ERCP in patients with prior sphincterotomy has a 50% lower rate of post-ERCP pancreatitis and fewer unplanned hospital admissions.

OBJECTIVES: ERCP is essential in managing pancreaticobiliary disease, with well-documented complications. Rates of clinically significant complications are about 10%, approximately half of which is related to post-ERCP pancreatitis (PEP). We aimed to quantify the effect of previous sphincterotomy on post-endoiscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP). MATERIALS AND METHODS: Data were collated from a contemporaneously collected database of 2876 consecutive ERCP procedures of a single operator in a tertiary referral centre. Analysis was conducted using R software, and logistic regression models. RESULTS: Of 2876 procedures (mean age 63 years, 56% female), 120 (4.2%) developed PEP and 268 (9.3%) had prolonged/unplanned hospital admission. Univariate analysis showed patients with previous sphincterotomy 28/1054 (2.7%) had decreased risk of PEP compared with those without sphincterotomy 92/1822 (5.0%) (OR 0.52, p = .0021). This difference was not evident when multivariate analysis for age, sex and indication was undertaken due to a particularly low risk of PEP in stent change patients (1.4%), which were disproportionately represented in the previous sphincterotomy group. The rate of prolonged/unplanned hospital admission was recorded for a total of 2876 patients, occurring in 184/1802 (10.1%) in the native ampulla group, versus 84/1045 (8.0%) in the previous sphincterotomy group. CONCLUSIONS: The risk of PEP is halved by prior sphincterotomy. The presence of a biliary stent conferred an even lower risk of PEP (1.4%), but those without an in situ stent at the time of ERCP had a similar risk of PEP (4.6%) of prolonged/unplanned hospitalisation to those with a native ampulla.

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.

Development of rapid word-object associations in relation to expressive vocabulary: Shared commonalities in infants and toddlers with and without Williams syndrome.

Associative word learning, i.e., associating a word with an object, is an important building block of early word learning for TD infants. This study investigated the development of word-object associations by TD infants and infants and toddlers with Williams syndrome (WS), a rare genetic disorder associated with delayed language and cognitive development. The specific reasons for the language delays remain unknown. We investigated whether their early language delay could be related to differences in how word-object associations are formed. Fifty-nine 11- to 14-month-old TD infants and thirty-one 12- to 35-month-olds with WS were tested on a modified version of the "switch" task (Werker, Cohen, Lloyd, Casasola, & Stager, 1998) using phonetically dissimilar words and novel objects. Infants were classified as word learners or novice word learners based on their expressive vocabularies (greater than 10 words vs. 10 words or fewer). We found similar developmental patterns across both populations: Expressive vocabulary size classification was an important index of the development of word-object associations. Moreover, the development of word-object associations evidenced a domain-general progression from independent (processing objects separately from words) to integrated (processing associations between words and objects). As a group, word learners formed word-object associations, but novice word learners did not; instead, they focused primarily on the objects. Findings build on previous research suggesting that although early language acquisition is delayed in infants with WS, infants and toddlers with and without WS share a common developmental pattern and set of mechanisms in early word learning.

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.

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.

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.

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.

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.

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.

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 new paradigm for examining the correlates of aerobic, strength, and combined exercise: an application to gynecologic cancer survivors.

PURPOSE: Almost all exercise guidelines recommend both aerobic and strength exercise, however, few studies have simultaneously examined the correlates of meeting both exercise guidelines. Here, we propose a new paradigm that calls on researchers to examine not only the correlates of meeting the various exercise guidelines versus no guideline but also the correlates of meeting the combined guidelines versus one guideline and meeting one guideline versus the other guideline. METHODS: A random sample of 621 gynecologic cancer survivors located in Alberta, Canada, completed a mailed questionnaire. RESULTS: A multivariate multinomial logistic regression analysis indicated that (a) meeting only the aerobic exercise guideline compared to neither guideline was associated with younger age, social drinking, healthy weight, better general health, and no comorbidities; (b) meeting only the strength exercise guideline compared to neither guideline was associated with social drinking and being healthy weight; (c) meeting the combined exercise guideline compared to neither guideline was associated with social drinking, being healthy weight, and better general health; (d) meeting the aerobic guideline only compared to the strength guideline only was associated with younger age and better general health; and (e) few correlates distinguished between meeting the combined guidelines compared to a single guideline. CONCLUSIONS: Demographic and health variables are associated with meeting the various exercise guidelines versus no guideline but they are not associated with meeting the combined exercise guidelines versus a single guideline or meeting one guideline versus the other guideline. Application of this new paradigm to cancer survivors is encouraged.

An intergenerational study of perceptions of changes in active free play among families from rural areas of Western Canada.

BACKGROUND: Children's engagement in active free play has declined across recent generations. Therefore, the purpose of this study was to examine perceptions of intergenerational changes in active free play among families from rural areas. We addressed two research questions: (1) How has active free play changed across three generations? (2) What suggestions do participants have for reviving active free play? METHODS: Data were collected via 49 individual interviews with members of 16 families (15 grandparents, 16 parents, and 18 children) residing in rural areas/small towns in the Province of Alberta (Canada). Interview recordings were transcribed verbatim and subjected to thematic analysis guided by an ecological framework of active free play. RESULTS: Factors that depicted the changing nature of active free play were coded in the themes of less imagination/more technology, safety concerns, surveillance, other children to play with, purposeful physical activity, play spaces/organized activities, and the good parenting ideal. Suggestions for reviving active free play were coded in the themes of enhance facilities to keep kids entertained, provide more opportunities for supervised play, create more community events, and decrease use of technology. CONCLUSIONS: These results reinforce the need to consider multiple levels of social ecology in the study of active free play, and highlight the importance of community-based initiatives to revive active free play in ways that are consistent with contemporary notions of good parenting.

The Development and Refinement of an e-Health Screening, Brief Intervention, and Referral to Treatment for Parents to Prevent Childhood Obesity in Primary Care.

BACKGROUND: Nearly one-third of Canadian children can be categorized as overweight or obese. There is a growing interest in applying e-health approaches to prevent unhealthy weight gain in children, especially in settings that families access regularly. Our objective was to develop and refine an e-health screening, brief intervention, and referral to treatment (SBIRT) for parents to help prevent childhood obesity in primary care. MATERIALS AND METHODS: Our SBIRT, titled the Resource Information Program for Parents on Lifestyle and Education (RIPPLE), was developed by our research team and an e-health intervention development company. RIPPLE was based on existing SBIRT models and contemporary literature on children's lifestyle behaviors. Refinements to RIPPLE were guided by feedback from five focus groups (6-10 participants per group) that documented perceptions of the SBIRT by participants (healthcare professionals [n = 20], parents [n = 10], and researchers and graduate trainees [n = 8]). Focus group commentaries were transcribed in real time using a court reporter. Data were analyzed thematically. RESULTS: Participants viewed RIPPLE as a practical, well-designed, and novel tool to facilitate the prevention of childhood obesity in primary care. However, they also perceived that RIPPLE may elicit negative reactions from some parents and suggested improvements to specific elements (e.g., weight-related terms). CONCLUSIONS: RIPPLE may enhance parents' awareness of children's weight status and motivation to change their children's lifestyle behaviors but should be improved prior to implementation. Findings from this research directly informed revisions to our SBIRT, which will undergo preliminary testing in a randomized controlled trial.

A meta-study of qualitative research examining determinants of children's independent active free play.

PURPOSE: To produce a meta-study by completing a systematic review of qualitative research examining determinants of independent active free play in children. METHOD: Following systematic electronic and manual searches and application of inclusion/exclusion criteria, 46 studies were retained and subjected to meta-method, meta-theory, and meta-data analyses, followed by a final meta-synthesis. RESULTS: Identified determinants of independent active free play were child characteristics (age, competence, and gender), parental restrictions (safety concerns and surveillance), neighborhood and physical environment (fewer children to play with, differences in preferences for play spaces between parents and children, accessibility and proximity, and maintenance), societal changes (reduced sense of community, good parenting ideal, changing roles of parents, privatization of playtime and play spaces), and policy issues (need to give children voice). An ecological model depicting these factors, and the relationships therein, was created. CONCLUSIONS: This comprehensive meta-study helps establish a knowledge base for children's independent active free play research by synthesizing a previously fragmented set of studies. Parents' perceived safety concerns are the primary barrier to children's active free play. These safety concerns are moderated by child-level factors (age, competence, gender) and broader social issues. Interventions should focus on community-level solutions that include children's perspectives. From a methods perspective, the reviewed studies used a range of data collection techniques, but methodological details were often inadequately reported. The theoretical sophistication of research in this area could be improved. To this end, the synthesis reported in this study provides a framework for guiding future research.

Associations between exercise and posttraumatic growth in gynecologic cancer survivors.

PURPOSE: Exercise improves numerous psychosocial outcomes in cancer survivors; however, few studies have examined posttraumatic growth. The primary objective of this study was to examine the association between exercise and posttraumatic growth in gynecologic cancer survivors (GCS). METHODS: Using the Alberta Cancer Registry, a random sample of endometrial, ovarian, and cervical cancer survivors were mailed a self-report survey that assessed demographic and medical variables, aerobic and strength exercise, and posttraumatic growth using the posttraumatic growth inventory, impact of cancer scale, and benefit finding scale. RESULTS: Completed surveys were received from 621 (38 %) of the 1,626 eligible survivors. One-third (32.9 %) of GCS were meeting aerobic exercise guidelines and 19.0 % were meeting strength exercise guidelines. Multivariate analyses of covariance showed significant differences in the posttraumatic growth scales for aerobic exercise guidelines (p < 0.001) and combined (strength and aerobic) exercise guidelines (p < 0.001). Analyses of covariance indicated significant differences favoring those meeting the aerobic exercise guidelines for the negative impact of cancer scale (p < 0.001) and several of its subscales. Moreover, those meeting the combined exercise guidelines reported higher scores for the posttraumatic growth inventory (p = 0.014), the negative impact of cancer scale (p < 0.001), and several of their subscales compared to those meeting only one or neither guideline. Marital status moderated the association between exercise and posttraumatic growth with only unmarried GCS demonstrating the associations. CONCLUSION: Exercise is a modifiable lifestyle factor that is associated with posttraumatic growth in GCS. Randomized controlled trials testing the effects of exercise interventions on posttraumatic growth in this population are warranted.

Using Masculine Capital to Understand the Role of a Sport Program in the Lives of Men From a Western Canadian Inner City.

The purpose of this study was to examine the role of a sport program in the lives of homeless men with severe mental illnesses and addictions. Interviews were conducted with eight men who attended a floor hockey program, and data examined using categorical-content narrative methodology. Five themes captured the role of the floor hockey program in the men's lives: (a) relationships with program leader, (b) therapy, (c) community, (d) action, and (e) achievement. These themes were interpreted using theories of masculinity (Connell, 1995; Gough, 2014). Relationships with the program leader and other men, and ways in which they were allowed to play with physicality, provided opportunities to accumulate masculine capital (i.e., ways in which competence in traditionally masculine behaviors provides masculine credit). Practically, the findings suggest that sport program delivery for men such as those in this study can be enhanced by providing opportunities for accruing masculine capital.

Why don't families initiate treatment? A qualitative multicentre study investigating parents' reasons for declining paediatric weight management.

BACKGROUND: Many families referred to specialized health services for managing paediatric obesity do not initiate treatment; however, reasons for noninitiation are poorly understood. OBJECTIVE: To understand parents' reasons for declining tertiary-level health services for paediatric weight management. METHOD: Interviews were conducted with 18 parents of children (10 to 17 years of age; body mass index ≥85th percentile) who were referred for weight management, but did not initiate treatment at one of three Canadian multidisciplinary weight management clinics. A semi-structured interview guide was used to elicit parents' responses about reasons for noninitiation. Interviews were audio-recorded and transcribed verbatim. Data were managed using NVivo 9 (QSR International, Australia) and analyzed thematically. RESULTS: Most parents (mean age 44.1 years; range 34 to 55 years) were female (n=16 [89%]), obese (n=12 [66%]) and had a university degree (n=13 [71%]). Parents' reasons for not initiating health services were grouped into five themes: no perceived need for paediatric weight management (eg, perceived children did not have a weight or health problem); no perceived need for further actions (eg, perceived children already had a healthy lifestyle); no intention to initiate recommended care (eg, perceived clinical program was not efficacious); participation barriers (eg, children's lack of motivation); and situational factors (eg, weather). CONCLUSION: Physicians should not only discuss the need for and value of specialized care for managing paediatric obesity, but also explore parents' intention to initiate treatment and address reasons for noninitiation that are within their control.

HISTORIQUE: De nombreuses familles dirigées vers des services de santé spécialisés pour gérer l'obésité juvénile n'amorcent pas le traitement. On comprend mal les raisons qui les incitent à agir ainsi. OBJECTIF: Comprendre les raisons pour lesquelles les parents refusent des services de soins tertiaires pour la gestion du poids en pédiatrie. MÉTHODOLOGIE: Les chercheurs ont effectué des entrevues avec 18 parents d'enfants (de dix à 17 ans; IMC ≥85e percentile) orientés vers une gestion du poids qui n'ont pas amorcé le traitement à l'une des trois cliniques canadiennes multidisciplinaires de gestion du poids. Ils ont utilisé un guide d'entrevue semi-structuré pour obtenir les réponses des parents sur les raisons de ne pas amorcer le traitement. Les entrevues ont été enregistrées sur bande audio et transcrites in extenso. Les données ont été gérées au moyen de NVivo 9 et analysées par thèmes. RÉSULTATS: La plupart des parents (âge moyen de 44,1 ans, plage de 34 à 55 ans) était des femmes (n=16 [89 %]), obèses (n=12 [66 %]) qui avaient un diplôme universitaire (n=13 [71 %]). Les raisons pour lesquelles les parents n'amorcent pas les services de santé étaient regroupées en cinq thèmes : aucun besoin perçu de gestion du poids en pédiatrie (perception que l'enfant n'avait pas de problème de poids ou de santé), aucun besoin perçu de prendre d'autres mesures (perception que l'enfant avait déjà un mode de vie sain), aucune intention d'amorcer les soins recommandés (perception de l'inefficacité du programme clinique), obstacles à la participation (absence de motivation des enfants) et facteurs situationnels (température). CONCLUSION: Les médecins devraient non seulement discuter de la nécessité et de l'importance des soins spécialisés pour gérer l'obésité pédiatrique, mais également explorer l'intention des parents d'amorcer le traitement et les raisons de ne pas l'amorcer qui relèvent de leur compétence.