Engagement in Child and Adolescent Weight Management Programmes

Introduction: Engagement denotes the extent to which, and how, individuals and families participate in a weight management (WM) programme. Data suggest that between 8-83% of families do not complete the paediatric WM programme which they initiated, but the underlying mechanisms which drive participant engagement are poorly understood. This thesis aims to 1) establish if participant-and programme-characteristics are associated with various engagement trajectories in paediatric WM programmes, and 2) explain the factors associated with initial-and continued-programme engagement. The Model of Retention – translated from Higher Education – underpins this thesis. 

Study 1: Methods – Secondary data of 2948 MoreLife participants (age: 10.44±2.80 years, BMI SDS: 2.48±0.87 units, white ethnicity: 70.52 %) were used. Multivariable linear regression and multivariable logistic regression examined the predictors of attendance and engagement groups (e.g. early dropout, late dropout, completion…) respectively. Results – Six variables were associated with engagement (Programme: group size, delivery period, & programme year; Participant: BMI SDS, Ethnicity, & IMD score). Programme characteristics were stronger predictors of engagement than participant characteristics, and the predictors varied between engagement groups. A small proportion of the variance in engagement was explained by the final predictors. 

Study 2: Methods – Qualitative data were collected from 31 families (parents and children) across three paediatric WM programmes (MoreLife, SHINE, and Weigh To Go) at the early-and late-programme stages. The Model of Retention guided the lines of inquiry and data analysis framework. Results – Six factors were central to engagement: 1) having support; 2) self-efficacy in one’s ability to attend; 3) coping with the demands of programme engagement; 4) controlling engagement decisions; 5) experiencing benefits from engagement; and, 6) having an engagement promoting programme design. The importance and dominance of these factors varied between the early-and lateprogramme stages, and moreover, between parents and children. 

Conclusions: Participant engagement was demonstrated to be a complex phenomenon; one that is challenging to predict and currently better explained through qualitative investigation. This thesis, and the collective discussion within, illuminate methods of improving WM programme engagement through design and delivery modification. The Model of Retention offers a means of comprehensively explaining engagement. Finally, this thesis provides a conceptual framework for discussing programme engagement.