Understanding Family Motivations and Barriers to Participation in Community-Based Programs for Overweight Youth

In Brief Context: Successful obesity intervention efforts depend on effective recruitment and retention, an ongoing challenge for community-based programs. Objective: We sought to provide insights into the most salient factors affecting family enrollment and retention in community-based programs for overweight youth and their families. We especially sought to understand potentially modifiable program factors affecting participation. Design: We conducted semistructured, in-depth, face-to-face interviews with parents of overweight children within 1 year of referral to a public health grant–funded community-based healthy lifestyle promotion program. Purposeful sampling was used to select participants across program sites, by level of program completion, and child age and sex. Transcribed interviews were coded independently by 2 staff with a structured codebook and then analyzed by themes through an iterative process using Atlas.ti. The Integrative Model of Behavior served as an orienting theoretical framework. Setting: Community-based child obesity intervention program in King County, Washington. Participants: Twenty-three parents from diverse socioeconomic backgrounds were interviewed, of which 10 completed the program, 9 did not complete, and 4 did not enroll. Main Outcome Measure(s): Parent-reported factors related to enrollment and retention. Results: Key parent reasons for program enrollment included: (a) addressing both eating and activity, (b) concern about child's weight, (c) seeking help outside the family, and (d) structured parent-child time. Parents perceived a lack of child motivation to enroll; some youth initially opposed attending, which was overcome through positive program experience. All families described barriers to attending, and some identified specific strategies or skills they used to overcome barriers. No single program design emerged to address every family's needs. Instead, using the themes of accessibility and accountability, we present parent- recommended design options. Conclusions: To meet different families' needs, public health and health care agencies offering youth health promotion programs should consider providing program options that vary intensity level and weight loss emphasis. This article provides understanding of the divergent family preferences for community-based healthy lifestyle programs and highlights the complexity of child overweight as a motivator. Results suggest that a "one-size-fits-all" community program for overweight children is unlikely. Findings underscore families' desire for community-based program options that offer different levels of intensity and address child obesity across the spectrum from healthy lifestyle promotion to weight loss treatment.