The implementation of a family-focused lifestyle programme for managing childhood obesity in the community setting in Ireland

Objective To explore the barriers and facilitators experienced by those implementing a governmentfunded, community-based childhood weight management programme. Design Qualitative using semistructured interviews. Setting Two geographical regions in the south and west of Ireland. Participants 29 national-level and local-level stakeholders responsible for implementing the programme, including professionals from dietetics, psychology, public health nursing, physiotherapy, health promotion and administration. Methods Framework analysis was used to identify barriers and facilitators, which were mapped onto six levels of factors influencing implementation outlined by Grol and Wensing: the innovation, the individual professional, the patient, the social context, the organisational context and the external environment. Results Most barriers occurred at the level of the organisational context. For all stakeholders, barriers arose due to the multidisciplinary nature of the programme, including the lack of role clarity and added complexity of working in different locations. Health professionals’ low-perceived self-efficacy in approaching the subject of weight with parents and parental resistance to hearing about their child’s weight status were barriers to programme implementation at the individual professional and patient levels, respectively. The main facilitators of implementation, occurring at the level of the health professional, included stakeholders’ recognition of the need for a weight management programme and personal interest in the area of childhood obesity. Having a local lead and supportive colleagues were further implementation drivers. Conclusions This study highlights the complexities associated with implementing a multidisciplinary childhood weight management programme, particularly translating such a programme to a community setting. Our results suggest the assignment of clear roles and responsibilities, the provision of sufficient practical training and resources, and organisational support play pivotal roles in overcoming barriers to change. This evidence can be used to develop an implementation plan to support the translation of interventions into real-world settings. BACKGROUND Childhood obesity is a worldwide public health concern, and there is now widespread agreement that the complex aetiology of the issue requires a multifaceted approach to treatment. International recommendations agree that initiatives to reduce and manage childhood obesity should be family-focused and combine healthy eating, physical activity and behavioural components. 4 5 In 2016, Barriers and facilitators to the implementation of a community-based, multidisciplinary, family-focused childhood weight management programme in Ireland: a qualitative study Emily Kelleher, Janas M Harrington, Frances Shiely, Ivan J Perry, Sheena M McHugh To cite: Kelleher E, Harrington JM, Shiely F, et al. Barriers and facilitators to the implementation of a community-based, multidisciplinary, family-focused childhood weight management programme in Ireland: a qualitative study. BMJ Open 2017;7:e016459. doi:10.1136/ bmjopen-2017-016459 ► Prepublication history and additional material for this paper are available online. To view please visit the journal (http:// dx. doi. org/ 10. 1136bmjopen2017016459). Received 16 February 2017 Revised 8 July 2017 Accepted 26 July 2017 Department of Epidemiology and Public Health, University College Cork, Cork, Munster, Ireland HRB Clinical Research Facility, Mercy University Hospital, Cork, Ireland Correspondence to Sheena M McHugh; s. mchugh@ ucc. ie Research Strengths and limitations of this study ► This is one of few qualitative studies, and the first in Ireland, that explored the factors that hampered and facilitated the implementation of a community-based, multicomponent childhood weight management programme from a wide range of stakeholder perspectives. ► While interviewing a wide range of stakeholders provided a thorough overview of the relevant issues, the themes that emerged were relatively homogeneous across disciplines, which added to the authority of the findings. ► Data were analysed using a systematic approach, and an adapted version of the implementation model by Grol and Wensing was used to classify the barriers and facilitators into levels. ► Using a preconceived framework runs the risk of prematurely excluding other ways of organising the data. However, data were analysed inductively first before mapping onto the Grol and Wensing framework. group.bmj. com on March 6, 2018 Published by http://bmjopen.bmj. com/ Downloaded from