The ‘Stages towards Completion Model’: what helps and hinders children with overweight or obesity and their parents to be guided towards, adhere to and complete a group lifestyle intervention

ABSTRACT

Purpose: Lifestyle interventions can be effective in the management of overweight and obesity in children. However, ineffective guidance towards interventions and high attrition rates affect health impacts and cost effectiveness. The aim of this study was to gain insight into the factors influencing participation, in particular guidance towards, adherence to and completion of an intervention.

Methods: A narrative literature review was performed to identify factors related to participation, leading to the development of the “Stages towards Completion Model”. Semi-structured interviews (n = 33) and three focus group discussions (n = 25) were performed with children and parents who completed two different group lifestyle interventions, as well as with their coaches.

Results: The main barrier to participating in a lifestyle intervention was the complex daily reality of the participants. The main facilitator to overcome these barriers was a personal approach by all professionals involved.

Conclusions: Participation in a lifestyle intervention is not influenced by one specific factor, but by the interplay of facilitators and barriers. A promising way to stimulate participation and thereby increase the effectiveness of interventions would be an understanding of and respect for the complex circumstances of participants and to personalize guidance towards and execution of interventions.

KEYWORDS:

• Childhood obesity
• lifestyle intervention
• personalized approach
• facilitators
• barriers
• qualitative research
• participation

Acknowledgments

We acknowledge the important views and input of Sanne Niemer in this study, as well as dr. Nadine Blignaut for conducting interviews. We acknowledge the support from the Netherlands Cardiovascular Research Initiative: An initiative with support of the Dutch Heart Foundation and ZonMw, CVON2016-07 LIKE. Furthermore we would like to thank the children, their parents/caretakers and coaches in participating in this study.

Disclosure Statement

Authors EvE, JH and JS were involved in the development and implementation of the LEFF intervention trough which part of the study participants were recruited.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, EvdE, upon reasonable request by e-mail.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work was supported by the Amsterdam Healthy Weight Programme and the Dutch Ministry of Health under Grant 324043. Also partly funded by the Netherlands Cardiovascular Research Initiative: An initiative with support of the Dutch Heart Foundation and ZonMw, CVON2016-07 LIKE.

Notes on contributors

Petronella Grootens-Wiegers

Ronella Grootens, PhD, is researcher at the Medical Ethics and Health Law dept. of the Leiden University Medical Center. She is an expert on patient participation, targeted communication, and informed consent. She has led the participatory development & national implementation of an innovative research information model for minors, and is involved in multiple projects and working groups on stimulating patient engagement.

Emma van den Eynde

Emma van den Eynde (MSc) has studied Psychology of Health Behaviour with a special focus on (childhood) obesity. After finishing her master’s degree cum laude, she worked as a project manager on the combined lifestyle intervention LEFF (Lifestyle, Energy, Fun & Friends) for children with overweight or obesity. Where she was responsible for development, implementation and research into process and effect. Now she is a PhD candidate within the LIKE (Lifestyle Innovations based on youths' Knowledge and Experience) study, where she researches the needs and possibilities from children with obesity in healthcare.

Jutka Halberstadt

Jutka Halberstadt (PhD), has a MSc in clinical psychology from the University of Amsterdam (The Netherlands) and a PhD in childhood obesity from the VU University Amsterdam (The Netherlands). Currently she works as assistant professor at the department of Health Sciences, VU University Amsterdam. She is the national project manager of Care for Obesity that is commissioned by the Dutch ministry of Health to work on improving integrated health care for children with overweight and obesity and their parents.

Jacob C Seidell

Jacob C. Seidell is a professor at Vrije Universiteit Amsterdam and director of Sarphati Amsterdam, a multidisciplinary research institute that focuses on healthy development of children through healthier lifestyles and environments. His research focuses on the understanding of determinants of food choice and the effectiveness of (policy) interventions in the context of the prevention and management of non-communicable diseases in general and of obesity in particular.

Christine Dedding

Christine Dedding is Assoc. Professor at the Department of Medical Humanities, Amsterdam UMC, Vrije Universiteit Amsterdam. She has conducted and supervised a series of studies on how patients define, experience and treat their health problems, and their responses to health programs. She is an expert in participation and co-creation in research, health and welfare.