title: Understanding family motivations and barriers to participation in community-based programs for overweight youth: one program model does not fit all.
abstract: BACKGROUND
  Successful obesity intervention efforts depend on effective recruitment and retention, an ongoing challenge for community-based programs.
  
  
  OBJECTIVE
  We sought to provide insights into the most salient factors affecting family enrollment and retention in community-based programs for overweight youth and their families. We especially sought to understand potentially modifiable program factors affecting participation.
  
  
  METHODS
  : We conducted semistructured, in-depth, face-to-face interviews with parents of overweight children within 1 year of referral to a public health grant-funded community-based healthy lifestyle promotion program. Purposeful sampling was used to select participants across program sites, by level of program completion, and child age and sex. Transcribed interviews were coded independently by 2 staff with a structured codebook and then analyzed by themes through an iterative process using Atlas.ti. The Integrative Model of Behavior served as an orienting theoretical framework.
  
  
  METHODS
  Community-based child obesity intervention program in King County, Washington.
  
  
  METHODS
  Twenty-three parents from diverse socioeconomic backgrounds were interviewed, of which 10 completed the program, 9 did not complete, and 4 did not enroll.
  
  
  METHODS
  Parent-reported factors related to enrollment and retention.
  
  
  RESULTS
  Key parent reasons for program enrollment included: (a) addressing both eating and activity, (b) concern about child's weight, (c) seeking help outside the family, and (d) structured parent-child time. Parents perceived a lack of child motivation to enroll; some youth initially opposed attending, which was overcome through positive program experience. All families described barriers to attending, and some identified specific strategies or skills they used to overcome barriers. No single program design emerged to address every family's needs. Instead, using the themes of accessibility and accountability, we present parent- recommended design options.
  
  
  CONCLUSIONS
  To meet different families' needs, public health and health care agencies offering youth health promotion programs should consider providing program options that vary intensity level and weight loss emphasis.
authors: Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, WA 98145, USA. mollie.grow@seattlechildrens.org
authors: H Mollie Greves
authors: HM
authors: Grow
authors: Clarissa
authors: C
authors: Hsu
authors: Lenna L
authors: LL
authors: Liu
authors: Leslie
authors: L
authors: Briner
authors: Tricia
authors: T
authors: Jessen-Fiddick
authors: Paula
authors: P
authors: Lozano
authors: Brian E
authors: BE
authors: Saelens
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003153:Community Health Services / Q000458:organization & administration*; D005190:Family / Q000523:psychology*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D009042:Motivation; D050177:Overweight / Q000628:therapy*; D010290:Parents / Q000523:psychology; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D040242:Risk Reduction Behavior; D014861:Washington