Skip to main content

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

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

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
  1. aIn Liu et al.’s Typology of cultural adaptation, each adaptation type is numbered and it is these numbers that are used in this column
  2. bNICE guideline PH47:Weight management: lifestyle services for overweight or obese children and young people