Table 1 Barriers and needs in the thematic analysis. Indicated by GPs, YHC workers, pediatricians, dieticians, psychologists and physiotherapists during the focus groups and individual interviews
Barriersa | Needs | |
|---|---|---|
Component 1: identification | ||
Individual care provider | Afraid of harming relationship with parents as a result of discussing a child’s weight problem. Afraid of the reaction of obese child while discussing the weight problem. | Increase knowledge and awareness of health care providers in identifying obese children. |
System | When society does not change (pro-healthy lifestyle), it feels like a waste of time to identify and treat obese children. | |
No regular screening program for children between 5–10 years of age; therefore children don’t show up for consultation. | Annual screening. | |
Reluctance to provide evidence-based care due to insufficient financial compensation. | Financial reimbursement for health care providers by health insurance companies. | |
Social setting | Not able to discuss weight problem because parents lack knowledge, expertise and obesity awareness. | Education and information leaflets for parents and children. |
Impression that parents lack motivation to attend follow-up appointments, lack disease awareness, lack motivation to change lifestyle and are unaware of the consequences of overweight/obesity. | Increase knowledge and awareness of parents and children. | |
Prevalence of multiple-problems families and low socio-economic status of families with obese children. | More time to help these families, which means funding for extra human resources. | |
Component 2: diagnosis and risk stratification | ||
Individual care provider | Unfamiliar with weight-related health risk (GGR) and risk stratification. | Clear cut-off points and tools with which to perform a risk stratification (GGR). |
System | ||
Social setting | ||
Component 3: individual care plan and treatment | ||
Individual care provider | Time consuming to create an individual care plan. | Social map with an overview of effective lifestyle interventions. |
Negative experience with previous lifestyle intervention. | ||
System | Difficult to keep all health care providers informed of (temporary) lifestyle interventions. | Financial compensation for lifestyle interventions. |
Social setting | Parents and obese children do not enter the lifestyle interventions due to financial constraints. | Financial compensation for sports/fitness facilities. |
Component 4: continuity of care | ||
Individual care provider | Lack of time to monitor and give sufficient attention to parents and obese children. | Financial compensation for continuity of care. |
System | Lack of long-term lifestyle interventions. Lack of structural funding for long-term lifestyle interventions. | Reimbursement by insurance company for long-term lifestyle interventions. |
Social setting | High drop out rate of children in “expensive (long) term pediatric care”. | |
No insight into the number of children being referred. Changing lifestyle behavior is difficult for parents and obese children. | ||
Component 5: multidisciplinary approach | ||
Individual care provider | ||
System | Lack of collaboration with health care providers involved. | Recruitment of a central care coordinator could enable the provision of multidisciplinary care. |
No clear task (re-)arrangements | Collaboration agreements and task rearrangements with health care providers involved in an region. | |
Structural funding needed to provide multidisciplinary care. | ||
Social setting | No collaboration with health care providers involved due to lack of feedback information from health care providers. | Feedback information from health care providers provided. |