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. 2015 Feb 4;5(2):e006519. doi: 10.1136/bmjopen-2014-006519

Table 1.

GOALS intervention details

Item Description
Name (1) GOALS
Why (2) The aim of GOALS was to promote a healthy weight trajectory in children who were obese, with a focus on supporting the whole family to become more physically active and make healthy changes to their diet.
Owing to the lack of available evidence when GOALS was founded in 2003, a continuous improvement methodology was used to develop and evaluate the intervention (see ref. 35 for a full outline of this process). The whole family, multidisciplinary approach is supported by international evidence.6 43
Intervention topics were informed by social cognitive theory12 13 and the theorised triadic reciprocal causation between environmental, behavioural and cognitive factors. Sessions aimed to enhance the self-efficacy of children and parents/carers for PA and healthy eating by providing positive mastery experiences, reciprocal modelling opportunities, and positive encouragement (see ref. 41 for further details).
Dietary objectives:
To encourage families to:

  • Eat a healthy balanced diet

  • Reduce portion sizes

  • Consume fewer processed foods

  • Cook more meals from fresh

  • Increase fruit and vegetable intake

  • Replace snacks high in fat and sugar with healthier alternatives

  • Reduce the amount of salt and sugar added to food and drink

  • Reduce the frequency of takeaways

  • Increase water consumption

  • Eat regular meals, focusing on breakfast in particular

  • Read food labels and become more aware of what they are eating

 PA objectives:
To encourage families to increase their PA through:

  • Active transport (eg, walking to school)

  • Lifestyle activity (eg, taking stairs instead of lift)

  • Active play (at home, out or with friends)

  • Structured exercise (eg, zumba)

  • Sport participation
What—procedure (4) Children were referred to GOALS through multiple routes, including self-referral in response to promotional activities (eg, press articles, leaflets, whole school letters) and referral from health professionals in primary or secondary care. In addition from April 2007 children aged 9–10 years were recruited via letters to their parents/carers following participation in a local health and fitness programme in schools (SportsLinx44).
Approximately 1-week before the intervention each family attended a ‘lifestyle assessment’ with an intervention delivery staff member. The purpose of these sessions was to build rapport with families, complete paperwork such as consent and monitoring forms, and to gather information about the family's PA and dietary habits through an informal interview.
The intervention sessions focused on diet (Fun Foods), PA (Move It) and behaviour change and well-being (Target Time).
Fun Foods: Aimed to equip families with the knowledge and practical skills to incorporate a healthy balanced diet into their lifestyle, based on the NHS Choices eatwell plate.45 A range of classroom-based and practical sessions addressed topics such as portion sizes, reading food labels and healthy snacking. Families were provided with practical opportunities to develop their cooking skills, and to try out new recipes and foods.
Move It: Involved a practical PA session with the aim of improving self-efficacy to be physically active outside the weekly sessions. Sessions aimed to engage the whole family, with a focus on enjoyment and personal achievement rather than competition.
Target Time: Supported families to make their lifestyle changes easier through the use of multiple behaviour change techniques (full description of techniques used is available in online supplementary resource 1) and through promoting and enhancing psychosocial well-being. Classroom-based sessions focused on topics such as hunger and craving, raising self-esteem, dealing with bullying and parental role-modelling. Each week families were supported to set small, realistic goals focused on changing their PA and dietary behaviours outside of the structured GOALS sessions.
Specific content evolved according to ongoing evaluation. An example timetable is available from PMW (p.m.watson@ljmu.ac.uk).
What—materials (3) Sessions were supported by a number of informative materials, such as parent/carer and child handbooks, personal log books to track progress and a GOALS cookbook containing healthy recipes to cook at home. Delivery staff were supplied with weekly session plans. Copies of all informative materials are available from PMW (p.m.watson@ljmu.ac.uk). Growth charts and BMI charts were used to monitor child height and weight (available from http://www.childgrowthfoundation.org/).
Who provided (5) GOALS was designed, delivered and evaluated by a team from Liverpool John Moores University (LJMU), operationally led by the project manager/principal researcher (PMW). The team consisted of one senior staff member and several sessional staff for each section (Fun Foods, Move It, Target Time). Both senior and sessional staff were involved in delivering the intervention. Senior staff held postgraduate qualifications in public health nutrition (SB—Fun Foods lead), exercise physiology (KP—Move It lead), health psychology (JH—Target Time lead to April 2008) and sport and exercise psychology (LJS—Target Time lead from September 2008) and were responsible for developing the intervention content, delivering sessions and supervising sessional staff in the delivery of sessions. Sessional staff were recruited from a range of backgrounds and were employed part-time to deliver the intervention. For the sessional staff, the following skills and attributes were pre-requisites:

  • Minimal vocational qualification for their subject area

  • An interest in promoting healthy lifestyles

  • Interpersonal skills and the ability to engage groups of different ages and abilities

  • Experience of delivering activities to groups of children and/or families.
How (6) Interventions were delivered to groups of families, arranged where possible by child age (eg, 4–7 years, 8–11 years, 12–16 years). Groups ranged from 5–12 families at baseline. Some sessions included parents/carers and children together, but topics involving sensitive discussion (eg, dealing with bullying) or aimed specifically at parents/carers (eg, meal planning) were delivered to children and/or parents/carers separately.
Where (7) Sessions were delivered after school in primary and secondary schools across Liverpool. Liverpool is a city in the north-west of England with approximately 470 780 residents46 and high levels of socioeconomic deprivation.47 Despite indications that childhood obesity rates have begun to plateau,48 prevalence of childhood obesity in Liverpool remains higher than the national average with 28.6% of 4–5-year-olds and 39% of 10–11-year-olds overweight or obese.49
When and how much (8) Sessions lasted for 2 h and ran once a week after school (usually 17:30–19:30 or 18:00–20:00) during term-time only. During year 1 (September 2006–March 2007), contact varied between 17, 18 and 19 sessions. During years 2 and 3 (April 2007–March 2009), the intervention included 18 sessions. Owing to the term-time only delivery, interventions varied in duration depending on whether they started during autumn/winter (approximately 5 months) or during spring/summer (approximately 6 months due to the long summer holiday break)Families were invited to individual follow-up sessions 9 months (from April 2007 only) and 12 months after they had started GOALS. These sessions lasted approximately 45 min and involved a progress review and height and weight measurements.
Tailoring (9) Each family was assigned a personal mentor who they met with every few weeks to track their progress. The use of social cognitive theory allowed staff mentors to set weekly goals with families that focused on either the home environment, parental behaviours/cognitions or child behaviours/cognitions, depending on the underlying cause of the target behaviour. For example, the goal for a family where the child was overeating in response to being bullied might focus on developing coping skills for the child (child cognitions), whereas the goal for a family where the child was overeating because their portions were too large might be for the parent/carer to serve appropriate child portion sizes (parent/carer behaviour).
Provision was made for childcare of younger siblings where required.
Taxis were provided for families without transport in 8 of the 21 intervention cohorts.
How well—planned and actual (11, 12) During the first year, reflective staff meetings were held weekly to ensure the intervention was delivered as intended and to agree actions for the following week. Staff completed a written evaluation after each session to note what worked well, challenges they had faced and ideas for improvement. During the later stages, meetings continued on a six weekly basis with regular session visits from the project manager. Regular training ensured the GOALS ethos and core framework was understood and practised by all staff.

Numbers in parentheses refer to the item number on the TIDieR checklist.39

GOALS, Getting Our Active Lifestyles Started; PA, physical activity; TIDieR, Template for Intervention Description and Replication.