Table 3.
Barriers of childhood obesity prevention policies
| Themes | Barrier (reference) |
|---|---|
| Individual level (N = 17) | Lack of risk perception in children (48) Lack of Self-regulation and self-control when eating in children (48) Lack of coping skills in children (48) lack of access to sports teams (62) feeling tired in the children (62) Lack of confidence in CHC nurses communication skills (50) Lack of sufficient knowledge in nurses (50) Lack of sufficient knowledge in parents (56, 60) Difficulties in health information utilization among parents (60) Low parent participation rates (67) Poor utilization of maternal and child health services by parents (60) Lack a sense of responsibility in assistant cooks (48) Little or no knowledge in assistant cooks (48) Lack of active transport by parents (51) Parents’ financial problems (48, 62) Parent's reluctance to become involved in COP activities (51, 53, 67) Language problem (56)a |
| Sociocultural level (N = 8) | Insufficient cooperation with other healthcare providers in nurses (50) Cycling is unsuitable for girls (51) Cycling to school is unsafe (51) Nurses concerns about discuss of obesity stigma as a barrier to the parents (60) Cultural beliefs on childhood obesity (56, 60, 66) Teamwork (59) Passive managerial commitment (59) Existence of misinformation in the society (66) |
| Structural level (N = 35) | Lack of space in the building (49, 57) Time limitations in stakeholders in the implementation level (49, 51, 52, 60, 62, 66) Program accessibility barriers in parents (56) Top-down process (59) Lack of monitoring (47) Insufficient cooperation with other healthcare providers in nurses (50) Conflicting policies within preschools (49) Problems in agenda setting (59) Insufficient training (52, 63) Lack of clear childhood obesity and policies effectiveness data (51, 60) Lack of infrastructure near schools (39, 51) Absence of a travel plan (51) Lack of equipment and facilities (52, 53) insufficient workforce (53) Competing prioritiesb (53, 65) Parents and administrative principals as preventing the implementation of interventions (54) Obesogenic environments (54) Limited funding and resources at the executive level (47, 55, 61, 63–67) Restrictive policies (55) Junk food advertisement (47, 56) Lack of mandatory weight checks for schoolchildren (56) Academic pressure (57) Lack of external, institutional and experts support of policy (53, 57, 63, 65–67) Lack of planning (58) Other urgent unforeseen priorities (58) No plan to cope with teacher and staff turnover (58, 61, 64) High teacher or nurse workload (54, 58) Operational level policy formulation (59)c Inadequate dietetic services (60) Limited local control over food provided in schools (39, 61) Lack of strategy and policy guidelines clarity (47, 60, 63) Lack of buy-in (64) Legal roadblocks (64) Magnitude of the obesity problem (66) |
a
Language problem: The community language is other than language at home.
b
Competing curriculum demands and priorities or competing commitments/priorities in the schools.
c
Formulation appropriate policies and not implement them properly at the operational level.