What is the Healthy Lifestyles Pathway?

In September 2023, Small Steps Big Changes (SSBC), a multi-year Big Lottery funded programme focusing on early intervention, commissioned the Royal Society for Public Health (RSPH) to conduct a comprehensive process and impact evaluation of their Healthy Lifestyles Pathway (HLP).

Focused on early intervention for childhood obesity, the pathway engages with families with 0-4-year-old children at risk of obesity in areas of high deprivation, offering support that is both convenient and relevant to them.

In practical terms, this means providing tailored one-to-one support at the family’s accommodation, covering nutrition, physical activity, and parenting at convenient times. Additionally, the service provides training and support to other healthcare and support professionals to ensure effective referrals to the HLP service.

Our evaluation approach to the Healthy Lifestyles Pathway

To assess the effectiveness and impact of the HLP, our evaluation followed several key steps:

1. Understanding the Intervention: We carried out a high-level review of relevant literature, including national guidance for interventions like HLP. We also met with the team and parent champions to develop a Theory of Change (ToC) – a diagrammatic framework outlining how the intervention is designed to work, the underlying assumptions, and the expected outcomes. This ToC provided a foundation for comparing the intended design with actual delivery and assessing the impact of the intervention.
2. Hearing from Families: Using our ToC as a reference, we conducted semi-structured interviews with families to explore key questions, such as: What did the service provide them with? How did it work for them? What did they like about it and why? What challenges did they face and why? These insights helped identify the ingredients for success, barriers to engagement, and the role of both the intervention and the wider context.
3. Engaging with Professionals: We spoke to professionals from the Health Visiting Team working in service wards (Aspley, Bulwell, Hyson Green & Arboretum, and St Ann’s) to explore their experiences with discussing relevant topics with families, the referral process, and how the HLP service aligns with and supports their work.
4. Analysing Service Data: We reviewed data from 199 families and their referred children, including demographic details (e.g., ethnicity, postcode, and age) and lifestyle-related information gathered pre-, post-, and during follow-up stages of the intervention. We also analysed post-intervention qualitative feedback from parents.

What we learned from the evaluation

Our literature review confirmed that the HLP service aligns with best practice and national guidelines, demonstrating key characteristics such as:

• Accessibility: Support is provided at families' accommodation, in their preferred language, and at suitable times.
• Family-centred approach: Tailored support is based on families' priorities and what is realistic for them.
• Cultural responsiveness: The service takes into account cultural foods, meanings, and support.

The evaluation showed that the service was well received and effective in supporting families to change health behaviours by providing information and practical resources that were convenient, relevant, and accessible.

Families particularly valued the one-to-one interaction, as well as the opportunity to ask questions and discuss ideas with knowledgeable local professionals. First-time parents from diverse backgrounds especially appreciated the service’s role in helping them care for their babies' nutrition, overall health, and wellbeing.

Post-intervention and follow-up data suggested that families were able to:

• Implement healthier cooking practices.
• Reduce screen time.
• Increase the frequency of home-cooked meals.
• Significantly reduce children’s consumption of sugary drinks (from 54% pre-intervention to 76% post-intervention).
• Show higher parental motivation (90%) and this was sustained at follow-up.

However, families continue to face barriers that are difficult to overcome, including low income, fuel poverty, limited access to healthy foods and playgrounds, and language/cultural gaps. First-time parents also reported knowledge gaps around weaning, physical activity, and child development.

Health professionals confirmed that the HLP service fills an important service gap, providing expertise and referrals to additional resources that allow them to offer the support that families need.

The bigger picture

These findings confirm how well designed and delivered interventions can be effective at supporting families change lifestyles.  However, it also reinforces the importance of local systems working collaboratively to tackle wider determinants of health. While services like HLP are essential, they need to be complemented by broader environmental and policy changes to ensure sustainable impact, particularly for those in most need.

Find out more

To read the full evaluation report, please visit: Healthy Lifestyles Pathway Report

To discuss how we can help you evaluate your programme or service, get in touch with Nelly Araujo on [email protected].