The acceptability, effectiveness, and impact of different models of care for pediatric weight management services: protocol for a concurrent mixed-methods study

Clinician and healthcare managers' perspectives on the delivery of secondary and tertiary pediatric weight management services

Clinician and healthcare managers' (HCMs) views on weight management service delivery are imperative for informing the nature of future services to treat children with obesity. This qualitative study used semi-structured focus groups and one-on-one semi-structured interviews. Participants were 27 clinicians (medical, nursing, or allied health) and nine HCMs (senior executives in the hospital) who worked in six secondary or tertiary pediatric weight management clinics across five public hospitals in New South Wales, Australia. Clinicians reported that using a combination of group and individual sessions improved engagement with families and reduced attrition rates. Clinicians and HCMs recommended integrating clinics into community centers and providing specific programs for sub-groups, such as children from culturally and linguistically diverse communities or children with developmental delay. Many clinicians and HCMs stressed the importance of pediatric weight clinics using a holistic approach to treatment. To improve the likelihood of future funding for pediatric weight management clinics and to optimize models of care, centers must embed research into their practice. Addressing common barriers to current pediatric weight management services and designing future models of care based on key stakeholders' preferences is critical to achieving optimal care provision for this high-risk population.

Acceptability of the Direct Health Facility Financing (DHFF) initiative in Tanzania: A mixed methods process evaluation of the moderating factors

Despite wide agreement that stakeholder acceptability plays a critical role in an intervention's effectiveness, gaps remain on understanding acceptability of complex health financing interventions. We aimed to understand the moderators of acceptability of the Direct Health Facility Financing (DHFF) initiative across primary health facilities in Tanzania. Employing a mixed methods approach and guided by the theoretical framework for acceptability (TFA), we collected data from implementers and their supervisors using a structured questionnaire and semi-structured interview guides. We analysed data using a chi square test, logistic regression, and thematic analysis. We recruited 238 participants, of whom 71% were females and 54% were below 37 years old. Acceptability was found to be 63% and received high rating in qualitative interviews. Moderators of acceptability included sex (AOR = 1.93, p = 006), work experience (AOR = 3.47, p = 0.001), knowledge (13.8, p = 0.00), supportive work environment (AOR = 2.28, p = 0.019), and capability to implement the programme (AOR = 0.12, p = 0.00). Moderators reported in qualitative interviews related to individual and contextual factors. This study suggests that the DHFF initiative is acceptable and influenced by factors operating at the individual level and beyond. Addressing moderators of acceptability as programs are designed and implemented is the holy grail of acceptability of complex interventions.

Current status of multi-disciplinary paediatric weight management services in Australia

AIM

To identify multi-disciplinary paediatric weight management services currently available in Australia and determine gaps in service provision for children and adolescents with obesity.

METHODS

Surveys were distributed to 17 identified Australian multi-disciplinary paediatric weight management services. A representative from each service was asked to complete an online survey regarding service and patient characteristics, assessment and management practices, and professional development approaches.

RESULTS

Representatives from 16 multi-disciplinary paediatric weight management services completed the survey. Fourteen services were based in major metropolitan cities and two in regional areas. Fourteen services provided care to pre-school aged children (0-4 years old), 15 to primary school aged children (5-12 years old) and 13 to high school aged children (13-18 years old). The number of patients seen per year per service ranged from 20 to 250 and duration of waiting lists ranged from 2 months to more than 12 months.

CONCLUSIONS

The current availability and accessibility of multi-disciplinary paediatric weight management services is inadequate to service Australian children and adolescents with obesity, particularly those with severe obesity and those in rural and remote communities. To better address the issue of paediatric obesity, establishment of additional multi-disciplinary services, training for health-care professionals and monitoring of the provision of evidence-based care is urgently needed.

Satisfaction and acceptability of paediatric weight management services amongst parents and carers: A mixed-methods study

To optimize treatment for children and adolescents with obesity and minimize attrition, consideration of parents' engagement and satisfaction with paediatric weight management services is crucial. The aim of this study was to conduct a mixed-methods evaluation of parental acceptability and satisfaction of available paediatric weight management services in New South Wale, Australia's most populous state. Parents/carers referred to one of six weight management services between March 2018 and July 2019 were invited to participate. The study involved: (a) surveys and one-on-one phone interviews to assess overall satisfaction, acceptability of service design and delivery, treatment expectations, and service accessibility, strengths, weaknesses and areas of improvement; (b) a survey to determine costs to families of attending the service; and (c) a survey assessing families' reasons for treatment non-attendance. N = 146 participants completed the survey to assess service satisfaction and acceptability and 37 of these also participated in phone interviews. Ninety-three per cent were satisfied with the overall care they received and patient weight loss/cessation of weight gain and improvement in the family's overall health were rated as the most valued changes. Content analysis of interviews highlighted participants' recognition of positive changes achieved during treatment and appreciation of the resources provided, and the encouraging/empathetic nature of staff. The most common reasons for treatment attrition were difficulty in accessing the weight management service and flexibility of appointment times. Findings from this study can be utilized in future planning and development of paediatric weight management services to facilitate integrated, responsive and effective care of children and adolescents with obesity.