Changes in referral patterns for weight in association with the preschool Raising Healthy Kids target
Tami L. Cave 1 , José G. B. Derraik 1 2 , Esther J. Willing 3 , Sarah E. Maessen 2 , Paul L. Hofman 1 , Yvonne C. Anderson
2 4 5 6 *
1 Liggins Institute, University of Auckland, Auckland, New Zealand.
2 Department of Paediatrics: Child and Youth Health, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
3 Kōhatu – Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, New Zealand.
4 Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia.
5 Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia.
6 Community Health, Child and Adolescent Health Service, Perth, Western Australia, Australia.
Journal of Primary Health Care 14(4) 310-317 https://doi.org/10.1071/HC22076
Published: 28 October 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: The ‘Raising Healthy Kids (RHK) health target’ recommended that children identified as having obesity [body mass index (BMI) ≥98th centile] through growth screening at the B4 School Check (B4SC) be offered referral for subsequent assessment and intervention.
Aim: To determine the impact of the ‘RHK health target’ on referral rates for obesity in Aotearoa New Zealand (NZ).
Methods: A retrospective audit was undertaken of 4-year-olds identified to have obesity in the B4SC programme in Taranaki and nationally in 2015–19. Key outcomes were: ‘RHK health target’ rate [proportion of children with obesity for whom District Health Boards (DHBs) applied the appropriate referral process]; Acknowledged referral rate (proportion of children with a referral for obesity whose referral was acknowledged by DHBs); and Declined referral rate (proportion of children offered a referral for obesity who declined their referral).
Results: Data were audited on 266 448 children, including 7464 in Taranaki. ‘RHK health target’ rates increased markedly between 2015–16 and 2016–17 following the health target implementation (NZ: 34–87%; P < 0.0001, Taranaki: 21–68%; P < 0.0001). Acknowledged referral rates also increased post-target nationally (56–90%; P < 0.0001), and remained high in Taranaki over the 4-year period (ranging from 89 to 99%). However, there were notably high Declined referral rates across NZ (26–31%) and in Taranaki (although variable: 38–69%).
Discussions: The ‘RHK health target’s’ focus on referral rather than intervention uptake limited the policy’s impact on improving preschool obesity. Future policy should focus on ensuring access to multidisciplinary intervention programmes across NZ to support healthy lifestyle change.
Keywords: B4 School Check, childhood obesity intervention, health target, healthy lifestyle change, multidisciplinary intervention programme, preschool, referral, Whānau Pakari.
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