Table 4 Mapping of qualitative themes to COM-B components and cultural adaptation types, identification of intervention functions, planned intervention design and corresponding NICE recommendation
Factors to address identified from qualitative data | Behaviour Change Wheel | Cultural adaptation | NICE guidelinesb | Intervention adaptation | ||
|---|---|---|---|---|---|---|
COM-B element | Intervention function | Typology of adaptationa | Programme theory stage | |||
Behaviour target 1: Improve session attendance and completion of the programme | ||||||
Convenient programme location Ease of travel and parking Convenient timing of programme | Physical opportunity | Environmental restructuring | 25. Consider target populations employment/home situations 29. Utilise appropriate incentives and timing of programme 33. Located in ethnically/culturally appropriate/familiar location | Conception/ planning Promotion Recruitment Retention | Programmes should be provided at flexible times to meet the needs of the community | Increase opportunity for Saturday sessions Identify convenient programme locations (e.g. schools, good transport links) |
Parental responsibility for other siblings | Physical opportunity Psychological capability | Environmental structuring Enablement | 24. Intervention delivered in a culturally appropriate or preferred format 39. Address structural barriers to participation | Promotion Recruitment Retention | Allow siblings to attend Ensure siblings are made welcome and included in sessions | |
Facilitate children attending in school hours | Psychological capability | Enablement | 38. Address emotional barriers and stressors | Promotion Recruitment Retention | Programmes should provide a tailored plan to meet the needs of the child and family (such as child age, family social and economic circumstances, ethnicity, and cultural background) | Improve knowledge of authorisation for children to have time out of school |
Language barriers at initial recruitment Language requirements in programme sessions | Psychological capability Social opportunity Reflective motivation Automatic motivation | Enablement | 14. Reflect target population’s language | Recruitment Implementation Retention Evaluation | Provide high quality language support at recruitment stage and within programme | |
Increase duration of programme sessions | Physical opportunity | Environmental restructuring | 24. Intervention delivered in a culturally appropriate or preferred format | Conception/ planning Implementation | – | Increase session length from 60 to 90 mins |
Weight not perceived as a) a problem or b) something that can be changed by some parents | Reflective motivation Automatic motivation Psychological capability | Education Persuasion Enablement | 22. Intervention content targets population’s social and cultural values 23. Intervention goals and outcomes are culturally appropriate | Conception/ planning Promotion Recruitment Implementation Outcome | Programmes should be multicomponent and focus on diet, healthy eating habits, physical activity, reducing time spent sedentary and strategies for changing behaviour of the child and their family | Focus on the benefits of healthy behaviours for good health outcomes at recruitment and throughout the programme (vs. focus on weight) Inclusion of effective behaviour change techniques |
Sensitivity of children to being weighed | Automatic motivation | Enablement | 38. Address emotional barriers and stressors | Conception/ planning Recruitment Implementation Outcome | Focus on healthy behaviours to influence health outcomes, rather than weight | |
Interactive format better received than didactic format | Social opportunity Automatic motivation | Enablement | 16. Reflect target population’s preferred method of communication 24. Intervention delivered in a culturally appropriate or preferred format | Conception/ planning Implementation Retention | Programmes should include behaviour change techniques parent skills training, incorporate learning of practical skills and introduce simple physical activity opportunities within the programme | Inclusion of more interactive activities More opportunities to socialise and share experiences to encourage peer support |
Visual materials are important to communicate messages | Psychological capability Automatic motivation | Education Persuasion | Conception/planning Implementation Retention | Inclusion of visual materials with clear educational messages | ||
Parents prefer less ‘paperwork’ (handouts) | Psychological capability Automatic motivation | Education Environmental restructuring | 15. Match reading level and literacy 16. Reflect target population’s preferred method of communication | Implementation Retention | Programmes should provide a tailored plan to meet the needs of the child and family (such as child age, family social and economic circumstances, ethnicity, and cultural background) | Reduce volume of handouts; make them attractive and visual, with less written information |
Children should attend all sessions to interact directly with programme facilitators | Physical opportunity Social opportunity | Environmental restructuring | 24. Intervention delivered in a culturally appropriate or preferred format | Conception/planning Promotion Recruitment Retention | Children attend all sessions with parents Session content appropriate for children aged 4–11 years | |
Encourage social interaction and peer support | Social opportunity Automatic motivation | Enablement | 41. Encourage/ involve social support | Conception/ planning Implementation Retention | Inclusion of more interactive activities More opportunities to socialise and share experiences to encourage peer support | |
Perceived value of the programme; parents feel they have enough knowledge about healthy lifestyles | Reflective motivation | Education Persuasion Incentivisation | 19. Material/guidance based on preferences of target population 23. Intervention goals and outcomes are culturally appropriate | Conception/ planning Recruitment Implementation Retention Outcomes | Include parent skills training, behaviour change techniques and learning of practical skills | Increased focus on how to change dietary and physical activity behaviours Inclusion of effective behaviour change techniques Attractive recruitment materials, emphasising relevance of programme to families |
Behaviour target 2: Improve physical activity behaviours | ||||||
Physical activities should be included in the sessions | Physical opportunity | Training Enablement | 19. Material/ guidance based on preferences of target population 36. Provide ethnically/culturally appropriate food/activities | Conception/ planning Recruitment Implementation Retention Outcome | Programmes should introduce simple physical activity opportunities within the programme | Incorporate fun physical activities into all programme sessions |
Lack of local physical activity opportunities, lack of time for physical activity and reliance on sedentary transport | Physical opportunity Psychological capability | Education Training | 22. Intervention content targets population’s social and cultural values 24. Intervention delivered in a culturally appropriate or preferred format 25. Consider target populations employment/home situations 36. Provide ethnically/culturally appropriate food/activities 39. Address structural barriers to participation | Conception/ planning Implementation Retention Outcome | Programmes should provide a tailored plan to meet the needs of the child and family (such as child age, family social and economic circumstances, ethnicity, and cultural background) | Include a range of physical activities throughout, led by the facilitator, encouraging simple movement patterns and aerobic exercise opportunities that can be performed in the home and require little time Address cultural norms resulting in perceived limitations to physical activity Discuss active transport and other walking opportunities |
Perceived dangers of undertaking physical activity | Psychological capability Automatic motivation | Training Modelling | 38. Address emotional barriers and stressors 39. Address structural barriers to participation | Implementation Retention | Programmes should introduce simple physical activity opportunities within the programme | Undertake fun and safe physical activities that can be done at home |
Parents’ perceived ability to effectively influence their child’s physical activity behaviours | Psychological capability | Enablement Training | 23. Intervention goals and outcomes are culturally appropriate 26. Intervention addresses health behaviour patterns found in target populations 38. Address emotional barriers and stressors 41. Encourage/involve social support | Conception/ planning Implementation Retention Outcome | Programmes should include behaviour change techniques to increase confidence and motivation in ability to make changes and also include parent skills training | Improved social support to encourage self-belief Encourage parental physical activity Incorporate parenting skills training Set achievable targets and rewards |
Behaviour target 3: Improve dietary habits | ||||||
A need to address both Asian and Western foods in sessions focusing on diet | Reflective motivation Social opportunity | Education Enablement | 19. Material/ guidance based on preferences of target population 27. Dietary issues unique to their context 36. Provide ethnically/culturally appropriate food/activities 43. Maintaining cultural significance of food | Conception/ planning Implementation Retention | Programmes should provide a tailored plan to meet the needs of the child and family (such as child age, family social and economic circumstances, ethnicity, and cultural background) | Nutrition education content to include traditional and Western food examples Sensitivity to the social importance of food in different cultures Encourage sharing of skills and experiences through social interactivity and support |
A need to know how to prepare healthier food | Physical capability | Training | 24. Intervention delivered in a culturally appropriate or preferred format 36. Provide ethnically/culturally appropriate food/activities 43. Maintaining cultural significance of food | Conception/ planning Implementation Outcome | Programmes should incorporate learning of practical skills such as reading nutrition labels | Include content on healthy portion sizes healthier ways to prepare traditional foods, alongside Western foods. Hands on healthy food preparation and tasting session |
Address excessive consumption of ‘junk food’ and takeaways | Psychological capability Physical opportunity | Training Enablement | 19. Material/guidance based on preferences of target population 26. Intervention addresses health behaviour patterns found in target populations | Conception/ planning Implementation Outcome | Programmes should include behaviour change techniques to increase confidence and motivation in ability to make changes and also include parent skills training | Incorporate training on parenting skills, cut down on undesirable behaviours and change food availability in the home Set achievable targets and rewards |
Difficulty understanding food labelling and purchasing healthy foods | Physical capability | Training | 19. Material/guidance based on preferences of target population 36. Provide ethnically/culturally appropriate food/activities | Conception/ planning Implementation Outcome | Programmes should incorporate learning of practical skills such as reading nutrition labels | Educational interactive activities on food labelling Hands on healthy food preparation and tasting session |
Parents’ perceived ability to influence their child’s eating behaviours | Psychological capability | Enablement Training | 23. Intervention goals and outcomes are culturally appropriate 26. Intervention addresses health behaviour patterns found in target populations 38. Address emotional barriers and stressors 41. Encourage/involve social support | Conception/ planning Implementation Retention Outcome | Programmes should include behaviour change techniques to increase confidence and motivation in ability to make changes and also include parent skills training | Improved social support to encourage self-belief Incorporate parenting skills training. Set achievable healthy eating targets and rewards |