Background: Maintaining initial engagement and achieving long-term retention in paediatric obesity intervention services is challenging. Inequalities in outcomes for Indigenous populations are a concern. Whānau Pakari is a multi-disciplinary assessment-and-intervention healthy lifestyles programme based in the home and community, in Taranaki, New Zealand. It was effective at 12 months, with improvements in cardiovascular fitness and health-related quality of life, with improvements in BMI SDS if participants attend ≥70% of intervention sessions. This study aimed to understand the barriers and facilitators to engagement.
Methods: 64 semi-structured, home-based interviews were undertaken with past participants of the Whānau Pakari service, with equal numbers of Māori and non-Māori. Participants included those who attended ≥70% of programme sessions, those who attended <30%, those who had one assessment and then discontinued, and those who declined input altogether. The interviews were thematically analysed with peer debriefing for validity.
Findings: Four interactive and compounding domains were identified as influencing engagement in Whānau Pakari: acute and chronic life stressors, societal norms of weight and body size, historical negative experiences of healthcare and respectful, compassionate care. Inequities between Māori and non-Māori participants were due to differences in life stressors and deprivation, and increased weight stigma and racism within the health system.
Conclusions: Families deal with multiple complex stressors at once, which impact on their ability to engage with healthy lifestyle services, along with prevailing weight norms. The experience of the referral to Whānau Pakari is key to future engagement with the service. A negative referral can set participants up to decline further input or disengage from the service or wider healthcare system. However, respectful, compassionate care can mitigate past negative experiences in the health system and facilitate continued engagement with services. A referral which is respectful and acknowledges past experiences of stigma within the health system may increase retention.