Culturally adapting the Healthy Beginnings program

How can modifications be made to an existing health promotion program to make it more relevant and accessible for new mothers from diverse cultural backgrounds? A new study describes the process taken to culturally adapt/modify the Healthy Beginnings early obesity prevention program for Arabic and Chinese speaking migrant mothers in Sydney, Australia.

What is the issue and what do we know?

  • Migrant mothers face barriers to access Maternal and Child healthcare in Australia, including language barriers and unfamiliarity with the health system.
  • Australian children from culturally and linguistically diverse backgrounds are at greater risk of overweight and obesity in early childhood compared to the mainstream English speaking population.
  • Evidence-informed early childhood obesity prevention programs in Australia have been effective in mainstream populations, but there is limited evidence about engagement and effectiveness among culturally and linguistically diverse communities.

What did we do about it?

  • Healthy Beginnings is an early obesity prevention program that we know works with English speaking mothers. It involves nurse phone calls, SMS messages and written health promotion booklets that promote key messages related to feeding and active play for babies.
  • We made modifications (cultural adaptations) to Healthy Beginnings to improve the program’s relevance among Arabic and Chinese speaking migrant mothers.
  • From January 2018 to December 2019, the project team spoke to community members, project partners, bi-cultural staff and community organisations to better understand their experiences with feeding and active play and to modify the program.
  • The main program changes (cultural adaptations) included having bicultural staff and nurses deliver the nurse calls and modifying the content (such as concepts such as tummy time that don’t directly translate, modifying and translating the language used and including culturally relevant images of people and foods).

What is cultural adaptation of a health promotion program?

Cultural adaptation is a multi-step process to improve a program’s cultural relevance. Established process and reporting frameworks should be used to guide cultural adaptations of health promotion programs/ behavioural interventions so that the process is transparent and replicable.

What does this research add?

  • This is the first cultural adaptation of an established, evidence-based early life obesity prevention research intervention in Australia, resulting in a program with enhanced relevance and accessibility among Arabic and Chinese speaking migrant mothers.
  • Use of established cultural adaptation frameworks and reporting guidance offers insights for future cultural adaptations of evidence-based maternal and child health promotion programs.
  • Planning and resources are essential for cultural adaptations of programs and are essential for equitable support for culturally and linguistically diverse families with early life behaviours.

Outcomes for policy, practice and future directions

  • Learnings from this project will help to support Arabic-speaking and Chinese-speaking migrant mothers in Australia with optimal infant feeding and active play behaviours to reduce risk for overweight and obesity in early childhood.
  • This work will inform the future cultural adaptation stages: testing, refining, and trialling the culturally adapted Healthy Beginnings program to assess acceptability, feasibility and effectiveness.


Read the full paper here

Marshall, S., Taki, S., Love, P. et al. The process of culturally adapting the Healthy Beginnings early obesity prevention program for Arabic and Chinese mothers in Australia. BMC Public Health 21, 284 (2021).

Download the parent resources

Visit the Healthy Beginnings website

 Hear from a mother who participated in the program

Read this short article published by Sydney Local Health District


The project team included A/Prof Li Ming Wen, Prof Chris Rissel, Prof Louise Baur, Dr Sarah Taki, Marianne Kearney, Nancy Tam, Sarah Marshall, Wenjie Liao, Huilan Xu, Linda Elbayeh, Karen Bedford, Julia Shadid, Sally Zhang and Carrie Tang.

This work was funded by the New South Wales Health Translational Research Grant Scheme 2016; Sydney Local Health District; and the National Health and Medical Research Council Centre for Research Excellence in The Early Prevention of Obesity in Childhood (EPOCH).

We sincerely thank the mothers who participated in the program. We also sincerely thank our many participating partners from the Sydney, South Eastern Sydney, South Western Sydney NSW Local Health Districts; Chinese Australian Services Society (CASS); Lebanese Muslim Association (LMA); Advance Diversity Services; Diversity Kids; NSW Refugee Health Service; and all those part of the Healthy Beginnings mainstream project and members of the advisory and executive committees.

For further details, contact Sarah Marshall

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