title: Health care providers' perceived barriers to and need for the implementation of a national integrated health care standard on childhood obesity in the Netherlands - a mixed methods approach.
abstract: BACKGROUND
  In 2010, a national integrated health care standard for (childhood) obesity was published and disseminated in the Netherlands. The aim of this study is to gain insight into the needs of health care providers and the barriers they face in terms of implementing this integrated health care standard.
  
  
  METHODS
  A mixed-methods approach was applied using focus groups, semi-structured, face-to-face interviews and an e-mail-based internet survey. The study's participants included: general practitioners (GPs) (focus groups); health care providers in different professions (face-to-face interviews) and health care providers, including GPs; youth health care workers; pediatricians; dieticians; psychologists and physiotherapists (survey). First, the transcripts from the focus groups were analyzed thematically. The themes identified in this process were then used to analyze the interviews. The results of the analysis of the qualitative data were used to construct the statements used in the e-mail-based internet survey. Responses to items were measured on a 5-point Likert scale and were categorized into three outcomes: 'agree' or 'important' (response categories 1 and 2), 'disagree' or 'not important'.
  
  
  RESULTS
  Twenty-seven of the GPs that were invited (51 %) participated in four focus groups. Seven of the nine health care professionals that were invited (78 %) participated in the interviews and 222 questionnaires (17 %) were returned and included in the analysis. The following key barriers were identified with regard to the implementation of the integrated health care standard: reluctance to raise the subject; perceived lack of motivation and knowledge on the part of the parents; previous negative experiences with lifestyle programs; financial constraints and the lack of a structured multidisciplinary approach. The main needs identified were: increased knowledge and awareness on the part of both health care providers and parents/children; a social map of effective intervention; structural funding; task rearrangements; a central care coordinator and structural information feedback from the health care providers involved.
  
  
  CONCLUSIONS
  The integrated health care standard stipulate that the care of overweight or obese children be provided using an integrated approach. The barriers and needs identified in this study can be used to define strategies to improve the implementation of the integrated health care standard pertaining to overweight and obese children in the Netherlands.
authors.affiliation: Department of General Practice and Elderly Care and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands. a.schalkwijk@vumc.nl.
authors.forename: Annemarie A H
authors.initials: AAH
authors.lastname: Schalkwijk
authors.affiliation: Department of General Practice and Elderly Care and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Giel
authors.initials: G
authors.lastname: Nijpels
authors.affiliation: Department of General Practice and Elderly Care and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Sandra D M
authors.initials: SDM
authors.lastname: Bot
authors.affiliation: Department of General Practice and Elderly Care and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Petra J M
authors.initials: PJM
authors.lastname: Elders
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards; D034742:Electronic Mail; D005260:Female; D017144:Focus Groups; D058005:General Practitioners; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D010290:Parents; D063766:Pediatric Obesity / Q000453:epidemiology / Q000517:prevention & control*; D011368:Professional-Family Relations; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D059039:Standard of Care