Barriers & facilitators associated with initial and continued attendance at community-based interventions among families of overweight & obese children – Preliminary findings Ms. Emily Kelleher, University College Cork

Childhood Obesity In Ireland, almost 1 in 4 children are carrying excess weight (1) Programmes to treat childhood obesity should ideally be family-based and should combine healthy eating, physical activity and behavioural components (2)

Rationale for Review The success of these programmes relies heavily on family attendance and retention Majority of families referred to treatment decline High programme attrition negatively impacts family and health service

Aim of Review To synthesise the findings of a range of studies investigating factors influencing attendance at community-based lifestyle programmes among families of overweight or obese children ▫Specifically to explore the barriers and facilitators related to initial and continued attendance

Methods PubMed (n=978) CINAHL (n=258) EMBASE (n=513) PsychINFO (n=401) Inclusion and Exclusion Criteria Articles published in English if they; 1.were original research studies, 2.included children aged 4-12 years, 3.had a primary focus on pediatric weight management that 4.incorporated lifestyle (i.e. diet, physical activity and behavioural components), 5.reported on the factors influencing attendance at family-based programmes delivered in the community setting

Records after duplicates removed (n=1405) Additional records identified through other sources (n=27) Records identified through systematic database searching (n=2105) Records screened (n=1432) Records excluded (n=1354) Full-text articles assessed for eligibility (n=78) Excluded articles (n=65) - Hospital-based (n=17) - Does not explore attendance (n=10) - No full-text / conference abstract (n=9) - Not lifestyle intervention (n=7) - University setting (n=6) - Not original study (n=3) - Unsuitable age-group (n=3) - Not community-only (n=3) - Does not explore family perspectives (n=2) Studies included in review (n=13) Quantitative (n=6) Qualitative (n=6) Mixed-methods (n=1)

Results I Facilitators for Enrolment Programme Parent Child Making friends Improving Weight Improving Fitness Improving Appearance Existing Co- morbidities Improve child's psychological well-being Desire for ‘outside’ help Understood Health Risks Learn new skills Family- approach Lifestyle approach

Results II Barriers to Enrolment Programme Parent Child Family Stigma Gender Stigma Denial of issue No perceived need Changing family circumstances Scheduling conflicts Rural / suburban areas Logistics Sustainability

Results III Facilitators for Continued Attendance Programme Parent Child Making new friends Group support Having fun Programme staff Family approach Practical sessions Regular communication

Results IV Barriers to Continued Attendance Programme Parent Child Family Gender Unrealistic expectations Unemployment Changing family circumstances Scheduling conflicts Ethnic Minority Lower SEA Lone-parents Logistics Programme staff

Conclusions & Recommendations I Programme marketing materials should be bright and fun, highlighting positive psychological impacts Highlight opportunity to try new activities/learn new skills Ensure families’ expectations are consistent with programme goals

Conclusions & Recommendations II Ensure programmes are delivered in a familiar and accessible setting Discuss and troubleshoot barriers to attendance with families before programme commencement Enhance and incorporate family-approach Future research should explore strategies to encourage participation with hard to reach groups