A grounded theory of personal development in high-performance sport environments.

OBJECTIVES: The purpose of this study was to develop a grounded theory of how to promote personal development in high-performance sport environments. METHODOLOGY: Individual interviews were conducted with 32 members of the Canadian junior and senior national biathlon teams, including 18 athletes (9 women, 9 men, Mage = 20.8 years, SD = 2.9), 5 coaches (1 woman, 4 men), 3 technical leaders (2 women, 1 man), and 6 parents (3 mothers, 3 fathers). Follow-up interviews were conducted with five key participants. Straussian grounded theory methodology was used. Analytic techniques included open coding, constant comparison, questioning, memoing, diagramming, and theoretical integration. RESULTS: The grounded theory is based on the core category that personal development is a continual and individualized process. Three propositions represent how to promote athletes' personal development process. Proposition 1: Athletes use realistic self-evaluation and goal setting. Proposition 2: Athletes experience different situations and reflect on their areas for personal development. Proposition 3: Athletes perceive and receive social support. CONCLUSION: The grounded theory portrays propositions that can be used to promote athletes' personal development in high-performance sport environments. It may inform future applied research and the delivery of sport psychology support to high-performance athletes.

A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol.

BACKGROUND: Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families' access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children's and caregivers' acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data. METHODS: In our 2.5-year study, 108 6-17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families' barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive. DISCUSSION: Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition. TRIAL REGISTRATION: This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).

Parents as Agents of Change in Managing Pediatric Obesity: A Randomized Controlled Trial Comparing Cognitive Behavioral Therapy versus Psychoeducation Interventions.

Background: Obesity interventions for parents of children with obesity can improve children's weight and health. This randomized controlled trial (RCT) evaluated whether a parent-based intervention based on cognitive behavioral therapy (CBT) principles was superior to a parent-based intervention based on a psychoeducation program (PEP) in improving children's obesity. Methods: This study was a pragmatic, two-armed, parallel, superiority RCT. Conducted at a Canadian outpatient pediatric obesity management clinic (September 2010-January 2014), this trial included families with children 8-12 years with an age- and sex-specific BMI ≥85th percentile. The 16-week manualized interventions were similar in content and delivered to parents exclusively, with different theoretical underpinnings. The primary outcome was children's BMI z-score at postintervention (4 months). Secondary outcomes included anthropometric, lifestyle, psychosocial, and cardiometabolic variables. Data were collected at preintervention (0 months), postintervention (4 months), 10, and 16 months. Intention-to-treat analysis using linear mixed models was used to assess outcomes. Results: Among 52 randomly assigned children, the mean age (standard deviation) was 9.8 (1.7) years and BMI z-score was 2.2 (0.3). Mean differences in BMI z-score were not significantly different between the CBT (n = 27) and PEP (n = 25) groups from 0 to 4-, 10-, and 16-month follow-up. At 4 months, the mean difference in BMI z-score from preintervention between the CBT (-0.05, 95% CI = -0.09 to 0.00) and PEP (-0.04, 95% CI = -0.09 to 0.01) groups was -0.01 (95% CI = -0.08 to 0.06, p = 0.80). Similar results were found across all secondary outcomes. Conclusions: Our CBT-based intervention for parents of children with obesity was not superior in reducing BMI z-score vs. our PEP-based intervention.

The application and reporting of motivational interviewing in managing adolescent obesity: A scoping review and stakeholder consultation.

Motivational interviewing (MI) is an evidence-based counseling approach that can help individuals make positive behavioral and cognitive changes for managing obesity. We conducted a scoping review to summarize evidence on fidelity and key elements of MI-based interventions for managing adolescent obesity and examine the reporting of these interventions. Ten electronic databases and gray literature were searched systematically and included literature from January 1983 to February 2022, and 26 studies were included. Data on MI features, delivery context, training, and fidelity to treatment were summarized. Fidelity was assessed using an assessment grid with five domains-theory, training, implementation, treatment receipt, and treatment enactment. The last step of the review involved stakeholder consultation with clinician-scientists and researchers with experience in MI and managing adolescent obesity. Thirteen stakeholders were interviewed about our review findings on MI and treatment fidelity. Our analyses revealed that MI-based interventions for managing adolescent obesity had "low treatment fidelity"; no studies had "high treatment fidelity" across all five domains. Fidelity strategies adhered to the most was theory, and treatment enactment was the lowest. Stakeholders mentioned that "low treatment fidelity" may be due to increased time to complete fidelity assessments and increased cost associated with treatment fidelity. These findings have implications for planning, implementing, and evaluating MI-based interventions for managing adolescent obesity.

Recommendations from parents, administrative staff and clinicians to improve paediatric ambulatory appointment scheduling.

BACKGROUND: Stakeholders can provide valuable input to improve scheduling paediatric ambulatory clinic appointments, a complex process that requires effective planning and communication between parents, administrative staff and clinicians. The purpose of our study was to characterize recommendations from parents, administrative staff and clinicians to improve paediatric ambulatory appointment scheduling. METHODS: Conducted between February 2018 and January 2019, this qualitative study was guided by qualitative description. Data collection was completed using focus groups with three stakeholder groups: parents, administrative staff and clinicians. Participants provided recommendations to optimize paediatric ambulatory appointment scheduling at the Stollery Children's Hospital in Edmonton, Alberta, Canada. Focus group data were transcribed verbatim and analysed using manifest inductive content analysis. RESULTS: Forty-six participants (mean age: 42.7; 87% female) participated in 12 focus groups. Parents (n = 11), administrative staff (n = 22) and clinicians (n = 13) made recommendations that were organized into two categories: appointment triaging and arranging. Triaging recommendations were related to appointment availability (e.g. providing alternatives to cancelling clinics with short notice) and waitlist management (e.g. developing clear and consistent policies regarding information flow and communication between clinics and administrative staff). Appointment arranging recommendations referred to booking (e.g. directly involving parents in the booking process), reminders (e.g. using text message reminders) and attendance (e.g. providing parents with a single point of contact who can provide the correct information about late and cancellation policies). Recommendations were similar across stakeholder groups. CONCLUSION: Our findings showed congruent recommendations across stakeholder groups to address challenges with scheduling ambulatory appointments, many of which have the potential to be modified. Experimental research and quality improvement initiatives are needed to determine the feasibility, acceptability and effectiveness of stakeholder recommendations to improve triaging and scheduling paediatric ambulatory appointments.

How Do Sport Parents Engage in Autonomy-Supportive Parenting in the Family Home Setting? A Theoretically Informed Qualitative Analysis.

The purpose of this study was to identify and examine how sport parents engage in autonomy-supportive parenting in the family home setting. A total of 44 parents and children from 19 families were initially interviewed. Data from these families were profiled to identify seven families that adopted a highly autonomy-supportive parenting style. The seven families' data were then examined using a theoretically focused qualitative analysis using the three dimensions of autonomy-supportive parenting. Sport parents engaged in autonomy support (vs. control) through flexible conversations and supporting decision making. The themes of boundary setting and establishing expectations based on values were indicative of structure. The authors found high levels of involvement across contexts. These findings depict the nature and types of social interactions in the family home that created an autonomy-supportive emotional climate, which often extended to sport, providing a foundation for future theoretical development and applied research in sport.

Pediatric ambulatory appointment scheduling: a qualitative study of stakeholders' perceptions and experiences.

OBJECTIVE: Scheduling ambulatory clinic appointments includes a complex set of factors and diverse stakeholders. Families, administrative staff and clinicians may have varied experiences with scheduling clinic appointments. The objective of our study was to understand stakeholders' perceptions and experiences with scheduling pediatric ambulatory clinic appointments. DESIGN: Guided methodologically by qualitative description, focus groups were conducted separately with three stakeholder groups and analyzed using qualitative content analysis. SETTING: This qualitative study was completed at a children's hospital in Alberta, Canada. PARTICIPANTS: Parents, administrative professionals and clinicians who used the pediatric ambulatory scheduling system regularly to elicit perceptions and experiences about issues and areas where improvements could be made. RESULTS: Across 12 focus groups, parents (n = 11), administrative professionals (n = 23) and clinicians (n = 13) discussed areas for improvement related to the pediatric ambulatory scheduling system. The perceived areas for improvement were grouped into three categories regarding levels of influence: (i) 'intrapersonal': knowledge, skills and behaviors (e.g. insufficient training of administrative professionals); (ii) 'interpersonal': communication processes (e.g. parents not receiving confirmation letters); and (iii) 'institutional': structures and processes (e.g. varying practices and processes across clinics). CONCLUSIONS: Stakeholders provided a rich description of the interrelated factors and processes that influenced the scheduling of pediatric ambulatory clinic appointments. Multilevel, experimental interventions are needed to test whether the findings described herein can enhance the structure and function of pediatric ambulatory appointment scheduling.

Experiences in Physical Education for Children at Risk for Developmental Coordination Disorder.

Children with developmental coordination disorder (DCD) may experience stress in physical activity contexts due to emphasis on their poor motor skills. The purpose of this study was to explore the lived experiences of children at risk for DCD in physical education in order to develop a deeper understanding about what they experience as stress and how they cope with it. Using interpretative phenomenological analysis, six children in Grades 4-6 participated in two semistructured interviews. A motivational (and developmental) stress and coping theory informed interpretation of the three themes that described the children's experiences: (a) they hurt me-psychological and physical harm sustained from peers, (b) it's hard for me-difficulties encountered in activities, and (c) I have to-pressure to meet the teacher's demands. Although the children at risk for DCD were confronted with various stressors in physical education, they coped more adaptively when social support was provided.

Continued attendance for paediatric weight management: A multicentre, qualitative study of parents' reasons and facilitators.

Although prolonged engagement in paediatric weight management (PWM) is associated with positive treatment outcomes, little is currently known about enablers of long-term programme attendance. The purpose of our study was to explore families' reasons for and facilitators of their continued attendance at health services for PWM. Semi-structured, individual interviews were conducted with parents of children (10-17 year old; body mass index ≥85th percentile) who completed the active phase of treatment in one of four Canadian multidisciplinary clinics for PWM. Interview data were recorded digitally, transcribed verbatim and analysed thematically. Parents' (n = 40) reasons for continued clinic attendance included ongoing concerns (eg, parental concern about their child's health), actual and expected benefits from treatment (eg, lifestyle improvements) and perceived quality of care (eg, structured, comprehensive, tailored health services). Several logistical and motivational factors contributed to continued attendance, including flexible work schedules, flexible appointment times, financial resources and children's motivation for treatment. Helping families address treatment barriers and ensuring that weight management services meet families' treatment expectations are promising strategies to enhance retention in PWM to optimize health outcomes.

A Meta-Study of Qualitative Research Examining Sport and Recreation Experiences of Indigenous Youth.

Participation in sport and recreation may contribute to various holistic benefits among Indigenous youth in Canada. However, there is a need for a consolidated evidence base to support the development of sport and recreation opportunities that could facilitate such holistic benefits. The purpose of this research was to produce a meta-study of qualitative research examining sport and recreation experiences of Indigenous youth in Canada. Following record identification and screening, 20 articles were retained for analysis and synthesis. Strengths and weaknesses of included studies were identified through the meta-method and meta-theory analysis. The meta-data analysis revealed five themes that represent the sport and recreation experiences of Indigenous youth. Working collaboratively with community members, our final meta-synthesis situated these five themes within the integrated Indigenous ecological model. This review consolidates the qualitative evidence base, and provides direction for future research and practice.

Female Athletes' Experiences of Positive Growth Following Deselection in Sport.

The purpose of this study was to explore female athletes' experiences of positive growth following deselection from provincial sport teams. Interviews were conducted with 18 women (Mage = 22.45 years, SD = 1.38) who were deselected from provincial soccer, ice hockey, and volleyball teams as adolescents. Interpretative phenomenological analysis methodology was used. The analysis was guided by Tedeschi and Calhoun's model of posttraumatic growth. Results showed that participants questioned their identity and ability as athletes following deselection. Growth was a gradual process that unfolded over several years, experienced through a greater appreciation of the role of sport in the participants' lives and sport becoming a priority, an enhanced sense of personal strength, developing closer social relationships, and a recognition of new and other opportunities. These findings show that cognitive processes and social relationships are critical components in the process of positive growth.

Mediating Effects of Parents' Coping Strategies on the Relationship Between Parents' Emotional Intelligence and Sideline Verbal Behaviors in Youth Soccer.

The overall purpose of this study was to examine the mediating effects of parents' coping strategies on the relationship between parents' emotional intelligence and sideline verbal behaviors during their children's soccer games. Participants were 232 parents (120 mothers and 110 fathers) of youth soccer players age 9-13 years. Observations in situ were carried out at 30 soccer games during a soccer tournament. At the end of the game, parents were approached and asked to complete the Emotional Intelligence Scale and the Brief COPE scale. Structural-equation-modeling analyses revealed that adaptive and maladaptive coping mediated the relationship between regulation of emotion and parents' praise/encouragement, and negative and derogatory comments during the game. In addition, game result moderated the relationships between emotional intelligence, coping strategies, and parent behaviors. Emotional regulation and adaptive coping may promote desirable parent sideline behaviors and reduce undesirable behaviors.

Factors associated with using research evidence in national sport organisations.

The purpose of this study was to explore factors associated with the use of research evidence in Canadian National Sport Organisations (NSOs). Data were collected via individual semi-structured interviews with 21 representatives from Canadian NSOs. A qualitative description approach was used. Interviews were transcribed verbatim and subjected to an inductive-to-deductive thematic analysis. A research implementation framework (Rycroft-Malone, 2004) was used to organise inductively derived themes into the higher-order categories of evidence (use of evidence, disconnection between research and practice), context (lack of capacity, organisational structure), and facilitation (personal connections with researchers and sport scientists, formal meetings with stakeholders). Overall, NSO representatives did not have a clear understanding of evidence and lacked capacity to access and translate research. However, some context factors, along with internal and external facilitators, were in place and could be used to enhance research implementation.

Parent Recommendations to Enhance Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management.

OBJECTIVE: To explore parents' recommendations to enhance enrollment in multidisciplinary clinical care for managing pediatric obesity. STUDY DESIGN: Data for this interpretative description study were collected through individual, semistructured interviews that were audiorecorded, transcribed verbatim, and analyzed thematically. Parents (n = 79) were recruited from 4 multidisciplinary weight management clinics in Canada located in Edmonton, Hamilton, Montreal, and Vancouver. RESULTS: Most interviewed parents had children with obesity (body mass index ≥95th percentile; 84.2%), were female (87.3%), had postsecondary education (69.6%), and were white (75.9%). Parents' recommendations referred to enrollment opportunities, information about obesity services, motivation for treatment, and accessibility to obesity services. Specifically, parents recommended to increase referral options and follow-up contacts with families during the enrollment process, inform referring physicians and families about the availability and characteristics of obesity services, enhance families' motivation for treatment, prevent families from getting discouraged, make services more appealing to families, and address accessibility issues (eg, offering multiple options for appointment times, providing support for transportation). CONCLUSIONS: Parents' recommendations support the need for family-centered approaches to enhance enrollment; however, their feasibility, acceptability, and effectiveness remain to be tested empirically.

Families' perceived benefits of home visits for managing paediatric obesity outweigh the potential costs and barriers.

AIM: Home visits have successfully been used to deliver various health services, but what role could they play in paediatric weight management? Low treatment initiation and high attrition prompted our multidisciplinary paediatric weight management clinic to investigate how families perceived the benefits and barriers of home visits. METHODS: We focused on children with obesity aged 2-17 who were enrolled in our tertiary-level clinic in Alberta, Canada. None had received a home visit. The families were interviewed face-to-face from October 2015 to October 2016, and we used a qualitative description methodological framework and manifest content analysis. The parents were the main interviewees. RESULTS: Of the 56 families, 89% were interested in a home visit, 82% wanted support from a dietician and 54% from an exercise specialist. The perceived benefits of home visits included comprehensive assessment (95%), convenience (86%), tailored care (29%) and family involvement (13%), while the costs and barriers included clinicians' potential judgmental attitudes (30%), loss of privacy (19%) and distractions (10%). Some thought clinicians would find home visits inconvenient (25%), with bureaucratic challenges (14%) and sustainability issues (5%). CONCLUSION: Families felt home visits were a convenient option for managing paediatric obesity and identified important benefits and barriers that could guide such interventions.

The readiness and motivation interview for families (RMI-Family) managing pediatric obesity: study protocol.

BACKGROUND: Experts recommend that clinicians assess motivational factors before initiating care for pediatric obesity. Currently, there are no well-established clinical tools available for assessing motivation in youth with obesity or their families. This represents an important gap in knowledge since motivation-related information may shed light on which patients might fail to complete treatment programs. Our study was designed to evaluate the measurement properties and utility of the Readiness and Motivational Interview for Families (RMI-Family), a structured interview that utilizes a motivational interviewing approach to (i) assess motivational factors in youth and their parents, and (ii) examine the degree to which motivation and motivation-related concordance between youth and parents are related to making changes to lifestyle habits for managing obesity in youth. METHODS: From 2016 to 2020, this prospective study will include youth with obesity (body mass index [BMI] ≥97th percentile; 13-17 years old; n = 250) and their parents (n = 250). The study will be conducted at two primary-level, multidisciplinary obesity management clinics based at children's hospitals in Alberta, Canada. Participants will be recruited and enrolled after referral to these clinics, but prior to initiating clinical care. Each youth and their parent will complete the RMI-Family (~1.5 h) at baseline, and 6- and 12-months post-baseline. Individual (i.e., youth or parent) and family-level (i.e., across youth and parent) responses to interview questions will be scored, as will aspects of interview administration (e.g., fidelity to motivational interviewing tenets). The RMI-Family will also be examined for test-retest reliability. Youth data collected at each time point will include demography, anthropometry, lifestyle habits, psychosocial functioning, and health services utilization. Cross-sectional and longitudinal associations between individual and family-level interview scores on the RMI-Family and these clinical measures will be examined. DISCUSSION: As a measurement tool drawing on family-centered care and motivational interviewing, the RMI-Family was designed to increase understanding of the role of motivational factors in pediatric obesity management, allowing healthcare providers and policymakers to manage pediatric obesity more effectively and efficiently. Findings will help to create an innovative, tailored model of health care delivery that uses resources judiciously and is designed to best meet families' needs.

A grounded theory of positive youth development through sport based on results from a qualitative meta-study.

The overall purpose of this study was to create a model of positive youth development (PYD) through sport grounded in the extant qualitative literature. More specifically, the first objective was to review and evaluate qualitative studies of PYD in sport. The second objective was to analyze and synthesize findings from these studies. Following record identification and screening, 63 articles were retained for analysis. Meta-method analysis revealed strengths of studies were the use of multiple data collection and validity techniques, which produced high-quality data. Weaknesses were limited use of 'named' methodologies and inadequate reporting of sampling procedures. Philosophical perspectives were rarely reported, and theory was used sparingly. Results of an inductive meta-data analysis produced three categories: PYD climate (adult relationships, peer relationships, and parental involvement), life skills program focus (life skill building activities and transfer activities), and PYD outcomes (in personal, social, and physical domains). A model that distinguishes between implicit and explicit processes to PYD is presented.

A Pilot Randomized, Controlled Trial of a Wall Climbing Intervention for Gynecologic Cancer Survivors.

PURPOSE/OBJECTIVES: To examine the feasibility and preliminary efficacy of an eight-week supervised climbing intervention for gynecologic cancer survivors (GCSs).
. DESIGN: A pilot randomized, controlled trial.
. SETTING: The Wilson Climbing Center in Edmonton, Alberta, Canada.
. SAMPLE: 35 GCSs who had completed cancer therapy.
. METHODS: GCSs were randomized to an eight-week (16 session) supervised wall climbing intervention (WCI) (n = 24) or usual care (UC) (n = 11).
. MAIN RESEARCH VARIABLES: Feasibility outcomes included recruitment rate, adherence rate, skill performance, and safety. Preliminary efficacy outcomes were objective health-related and functional fitness assessed before and after the eight-week intervention using the Senior Fitness Test.
. FINDINGS: Median adherence to the WCI was 13.5 of 16 sessions. Most GCSs were proficient on 16 of 24 skill assessment items. No serious adverse events were reported. Based on intention-to-treat analyses, the WCI group was superior to the UC group for the 6-minute walk, 30-second chair stand, 30-second arm curls, sit and reach, 8-foot up-and-go, grip strength-right, and grip strength-left assessments.
. CONCLUSIONS: The Gynecologic Cancer Survivors Wall Climbing for Total Health (GROWTH) Trial demonstrated that an eight-week supervised WCI was safe, feasible, and improved functional fitness in GCSs. Phase II and III trials are warranted to further establish the safety, feasibility, and efficacy of WCIs in cancer survivors.
. IMPLICATIONS FOR NURSING: Oncology nurses may consider a climbing wall as an alternative type of physical activity for improving functional fitness in GCSs.

Predictors of Short- and Long-Term Attrition From the Parents as Agents of Change Randomized Controlled Trial for Managing Pediatric Obesity.

INTRODUCTION: Attrition in pediatric weight management is a substantial problem. This study examined factors associated with short- and long-term attrition from a lifestyle and behavioral intervention for parents of children with overweight or obesity. METHOD: Fifty-two families with children ages 6 to 12 years old and body mass index at or above the 85th percentile participated in a randomized controlled trial focused on parents, comparing parent-based cognitive behavioral therapy with parent-based psychoeducation for pediatric weight management. We examined program attrition using two clinical phases of the intervention: short-term and long-term attrition, modeled using the general linear model. Predictors included intervention type, child/parent weight status, sociodemographic factors, and health of the family system. RESULTS: Higher self-assessed health of the family system was associated with lower short-term attrition; higher percentage of intervention sessions attended by parents was associated with lower long-term attrition. DISCUSSION: Different variables were significant in our short- and long-term models. Attrition might best be conceptualized based on short- and long-term phases of clinical, parent-based interventions for pediatric weight management.

Why do parents discontinue health services for managing paediatric obesity? A multi-centre, qualitative study.

OBJECTIVE: To explore parents' reasons for discontinuing tertiary-level care for paediatric weight management. METHODS: Participants were parents of 10-17year olds (body mass index [BMI] ≥85th percentile) who were referred for paediatric weight management. Parents were recruited from three Canadian sites (Vancouver, BC; Edmonton, AB; Hamilton, ON) and were eligible if their children attended at least one clinical appointment and subsequently discontinued care. Data were collected using semi-structured individual interviews that were digitally recorded, transcribed, and analysed using an inductive manifest content analysis. RESULTS: Parents (n=29) of children [mean age: 14.7±1.8years; mean BMI percentile: 98.9±1.6; n=17 (58.6%) boys] were primarily female (n=26; 89.7%), Caucasian (n=22; 75.9%), and had a university degree (n=23; 79.3%). Reasons for discontinuing care were grouped into three categories: (i) family factors (e.g., perceived lack of progress, lack of family support, children's lack of motivation), (ii) logistical factors (e.g., monetary costs, distance, scheduling), and (iii) health services factors (e.g., unmet expectations of care, perceived limited menu of services, no perceived need for further support). CONCLUSIONS: A range of multi-level factors influenced attrition from tertiary-level paediatric weight management. Our data suggest that experimental research is needed to examine whether addressing reasons for attrition can enhance families' retention in care and ultimately improve health outcomes for children living with obesity.