BACKGROUND:Children's centres in the UK provide a setting for public health programmes; offering support to families living in the most disadvantaged areas where obesity prevalence is at its highest. Health, Exercise and Nutrition in the Really Young (HENRY) is an eight-week obesity prevention programme currently delivered in children's centres across the UK. However, low participant engagement in some local authorities threatens its potential reach and impact. This study aimed to explore the factors influencing participant engagement with HENRY to describe where local intervention may support engagement efforts. METHOD:A focused ethnography study was undertaken in five children's centres delivering HENRY across the UK. One hundred and ninety hours of field observations, 22 interviews with staff (commissioners, HENRY co-ordinators, managers and facilitators) and six focus groups (36 parents), took place over five consecutive days in each centre. The Consolidated Framework for Implementation Research (CFIR) was used to guide the observations and analysis of the data. RESULTS:Three overarching themes described the factors influencing participant engagement with HENRY: local authority decision making around children's centre programmes; children's centre implementation of HENRY; and the participant experience of HENRY. The results indicate that factors influencing participant engagement with public health programmes begin at the commissioning body level, influencing children's centre implementation and subsequently the experience of participants. Local authority funding priorities and constraints influence availability of places and who these places are offered to, with funding often targeted towards those deemed most at need. This was perceived to have a detrimental effect on participant experience of the programme. CONCLUSION:In summary, participant engagement is affected by multiple factors, working at different levels of the children's centre and local authority hierarchy, most of which are at play even before participants decide whether or not they choose to enrol and maintain attendance. For programmes to achieve their optimal reach and impact, factors at the commissioning and local implementation level need to be addressed prior to addressing participant facing issues.

译文

背景:英国的儿童中心为公共卫生计划提供了场所;为生活在肥胖率最高的最贫困地区的家庭提供支持。真正的年轻人中的健康,运动和营养(HENRY)是一项为期八周的预防肥胖计划,目前已在英国各地的儿童中心开展。但是,参与者在某些地方当局的参与度低,威胁了其潜在的影响力和影响力。这项研究旨在探讨影响与HENRY参与的参与者的因素,以描述当地干预可以在哪些方面支持参与工作。
方法:在五个在英国各地分发HENRY的儿童中心进行了民族志研究。在每个中心连续五天进行了一百零九十小时的实地观察,对工作人员(专员,HENRY协调员,经理和协调人)和六个焦点小组(36名父母)进行了22次访谈。实施研究综合框架(CFIR)用于指导数据的观察和分析。
结果:三个主要主题描述了影响参与者参与HENRY的因素:围绕儿童中心计划的地方当局决策;亨利儿童中心的实施;以及HENRY的参与者经验。结果表明,影响参与者参与公共卫生计划的因素始于调试机构级别,影响儿童中心的实施,进而影响参与者的体验。地方当局的资金优先级和限制条件会影响场所的可用性以及向这些场所提供的人,而资金通常是针对那些最需要的人。人们认为这对计划参与者的经验有不利影响。
结论:总而言之,参与者的参与受到多种因素的影响,这些因素在儿童中心和地方当局等级的不同层次上起作用,甚至在参与者决定是否选择注册并保持出勤率之前,大多数因素都在发挥作用。为了使计划达到最佳效果和影响,在解决参与者面临的问题之前,必须先解决调试和本地实施层面的因素。

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