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Table 3 Themes emerging from the interviews and focus groups with Pakistani and Bangladeshi parents, and quotes to illustrate the themes

From: Cultural adaptation of a children’s weight management programme: Child weigHt mANaGement for Ethnically diverse communities (CHANGE) study

Themes Completers Non-completers Non-attenders
Logistical issues with programme attendance
 Close location If it’s closer, then it’s better because it saves time; because sometimes we have to collect the children, and both mother and father needed to attend, so we both went. (FG3 (conducted in Urdu), P2, male, Pakistani)   Well, it shouldn’t be too far away, it’s better if it’s closer because sometimes the car isn’t available and then I could walk too. (154, female, Pakistani (interview conducted in Urdu))
The reason why I couldn’t make it is because I’m not driving, so having to travel to the place and then coming back with another small child, at the time I think she was a baby, was really difficult for me… It was just that really, I really want to go as well (144, female, Pakistani)
 Familiar venue I think if you go through the school it’s better. Everybody has to take their children to school. So if in the morning when they’ve gone to school to drop their child off or in the afternoon if the teachers come forward and talk to the parents then like ‘this is what’s happening and if you would like to attend’ maybe they would be, because everybody takes their kids to school and that would be a good way of catching them. (FG1, P3, female, Bangladeshi)   
 Programme timing I think that it’s about timing because some people have young children and others are older so they need to pick them up from school, others are in college so they need to collect them, so I think it’s about timing. (FG3 (conducted in Urdu), P1, female, Pakistani)   …the timing and, you know, it’s not – and town is like, you know, busy and…so…especially after 4. It’s really hard. They have, like, their own activity. Mosque and everything. Tuition. This and that. So that’s why I couldn’t (133, female, Pakistani)
Weekends, because after school they go to school and Mosque, all Muslims, even Indian or Bengali or Pakistani, every Asian, children attends Mosque after school (139, female, Pakistani)
 Programme in school time Well, you know this weekend, it would be better, the children would be home and you could take them instead of missing them and they’re taking time off from school. (FG1, P1, female, Pakistani) I’m sure if it’s a school day, the school would give him an hour or so just to go into, it’s regarding health isn’t it, so I’m sure school would allow him to go for an hour or do the programme in the weekend like Saturday/Sunday. (129, male, Bangladeshi) I was upset because I couldn’t go. I couldn’t have the time, I couldn’t take my – especially with schools now where they’re strict on the children, you know, attending school and not missing days. So it was hard for me. (104, female, Pakistani)
 Siblings I didn’t have younger children but other families had young children with them. And they sat too, it wasn’t that the younger ones couldn’t sit and listen too. (FG2, P4, female, Pakistani)   When I started receiving letters and phone calls from yourselves then I realised that there might be support. My daughter says to me that ‘mamma I want to go for exercise’... I told her that I couldn’t go with her because I have other children. I have small children, my youngest is 2 years old. (109, female, Pakistani (interview conducted in Urdu))
Language barriers
 Initial contact    Someone rang on my home phone speaking English & inviting me to attend the programme but I was asking her if I needed to take my daughter with me, because my English is not very good; but she could not understand what I was trying to ask her. I was asking if I needed to take my daughter with me. She couldn’t understand me so she said she will call me back but we never heard from her again. (150, female, Bangladeshi (interview conducted in Bengali))
 Programme sessions I don’t know English, they were English, but I understood everything because of the way they explained it, with gestures and all the information so that we could understand.(FG3 (conducted in Urdu), P2, male, Pakistani)
From FG3 (conducted in Urdu):
Facilitator: So was there a translator there?
Participant 1: No. Because at first I didn’t really mention it because my daughter was with me and so I didn’t have any problems because my daughter would speak for me and she’d translate what I was saying back to them about what to do etc. (female, Pakistani)
Yes because I’ve seen some parents there that are like it was hard for them to understand and I was doing a lot of explaining to them as well (123, female, Pakistani) My niece had taken her son to First Steps programme, but she herself didn’t understand English, right? … She told me what was there, but she felt left out, as a parent—saying that, you know, ‘If there’s enough information for me, because I can’t read,’ she said, ‘and I can’t understand, then it would have been easier if there was somebody to explain to me (113, female, Pakistani)
Programme structure and delivery
 Programme and session duration    It’s not reasonable for me going and going back and coming back, so that is an issue, as well. So if the hours were extended, like an hour and a half or two hours, that would be reasonable. (113, female, Pakistani)
I think 7 weeks is OK, to be honest, yeah. That’s not a problem. I think that’s just about right to be honest, yeah. Because if you make it too long, probably get a bit boring wouldn’t it. (143, female, Pakistani)
 Children attending Because sometimes children don’t listen to their mum or dad but they listen to the teacher or outsider (FG4 (conducted in Urdu), P1, male, Pakistani)
So if like you know if like if these sessions are done but then it’s explained to the kids a little bit more about ‘this is what you need to do because it’s your life, you’re going to be affected in the future’ and stuff like that then it might help them. (FG1, P3, female, Bangladeshi)
It would have been a bit more ideal if the kids were more involved. That’s what I would -, because then yes we need to have that understanding, but I believe the kids need to understand what they should have and the intake and how it’s with their body. (107, female, Pakistani)
I think children should go every session because then, you know, well how I look at is if the children don’t go and then we’re telling ‘oh you’ve got to do this, this’, they probably think we just sometimes, most kids, they will think oh just my parents being horrible to me, my parents, but when they go into classes and they see these other people they don’t know who are actually telling them, then they will listen more because they will think: hang on if I don’t know the chap there was telling me, so I think my dad is right, so yeah OK I’ll try that. (129, male, Bangladeshi)
...although my daughter does listen to me. I think getting the information first hand would make a big difference. So it’s important for both mother & child to attend. (150, female, Bangladeshi (interview conducted in Bengali))
 Programme interactivity The visual, it was the visual things really that she all brought the visual things and that really like makes it more better understanding then like you know. (FG1, P1, female, Pakistani)
[Participant talking about a related workshop that was not delivered as part of the main programme] It wasn’t really cooking it was just readymade wraps, and you would just put salad in it, and we needed to cut it and put it in and whatever you need to put in there like butter they had brought along with them. So we cut it up, and the children cut it up and made them and then you have a look. In this way I think the children enjoy it too, so they understand that this is happening for them, so it sinks into their minds that if they do this then it will be of benefit to them. (FG3 (conducted in Urdu), P1, female, Pakistani)
I thought it was going to be like kind of activities where they actually show you what kind of activities you can do with your children, what kind of sports and obviously get them interested in them kind of activities. But obviously it was like just basically information just sit there and obviously giving us information about what kind of nutrition and diet and exercise and everything but I thought it was going to be more physical than obviously classroom based (142, female, Pakistani)
I think there was a bit too much paperwork and what it is, she was giving out the information, yes she was trying her best, but I think the way she was delivering it everyone was like going half asleep... because some parents don’t take it in as that, and it’s like they need to get up and do (107, female, Pakistani)
 
 Group sessions and shared experiences There was different community families, and friendly. Indian, Bengali, English, Sikh, and children’s mix up, and share their experiences. (FG2, P4, female, Pakistani)
Because it was the same lady [facilitator] for all five sections, and she nicely laughs and you know and mostly my son was happy you know and when different communities people sit and talk and like it was like a challenge between everyone and she used to push them to compete. (FG2, P4, female, Pakistani)
  I think this is a really good idea like when you go to a talk then you get to hear the views of others and that has an effect on you (109, female, Pakistani (interview conducted in Urdu))
Programme content
 Focus on weight status   I know it was weigh in and there was less time but with the kids I think if they approach them a bit differently because nowadays kids are very, very sensitive and every sort of thing just sticks in their head and I think, you know, ‘oh God mum’ and then in school they’ll have that -, because they had to come out of school and then it’s them like ‘oh we’re going for the weigh in’ and she was embarrassed to even tell her brother and sisters what she was going for (107, female, Pakistani) I don’t see it as overweight, ‘cause I know what they eat. I know they’re not eating the wrong food. Yes, they’re less active, but what do you do? (108, female, Pakistani)
My daughter, she’s not really overweight, it’s just that her weight has gone a bit over the mark (104, female, Pakistani)
I mean, if you look at my son, he’s not overweight, I mean, he’s quite, for his age, he looks bigger than his age, I mean, he doesn’t look like really big or anything but he is quite heavy (144, female, Pakistani)
 Nutritional knowledge and skills But the way they explained everything it was very interesting. I didn’t know just a bottle of water with lemon juice had like so many rounds of sugar in there and all that stuff and like they said biscuits you think that’s the healthy option, actually it isn’t. You know like so it was quite an eye opener. (FG1, P3, female, Bangladeshi)
Because they brought a lot of material about foods with them, like sweet packets, crisps, sugar etc., all these things were there and how much sugar was in them. How much salt is in things and how to swap these things and it will be effective. And I did this 100% and it took effect. (FG3 (conducted in Urdu), P1, female, Pakistani)
We went on the first session. The minute that plate came up and those sugary – you know, those little packets and everything, we thought, ‘Oh, we’ve been there, done that. Forget this’ (121, female, Pakistani)
When you buy the shopping, more labelling, more information, because I understand what they say sometimes there’s energy and then the parents, some get confused because obviously and some English is not even there, so if they can like give a bit more which is more better and which is more healthy, like [drink brand], because I didn’t pick it up from there, [drink brand] does have a lot more sugar than we thought (107, female, Pakistani)
I thought it would be just like talking through healthy and unhealthy but myself, I always look on the internet for healthy options, healthy meals and you know what’s good for me, what’s not good for me. So I’m constantly on the internet, right? So I thought I probably know it anyway’ (104, female, Pakistani)
 South Asian and Western foods From FG1:
Interviewer: And what sort of foods would you like to learn about in cooking, westernised or traditional or a bit of both?
Participant 4: A bit of both, yeah.
Participant 1: A bit of – the children do have both. (female, Pakistani)
Participant 4: They get to have, they get bored with this type of food all the time, they want to try something different. So that would be like a mixture really. (female, Pakistani)
  I think they should talk about both [Asian and Western food]. We do eat Asian food a lot but my children like both so it would be beneficial to get advice on both. (150, female, Bangladesh (interview conducted in Bengali))
We do eat fish and we do eat baked beans and stuff, but we do eat our own food, as well, so we need education on our own food (113, female, Pakistani)
We eat a range of foods and my daughter likes eating food like this. They eat Pakistani food too but also English foods that are vegetarian. (109, female, Pakistani (interview conducted in Urdu))
 Cooking of traditional foods Yeah because if I change using less oil, I can’t taste my curry without oil, since I was 3 and have grown up, I can’t change that but I can swap other things, fat milk with semi skimmed and white with wholemeal breads but I can’t change my curries. (FG2, P1, female, Pakistani)   I want to know, if I’m making a chapatti, how many calories are in there? You know. If I’m making a curry – it’s really hard to – how many calories – you know, hand-size or, you know, it’s hard – in reality, it’s really, really hard. Maybe do a cooking session; say, ‘This is a portion.’ You know. ‘It’s right.’ Maybe do it that way…or even, like, give recipes on maybe even healthier Asian food, rather than – fair enough, do the English food, as well. OK, we have it once a week or whatever. And that’s ovenly – oven-made or it’s grilled. But help us with the type of food that we’re eating. Where are we going wrong? (108, female, Pakistani)
 ‘Junk’ foods and takeaways    She eats a lot of chocolates, sweets and crisps, she eats a lot of takeaways, like burgers, drinks a lot of fizzy drinks, she eats a lot of this stuff. Stuff like chapatti and curry, she eats less of. (154, female, Pakistani (interview conducted in Urdu))
But, the temptation in this area is that we have cheap takeaways, and they are very tempting. You know, you think, ‘Why cook?’ And, you know, we’re tempted to, you know, just, ‘Oh, it’s an easier option. We’ll get chicken and chips. It’s only £1.50.’ So, you know, that’s why the weight is creeping up with children (113, female, Pakistani)
 Physical activity content If they could like have a meeting for half an hour and then integrate like another half an hour to do the sports, I think that would be good as well. (FG1, P3, female, Bangladeshi)
I think that if you are doing this programme then you need to put some exercise sessions in it too, whatever is best for children... if you have the space then you should have exercise programmes in it too (FG3 (conducted in Urdu), P1, female, Pakistani)
They should do more activities like, you know, physical activities to help them and not just concentrate on the food side (123, female, Pakistani)  
 Barriers and facilitators to physical activity And you can do something at home as well, children sitting down, it’s better to tell them to walk like ten times on the stairs, up and down. That’s a good exercise for them. (FG2, P1, female, Pakistani) There’s just nowhere for us to send them where they can get exercise. Whether they can play football or cricket or anything, they should do something. And I would enrol them there. (155, female, Pakistani)
My sister gets into the car and drops them off to the secondary school, you see. But they need that exercise. They need to learn how to walk, as well. You know, the car is very convenient, but it’s really bad for the kids (121, female, Pakistani)
We rarely get to go to the park unless it’s a hot summer’s day. It’s just busy. (108, female, Pakistani)
I want to ride a bike ... and my husband goes ‘can you see how dangerous it is, the cars out there (112, female, Pakistani)
And you can’t let them go to the parks alone. And it’s just round the corner but you just can’t... You just can’t let them out, ‘cause a lot has been, you know, happening around here. (108, female, Pakistani)
 Parental behaviours and influence over child I’ve tried to cut down. You know they showed us a certain plate of vegetables, that’s how much and all that stuff and I’ve tried doing that, I’ve really tried getting into it but I find that he sneaks behind me, he goes in the kitchen and helps himself. (FG1, P3, female, Bangladeshi) When he goes to my mum’s house, he helps himself a lot and then when we go to family, like, he doesn’t listen, he helps himself a lot (103, female, Pakistani)
But the drink wise, he does drink sometimes fizzy drink and I’m going to deny that I do bring sometimes, I feel bad, they like it, right, so just drink a bottle and give it to them, I say ‘look hide it (129, male, Bangladeshi)