primary healthcare, where dieticians and physiotherapists provide combined behavior treatment. Children and their parents can also be referred between primary healthcare and the pediatric clinic, if needed.
The Healthy School Start program is given to all children and their families in grade 1 (child age 6-7 years) and consists of a parental guide with health information and a diabetes risk test, a workbook for children and teacher led lectures. The targeted parental support program More and Less is offered to parents of children aged 6-12 years with overweight or obesity and is provided by primary healthcare. The More and Less program consists of ten group sessions followed by individual booster calls with the parents.
The objectives of Co-Fam study are to:
- Co-design a coherent model of family support for families with children 6-12 years, including universal and targeted components.
- Evaluate the model in a randomized controlled trial with outcomes at the individual level, and fidelity and costs at the organizational level.
- Explore acceptability and feasibility of the model through interviews with health professionals and parents.
The study will be ongoing from 2024 to 2028 in Södertälje municipality, where all schools are currently implementing A Healthy School Start in grade 1. Parents who have children with overweight or obesity aged 6–12 years are mainly recruited through school health services.
How has the Co-Fam model been developed?
The Co-Fam model has been developed in a co-design process between school health services, primary healthcare, a pediatric clinic and parents to ensure acceptance of the model. Involved actors and parents have discussed referral criteria, referral flow, adaptation of the content of the More and Less program for children 6-12 years, follow-up after completion of treatment and how to avoid stigmatization of children with overweight or obesity.
How will Co-fam be evaluated?
The model is being evaluated in a randomized controlled trial that will examine both effectiveness and implementation of the model in a hybrid type 2 study. Participants are randomized to one of two groups:
- More and Less: A parental support program with 10 group sessions over 10 weeks. The sessions are followed by 6 booster calls every 6th week for 12 months.
- Standard care for overweight or obesity: Individually adapted treatment from primary healthcare or a pediatric clinic for 12 months during which an individual treatment plan is developed.
Financing
This project has received funding from the Swedish Heart-Lung Foundation, the Norheds Foundation, the Swedish Research Council and the Foundation Frimurare Barnhuset in Stockholm.