Download MEND - Public Health Wales

MEND
The MEND programme runs as part of the implementation of the Food and Fitness for children and Young People action plan.
Description
An intensive parent and child obesity intervention, for children who are overweight, with the aim of reducing BMI through a
group based programme. It operates under a licence.
Priority area
Obesity
Life course stage
Children aged 7-13 years (who are > X centile for weight) and their families
Intervention
MEND is a community programme for children between 7-13 and their families, which uses a ‘train the trainer’ approach. The
highly prescriptive multi-disciplinary programme, delivered as a group-based educational intervention, places equal emphasis
on healthy eating, physical activity and behavioural change, aimed at empowering the child, building self confidence and
personal development. The programme is delivered over 2 x 2hr sessions per week for 10 weeks. Children are referred by
health professionals or parental self referral.
Level of intervention: Targeted population
‘Total’ spend 2012/13
£480k (PHW funded). The contract was recently re-negotiated and service is delivered “under licence”.
Evidence of effect AIII
A III There is some, limited, evidence to suggest that the MEND programme approach has the potential to be effective in
relation to its primary objectives, however the current evidence-base is not strong. The available evidence also suggests that
effectiveness may not be evenly distributed across children from different genders/socio-economic/ethnic groups and local
factors can have a significant impact on effectiveness. The data from MEND Wales are not presented for these different subgroups nor are data presented for outcome measure distribution and thus individual-level effectiveness cannot be judged fully.
There is likely to be considerable variation in local factors in Wales, which may impact upon implementation and may limit
effectiveness for some areas/groups. Recruitment may vary across LHBs and this will considerably affect the cost per
participant.
Cost effectiveness
Amber I - Fair quality economic evaluations showing cost-effectiveness/ cost-savings/ cost-benefits as appraised by
Drummond et al’s 2005 Checklist for a sound economic evaluation
AI
In the only initiative specific economic evaluation found (York Health Economics Consortium and NEF Consulting, 2010) using
a population of 7-13 year olds in England, MEND was shown to be cost-effective and provide returns on public investment.
PBMA Report – MEND
22/11/2012 Version 1
Reach
This programme targets overweight and obese children aged 7-13 years and their families with a focus on areas of deprivation.
Targets are 780 participants in year 1 and 850 in year 2. No data was currently available from the Childhood Measurement
Programme to identify reach. I
Inequalities
A programme objective is to address health inequalities by concentrating on areas of deprivation, but collection of deprivation
data appears inadequate, although is in line with the agreed specification. Volunteering to attending twice weekly sessions
requires motivated parents and is more difficult in rural and deprived areas, although where parents have participated retention
rates have been good.
Delivery: Structured group interventions.
Setting: Community
Mechanisms of delivery
Mend is a best practice community based programme for children between 7-13yrs and their families, using a train the trainer
approach. The programme focuses on Healthy eating, physical activity and behavioural change. Children are referred by health
professionals or parental self referral.
Wider views
Engagement events
This programme was criticised by 4 LPH teams and the LA HI leads with positive feedback from one LPHT.
Key Issues/ perceptions:
 Too inflexible making local implementation problematic.
 Poorly integrated and competing with other services and initiatives.
 Potential for participants to be “labelled” and stigmatised.
 No feedback to LPHTs.
Quantitative findings:
When prompted with the logo/website of MEND 15% of the sample (1,018 adults representative of the Welsh population) had
heard of it. This is not an unexpected finding as it is targeted at a very specific segment of the population. Those in the target
group were more likely to be aware of the scheme than the general population as a whole.
Qualitative findings (in-depth family interviews and focus groups):
When prompted, MEND provoked some interest among parents because it sounded fun and involved the whole family learning.
However, some doubted that certain members of their family would show any interest (teenage children, fathers). This potential
absence of certain family members could mean that different meals for different family members would have to be produced.
Online form findings:
PBMA Report – MEND
22/11/2012 Version 1
12 out of the 51 responders said they were aware of MEND, and six said they thought it worked well.
Primary Care:
There was the perception that the initiative was likely to have negligible impact because of perception of poor reach.
Alternative delivery as
proposed by
stakeholders
Some believe it needs to integrate better with other initiatives such as Flying Start and Families First. Some also felt that a
school based intervention would be far more appropriate and is something the school based clinic would tackle. Other potential
links include the NERS programme and ‘Childhood heights & weights measurement programme’.
Application across Wales is questionable. Where there are rurality issues, an individual family visiting model may be better.
Changes cannot be made to present service spec as it is delivered under license. The potential to integrate this into main
stream services should be explored.
Policy Link(s)
Child Poverty Strategy for Wales: Delivery Plan (2010)
Identified Action:
“Continue to support the Mind Exercise Nutrition Do it! (MEND) programme in Wales through the delivery of approximately 20
programmes per term up until March 2011.”
Creating an Active Wales (2009)
Identified Actions:
“Pilot the MEND childhood obesity referral programme.”
PBMA Report – MEND
22/11/2012 Version 1