Elsevier

Academic Pediatrics

Volume 12, Issue 5, September–October 2012, Pages 420-428
Academic Pediatrics

Nutrition/Overweight/Obesity
Attrition and Family Participation in Obesity Treatment Programs: Clinicians' Perceptions

https://doi.org/10.1016/j.acap.2012.05.001Get rights and content

Abstract

Objective

The majority of participants drop out of pediatric obesity treatment programs; however, clinicians have little knowledge of how to address this problem. The objective of this study was to explore obesity treatment clinicians' perceptions of contributors to attrition, as well as methods to maintain family participation.

Methods

Semistructured interviews were conducted with 29 pediatric obesity clinicians representing primary care (PC), community based (CB), and tertiary care (TC) treatment programs in North Carolina. Interviews were recorded, transcribed verbatim, and coded with a multistage inductive approach. Grounded theory was used to analyze responses.

Results

Eleven themes emerged from analysis, including: the influence of program elements, family characteristics, and the variety of approaches used to address retention. Only TC programs reported attempts to address attrition. Patients' past experiences with obesity treatment, desire for immediate outcomes, and relationships with clinicians were perceived as important factors related to attrition. Other important themes were: families' understanding of obesity treatment, importance of realistic expectations, and families' value of treatment. Important differences and similarities among programs were identified. All clinicians reported families came to treatment through physician referral, not self referral.

Conclusions

Clinicians perceive attrition to be a significant problem in pediatric obesity treatment. As a result of clinical interviews, several potential avenues to address attrition were identified, including: the need for clinicians to develop relationships with families, assist in building appropriate expectations, and address families' value of treatment. Findings of this study can inform larger investigations of attrition, and guide exploration of family impressions of and experiences in treatment.

Section snippets

Methods

A conceptual model was developed in accordance with expectancy theory of motivation (ETM; Fig.),25, 26 which was instrumental in research methodology, developing interview questions, and analysis.

Sample

A total of 35 pediatric obesity treatment clinicians were eligible from the 6 programs that participated; 29 clinicians consented and completed interviews. Interviews were conducted with 6 PC, 9 CB, and 14 TC clinicians. Participants were predominantly white women (Table 3); 34% worked full-time in pediatric obesity (40+ hours per week), and 58% worked less than 20 hours a week in their programs. The majority (57%) reported to have worked in pediatric obesity 5 years or less. Nearly all had

Discussion

This is the first study to investigate perceptions of pediatric obesity clinicians to better understand attrition, all of whom recognized it as a significant problem. Using an indepth qualitative approach, the findings revealed several key areas that clinicians believe influence attrition from pediatric obesity treatment. Clinicians recognized family characteristics (highly stressed, poor) and aspects of their treatment programs (scheduling, location) may contribute to attrition. There were

Acknowledgments

The authors thank Karen Klein (Research Support Core, Office of Research, Wake Forest School of Medicine) for her assistance in editing this manuscript; and Camila Pulgar, B.S., for her assistance in the conduct of this study.

Dr Skelton was supported in part through NICHD/NIH Mentored Patient-Oriented Research Career Development Award (K23 HD061597). Additional support was provided by the Kate B. Reynolds Charitable Trust Grant 2009-098 (MBI).

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