Lucas Patricia J, Curtis-Tyler Katherine, Arai Lisa, Stapley Sally, Fagg Jamie, Roberts Helen
School for Policy Studies, University of Bristol, Bristol, UK.
BMC Public Health. 2014 Jun 17;14:614. doi: 10.1186/1471-2458-14-614.
As part of a study considering the impact of a child weight management programme when rolled out at scale following an RCT, this qualitative study focused on acceptability and implementation for providers and for families taking part.
Participants were selected on the basis of a maximum variation sample providing a range of experiences and social contexts. Qualitative interviews were conducted with 29 professionals who commissioned or delivered the programme, and 64 individuals from 23 families in 3 English regions. Topic guides were used as a tool rather than a rule, enabling participants to construct a narrative about their experiences. Transcripts were analysed using framework analysis.
Practical problems such as transport, work schedules and competing demands on family time were common barriers to participation. Delivery partners often put considerable efforts into recruiting, retaining and motivating families, which increased uptake but also increased cost. Parents and providers valued skilled delivery staff. Some providers made adaptations to meet local social and cultural needs. Both providers and parents expressed concerns about long term outcomes, and how this was compromised by an obesogenic environment. Concerns about funding together with barriers to uptake and engagement could translate into barriers to commissioning. Where these barriers were not experienced, commissioners were enthusiastic about continuing the programme.
Most families felt that they had gained something from the programme, but few felt that it had 'worked' for them. The demands on families including time and emotional work were experienced as difficult. For commissioners, an RCT with positive results was an important driver, but family barriers, alongside concerns about recruitment and retention, a desire for local adaptability with qualified motivated staff, and funding changes discouraged some from planning to use the intervention in future.
作为一项关于儿童体重管理项目在随机对照试验后大规模推广时所产生影响的研究的一部分，这项定性研究聚焦于该项目对参与的提供者和家庭的可接受性及实施情况。
基于最大差异抽样选择参与者，以提供一系列的经历和社会背景。对29名委托或实施该项目的专业人员以及来自英格兰3个地区23个家庭的64个人进行了定性访谈。主题指南用作一种工具而非规则，使参与者能够构建关于他们经历的叙述。使用框架分析法对访谈记录进行分析。
诸如交通、工作安排以及家庭时间的相互冲突需求等实际问题是参与的常见障碍。实施伙伴通常在招募、留住和激励家庭方面投入大量精力，这增加了参与率，但也增加了成本。家长和提供者重视技术娴熟的实施人员。一些提供者进行了调整以满足当地的社会和文化需求。提供者和家长都对长期结果表示担忧，以及这如何受到致胖环境的影响。对资金的担忧以及参与和融入的障碍可能转化为委托实施的障碍。在没有经历这些障碍的地方，委托方热衷于继续开展该项目。
大多数家庭认为他们从该项目中有所收获，但很少有人觉得它对自己“有效”。对家庭的要求，包括时间和情感方面的付出，让人感到困难。对于委托方来说，一项结果积极的随机对照试验是一个重要的推动因素，但家庭障碍、对招募和留住人员的担忧、对具备资质且积极性高的工作人员进行本地化调整的需求以及资金变化，使得一些人不再计划在未来使用该干预措施。
