Barriers and facilitators to implementing practices for prevention of childhood obesity in primary care: A mixed methods systematic review

Abstract

Primary care providers (PCPs) have an important role in prevention of excess weight gain in pre-school children. Guidelines exist to support PCPs' practices. This systematic review of PCPs' practice behaviors and their perceptions of barriers to and facilitators of implementation of guidelines was the first step toward the development of an intervention aimed at supporting PCPs. Five databases were searched to identify qualitative, quantitative, and mixed methods studies which examined PCPs' practice patterns and factors influencing implementation of recommended practices. The convergent integrated approach of the Joanna Briggs Institute (JBI) methodology for mixed methods reviews was used for data synthesis. Following analyses, the resultant factors were mapped onto the Capability, Opportunity, and Motivation model of Behaviour (COM-B). Fifty studies met the eligibility criteria. PCPs inconsistently implement recommended practices. Barriers and facilitators were identified at the provider (e.g., lack of knowledge), parent (e.g., lack motivation), and organization level (e.g., inadequate training). Factors were mapped to all three components of the COM-B model: psychological capability (e.g., lack of skills), reflective motivation (e.g., beliefs about guidelines), automatic motivation (e.g., discomfort), physical opportunity (e.g., time constraints), and social opportunity (e.g., stigma). These findings reflect the complexity of implementation of childhood obesity prevention practices.

A collaborative approach to develop an intervention to strengthen health visitors’ role in prevention of excess weight gain in children

“…These findings suggested that several interventions appear to be necessary to address key barriers at the level of the individual practitioner, service provider organisation, and the parent/family. The findings are in accordance with the evidence synthesised from the SR [ 48 ] which suggested that change at multiple levels is required to produce sustainable improvement in PCPs’ adherence to guidelines.…”

“…Our SR included 50 studies from nine countries [ 48 ]. Nurses with a specialist public health role (such as UK health visitors and their counterparts in other countries) were identified as the sole participant group in 10 studies and as one participant group in nine studies that used mixed samples.…”

“…We conducted a mixed-methods systematic review (SR), the methods and the findings of which have been published elsewhere [ 48 ]. The review synthesised the evidence on gaps in implementation of guideline recommended practices for prevention of excess weight in children aged 0-5 years; and barriers to and facilitators of implementation, as perceived by PCPs.…”

Clinical practice guidelines for the prevention of childhood obesity: A systematic review of quality and content

“…This is concerning given evidence indicating that the existence of a guideline does not automatically translate into clinical practice changes 65 and more specifically, findings of low uptake of other guidelines in the setting of childhood obesity prevention 66 . This issue has also been highlighted by a recently published systematic review by Ray et al, 9 which identified a range of challenges and facilitators at the level of the provider, parent and organization to implementing childhood obesity prevention practices. Although the Ray et al review focused only on primary care and young children, many of the identified challenges are likely to be relevant to other healthcare sectors and a broader age range.…”

“…Preventive health care is the interaction between the clinician and patient to promote health and prevent illness 5 . And as part of a systems approach, healthcare providers can play an important role in the prevention of obesity 6 ; however, there are many cited barriers to obesity prevention in health services across adult and pediatric populations, 7–9 including lack of knowledge, time, and appropriate resources and discomfort of healthcare providers associated with talking about weight, and evidence supporting the role of clinicians in obesity prevention is reportedly scarce 10,11 …”