Abstract
The ‘early years’ is a crucial period for the prevention of childhood obesity. Health services are well placed to deliver preventive programs to families, however, they usually rely on voluntary attendance, which is challenging given low parental engagement. This study explored factors influencing engagement in the Infant Program: a group-based obesity prevention program facilitated by maternal and child health nurses within first-time parent groups. Six 1.5 h sessions were delivered at three-month intervals when the infants were 3–18 months. A multi-site qualitative exploratory approach was used, and program service providers and parents were interviewed. Numerous interrelated factors were identified, linked to two themes: the transition to parenthood, and program processes. Personal factors enabling engagement included parents’ heightened need for knowledge, affirmation and social connections. Adjusting to the baby’s routine and increased parental self-efficacy were associated with diminished engagement. Organisational factors that challenged embedding program delivery into routine practice included aspects of program promotion, referral and scheduling and workforce resources. Program factors encompassed program content, format, resources and facilitators, with the program being described as meeting parental expectations, although some messages were perceived as difficult to implement. The study findings provide insight into potential strategies to address modifiable barriers to parental engagement in early-year interventions.
Highlights
The ‘early years’, more recently defined as the first 1000 days, is widely acknowledged as a crucial period in laying the foundation for life-long learning and development [1,2], and for the prevention of childhood obesity [3]
Program attendance appeared to diminish with the acquisition of knowledge and growing confidence as a parent, especially once infants had transitioned to solid foods; and early program termination appeared to be linked to a loss of social connections with the group once parents returned to work
The evidence supports the benefits that social connections provide in enhancing program attendance, describing them as perhaps “more important than the information parents receive in the group” [12], as it creates a sense of solidarity [53], reduces feelings of social isolation and fosters confidence [11]
Summary
The ‘early years’, more recently defined as the first 1000 days (conception to 24 months), is widely acknowledged as a crucial period in laying the foundation for life-long learning and development [1,2], and for the prevention of childhood obesity [3]. An estimated 41 million children aged under five are overweight or obese [4]. In Australia, 20% of children aged 2–4 years are overweight or obese [5], with predictions that this could reach 33% by 2025 [6]. One in three children living in lower socioeconomic areas (33%) are overweight or obese compared with those living in higher socioeconomic areas (19%), while levels are comparable across urban (26%) or regional (27%). Overweight, obesity and related comorbidities track into adulthood.
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