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. Author manuscript; available in PMC: 2022 Dec 1.
Published in final edited form as: Obes Rev. 2021 Sep 1;22(12):e13335. doi: 10.1111/obr.13335

Table 3.

Data extraction for studies included in the systematic review assessing facilitators and barriers of children participation in nutrition, physical activity, and obesity interventions from the parents’ and children’s perspectives

Author (s) Study
name or
aim		 Type of
study		 Population Setting &
dates of
study		 Ethics Outcome (s) Methods Facilitators Barriers
Cruz et al. (2014)44 Child Health Initiative for Lifelong Eating and Exercise (CHILE) Mixed methods (RCT) 1,879 children, 655 parents, 7 grocery stores, and 14 healthcare providers from low-income communities in rural areas with a high prevalence of American Indian 16 Head Start centers in New Mexico, USA. 2006-2010 IRB approval and consent obtained from participants Obesity prevention program Interviews were conducted with parents being recruited for a multi-level, group RCT, and review of study records. Interviews in English or Spanish based on preference.

Study enrollment was done all year for 17 months.

  • feedback to intervention sites;

  • revised permission forms;

  • phone reminders;

  • increased site visits;

  • over-scheduling of interviews;

  • use of community champions;

  • bilingual/bicultural facilitators;

  • convenient location; centers <150 miles to minimize travel;

  • face-to-face recruitment;

  • not targeting specific age groups;

  • > recruitment & smaller sites;

  • setting goals for the number of interviews per site;

  • monetary incentives;

  • inclusion of physician in the recruitment team; physicians recruiting physicians to serve as role moles, support study goals, & participate in family events

  • meals provided at recruitment

  • No shows at the mandatory orientation

  • parents forgot to return permission slips

  • lack of adequate information to make an informed decision;

  • negative comments from others about participating in trials

  • no shows for the interview;

  • work schedules and obligations; parent interviews lasted approximately 1-2 hours
Drews et al. (2009)45 Recruitment and retention strategies and methods in the HEALTHY study Mixed methods (RCT) 59 parents of 8th graders University clinic setting (California, Texas, and North Carolina), USA. 2006-2009 IRB approval and consent & assent obtained from participants Prevention of modifiable risk factors for type 2 diabetes in youth Semi-structured phone interviews on reasoning for participating (n=40)or not participating (n=19)in the visit (anthropometrics and blood draw) Parent’s perspective:

  • family history of diabetes;

  • learn about child's health status;

  • convenience of having the screening at school; no travel time needed for data collection event

  • uncertainty on susceptibility for diabetes in childhood or adulthood;

Children’s perspective:

  • monetary incentives

The recruitment period extended through the end of the health screening (data collection event)in each school.		 Parent’s perspective from participating children:

  • concern of the blood draw (for oral glucose tolerance test);

  • potential health;

  • sending child to school fasting;

Parent’s perspective from non-participating children:

  • lack of understanding of informed consent;

  • child's refusal;

  • lack of time;

  • child forget to give parents the forms;

  • confusion about the consent copy to sign & one to keep;

  • language & communication barriers (although all materials were in English & Spanish)
Edwards et al. (2016)41 Implementation issues associated with the delivery of Bristol Girls Dance Project (BGDP) Mixed Methods (RCT) 571 girls aged 11-12 years old.
Qualitative data collected from 59 girls, 10 dance instructors, and 9 schools involved in BGDP		 18 secondary schools (9 intervention, 9 control)in the Greater Bristol area, UK IRB approval and consent obtained from participants Physical activity intervention 20-week school-based intervention (40 sessions, 2 sessions per week for 20 weeks); each session was 75 minutes; 9 focus sessions conducted at the school of 42 min;
Dance instructor interviews: were 67 min
School contact interviews 30 min)

  • Friend involvement and recruiting friendship groups;

  • Familiar recruiter to participants;

  • Endorsements from other places;

  • Detail information about tasks and requirements from participants;

  • Monetary incentives;

  • Promoting the importance and esteem of the university-led research;

  • Children could try a new activity;

  • Convenient location;

  • Recruiter not familiar with the participants

  • Recruiting children in the first few weeks of school year
Fleming, J et al. (2015)46 Evaluation of recruitment methods for a trial targeting childhood obesity. Mixed Methods (RCT) 115 families with obese children aged 6–11 years Medical centers, schools, community. W Midlands, UK. 2010-2014 IRB approval and consent & assent obtained from participants Obesity treatment Evaluation of study records, questionnaires, recruited parents.

Recruitment: 24 months (2012-2013);
Data collection for 10 weeks; sessions 2.5 hours/wk on Saturdays;
Duration of focus interview: 20 minutes

  • recognized child as overweight;

  • looking for support or had previously accessed services;

  • receiving study letter from physician; 4 of4% participants were recruited by this referral

  • receiving study letter from physician a second time.
Ghai NR et al. (2014)52

(Drews et al. 2009)45 		Recruitment among families for the Obesity Prevention Tailored for Health Study Mixed Methods (RCT) 361 parents & children 10-12 years enrolled in a large managed-care organization Claremont Graduate University, Kaiser Permanente Southern California, USA. 2010-2011 IRB approval and consent & assent obtained from participants Obesity prevention Recruitment staff called potential participants and recorded reasoning and reviewed medical records.
Recruitment: Jun 2010 – Nov 2011
Intervention: 18 weeks
Baseline visit: 2 hours

  • participation was higher if child was overweight or obese;

  • participation higher among those with more outpatient visits and more flu vaccinations.

 Acceptors not randomized:

  • inability or unwillingness to come to baseline visit;

  • lack of time or no longer interested;

  • no reason/other/missing

Refusal to participate:

  • lack of interest and time;

  • do not need the intervention

  • no reason/other/missing
Gillespie J et al. (2015)29 A social marketing approach to understanding triggers and barriers on weight management Qualitative 27 parents/caregivers of primary and secondary school children Different settings in local communities, UK. 2010 IRB approval and consent obtained from participants Weight management Four focus group discussions (~2 hours each in 4 sites)with semi-structured topic guide and blob tree visuals.

Recruitment: March 2010

  • emotional/social skills that would benefit their child (confidence and self-esteem);

  • support from other parents;

  • gain back control;

  • acceptance help from others;

  • easy to implement;

  • aspiration/goals: happy child;

  • information on how, where, and when to access a service;

  • Non-stigmatizing, a valuable sense of community;

  • lack of control: 'the problem is too big';

  • desire to avoid conflict: "It's easier just to give in’;

  • no good reason: 'the case isn't proven';

  • fear of confronting issues: 'I can't bear to raise it, and I don't want to make things worse'’

  • uncertain where to turn: 'I don't know what specialist support is out there'
Grow HM et al. (2013)30 Understanding family motivations and barriers to participation in community-based programs for overweight youth Qualitative 23 parents of children 8-14 years old (required to be referred by health care provider) YMCA sites, USA. 2008-2009 IRB approval and consent obtained from participants Obesity prevention In-person interviews about intention-motivation, environmental constraints, support, and skills to participate, with open-ended questions
Data collection: Fall 2008 – Winter 2009;
Intervention: 18 weeks, with 90 min sessions twice weekly for 12 weeks, then weekly for 6 weeks

  • exposure to knowledge and behaviors;

  • concern for weight and/or other health factors;

  • support/assistance from staff and similar families in the intervention;

  • help with parenting for health behaviors and reinforcement;

  • spending time with child;

  • parent's persistence despite child being reluctant.

  • scheduling conflicts;

  • too much time and too long;

  • no Saturday sessions;

  • not perceiving as needed;

  • long distance from home;

  • concern the program would not be 'ongoing';

  • lack of support from family;

  • bad traffic;

  • darkness and rain

  • Program only offered in English; no interpreters
Hamilton J et al. 2014)47 Changing eating behaviors to treat childhood obesity in the community: ComMando Mixed Methods (RCT) 37 children 5-11 years old (required to be referred by health care provider) Clinical and home setting, UK. 2012-2013 IRB approval and consent obtained from participants Obesity treatment Phone interview to identify barriers to participation.

Pilot phase was 9 months before trial (April 2012 – December 2012).
Intervention was for 12 months, with 9 visits & 3 support phone calls.
Focus group: 3 visits		 From 5 decliners:

  • encouragement from children;

  • concerns about child's weight and diet;

  • shared activity for parents & children to manage weight;

  • great opportunity due to lack of weight programs;

From acceptors:

  • enough information to make an informed decision;

  • long-term health benefits;

  • helping other families;

  • children want to stop bullying and want to be healthier.

 From decliners:

  • time conflicts;

  • misunderstanding of the trial

  • worried about having to do group work;

  • long duration;

  • lack of commitment;

  • Only offered in English
Jago et al. (2013)42 Process evaluation of the Teamplay parenting intervention pilot: implications for recruitment, retention, and course refinement Mixed Methods (RCT) 16 Parents of 6-8y old children in the intervention group and 10 from the control group for call interviews Bristol, UK IRB approval & consent obtained from participants Physical activity and screen viewing intervention Interviews were conducted via phone. 6 parents in the intervention group received face-to-face interviews due to language barriers.

Data collection: Mar-Jun 2011. Main study had 8 visits of 2h (once weekly for 8 weeks). 7 focus groups done in 2012 (within a month of the end of trial of 12-58 mins for intervention & 8-13 mins for control group).

  • Improve their parenting skills;

  • Increasing knowledge about how to change activity behavior;

  • Intervention resonated with parents;

  • An active parenting course;

  • Effective communication to parents;

  • Promotional materials;

  • Free childcare;

  • Encouraged by a friend;

  • Helping with a research project;

  • Peer learning;

  • Randomization was clear;

  • Course leaders were friendly;

  • Convenient location;

  • Text reminders;

  • Accommodated participants whom English was not the 1st language

  • Did not appeal to them until face-to-face interaction;

  • Misunderstood course to be specifically for parents with problems;

  • Initially wasn’t clear that the courses were for a research project;

  • Attending a course with new people;

  • Work and other commitments.
Jago et al. (2012)31 Designing a Physical Activity Parenting Course: Parental Views on Recruitment, Content and Delivery. Qualitative Parents of children 6-8y (29 females, 3 males)for call interviews (n=32)and for the online survey (n=750) Schools, children’s centers or nurseries, healthcare surgeries and local projects in Bristol, UK. 2011 IRB approval and consent obtained from participants Obesity prevention Interviews with parents and an anonymous online survey that was distributed via a national parenting website.

Data collection: Jan-Feb 2011. Online survey data collection: Sep-Oct 2011;
Phone interview was 20 mins.

  • free childcare;

  • different time options for sessions;

  • multiple locations close to participants;

  • recruitment materials aligned with the desired content;

  • varied and wide-reaching recruitment methods

  • being busy or having other commitments;

  • financial cost of transportation;

  • need for childcare.
Nicholl et al. (2018)32 Parental opinions on improving clinical dietary trials for young children. Qualitative 17 parents of children 2-6 years were invited to participate in one of the three focus groups Playgroups in Perth, Australia IRB approval and consent obtained from participants Dietary trials In person or online focus sessions (3 sessions each of 50 minutes). Parents had the option of attending 2 face-to-face, 1 online.

  • Altruism

  • needle fear; parents were hesitant about blood and stool samples unless they included additional analyses relevant to them;

  • understanding and ability to cope;

  • lack of awareness of current dietary guidelines;

  • randomization;

  • time commitment (near recruitment site, ~30 km) or online;

  • intervention for their child;

  • confronting tests positive;

  • Non-English-speaking participants were excluded
Rice et al. (2008)48 Successes and barriers for a youth weight-management program. Mixed Methods (RCT) Parents of children 7-17 years being recruited in the program on exercise. Private health club in Brentwood, TN, USA Private study: parents paid to enroll children in study Weight management Review of recruitment methods from study records and follow-up with interviews to participating pediatricians and referred families.

Intervention: 12 months with 8 nutrition counseling sessions (3 sessions/wk first 3 months; 1 session/wk next 3 months, and then 1 session/mo), each 60 minutes

  • Familiarity with the facility;

  • desire to change;

  • child's overweight status early;

  • inability to make the changes needed for the child themselves;

  • clear understanding linking weight to health;

  • physician referral;

  • word-of-mouth and direct consumer marketing

  • school recruitment was very low

  • cost;

  • preferred to help their child on their own;

  • facility too far from their home.
Speirs et al. (2016)33 Recruitment and retention into the Text2bHealthy, a text message-based health education program Qualitative 1355 parents enrolled in Text2BHealthy (different races/ethnicities) Food Supplement Nutrition Education program & schools. Maryland, USA. 2012-2013 IRB approval and consent obtained from participants Nutrition and physical activity 3 post-test surveys and 4 focus groups to measure program awareness, satisfaction, enrollment barriers, among others.

Recruitment: Feb-May 2012. Data collection: May-Jun 2012. Sent 3 reminders/wk

  • inability to enroll;

  • cost to participate;

  • enrollment of non-parents: people who were not parents at participating elementary schools had enrolled;

  • hard to reach with recruitment materials;
Spittaels et al. (2007)49 Review of participation in an online tailored physical activity program the internet Mixed methods (RCT) 1740 children aged 10-18 years and parents aged 20-55 years. Primary and secondary schools, Belgium IRB approval and consent obtained from participants Physical activity Review of reply cards of parents during the recruitment process

Parental intervention: 1 online survey (controls) and 2 online surveys (intervention);
Children: 1 survey at school

  • mothers more interested to participate than fathers;

  • parents of medium or high SES more interested than parents of low SES;

  • being employed predicted having interest in participating--but when persons were interested, this variable could no longer predict further participation.

  • child already involved in a lot of physical activity;

  • no interest;

  • not having a desktop computer or Internet access.
Buscail et al. (2018)43 Recruitment of precarious families in an interventional study: Lessons from the French: “Fruits and vegetables at home” FLAM Trial“ Mixed Methods 95 families with at least one child from 3 to 10 years old. Community centers or at home, France, 2015-2017. IRB approval and consent obtained from participants. Nutrition Face-to-face questionnaires. Children older than 5 years were directly interviewed. March to September 2017, qualitative surveys were conducted to assess recruitment.

  • Comprehension/communication issues with the recruiters;

  • Lack of time;

  • Mistrust from some people when they were solicited;

RCT: randomized clinical trials; SES: socio-economic status; UK: United Kingdom; USA: United States of America