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Table 2 Stimulating and impeding factors in the recruitment of overweight children

From: Barriers to successful recruitment of parents of overweight children for an obesity prevention intervention: a qualitative study among youth health care professionals

Factors

Quotations to illustrate the identified factors

Socio-political context

 

Norms and values in society

 

Weight-related

(–) ‘The norm about what is normal weight is changing.

Children who have a healthy weight are now regarded as too lean’

(–) ‘Parents don’t recognize their child being overweight, because there’s an increase in the number of fat children’

Participation in programmes

(–) ‘It should be regarded as normal that parents participate in such a programme’

Severity of overweight problem

(–) ‘Overweight should get more attention in the media to make people aware that it’s an important health problem’

YHC organization

 

Task of YHC

(+) ‘Yes, absolutely! I think that no one else will call the parents to account for their child’s overweight’

(+) ‘Youth health care is the only place where you can find all those young children. There’s no other place to reach all children’

(+) ‘We are partly responsible, but we’re not the only ones who are responsible. Primary schools have responsibilities as well, as they see what the children eat’

Training

(–) ‘Extra skills training for professionals on the prevention of childhood overweight is needed in YHC’

Time

(–) ‘Of course you make time for it, but there’s not much time to discuss it, and a lot of other things have to be discussed as well during a consultation’

Resources

(–) ‘I think we don’t have enough resources’

Cooperation

 

Within the organization

(–) ‘Nurses should be more closely involved in the recruitment of overweight children’

 

(–) ‘Unfortunately, we nurses didn’t receive any information’

Between organizations

(–) ‘We think that we should first try to get all relevant stakeholders to agree’

 

(+) ‘The more consistent people from different organizations are in their message to parents, the higher the chance that we reach them’

 

(+) ‘The municipal health service is also involved in prevention of childhood obesity.’

 

(+) ‘It would be better if more organizations were involved. I mean general practitioners, schools, day-care centres’

The YHC professional

 

Attitude

 

Programme - specific outcome beliefs

(+) ‘I think it’s a very positive programme, because overweight is mainly an educational problem’

 

(+) ‘Yes, I think it’s a nice programme, although it’s intensive. It takes a lot of time for the parents’

Target group - specific outcome beliefs

(–) ‘I don’t know. I wonder whether parents see the need for it’

 

‘I think a particular group does, but I don’t think that all parents see the relevance’

(+) ‘We do notice an increased need for parenting support’

(–) ‘I think we all thought: how can we motivate these parents? from the very beginning’

(–) ‘A lot of people feel uncomfortable when they hear their child is overweight. And that makes it hard for us’

(–) ‘They’re not interested. They have no time for it’

(–) ‘I think that one out of thirty people consciously want to change something’

 

(–) ‘You notice that parents are very unresponsive’

Perceived responsibility

(+) ‘I feel responsible and want to discuss it with parents’

 

(+) ‘It’s a growing problem’

Perceived severity of problem

(–) ‘Obesity is just one of the areas of special interest. I can’t say it’s more important than other areas; it’s just one of them, although I take it very seriously!’

 

(–) ‘To be honest, I think that a lot of children between S1 and S2 are actually not too fat’

 

(–) ‘My experience is that the majority of the overweight children are just above the norm. When you look at that child, using your clinical judgement, I think those children are not overweight’

Need for prevention

(+) ‘Prevention of childhood obesity is really important, especially to prevent long-term risks’

 

(–) ‘I think that prevention of psychosocial problems is more important, but by that I mean severe problems like neglect’

Self – efficacy

(–) ‘I think it’s a complicated problem’

(–) ´Sometimes parents were very critical and started asking me a lot of questions, which I couldn´t answer. I felt uncomfortable´

Skills

(–) ‘We’re not able to communicate the impact of the problem to the parents. We need more practice in communication skills’

(–) ‘I think we don’t have enough expertise about prevention of childhood obesity’

Forgetting

(–) ‘I have to admit, I had forgotten it after a while’

The innovation

 

Relative advantage

‘I think that the current protocol and the intervention can complement each other’

(+) ‘An advantage of the intervention is that professionals who are experienced in childhood obesity give the parents advice’

(–) ‘I think that we’re already quite effective in our own approach’

(+) ‘I think it’s a very positive programme, because overweight is mainly an educational problem’

Observability

(–) ‘I would prefer to get more timely feedback on which parents participated and which ones didn’t’

Relevance for the client

(+) ‘I think that the programme is very useful for parents. Childhood overweight is a problem which is closely related to parenting’

Low frequency of use innovation

(–) ‘No, I didn’t see any children who were eligible for participation’

The parents

 

Awareness of child’s overweight

(–) ‘Parents are not aware of their child’s overweight’

Perceived severity of child’s overweight

(–) ‘Parents often don’t see their child’s overweight as a problem’

Resistance in discussing weight issues with parents

(–) ‘You clearly notice that parents are unresponsive’

(–) ‘You notice that when you mention the word ‘overweight’ to parents, you immediately perceive resistance’

(–) ´Sometimes parents become angry when you continue to discuss overweight’

Motivation to change behaviour

(–) ‘Parents are just not motivated to change their behaviour’

(–) ‘It’s difficult to approach parents for overweight prevention; they just don’t see the long-term advantages’

Perceived responsibility

(–) ‘Parents don’t admit that they are themselves responsible for the weight of their child’

Willingness to cooperate in the intervention

(–) ‘Some parents want to reduce their child’s overweight themselves’

(–) ‘They mention that they are closely watching their child’s weight themselves and that they already know what to do about it’

(–) ‘A lot of parents don’t have time for it. Or they don’t want to make time for it’

Parent’s discomfort about the intervention

(–) ‘Parents think that it’s going too far to participate in an intervention’