"Let me take the lead": Qualitative Findings From the Parent-Preferred Topics for Childhood Obesity Study

New studies about childhood obesity-related risk communication are needed because barriers to family engagement with obesity treatment persist and have grown after pandemic.

In 2022, the authors conducted qualitative interviews with English-speaking caregivers of children aged 7-11 years with obesity receiving primary care at an urban academic primary care center. Open-ended questions elicited caregivers' level of concern, preferences for risk communication, and barriers to engagement in behavior change. Interviews were recorded, transcribed verbatim, and analyzed iteratively through thematic content analysis. The final purposive sample of n=17 was determined by thematic saturation.

Caregivers expressed willingness to engage in behavior change while acknowledging competing life priorities and a desire to center the child's mental health. Barriers to implementing lifestyle changes were identified at the systems level (i.e., financial insecurity, healthcare system gaps) and at the individual level (i.e., child food preferences). Facilitators also existed at both the systems level (i.e., a relationship of trust and accountability between patient and clinician) and the individual level (i.e., referrals to specialists and receipt of social welfare benefits). Caregiver's desire for clinicians to acknowledge their efforts and provide practical advice and tangible services was pervasive. The small sample size from 1 clinic may limit generalizability and was subject to selection bias.

Understanding caregivers' level and reasons for concern about their children's health can inform risk communication, and understanding barriers to accessing care can improve obesity counseling. These results will support the future development of a best-worst scaling tool to prioritize caregiver concerns among a larger and more generalizable sample, which may enable clinicians to better target caregiver concerns in motivational interviewing.