title: Barriers and enablers for participation in healthy lifestyle programs by adolescents who are overweight: a qualitative study of the opinions of adolescents, their parents and community stakeholders.
abstract: BACKGROUND
  Overweight or obesity during adolescence affects almost 25% of Australian youth, yet limited research exists regarding recruitment and engagement of adolescents in weight-management or healthy lifestyle interventions, or best-practice for encouraging long-term healthy behaviour change. A sound understanding of community perceptions, including views from adolescents, parents and community stakeholders, regarding barriers and enablers to entering and engaging meaningfully in an intervention is critical to improve the design of such programs.
  
  
  METHODS
  This paper reports findings from focus groups and semi-structured interviews conducted with adolescents (n?=?44), parents (n?=?12) and community stakeholders (n?=?39) in Western Australia. Three major topics were discussed to inform the design of more feasible and effective interventions: recruitment, retention in the program and maintenance of healthy change. Data were analysed using content and thematic analyses.
  
  
  RESULTS
  Data were categorised into barriers and enablers across the three main topics. For recruitment, identified barriers included: the stigma associated with overweight, difficulty defining overweight, a lack of current health services and broader social barriers. The enablers for recruitment included: strategic marketing, a positive approach and subsidising program costs. For retention, identified barriers included: location, timing, high level of commitment needed and social barriers. Enablers for retention included: making it fun and enjoyable for adolescents, involving the family, having an on-line component, recruiting good staff and making it easy for parents to attend. For maintenance, identified barriers included: the high degree of difficulty in sustaining change and limited services to support change. Enablers for maintenance included: on-going follow up, focusing on positive change, utilisation of electronic media and transition back to community services.
  
  
  CONCLUSIONS
  This study highlights significant barriers for adolescents and parents to overcome to engage meaningfully with weight-management or healthy lifestyle programs. A number of enablers were identified to promote ongoing involvement with an intervention. This insight into specific contextual opinions from the local community can be used to inform the delivery of healthy lifestyle programs for overweight adolescents, with a focus on maximising acceptability and feasibility.
authors.forename: Kyla L
authors.initials: KL
authors.lastname: Smith
authors.affiliation: School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia. l.straker@curtin.edu.au.
authors.forename: Leon M
authors.initials: LM
authors.lastname: Straker
authors.forename: Alexandra
authors.initials: A
authors.lastname: McManus
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Fenner
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D005260:Female; D017144:Focus Groups; D006801:Humans; D008019:Life Style; D008297:Male; D050177:Overweight / Q000517:prevention & control*; D010290:Parents / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D010549:Personal Satisfaction; D036301:Qualitative Research; D012111:Residence Characteristics