Abstract:
Family-based multidisciplinary interventions are recommended as best practice for addressing obesity in children/adolescents. However, engagement and retention in intervention programmes is challenging, and there is a lack of long-term follow-up to assess persistence of healthy lifestyle changes in real-world settings. The aim of this thesis was firstly, to understand the barriers and facilitators for participants and their families to engagement in Whānau Pakari, a family-based multidisciplinary healthy lifestyle programme in New Zealand, and secondly, to assess the persistence of healthy lifestyle change five years post-intervention. Methods: A multiple-methods approach was undertaken, underpinned by Kaupapa Māori theory principles and a critical application of the biomedical scientific method. Past participants of Whānau Pakari were surveyed to determine initial factors that served as barriers or facilitators of attendance. In-depth interviews were conducted with past participants and their families, with varying levels of attendance. A follow-up study post-randomised clinical trial of past participants in Whānau Pakari was undertaken at five years post-initiation to determine the persistence of change over time. Results: The interviews indicated that engagement with Whānau Pakari was affected by barriers including adverse life stressors and socioeconomic deprivation, societal norms of weight and body size and historical experiences of healthcare, including weight stigma and racism. Compassionate, respectful care mitigated these negative experiences and facilitated further engagement. The health system itself presented further barriers to access. Longitudinal outcome data to five years showed that the BMI SDS reduction observed at 12 months was not retained at five years. There were sustained improvements in secondary outcomes such as water intake and health-related quality of life.
