Lifestyle choices made in childhood have a tremendous impact on morbidity and mortality not only during the pediatric years, but throughout one's lifespan. Stakeholders have identified the importance of prioritizing multi-tiered approaches to wellness promotion for children. Naturopathic medicine has demonstrated benefit to illness prevention and wellness promotion, but is inaccessible to much of the population, particularly those at greatest risk of poor health. Group-based programs may be a successful and cost-effective method of delivering naturopathic care to greater numbers of families in the community as part of a larger public health effort. We propose a pilot program to evaluate the efficacy of such an approach.
Lifestyle choices are a significant determinant of morbidity and mortality in individuals of all ages, ultimately placing a significant burden on the delivery of healthcare.1 Childhood health, and the lifestyle behaviours that determine it, extend into adulthood.2,3 Determinants of health in childhood have shifted significantly over the last few decades, leading the clinician engaged in pediatric care to focus more on preventative medicine and anticipatory guidance.2 Addressing the risk factors for adult disease in childhood, infancy, and indeed pre-conception is a critical strategy in stemming the tide of the most significant causes of morbidity and mortality in Canada. Federal and provincial/territorial panels and action groups have identified non-communicable, lifestyle disease prevention as being a top priority.4,5 These conditions are multifactorial, socially and economically determined health concerns, requiring a multifactorial and collaborative approach that considers the social determinants of health.6
Most models for health promotion and disease prevention acknowledge the importance of a multitiered strategy, including targeting individuals and families, communities, schools, government, and industry.4,5 In 2010, Canada’s Ministers of Health and Health Promotion/Healthy Living declared the importance of accessible preventative approaches to health as key to a sustainable healthcare system.4 Naturopathic medicine is a system of primary healthcare that is well-suited and positioned to play an integral role in this vision, particularly in the pediatric population.
Holistic Approach to Children's Health
Caregivers desire to promote optimal health in children; however, many families are not compliant with recommendations given by healthcare providers.7 Although education of parents is a key method by which childhood wellness can be promoted, it may be that traditional in-office health education is insufficient to change parenting behavior with respect to lifestyle modifications.2 As a result, families may not be receiving adequate preventative care from their family practitioners. This may contribute to a decreased quality of the doctor-patient relationship, with possible inadequate management of concerns.7 Passive reception of information may be one element that hinders the adoption of health-promoting behaviors.8,9 Families desire practical and collaborative support to implement recommendations.10 A variety of mechanisms can be employed to address health beliefs and promote success in changing behaviors, including employing interactive, non-written, and peer support, along with one-on-one reinforcement through clinic visits.8,10
Family-centered care incorporates consideration of the role of the caregiver in the child’s health, providing a holistic approach to care.10,11 Models exist for family-centred group-setting programs that successfully deliver key messages of healthy lifestyle promotions.12,13 In addition to promoting the immediate and future health of the individual child from a biomedical model, family-centered care may promote wellness, happiness, and cohesiveness within the family unit.11 It has been demonstrated that the development of knowledge and skills, together with feelings of acceptance and support from participants in a parenting group, can enable parents to feel more resilient and able to cope. This may reduce guilt and a sense of isolation, as well as improve empathy toward the child(ren) and confidence in parenting.13 Some such programs have been validated using specified outcome measures (Table 1).
Table 1. Outcome measures used in existing parenting programs designed to encourage lifestyle modification for the purposes of preventative health.12,13
Better coping abilities
Reduced feelings of guilt
Willingness to seek support of other parents
Increased empathy with children
Increased physical activity
Improved mealtime behavior
Decreased household television viewing
Increased consumption of water (compared to sweetened beverages)
Increased daily fruit or vegetable consumption
Increased family activities to promote fitness
Patient education, holistic care, and an emphasis on prevention are foundational principles of naturopathic medicine. Naturopathic doctors effectively educate patients on the rationale of recommended behavior modifications, often engaging in techniques such as motivational interviewing and cognitive behavioral therapy to inspire change. Naturopathic intervention has demonstrated efficacy in decreasing risk for disease and use of pharmaceutical medication, effectively reducing healthcare costs.14 Many individuals would seek naturopathic care if they could.15 However, due to medical fee structures in many jurisdictions, and limited benefits for naturopathic care through third-party insurers, naturopathic medicine is not financially accessible or feasible for all. As social determinants of health dramatically affect lifestyle choices and disease risk,6 a naturopathic approach that reaches a larger proportion of the population may be a cost-effective component of a larger public health approach to wellness promotion in children. Governments across North America have identified the need for effective and cost-effective preventative care targeting pediatric populations; including naturopathic doctors in this strategy is likely to accomplish both goals.
Naturopathic intervention has demonstrated efficacy in decreasing risk for disease and use of pharmaceutical medication.
We will be piloting a group-based, family-centered program through which to deliver wellness education. Keeping with the mandate of most jurisdictions to move to a preventative approach to healthcare, the focus will emphasize health-promoting behaviors in the family as opposed to the management of specific health concerns. The program will consist of 6 two-hour sessions, designed to be interactive and practical in keeping with evidence shown to increase health literacy in families.8,10 The target population is families with at least 1 child between the ages of 0 and 6 in the city of Toronto. Families will be recruited through the city of Toronto using print and digital media. Initially families will self-select, with an intention to engage in targeted delivery once efficacy is initially demonstrated. Measures of behavior change will be assessed through surveys completed at the start and finish of the program, as well as 6 months post-completion. Long-term goals include a comparison of outcomes with control families within the same community of delivery; effectiveness within varying communities; and longitudinal observation of the participants to assess the longevity of the effects on endpoint outcomes, such as obesity and chronic disease incidence and exacerbation.
It is essential to develop cost-effective and successful strategies to promote health in our children. A naturopathic approach to illness prevention has been demonstrated; it is important to increase access to naturopathic care for those who are at greatest risk of poor health. A group-based, family-centered delivery method may be a cost-effective way of doing this, and could prove to be a successful component of a broader public health approach to pediatric and community wellness.
- Hale J, Phillips CJ, Jewell T. Making the economic case for prevention—a view from Wales. BMC Public Health. 2012;12:460.
- Licence K. Promoting and protecting the health of children and young people. Child: Care, Health & Development. 2004;30(6):623-635.
- Brunstrom JM, Mitchell GL, Baguley TS. Potential early-life predictors of dietary behaviour in adulthood: a retrospective study. Int J Obes. 2005;29(5):463-474.
- Creating a Healthier Canada: Making Prevention a Priority. A Declaration on Prevention and Promotion from Canada’s Ministers of Health and Health Promotion/Healthy Living. Ottawa, ON: Public Health Agency of Canada, 2010.
- Healthy Kids Panel. No Time to Wait: The Healthy Kids Strategy. Ottawa, ON: Ontario Ministry of Health and Longterm Care, 2013.
- Mikkonen J, Raphael D. Social Determinants of Health: The Canadian facts. Toronto: York University School of Health Policy and Management, 2010.
- Gance-Cleveland B. Motivational Interviewing as a Strategy to Increase Families’ Adherence to Treatment Regimens. J Spec Pediatr Nurs. 2005;10(3):151-155.
- Sanders LM, Shaw JS, Guez G, Baur B, Rudd R. Health Literacy and Child Health Promotion: Implications for Research, Clinical Care, and Public Policy. Pediatrics. 2009;124;S306-S314
- Osborn LM. Group well-child care. Clin Perinatol. 1985;12(2):355-65.
- Tyler DO and Horner SD. Family-centered collaborative negotiation: A model for facilitating behavior change in primary care. J Am Acad N Practitioners. 2008; 20:194–203.
- Committee on Hospital Care and Institute for Patient- and Family-Centered Care. Patient- and family-centered care and the pediatrician's role. Pediatrics. 2012; 129(2):394-404.
- McGarvey E, Keller A, Forrester M, et al. Feasibility and Benefits of a Parent-Focused Preschool Child Obesity Intervention. Am J Pub Health. 2004;94(9):1490-1495.
- Kane GA, Wood VA, Barlow J. Parenting programmes: a systematic review and synthesis of qualitative research. Child Care Health Dev. 2007;33(6):784-93.
- Seely D, Szczurko O, Cooley K, et al. Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial. CMAJ. 2013;185(9):E409-E416.
- Innovative Research Group, Inc. Ontario Telephone Omnibus: Attitudes towards Naturopathic Medicine. September 1, 2011. Toronto, Canada.