ECONOMIC AND OTHER BARRIERS TO ADOPTING BETTER NUTRITION AND PHYSICAL ACTIVITY BEHAVIORS AMONG OVERWEIGHT CHILDREN

 Purpose
   To explore parent-reported economic barriers to adopting obesity prevention recommendations for their children.

 Methods
   We conducted 4 focus groups (2 English, 2 Spanish) among a total of 19 parents of overweight (BMI ³ 85^th percentile) children aged 5-17 years.  The main discussion focused on 7 types of advice pediatricians often give: reducing TV watching, removing TV from child’s bedroom, increasing physically active games, participating in community or school-based athletics, walking to school, walking more in general, and eating less fast food. Parents were asked to discuss what factors would make each type of advice more difficult (barriers) or easier (facilitators) to implement.  Participants were also asked about the relative importance of economic (time and dollar costs/savings) barriers and facilitators if these were not brought into the discussion unprompted.  All focus groups were audiotaped and transcribed. Spanish groups were translated into English during transcription. We conducted qualitative analysis using the template organizing style. We did a topic by topic thematic analysis across focus groups within the English-speaking and Spanish-speaking population segment and a cross-population segment thematic analysis for each major theme. 

 Results
   Parents identified many barriers but few facilitators to adopting advice for nutrition and physical activity for their children. Commonly cited barriers were child’s preference for existing behaviors, ensuring parity among household members, lack of commitment from family members, and competing interests within the household.  Members of all groups mentioned time and dollar costs, particularly time costs, but they were not the most frequently cited barriers.  Lack of transportation, insufficient information, difficulty monitoring, and suboptimal neighborhood safety were also less frequently cited barriers.  Facilitators identified included education/support and the availability of acceptable alternatives.  Parents in all groups cited cultural beliefs/behaviors about food.  Cultural beliefs about weight norms were cited in the Spanish-speaking group only; cultural beliefs about physical activity norms were cited in the English-speaking group only. 

 Conclusions
   Parents identify numerous barriers to adopting obesity prevention recommendations, most notably child and family preferences and resistance to change, but also economic barriers.  Successful intervention programs need to consider how to overcome various types of barriers, including economic, during program development.