title: 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: BACKGROUND
  Parental 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.
  
  
  METHODS
  Focus 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.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  It 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.
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden. asa.norman@ki.se.
authors.forename: Åsa
authors.initials: Å
authors.lastname: Norman
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden. gisela.nyberg@ki.se.|Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29, Solna, Sweden. gisela.nyberg@ki.se.
authors.forename: Gisela
authors.initials: G
authors.lastname: Nyberg
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden. liselotte.schafer-elinder@ki.se.|Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 1497, 171 29, Solna, Sweden. liselotte.schafer-elinder@ki.se.
authors.forename: Liselotte Schäfer
authors.initials: LS
authors.lastname: Elinder
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Box 23100, 141 83, Huddinge, Sweden. anita.berlin@ki.se.
authors.forename: Anita
authors.initials: A
authors.lastname: Berlin
mesh_terms: D000328:Adult; D001290:Attitude; D002648:Child; D004032:Diet; D005069:Evaluation Studies as Topic; D015444:Exercise; D005178:Faculty; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D062405:Motivational Interviewing; D009765:Obesity / Q000517:prevention & control*; D010043:Outcome and Process Assessment, Health Care; D050177:Overweight / Q000517:prevention & control; D010290:Parents; D011203:Poverty; D015397:Program Evaluation; D012572:School Health Services; D012574:Schools; D012923:Social Class; D013548:Sweden; D035862:Vulnerable Populations