Abstract:
<jats:sec><jats:title>Objective</jats:title><jats:p> To identify barriers created and maintained by the health system affecting engagement in a family-based multidisciplinary healthy lifestyle programme for children and adolescents in New Zealand. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We conducted 64 semi-structured interviews with participants of the programme (n = 71) with varying levels of engagement, including those who declined contact after their referral. Half the interviews were with families with Māori children, allowing for appropriate representation. Interviews were analysed using thematic analysis. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Five health system factors affecting engagement were identified: the national policy environment, funding constraints, lack of coordination between services, difficulty navigating the health system, and the cost of primary health care. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Engaging with a health system that creates and maintains substantial barriers to accessing services is difficult, affecting programme engagement, even where service-level barriers have been minimised. Lack of access remains a crucial barrier to improved health outcomes for children and their families experiencing childhood obesity in New Zealand. There is a need for comprehensive approaches that are accompanied by a clear implementation strategy and coordinated across sectors. </jats:p></jats:sec>
