One size does not fit all–qualitative process evaluation of the Healthy School Start parental support programme to prevent overweight and obesity among children in disadvantaged areas in Sweden

Abstract

BackgroundParental support interventions have shown some effectiveness in improving children’s dietary and physical activity habits and preventing overweight and obesity. To date, there is limited research on barriers and facilitators of school-based parental support interventions targeting overweight and obesity. This study aimed to describe barriers and facilitators influencing implementation of the Healthy School Start (HSS) intervention in disadvantaged areas in Stockholm, Sweden, from the perspective of parents and teachers.MethodsFocus groups and individual interviews with teachers (n = 10) and focus groups with parents (n = 14) in the intervention group of the HSS were undertaken, guided by the Consolidated Framework for Implementation Research (CFIR). Transcriptions were analysed using qualitative content analysis in two steps: deductive sorting in two domains of the CFIR (intervention characteristics and process), and subsequent inductive analysis.ResultsThe overarching theme “tailoring the intervention to increase participant engagement” was found. Among teachers, barriers and facilitators were related to how the intervention was introduced, perceptions of the usefulness of the classroom material, preparation ahead of the start of the intervention, cooperation between home and school and children’s and parents’ active engagement in the intervention activities.For parents, barriers and facilitators were related to the perceived relevance of the intervention, usefulness of the material, experiences of the Motivational Interviewing (MI) sessions, the family member targeted by the intervention, cooperation between home and school and parents’ ability to act as good role models.ConclusionIt seems important to tailor the intervention to the abilities of the target group in order to increase participant engagement. Including activities that focus on parents as role models and cooperation between parents seems important to bring about changes in the home environment. It also appears important to include activities that target cooperation between home and school.

Are school‐based physical activity interventions effective and equitable? A meta‐analysis of cluster randomized controlled trials with accelerometer‐assessed activity

“…Process evaluations are critical to understanding implementation success and the contextual factors that influence how an intervention works. However, on the basis of the pool of studies included in this review, process evaluations are rare: only 24% (n = 4) of included trials conducted a process evaluation . Three of these process evaluations assessed the issue of intervention fidelity, each concluding wide variance in implementation of the program across schools and settings.…”

Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study

“…It became clear that to create commitment among staff and implement the obesity prevention intervention with high fidelity, the staff should be offered training and opportunities to discuss the content of the programme. Our second trial showed that teachers' time for making the necessary preparations for the intervention and doing so before finalising their plans for the school year, influenced their engagement in the programme (Norman et al, 2016). Furthermore, the results of this study demonstrated that lack of parental engagement is a barrier to securing parental support.…”

“…Our previous implementation study of HSS also supports this observation. Teachers who were told to carry out the programme felt they were being forced, which affected their engagement in the programme negatively (Norman, Nyberg, Elinder, & Berlin, 2016). To avoid opposition, staff should be actively involved in detailed planning regarding when and how the programme should be implemented.…”

“…The importance of facilitating communication and clearly defining the division of responsibilities between project management (i.e., researchers), schools, and parents is emphasized (Bergstrom et al, 2015). It is also important to tailor the intervention to the abilities of the target group to increase participant engagement (Norman et al, 2016).…”

Protocol for a mixed methods process evaluation of a hybrid implementation-effectiveness trial of a scaled-up whole-school physical activity program for adolescents: Physical Activity 4 Everyone (PA4E1)

“…The UK Medical Research Council's (MRC) framework for designing and evaluating complex interventions (programs) recommends process evaluations be undertaken as part of all randomised trials; as they describe important contextual factors, and can clarify causal mechanisms to aid interpretation of trial findings and explain variations in trial outcomes [16]. However, a recent systematic review of randomised controlled trials (RCTs) of schoolbased physical activity programs highlighted that process evaluations were rare, undertaken in just four of the 17 trials identified [11,[17][18][19][20]. Furthermore, none of the process evaluations described or assessed the delivery of implementation support strategies to facilitate implementation of the program [17][18][19][20], nor were process evaluation methods specified in a publically available protocol or register [17][18][19][20].…”