Table 4.
Perceived barriers and facilitators to the implementation of W82GO in the community
| Levels | Quotations to illustrate the identified levels |
| The innovation | |
| Credibility | * “I suppose because it was attached to an acute hospital and because there was a consultant paediatrician and you had a lot of disciplines and a lot of very competent professionals involved, and that it had been successful when delivered there. That was the main reason I believed in the programme I suppose.” (W82GO003) |
| Attractiveness (ie, multidisciplinary nature) | * “I do think the MDT approach was superb. I think that if you’re going to do something for a child who is obese then you need it.” (W82GO018) |
| Transferability (ie, different population, different resource issues) | † “You are talking about a different cohort of families. Families who are already in the system. They are used to going in for appointments. You’re talking about a group who’ve already had difficulties identified by their GP or whoever so by the time they are going for the group they are already sold, they are used to it and they are used to that sort of setting which is very kind of fast and quick-paced and very focused.” (W82GO002) |
| Relevance (eg, too medicalised) | † “I think the area medical officer, the medical input I think is probably optional or at least part-time. It’s of less importance. It medicalised this community programme a bit too much.” (W82GO021) |
| The individual professional | |
| Awareness of the problem/recognition of need | * “It is a problem, most definitely. I think it’s a time bomb that went off over the past 10 years and that we are behind it. Way behind it and the sooner we get going and get doing something the better.” (W82GO013) |
| Personal interest and motivation | * “So that enthusiasm and that dedication made it happen, it was key to its success.” (W82GO011) |
| Low self-efficacy | † “I wouldn’t be especially skilled in assessing children you know with obesity and that kind of thing… Or talking to parents about it… I was concerned about my own ability to, to get up to speed fairly quickly.” (W82GO015) |
| Attitudes (ie, multidisciplinary perspectives) | † “I suppose the other main challenge was the multidisciplinary nature of the programme. I think the challenges of it is when you put together a team obviously from all different backgrounds not with different agendas but with different experiences and knowledge and different perspectives.” (W82GO026) |
| The patient | |
| Parental resistance (weight misperception and denial) | † “I think there was a denial that there was anything wrong with their child, or that their child was overweight. There was a total denial about that because the population in general look like their child. Their child may be a little bit above of what the normal population looks like, but they didn’t see that as an issue at all.” (W82GO028) |
| The social context | |
| Supportive colleagues | * “Once she came on board there was two of us, it was a lot easier to share the workload and if I couldn’t be there for a day she could be there for it so I suppose that definitely took the load off and she also acted as a sounding board you know? If there was something I wasn’t sure of I could say what do you think about this and vice-versa, you know what I mean?” (W82GO016) |
| Leadership | * “I mean if we didn’t have her pulling all those people and bits together it wouldn’t have worked. She did a great job in I think the co-ordination role cause I think running something like this with people dispersed across a whole county and city then you need a project manager on the ground.” (W82GO017) |
| Collaboration between national and local teams | † “I did feel there was a very big gap once the decision had been made nationally to roll this out, there was a very big gap between us on the ground and them, there was no consultation or collaboration with people on the ground and I think that’s where the problem was.” (W82GO003) |
| The organisational context | |
| MDT structure (logistics) | † “I suppose one of the challenges definitely is that the health professionals are all in different places.” (W82GO004) |
| Resources | † “I guess time constraints ‘cause a lot of people were pressurised for time. Like even ourselves we wouldn’t have been able to go to every session and I would have liked to have gone but we just couldn’t. We didn’t have the time. We didn’t have the staff to be able to attend so I think time and resource pressures were the main concerns.” (W82GO013) |
| Training | † “It (the training) was as if they were trying to sell us the programme when you know we were already there. We were already sold. I mean we knew why it was important… because of the obesity issue so there was no need to go over all that again. They should have just focused on how to actually implement and deliver the programme.” (W82GO011) |
| External environment | |
| Lack of existing services | * “There is nothing out there so that’s where it was great to have something like W82GO. That if you did see a child that you knew there was something. Some sort of pathway.” |
| Media | * “There was a huge media campaign ongoing around the time we were implementing the programme which got some parents thinking and talking. I mean those things do have a big impact. Things like Operation Transformation that’s aired in January have a huge impact. I think we need more media on the immediate impact of childhood obesity and not just the long-term impacts.” (W82GO003) |
| † “I think maybe it’s (obesity) hyped up a little bit in the media. I think maybe that in itself could be making things difficult for parents to come forward. We don’t have any other disease related issue hyped up as much you know? If you had a child with obesity you would be feeling a small bit cringe like. You’d be wanting to find somewhere private to get some help like you know.” (W82GO020) | |
| Stigma | † “Wouldn’t have their child come to a programme in case they’d be labelled overweight or obese. There is a stigma and just from hearing again I wasn’t in the parents room, but just from hearing other colleagues feedback it’s the parents fear of feeling judged and blamed.” (W82GO002) |
*Facilitators.
†Barriers.
GP, General practitioner.
MDT, Multidisciplinary team