Background Research suggests that community-based family-focused weight management programmes that incorporate physical activity, diet and behavioural components can be effective in treating paediatric obesity. However, the majority of these programmes are small, feasibility trials whose findings have yet to be replicated in the real-world context. This study explores the barriers and facilitators experienced by those implementing a government-funded, multi-component childhood weight management programme in the community setting.
Methods Semi-structured interviews were conducted with a purposive sample of 28 stakeholders responsible for referring to or implementing the programme including professionals from dietetics, clinical psychology, public health nursing, physiotherapy, and health promotion. Interviews were audiotaped, with participants’ informed consent and transcribed verbatim. Framework analysis was used to identify barriers and facilitators which were then mapped onto six levels of influential factors outlined by Grol and Wensing: the innovation, the individual professional, the patient, the social context, the organisational context, and the external environment. This framework describes how barriers and facilitators can be identified, categorised, and used for the development of tailored-based implementation strategies to facilitate desired change.
Results Most perceived barriers occurred at the level of the social and organisational context while the majority of facilitators were at the level of the individual professional. For all participants, barriers arose due to the multi-disciplinary nature of the programme, including the lack of role clarity, lack of understanding of other disciplines as well as the added complexities of working in different locations. Participants’ recognition of the need for a programme and their own personal interest in the area were the main drivers behind implementation while the provision of incentives and the presence of supportive colleagues were further enabling factors.
Conclusion This study highlights the complexities associated with implementing multi-disciplinary childhood weight management programmes in the community setting from a wide range of stakeholder perspectives. Our results suggest the assignment of clear roles and responsibilities, the provision of sufficient training and resources as well as organisational support play pivotal roles in overcoming barriers to change. This evidence should be used to develop an implementation plan to support the translation of efficacious interventions into real world settings.
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