BMC Pediatrics | |
Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders | |
Ashley A Fenner1  Alexandra McManus2  Leon M Straker2  Kyla L Smith2  | |
[1] School of Psychology and Speech Pathology, Curtin University, Perth, Australia;Curtin Health Innovation Research Institute, Curtin University, Perth, Australia | |
关键词: Qualitative research; Intervention; Obesity; Adolescent; | |
Others : 1138999 DOI : 10.1186/1471-2431-14-53 |
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received in 2013-10-09, accepted in 2014-02-13, 发布年份 2014 |
【 摘 要 】
Background
Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs.
Methods
This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses.
Results
Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services.
Conclusions
This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility.
【 授权许可】
2014 Smith et al.; licensee BioMed Central Ltd.
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【 图 表 】
Figure 3.
【 参考文献 】
- [1]National Health and Medical Research Council: Clinical Practice Guidelines For The Management Of Overweight And Obesity In Children And Adolescents. Canberra: National Health and Medical Research Council; 2003.
- [2]Commonwealth Scientific Industrial Research Organisation (CSIRO), Preventative Health National Research Flagship, University of South Australia: 2007 Australian National Children’s Nutrition and Physical Activity Study- Main Findings. Canberra: Australian Government Department of Health and Ageing; 2008.
- [3]Patton GC, Coffey C, Carlin JB, Sawyer SM, Williams J, Olsson CA, Wake M: Overweight and obesity between adolescence and young adulthood: a 10-year prospective cohort study. J Adolesc Health 2011, 48:275-280.
- [4]Baur LA: Child and adolescent obesity in the 21st century: an Australian perspective. Asia Pac J Clin Nutr 2002, 11(Suppl 3):S524-S528.
- [5]Steinbeck K: Childhood obesity: treatment options. Best Pract Res Clin Endocrinol Metab 2005, 19:455-469.
- [6]Merten M, Wickrama K, Williams A: Adolescent obesity and young adult psychosocial outcomes: gender and racial differences. J Youth Adolesc 2008, 37:1111.
- [7]Strauss R: Childhood obesity and self-esteem. Pediatrics 2000, 105:e15.
- [8]Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O’Malley C, Stolk RP, Summerbell CD: Interventions for treating obesity in children. Cochrane Database Syst Rev 2009., 1CD001872
- [9]Shrewsbury V, O’Connor J, Steinbeck K, Stevenson K, Lee A, Hill A, Kohn M, Shah S, Torvaldsen S, Baur L: A randomised controlled trial of a community-based healthy lifestyle program for overweight and obese adolescents: the Loozit® study protocol. BMC Public Health 2009, 9(1):119. BioMed Central Full Text
- [10]Bean MK, Mazzeo SE, Stern M, Evans RK, Bryan D, Ning Y, Wickham EP, Laver J: Six-month dietary changes in ethnically diverse, obese adolescents participating in a multidisciplinary weight management program. Clin Ped 2011, 50(5):408-416.
- [11]Evans RK, Franco RL, Stern M, Wickham EP, Bryan DL, Herrick JE, Larson NY, Abell AM, Laver JH: Evaluation of a 6-month multi-disciplinary healthy weight management program targeting urban, overweight adolescents: Effects on physical fitness, physical activity, and blood lipid profiles. Int J Pediatr Obes 2009, 4(3):130-133.
- [12]Davis JN, Tung A, Chak SS, Ventura EE, Byrd-Williams CE, Alexander KE, Lane CJ, Weigensberg MJ, Spruijt-Metz D, Goran MI: Aerobic and strength training reduces adiposity in overweight Latina adolescents. Med Sci Sport Exer 2009, 41(7):1494-1503.
- [13]DeBar LL, Stevens VJ, Perrin N, Wu P, Pearson J, Yarborough BJ, Dickerson J, Lynch F: A primary care-based, multicomponent lifestyle intervention for overweight adolescent females. Pediatrics 2012, 129(3):e611-e620.
- [14]Savoye M, Shaw M, Dziura J, Tamborlane WV, Rose P, Guandalini C, Goldberg-Gell R, Burgert TS, Cali AM, Weiss R, Caprio S: Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA 2007, 297(24):2697-2704.
- [15]Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Huerta M, Silverstein JH, Brumback B: Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project STORY. Arch Pediat Adol Med 2008, 162(12):1119-1125.
- [16]Steele RG, Aylward BS, Jensen CD, Cushing CC, Davis AM, Bovaird JA: Comparison of a family-based group intervention for youths with obesity to a brief individual family intervention: a practical clinical trial of positively fit. J Pediatr Psychol 2012, 37(1):53-63.
- [17]Nguyen B, Shrewsbury VA, O’Connor J, Steinbeck KS, Lee A, Hill AJ, Shah S, Kohn MR, Torvaldsen S, Baur LA: Twelve-month outcomes of the loozit randomized controlled trial: a community-based healthy lifestyle program for overweight and obese adolescents. Arch Pediat Adol Med 2012, 166(2):170-177.
- [18]Nguyen B, Shrewsbury VA, O’Connor J, Steinbeck KS, Hill AJ, Shah S, Kohn MR, Torvaldsen S, Baur LA: Two-year outcomes of an adjunctive telephone coaching and electronic contact intervention for adolescent weight-loss maintenance: the Loozit randomized controlled trial. Int J Obes (Lond) 2013, 37(3):468-472.
- [19]Savoye M, Nowicka P, Shaw M, Yu S, Dziura J, Chavent G, O’Malley G, Serrecchia JB, Tamborlane WV, Caprio S: Long-term results of an obesity program in an ethnically diverse pediatric population. Pediatrics 2011, 127(3):402-410.
- [20]Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, Armstrong R, Prosser L, Summerbell CD: Interventions for preventing obesity in children. Cochrane Datab Syst Rev 2011., 12CD001871
- [21]Nguyen B, McGregor KA, O’Connor J, Shrewsbury VA, Lee A, Steinbeck KS, Hill AJ, Shah S, Kohn MR, Baur LA: Recruitment challenges and recommendations for adolescent obesity trials. J Paediatr Child Health 2012, 48(1):38-43.
- [22]Ball GDC, Garcia AP, Chanoine JP, Morrison KM, Legault L, Sharma AM, Gokiert R, Holt NL: Should I stay or should I go? Understanding families’ decisions regarding initiating, continuing, and terminating health services for managing pediatric obesity: the protocol for a multi-center, qualitative study. BMC Health Serv Res 2012., 12
- [23]Skelton JA, Beech BM: Attrition in paediatric weight management: a review of the literature and new directions. Obes Rev 2011, 12(5):e273-e281.
- [24]Brennan L, Walkley J, Wilks R: Parent- and adolescent-reported barriers to participation in an adolescent overweight and obesity intervention. Obesity 2012, 20(6):1319-1324.
- [25]Skelton JA, Irby MB, Beech BM, Rhodes SD: Attrition and family participation in obesity treatment programs: clinicians’ perceptions. Acad Pediatr 2012, 12(5):420-428.
- [26]Douketis JD, Macie C, Thabane L, Williamson DF: Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice. Int J Obes Relat Metab Disord 2005, 29(10):1153-1167.
- [27]Turk MW, Yang K, Hravnak M, Sereika SM, Ewing LJ, Burke LE: Randomized clinical trials of weight loss maintenance: a review. J Cardiovasc Nurs 2009, 24(1):58-80.
- [28]Stubbs J, Whybrow S, Teixeira P, Blundell J, Lawton C, Westenhoefer J, Engel D, Shepherd R, McConnon A, Gilbert P, Raats M: Problems in identifying predictors and correlates of weight loss and maintenance: implications for weight control therapies based on behaviour change. Obes Rev 2011, 12(9):688-708.
- [29]Fulton JE, McGuire MT, Caspersen CJ, Dietz WH: Interventions for weight loss and weight gain prevention among youth: current issues. Sports Med 2001, 31(3):153-165.
- [30]Epstein LH, Valoski A, Wing RR, McCurley J: Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol 1994, 13(5):373-383.
- [31]Elfhag K, Rossner S: Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain. Obes Rev 2005, 6(1):67-85.
- [32]Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M: Developing And Evaluating Complex Interventions: New Guidance. London: Medical Research Council; 2008:39.
- [33]Centre for Physical Activity and Nutrition Research: Identifying Effective Strategies To Increase Recruitment And Retention In Community-Based Health Promotion Programs. Melbourne: Deakin University; 2012.
- [34]Straker L, McManus A, Kerr D, Smith K, Davis M, Weiss M, Fielding A, Fidzewicz A, Stewart C, Hamilton N: CAFAP: A multi-disciplinary family-centred community-based intervention for overweight/obese adolescents. J Sci Med Sport 2010, 13(Suppl 1):e11-e12.
- [35]Bronfenbrenner U: Toward an experimental ecology of human development. Am Psychol 1977, 32(7):513-531.
- [36]Davison KK, Birch LL: Childhood overweight: a contextual model and recommendations for future research. Obes Rev 2001, 2(3):159-171.
- [37]Broom A: Using qualitative interviews in CAM research: a guide to study design, data collection and data analysis. Complement Ther Med 2005, 13(1):65-73.
- [38]Thomas DR: A general inductive approach for analyzing qualitative evaluation data. Am J Eval 2006, 27(2):237-246.
- [39]Gliner JA: Reviewing qualitative research - proposed criteria for fairness and rigor. Occup Ther J Res 1994, 14(2):78-90.
- [40]Polgar S, Thomas SA: Introduction To Research In The Health Sciences. 3rd edition. Melbourne: Churchill Livingstone; 1995.
- [41]Bailey DM: Research For The Health Professional. A Practical Guide. 2nd edition. Philadelphia: F.A. Davis Company; 1997.
- [42]McManus A, Smith K, Kerr D, Newton W, McManus J, Storey J, White J, Cuesta-Briand B, Straker L: Enhancing Activity, Nutrition And Mental Health In Overweight Adolescents. Stage 1 - Formative Research. Perth: Healthway; 2012.
- [43]Wake M, Campbell MW, Turner M, Price A, Sabin MA, Davis E, Baur LA: How training affects Australian paediatricians’ management of obesity. Arch Dis Child 2013, 98(1):3-8.
- [44]Perrin EM, Flower KB, Garrett J, Ammerman AS: Preventing and treating obesity: pediatricians’ self-efficacy, barriers, resources, and advocacy. Ambul Pediatr 2005, 5(3):150-156.
- [45]Woolford SJ, Sallinen BJ, Schaffer S, Clark SJ: Eat, play, love: adolescent and parent perceptions of the components of a multidisciplinary weight management program. Clin Pediatr 2012, 51(7):678-684.
- [46]Alberga AS, Medd ER, Adamo KB, Goldfield GS, Prud’homme D, Kenny GP, Sigal RJ: Top 10 practical lessons learned from physical activity interventions in overweight and obese children and adolescents. Appl Physiol Nutr Metab 2013, 38(3):249-258.
- [47]Barlow SE: Expert committee recommendations regarding the prevention, assessment and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007, 120(Supplement 4):s164-s192.
- [48]Shilts MK, Horowitz M, Townsend MS: Goal setting as a strategy for dietary and physical activity behavior change: a review of the literature. Am J Health Promot 2004, 19(2):81-93.
- [49]Locke EA, Latham GP: A theory of goal setting and task performance. Englewood Cliffs, New Jersey: Prentice Hall; 1990.
- [50]Lindelof A, Nielsen CV, Pedersen BD: Obesity treatment-more than food and exercise: a qualitative study exploring obese adolescents’ and their parents’ views on the former’s obesity. Int J Qual Stud Heal 2010., 5(2)
- [51]Chatzisarantis NL, Hagger MS: Effects of an intervention based on self-determination theory on self-reported leisure-time physical activity participation. Psychol Health 2009, 24(1):29-48.
- [52]Fenner AA, Straker LM, Davis MC, Hagger MS: Theoretical underpinnings of a need-supportive intervention to address sustained healthy lifestyle changes in overweight and obese adolescents. Psychol Sport Exer 2013, 14(6):819-829.
- [53]Helmink JH, Kremers SP, Van Boekel LC, Van Brussel-Visser FN, Preller L, De Vries NK: The BeweegKuur programme: a qualitative study of promoting and impeding factors for successful implementation of a primary health care lifestyle intervention for overweight and obese people. Fam Pr 2012, 29(Suppl 1):i68-i74.
- [54]Hollander JA: The social contexts of focus groups. J Contemp Ethnogr 2004, 33(5):602-637.
- [55]Boutelle KN, Feldman S, Neumark-Sztainer D: Parenting an overweight or obese teen: issues and advice from parents. J Nutr Educ Behav 2012, 44(6):500-506.
- [56]Straker L, Levine J, Campbell A: The effects of walking and cycling computer workstations on keyboard and mouse performance. Hum Factors 2009, 51(6):831-844.
- [57]Straker LM, Smith KL, Fenner AA, Kerr DA, McManus A, Davis MC, Fielding AM, Olds TS, Hagger MS, Smith AJ, Abbott RA: Rationale, design and methods for a staggered-entry, waitlist controlled clinical trial of the impact of a community-based, family-centred, multidisciplinary program focussed on activity, food and attitude habits (Curtin University’s Activity, Food and Attitudes Program--CAFAP) among overweight adolescent. BMC Public Health 2012, 12:471. BioMed Central Full Text