Engagement with Childhood Weight Management Interventions: A Qualitative Evaluation of MEND Programme Delivery in North Somerset

Abstract

Background: The prevalence of child obesity remains a serious public health concern in England and tackling obesity effectively has become a major government priority. Guidelines on obesity management [1] recommend the provision of multi component treatment interventions but recognise that commercial and community programmes are of variable quality. MEND (Mind, Exercise, Nutrition…Do It!) is a commercial multi component childhood weight management programme that has been running across the UK since 2004. This qualitative evaluation examined the experiences of families referred to MEND in order to identify the perceived barriers and facilitators to successful engagement with childhood weight management interventions and what families require from such interventions. Methods: A qualitative evaluation incorporating semi-structured, incentivised telephone interviews with the parent(s)/carer(s) of children referred to MEND. Subjects were recruited using an opt-in design and the sampling strategy employed aimed to include as broad a range of participant characteristics as possible. Telephone interviews were recorded and transcribed verbatim and then analysed using the framework method [2] with the aid of the NVivo software package. This evaluation was approved by the University of Bristol Ethics Committee of the Faculty for Medicine and Dentistry and was registered with the Avon Primary Care Research Collaborative.  Results: Of the 85 families referred to MEND programmes in the North Somerset area, 25 initially agreed to participate in the evaluation. Of these, telephone interviews were conducted with 13 families (response rate: 52%); nine who had completed MEND, four who had not. The main referral method onto the MEND programme was self-referral through information received from the child’s school. The key barriers to a family’s successful engagement with the programme were identified as parental difficulties in understanding and accepting their child’s overweight status, practical difficulties in attending sessions and a lack of perceived support from families, schools and health professionals. Positive feedback was expressed overall in relation to programme content and delivery, but a lack of individually tailored advice was seen as a barrier to engagement by some. Practical considerations such as location and timing of sessions and childcare options, were reported as being very important for successful programme completion. A desire for longer-term support and continuing engagement with weight management services was expressed. Discussion: Consistent with previous work, in the current study few parents considered their child to be overweight [3]. Furthermore, few referrals to MEND were made from healthcare professionals suggesting difficulties in engaging healthcare professionals in child weight management [4]. Feasible practical arrangements were cited as a key element to a family’s ability to engage with MEND.  Conclusion: To facilitate successful engagement in child weight management interventions there must be adequate awareness of, and accessibility to, local services. An integrated approach with co-operation from healthcare professionals is needed. Sufficient consideration must be given to the practical arrangements of interventions and to the provision of continued support in the longer term.