title: Community stakeholders' perceptions of barriers to childhood obesity prevention in low-income families, Massachusetts 2012-2013.
abstract: BACKGROUND
  The etiology of childhood obesity is multidimensional and includes individual, familial, organizational, and societal factors. Policymakers and researchers are promoting social-ecological approaches to obesity prevention that encompass multiple community sectors. Programs that successfully engage low-income families in making healthy choices are greatly needed, yet little is known about the extent to which stakeholders understand the complexity of barriers encountered by families. The objective of this study was to contextually frame barriers faced by low-income families reported by community stakeholders by using the Family Ecological Model (FEM).
  
  
  METHODS
  From 2012 through 2013, we conducted semistructured interviews with 39 stakeholders from 2 communities in Massachusetts that were participating in a multisector intervention for childhood obesity prevention. Stakeholders represented schools; afterschool programs; health care; the Special Supplemental Nutrition Program for Women, Infants, and Children; and early care and education. Interviews were audio-recorded, transcribed, coded, and summarized.
  
  
  RESULTS
  Stakeholder reports of the barriers experienced by low-income families had a strong degree of overlap with FEM and reflected awareness of the broader contextual factors (eg, availability of community resources, family culture, education) and social and emotional dynamics within families (eg, parent knowledge, social norms, distrust of health care providers, chronic life stressors) that could affect family adoption of healthy lifestyle behaviors. Furthermore, results illustrated a level of consistency in stakeholder awareness across multiple community sectors.
  
  
  CONCLUSIONS
  The congruity of stakeholder perspectives with those of low-income parents as summarized in FEM and across community sectors illustrates potential for synergizing the efforts necessary for multisector, multilevel community interventions for the prevention of childhood obesity.
authors: Department of Nutrition, Harvard School of Public Health, Landmark Center, 401 Park Drive, 3rd floor East, Boston, MA 01225. Email: cgehre@hsph.harvard.edu. Ms. Ganter is also affiliated with the Technical University of Berlin, Department of Health Care Management, Berlin, Germany.
authors: Claudia
authors: C
authors: Ganter
authors: University of California, Los Angeles, Los Angeles, California (Dr. Chuang was at University of California, San Diego, at the time this article was written).
authors: Emmeline
authors: E
authors: Chuang
authors: Harvard School of Public Health, Boston, Massachusetts.
authors: Alyssa
authors: A
authors: Aftosmes-Tobio
authors: Harvard School of Public Health, Boston, Massachusetts.
authors: Rachel E
authors: RE
authors: Blaine
authors: Montachusett Opportunity Council, Fitchburg, Massachusetts.
authors: Mary
authors: M
authors: Giannetti
authors: Massachusetts Department of Public Health, Boston, Massachusetts.
authors: Thomas
authors: T
authors: Land
authors: Harvard School of Public Health, Boston, Massachusetts.
authors: Kirsten K
authors: KK
authors: Davison
mesh_terms: D002648:Child; D002662:Child Health Services; D003159:Community-Institutional Relations; D005191:Family Characteristics; D005260:Female; D063105:Food Assistance; D007722:Health Knowledge, Attitudes, Practice; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007407:Interviews as Topic; D008404:Massachusetts; D063766:Pediatric Obesity / Q000517:prevention & control*; D011203:Poverty / Q000706:statistics & numerical data; D011204:Poverty Areas; D011314:Preventive Health Services; D012572:School Health Services / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data; D014932:Women's Health Services