Factors Contributing to Program Commencement
When discussing the factors that led them to commence the program, the interviewees focused on anticipated outcomes and the proximity of the training venue in relation to the participants' homes. These two themes are outlined below.
Anticipated Outcomes
The parents reported that their primary motivation for enrolling their children in the resistance training program was for their children's health to improve through weight loss This was in accordance with the benefits stated in the advertisement for the program featured in the local newspaper, which included specific mention of the goal of reduced body fat. It was therefore not surprising that this factor emerged as the dominant motivator:
I think we could see that Sean was getting just a little bit of puppy fat and we thought we could strengthen him up. And also, he is a big boy so it would be nice to get his muscles moving a bit. (Sean's mother, 24 weeks)
I think it was that she wasn't doing very much in the way of exercise. She's a fairly solid sort of build, that sort of concerns her mother a little bit - partly because her father is a very solid build, quite overweight. So her mother is sort of worried about Sarah a bit, and so that was the motivation initially (that) came from her mother. And Sarah was happy to go along to it. I doubt very much that it was expressed in those terms to Sarah. (Sarah's Stepfather, 8 weeks)
Probably more the weight loss. Like I'd read they'd sort of said, you know, we're looking at children who are overweight and Tiffany was quite overweight for her height at the time. So it was like, "Oh great, this sounds like a program specifically tailored for Tiffany". (Tiffany's Mother, 24 weeks)
What were your expectations of the program? Basically for Larry to get healthy and to lose the extra weight he'd put on. (Larry's Mother, 24 weeks)
For some of the parents, an improvement in body weight was associated with enhanced self-esteem, which was another important motivator:
I think a lot of people were looking at improving self-esteem. Yeah, yeah it was good from that point of view, of self-confidence and self-esteem. (Sean's Mother, 24 weeks)
In terms of the children's motivations to commence the program, the boys were typically more interested than girls in the strength building and performance benefits of the program:
Well, I always wanted to get a bit faster because usually in the sports carnivals I always come last, so I wanted to become a bit faster. A bit of strength because my Dad always tried to push me down, but he always won and I wanted to beat him one time at least. (Aaron, 24 weeks)
My parents, I think they said, "Sean, would you like to do this program?"...They said, "You can go in and do some weights to build up some muscle", and I thought, "Oh yeah, I'll do that". (Sean, 24 weeks)
The girls tended to focus more on the general concept of health, which was described as being within a normal weight range and being fit.
It sounded interesting, and for health and fitness reasons. (Tiffany, 24 weeks)
Just because I wanted to lose weight and get healthier. (Cynthia, 24 weeks)
While most of the child interviewees were able to nominate reasons for their own interest in commencing the program, they acknowledged that initially it was their parents who wanted them to participate and made the decision to enrol them:
...I think it was more my parents wanted me to do it. (Elizabeth, 24 weeks)
My mum was the one who told me about it and I think there was an ad somewhere and she said, "Why don't you decide to do this? It will be good for you." (Sarah, 8 weeks)
Proximity
For those families living close by, a facilitator to enrol in the trial program was the close proximity of the facility to their place of residence. Most of the families lived near the University, (i.e. within five kilometres), and only few lived further afield (i.e. up to 25 kilometres). Proximity was perceived to be important because of the competing schedules of different family members that needed to be accommodated to allow attendance:
We were living only five minutes away, so we could drop her and then come back if we had things on. And some days a friend might drop her off if I was coming late home from work. So yeah, it worked in really well... We were lucky we were just living in (nearby suburb), so it was really good. (Elizabeth's Mother, 24 weeks)
As only those who participated in the trial program were interviewed, it was not possible to determine whether lack of proximity may have discouraged non-attendees from participating. However, it is likely that this played an important role given the need to accommodate siblings' and parents' other commitments and a lack of transportation options for some families.
Factors Contributing to Program Continuation
The interviewees discussed several factors that encouraged program continuation, including the quality of the program management, social aspects, supportive parents, and physical and emotional improvements. There were also factors that appeared to act as barriers. For the parents, the primary issue was cost of the program once the study period had finished, and for the children there were the issues of physical exertion and ongoing motivation in the face of other commitments. Each of these factors is discussed below.
Program Management
The parents frequently mentioned that they were very impressed with the program coordinator. They especially appreciated his pleasant and welcoming nature and the way in which he ran the program.
(The man) who was running it, he was great. (Elizabeth's Mother, 24 weeks)
What he did was fantastic...he deserves a medal that guy. (Lara's Mother, 24 weeks)
The operational aspects of the program were considered to be well designed, such as in the wide range of training and body composition measurement appointment times that were available. These covered early morning, afternoon, and weekend options for the convenience of participants and their carers:
(The program manager) understood that only a few of us could come in the morning, so like when Tiffany had to do a re-scan he would make sure that whether it was him or someone else, that someone was there to do the scan in the morning. So that worked really well. (Tiffany's Mother, 24 weeks)
One mother discussed how the trainers assisted her son in continuing with the program by ensuring the timing of sessions was appropriate for his needs. The rest of the training groups wanted to change the session to a later time, but this mother was concerned about her son's motivation waning later in the day:
He would come at 4 pm and they wanted to change it to 4:30 pm. I said to them, "Look, if I go home, if he finishes school, goes home, gets changed, sits on the couch, eats something, then he's not going to want to go anywhere." And the guy that was actually training him said, "Oh it's all right, just bring him in at 4 pm and we'll just train him at 4 pm." (Aaron's Mother, 24 weeks)
When asked if there was anything that made attending the sessions difficult, the most common response was that on occasion they would arrive late because of traffic or that parents had to leave work early to make it on time. This was not seen as a major obstacle, largely because of the high level of perceived value of the program. Parents used a variety of strategies to overcome time constraints, such as choosing early morning rather than afternoon sessions and sharing transportation with other families in the program.
Social Aspects
The social aspects of the trial program were generally perceived to be one of the most positive elements of the experience. This had not been anticipated, but was found to be an important motivator for ongoing participation. Most of the parents and children explicitly mentioned the development of friendships among the children and between the children and their trainers. The friendships were not maintained once the program was completed, but for the duration of the program they were an important reason to continue. Friendships were particularly valued by the girls:
So that was another reason for me to go, because I knew I would be catching up with (friends), whereas I wouldn't normally see them... Sometimes when I said, "Oh, I really don't want to go this week", and I knew I should because it was a research program for the students here. And I did enjoy it a lot, and I knew it would be fun, and I'd always end up having a good time. (Sarah, 8 weeks)
I thought it was really good. I mean like, at the beginning I thought I was just going to do it to lose a bit of weight, but in the end I really enjoyed it because I made friends and yeah, I also lost weight. (Cynthia, 24 weeks)
Some of the parents mentioned that while their children did not make long-lasting friends with their peers during the sessions, they still enjoyed the social aspects of interacting with both the other children and the trainers. In many cases the trainers were not just seen as the children's teachers, but also as friends and mentors. This appeared to contribute to the children's enjoyment and encouraged their continued participation in the program.
No, he didn't make friends with any of the kids. He more made friends with the students who were running the program. And then we used to see them at the shops and things like that and say, "Hello", so that was good...They used to have a laugh, and a joke, and they liked that. (Sean's Mother, 24 weeks)
The trainers were excellent with the kids. They were really, really kid orientated. So they made it lots of fun while they were doing all the work. (Elizabeth's Mother, 24 weeks)
Researcher: What were your favourite parts of the program? I suppose the actual students that were running it, they were really friendly. As you'd wait there to start the program they'd always have a big smile, "Hello, come on in and we'll start up." ...They helped us enjoy it and they were really good. (Sarah, 8 weeks)
Parental Support
Parents were found to play two primary roles in facilitating their children's ongoing involvement in the trial program. First, as noted above, they were instrumental in transporting children to and from the sessions. This was often a logistical problem that required purposeful planning by parents to overcome. The ability of parents to stay for the training sessions was appreciated by some parents because it reduced total travel time. It also allowed them to observe their children's progress and learn more about how the exercises were performed.
I tended to sit in the room and watch so I could try and see how they were telling her how to do the exercises properly, and the stretches. (Tiffany's Mother, 24 weeks)
Second, in a small number of instances it was reported that parents had to actively encourage their children to attend, particularly if they were tired or had numerous other commitments at that point in time. In the case of the one unwilling child, this encouragement took the form of bribery to ensure he completed the program:
Mum blackmailed me with things like computer games and a computer and stuff like that. (Larry, 24 weeks)
Physical and Emotional Improvements
Some of the children reported enjoying the new sense of ability derived from the exercises. This became a source of ongoing motivation to continue with the program:
I actually enjoyed it, I thought it was good. I enjoyed the exercises and knowing what I can and can't do, and being able to...I enjoyed challenging myself and being able to know more about myself and what I am capable of, and yeah, it was really good. (Sarah, 8 weeks)
Several of the parents and a few of the children mentioned that evident weight loss was a major motivator for continued participation in the program. The body composition results that were given to the families on a regular basis were found to be useful in providing a tangible measure of weight loss, which motivated continued participation in the program.
She did lose quite a bit of weight at the time. (Cynthia's Mother, 24 weeks)
It was pretty good. It actually helped Liam to lose weight. (Liam's Mother, 24 weeks).
He did really well, like with the DEXA scans and all that sort of stuff, and like you know, he'd lost five percent body fat in the research program. (Aaron's Mother, 24 weeks)
If you're really like obese, like I was, you lose heaps of weight and you just feel good. (Lara, 24 weeks)
Many of the parents also noticed improvements in their children's confidence. They reported that by giving their children an opportunity to be good at something, the program increased their self-esteem:
I think confidence was a really big thing. She got more enthusiastic as she was doing the exercises and things like that. I think that confidence is very important to children that may be a little bit chubbier than others, you know. And it's important that they get more comfortable with their physical self. Once you start feeling better and stronger, well then you go on to more things. (Cynthia's Mother, 24 weeks)
He doesn't like to do team sport. He's not that good at team sports or anything like that. It's really repetitive and I just know that whenever we tried to get him to do something he wouldn't. He was like, "Oh no, I might not be good enough", and all this sort of stuff. So the reason for this was just to get him to do something, but it was an individual thing as well. So it was just him and he knew he could do it. Like once he started doing it, he knew he could do it and he didn't have to please anybody else. It was all about himself. (Aaron's Mother, 24 weeks)
Some of the children, especially the girls, were also aware that their self-perceptions altered during the program as a result of their growing capabilities and weight loss.
I enjoyed challenging myself and being able to know more about myself and what I am capable of. (Sarah, 8 weeks)
...you just feel good about yourself; you don't feel like different to others. (Lara, 24 weeks)
Improved coordination was described by some parents as an important further reason to ensure that their children continued with the trial program. This was particularly important for the parents of the girls, perhaps reflecting a social expectation for girls to be graceful [
30].
She's not tremendously well coordinated and her coordination improved, and her overall confidence. (Cynthia's Mother, 24 weeks)
Her coordination has gotten better and her balance in general. (Tiffany's Mother, 24 weeks)
Barriers
Three potential barriers to retention were identified. Numerous parents mentioned the cost associated with migrating to the new program once the research phase was completed as a substantial barrier to continuation. Many of the parents were low income earners who could not afford the new program regardless of its benefits for their children:
I would have loved to have kept doing the program, and I would probably be doing it now, I just can't afford to do it. (Cynthia's Mother, 24 weeks)
Yeah, she really enjoyed it, she was hoping there was going to be another one, but they said they had to pay for the next one. So yeah, we just couldn't afford it. (Michelle's Mother, 24 weeks)
I came along to all of the sessions that they had. I would have liked to have continued it, but I think after the initial training sessions they did offer it, but it had a fee. So, and that's sort of what's holding us back at the moment, because I can't afford it at this point in time. (Peter's Mother, 16 weeks)
It was all good except the only thing was there was nowhere for the kids to go and exercise in a similar program after it finished. I'm on a single income so I cannot afford to pay for Larry to do another program like this one. (Larry's Mother, 24 weeks)
This finding illustrates the substantial barrier of cost, suggesting that it should be a primary consideration in programs designed for less affluent families.