Exploring the development and prevention of the childhood obesity epidemic in Barbados using the socio-ecological framework: a qualitative study.

Introduction: Barbados is currently experiencing an epidemic of childhood obesity, representing an urgent public health concern. The government has implemented policies encouraging healthier lifestyles. Concurrently, civil society organisations have undertaken numerous bottom-up initiatives and advocacy. Despite these efforts, there is little knowledge about how different community partners and sectors experience and perceive these initiatives or how local contextual factors affect their success. Understanding these perspectives is crucial to inform culturally appropriate and sustainable initiatives. Methods: Semi-structured interviews were conducted in May 2023 with participants (n=27) who were deemed critical in childhood obesity prevention through purposive and snowball sampling. Recruitment was facilitated by community partners, the Healthy Caribbean Coalition and the Heart and Stroke Foundation of Barbados. Interviews were then transcribed and analysed using an inductive thematic analysis framework along with the socio-ecological model to examine how different actors perceived the contributors, challenges and solutions for childhood obesity. Results: Participants highlighted several interconnected factors that contribute to childhood obesity in Barbados, such as the country's dependence on imported foods, cultural norms and preferences and the long-lasting effects of colonialism. Lack of coordination across sectors as well as a lack of resources were major obstacles to the implementation of successful interventions. Participants described numerous strategies to address childhood obesity, including the School Nutrition Policy, Sugar-Sweetened Beverage Tax, advocacy efforts and targeted community-led programmes, all of which could be striated across the socio-ecological model. Conclusion: Findings from this study show that tackling childhood obesity necessitates culturally responsive and context-specific approaches based on the perceptions and experiences of community members and sector officials. Developing and maintaining successful initiatives requires cross-sectoral collaboration and civil society engagement and buy-in. Long-term and equitable reductions in childhood obesity can be achieved by strengthening the execution of current programmes and policies while continuing to document and understand local experiences and contexts.