Abstract
Background: The rising prevalence of overweight and obesity among children and adults is an urgent public health challenge. The multidisciplinary Dutch national healthcare guideline ‘Overweight and Obesity in Adults and Children’ advises an integrated network approach as the most optimal organisational structure for overweight and obesity support and care. In recent years, two healthcare standards, the National model for integrated care for childhood overweight and obesity and the Model for integrated care for adults with overweight and obesity, have been developed and are being implemented nationally. Current models do not optimally support families where both generations (adult and child) need support and care. As the prevalence of obesity among multiple family members is high, municipalities are increasingly demanding a combined network approach. However, clear guidance on effectively integrating child and adult models in practice is lacking. Therefore, this study iteratively explores the development and early implementation of a combined integrated care approach for overweight and obesity in both children and adults within the family context.
Approach: After the formation of a project group (Stage 1), establishment of a learning community (LC) took place (Stage 2). Five municipalities were selected to participate in the LC based on factors such as geographical spread, relationships with various national health insurers, their willingness and local support to adopt both integrated care models, and financial resources to participate in this project. Three municipalities were working with both models, one had been implementing the children’s model, and one was going to start with both models.
Results: By analysing existing integrated care models, we identified differences and similarities between the adult and children’s models (Stage 3), among others, this included theoretical and operational differences. The LC sessions subsequently helped identify implementation challenges (Stage 4), including challenges regarding financial resources, capacity, policy integration, procedures, and ICT compatibility. We then co-created an implementation plan with the municipalities (Stage 5) to execute a pilot (Stage 6). In this pilot, we will identify key implementation barriers and facilitators (Stage 7) and link the barriers to theory of the Consolidated Framework for Implementation Research (CFIR) (Stage 8) to identify tailored strategies for practice (Stage 9). We will differentiate between guideline content-specific barriers to focus on evidence-based guideline content-specific solutions, and implementation-specific barriers by selecting evidence-based strategies, with the help of the CFIR-ERIC matching tool and input from the municipalities. Finally, we will identify key principles and lessons learned for realising a combined integrated care approach within the family context (Stage 10).
Implications: This study underscores the need for a combined approach to effectively offer support and care for obesity in both children and adults within one family. The initial results show the potential of supporting entire families rather than individuals in isolation, using a combined approach. Achieving this requires cross-sector collaboration and local adjustments to existing policies and funding mechanisms to facilitate combined care. The next steps involve expanding this approach to a greater number of families within the current municipalities and other municipalities to refine the combined integrated care approach continuously.