The implementation of a family-focused lifestyle programme for managing childhood obesity in the community setting in Ireland

Background and aim: Childhood obesity is a significant public health issue. International guidelines continue to recommend family-focused, multicomponent, childhood weight management programmes despite limited evidence on their effectiveness or implementation in real-world settings. In 2014, the Irish Health Service proposed a national pilot of the W82GO-community programme. The overall aim of this thesis was to investigate the barriers and facilitators to the implementation of W82GO-community and explore the factors influencing family engagement. Methods: W82GO-community aimed to improve nutrition, increase physical activity and facilitate behaviour change in children aged 5-7 years who measured ≥98th percentile over one year. It was piloted in two community sites by two multidisciplinary teams from April 2015 to April 2016. Firstly, a qualitative study was conducted to explore implementation from the perspective of 29 national and local level stakeholders responsible for implementing the programme including professionals from dietetics, psychology, public health nursing, physiotherapy, health promotion and administration. Framework analysis was used to identify barriers and facilitators which were mapped onto a well-known implementation framework. Secondly, a systematic review of international literature was carried out to investigate what factors influence attendance at similar community-based lifestyle programmes among families of overweight or obese children. This was followed by another qualitative study exploring public health nurses (PHNs) experiences of referring families to, and families’ feelings of being referred to, W82GO-community. It also investigated families’ motivation to participate in and complete treatment. Finally, in light of findings from the aforementioned studies a cross-sectional analysis of data collected as part of the Cork Children’s Lifestyle Survey (CCLaS) was conducted to identify factors influencing parent and child misperception of child weight. Results: For all stakeholders, barriers to the implementation of W82GO-community arose due to the multidisciplinary nature of the programme, including the lack of role clarity and added complexity of working in different locations. Furthermore, a lack of parental engagement, as evidenced by low enrolment and retention rates, presented a further challenge for programme implementation. Of the 121 children who were eligible for initial assessment, less than half of families accepted the invitation and of those who presented, 19 subsequently started the programme. Just eight families completed the W82GO-community programme. The systematic review on barriers and facilitators to family attendance and retention found that parents are largely driven to enrol because of a concern for their child’s psychological health and wellbeing. However, the stigma surrounding excess weight and the denial of the issue amongst some parents presents significant barriers to enrolment. The systematic review findings also suggest that over the course of a programme, children’s positive social experiences such as having fun and making friends foster the desire to continue participating in treatment. Results from our qualitative study involving PHNs and parents who participated in W82GO-community found that both PHNs and parents were fearful of the referral process. They had concerns about both the practicality of making the referral and the significance of the referral on the health and wellbeing of the child, respectively. Despite these initial fears, parents concern for their child’s future was a major driver behind their participation. Finally, the cross-sectional analysis of CCLaS data highlighted that 45% of parents of overweight/obese children underestimated their child’s weight and this was influenced by child age and child misperception of own weight. 77% of overweight/obese children misclassified their own weight. Conclusion: This thesis provides critical evidence on the complexities associated with implementing a multidisciplinary childhood weight management programme in real-world settings. It provides practical recommendations to guide future policy makers, programme delivery teams and researchers, in particular, when developing strategies to boost recruitment, minimise attrition and subsequently enhance effectiveness. Findings highlight the profound limitations of family-focused, community-based, weight management programmes and confirm the critical need for broader societal intervention