"It's like a sinking ship and you've got a cup to try and save it" : a thematic account of health professionals and parents thoughts and experiences of childhood obesity in Aotearoa/New Zealand : a thesis presented in partial fulfilment of the requirements of the degree of Master of Science in Psychology (Endorsement in Health Psychology) at Massey University, Wellington, New Zealand

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The prevalence of childhood obesity is growing at a serious rate globally, and the World Health Organisation states that it is one of the most serious public health challenges of the 21st century. Childhood obesity is now a well-recognised problem in Aotearoa/New Zealand. New Zealand has the third highest rates of childhood obesity among 40 OECD countries, with 1 in 3 children in New Zealand above what is considered a healthy weight range. Consequently, New Zealand’s government have made tackling the high rates of childhood obesity a top public health priority by introducing multi-disciplinary weight management programmes across the country. However to date, little is known about how the implementation of childhood weight management programmes is going in practice. Programme evaluations are important to guide programme development and to make sure health interventions are working to their fullest potential for all New Zealanders. The current study explored key stakeholders (health professionals and parent’s) views and experiences of childhood obesity management in a New Zealand context. Health professionals’ personal experiences and perceptions were explored, around their management of childhood obesity and the perceived barriers to engaging families in intervention programmes for childhood weight management. Additionally, families’ reasons and rationales for declining a referral to a multi-disciplinary weight service were a key focus. A secondary aim of the current research was to produce pragmatic suggestions for the MidCentral District Health Board, to facilitate the implementation of childhood obesity prevention and management initiatives. A qualitative approach to inquiry was employed for an in-depth exploration of health professionals’ and parents’ thoughts and experiences. A purposive sampling method was used to recruit participants. Four focus groups were held, comprising 33 health professionals; additionally, face-to-face interviews were conducted with five mothers of pre-school aged children who had been identified as being above the healthy weight range and who declined a referral to a multi-disciplinary childhood weight management service. The interviews were focussed on mothers’ thoughts and perceptions of childhood obesity programmes. All transcripts were analysed using an explorative, inductive and data driven approach to thematic analysis. The interviews and focus groups with key stakeholders generated insights into the difficulties and challenges perceived by health professionals and parents at the individual, organisational and social level, in relation to implementing childhood obesity management. Health professional’s accounts reflected awareness of the broader contextual factors (e.g., availability and accessibility of healthy foods, family culture, and health literacy) and social and emotional factors (e.g., parental knowledge, social norms, family pressures) that could affect family adoption of healthy lifestyle behaviours. The mother’s accounts were largely focussed on the social factors affecting their ability to live a healthy lifestyle and the importance of feeling understood by health professionals. The findings from this study identify opportunities for assisting families and health professionals in the management of childhood obesity.