What practices do parents perceive as effective or ineffective in promoting a healthy diet, physical activity, and less sitting in children: parent focus groups

BMC Public Health

Ilse De Bourdeaudhuij¹  Greet Cardon¹  Maïté Verloigne¹  Ann DeSmet¹  Sara De Lepeleere¹ 

[1] Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000 Ghent, Belgium

关键词: SCT;    SDT;    Sedentary behavior;    Physical activity;    Healthy diet;    Children;    Parenting;   

Others  :  1161560
DOI  :  10.1186/1471-2458-13-1067

 received in 2013-05-21, accepted in 2013-10-09,  发布年份 2013

【 摘 要 】

Background

To support parents in improving the health of their young children, examples of effective parenting practices for a healthy diet, physical activity (PA) and sedentary behavior (SB) are needed. This study explores perceived effective and ineffective parenting practices in difficult situations concerning raising healthy children and investigates their relationship with Self-Determination Theory (SDT) and Social Cognitive Theory (SCT). The current study is formative work to inform the content of a randomized controlled trial.

Methods

Four focus groups were conducted between June and October 2012 at worksites during lunch break. A total of 21 unrelated parents of primary schoolchildren (6 fathers, 15 mothers) participated. A short written questionnaire introduced typical difficult situations derived from parental anecdotal reports, concerning healthy diet, PA and SB. These situations formed the backbone for the subsequent focus group discussion. In October 2012, discussions were audio-recorded and analyzed in Nvivo to identify key response items using thematic analysis.

Results

Parents experienced explaining why the child should behave healthily, monitoring, being consistent, offering alternatives, reacting empathetically, modeling, motivating, increasing intrinsic value and availability, and using time-out as effective practices, whereas anger was considered ineffective. Opinions were mixed about the effectiveness of giving as much freedom as possible, obliging, rewarding and punishing, and setting rules and agreements. Parenting practices were consistent with principles from both SDT and SCT.

Conclusions

Parents identified numerous perceived effective practices to respond to their child’s health-related behavior. Since many of them coincide with the evidence base and the success of a parenting program depends upon the degree to which parents’ concerns and motivations are integrated into the program design, important opportunities are created for future intervention programs.

【 授权许可】

   
2013 De Lepeleere et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Maffeis C: Aetiology of overweight and obesity in children and adolescents. Eur J Pediatr 2000, 159(Suppl 1):S35-S44.
• [2]Magnusson MB, Sjoberg A, Kjellgren KI, Lissner L: Childhood obesity and prevention in different socio-economic contexts. Prev Med 2011, 53:402-407.
• [3]de Jong E, Schokker DF, Visscher TL, Seidell JC, Renders CM: Behavioural and socio-demographic characteristics of Dutch neighbourhoods with high prevalence of childhood obesity. Int J Pediatr Obes 2011, 6:298-305.
• [4]Ekelund U, Luan J, Sherar LB, Esliger DW, Griew P, Cooper A: Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA 2012, 307:704-712.
• [5]Gerards SM, Sleddens EF, Dagnelie PC, de Vries NK, Kremers SP: Interventions addressing general parenting to prevent or treat childhood obesity. Int J Pediatr Obes 2011, 6:e28-e45.
• [6]Michels N, Sioen I, Braet C, Eiben G, Hebestreit A, Huybrechts I, et al.: Stress, emotional eating behaviour and dietary patterns in children. Appetite 2012, 59:762-769.
• [7]Santiago S, Cuervo M, Zazpe I, Ortega A, Garcia-Perea A, Martinez JA: Weight status, dietary habits and physical activity among 6–12 year-old children in Castile-La Mancha. An Pediatr (Barc)in press
• [8]Riddoch CJ, Mattocks C, Deere K, Saunders J, Kirkby J, Tilling K, et al.: Objective measurement of levels and patterns of physical activity. Arch Dis Child 2007, 92:963-969.
• [9]Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, et al.: Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act 2011, 8:98. BioMed Central Full Text
• [10]Mikkila V, Rasanen L, Raitakari OT, Marniemi J, Pietinen P, Ronnemaa T, et al.: Major dietary patterns and cardiovascular risk factors from childhood to adulthood. The Cardiovascular Risk in Young Finns Study. Br J Nutr 2007, 98:218-225.
• [11]Hingle MD, O’Connor TM, Dave JM, Baranowski T: Parental involvement in interventions to improve child dietary intake: a systematic review. Prev Med 2010, 51:103-111.
• [12]Janz KF, Burns TL, Levy SM: Tracking of activity and sedentary behaviors in childhood: the Iowa Bone Development Study. Am J Prev Med 2005, 29:171-178.
• [13]Telama R: Tracking of physical activity from childhood to adulthood: a review. Obes Facts 2009, 2:187-195.
• [14]Biddle SJ, Pearson N, Ross GM, Braithwaite R: Tracking of sedentary behaviours of young people: a systematic review. Prev Med 2010, 51:345-351.
• [15]Sonneville KR, La Pelle N, Taveras EM, Gillman MW, Prosser LA: Economic and other barriers to adopting recommendations to prevent childhood obesity: results of a focus group study with parents. BMC Pediatr 2009, 9:81. BioMed Central Full Text
• [16]Gustafson SL, Rhodes RE: Parental correlates of physical activity in children and early adolescents. Sports Med 2006, 36:79-97.
• [17]Beets MW, Cardinal BJ, Alderman BL: Parental social support and the physical activity-related behaviors of youth: a review. Health Educ Behav 2010, 37:621-644.
• [18]Lindsay AC, Sussner KM, Kim J, Gortmaker S: The role of parents in preventing childhood obesity. Future Child 2006, 16:169-186.
• [19]Campbell K, Hesketh K, Crawford D, Salmon J, Ball K, McCallum Z: The Infant Feeding Activity and Nutrition Trial (INFANT) an early intervention to prevent childhood obesity: cluster-randomised controlled trial. BMC Public Health 2008, 8:103. BioMed Central Full Text
• [20]Trost SG, Loprinzi PD: Parental Influences on Physical Activity Behavior in Children and Adolescents: A Brief Review. Am J Lifestyle Med 2011, 5:171-181.
• [21]Sallis JF, Prochaska JJ, Taylor WC: A review of correlates of physical activity of children and adolescents. Med Sci Sports Exerc 2000, 32:963-975.
• [22]Nowicka P, Flodmark CE: Family in pediatric obesity management: a literature review. Int J Pediatr Obes 2008, 3(Suppl 1):44-50.
• [23]Young KM, Northern JJ, Lister KM, Drummond JA, O’Brien WH: A meta-analysis of family-behavioral weight-loss treatments for children. Clin Psychol Rev 2007, 27:240-249.
• [24]Kitzmann KM, Beech BM: Family-based interventions for pediatric obesity: methodological and conceptual challenges from family psychology. J Fam Psychol 2006, 20:175-189.
• [25]Bentley GF, Goodred JK, Jago R, Sebire SJ, Lucas PJ, Fox KR, et al.: Parents’ views on child physical activity and their implications for physical activity parenting interventions: a qualitative study. BMC Pediatr 2012, 12:180. BioMed Central Full Text
• [26]Jago R, Sebire SJ, Turner KM, Bentley GF, Goodred JK, Fox KR, et al.: Feasibility trial evaluation of a physical activity and screen-viewing course for parents of 6 to 8 year-old children: Teamplay. Int J Behav Nutr Phys Act 2013, 10:31. BioMed Central Full Text
• [27]Maccoby E, Martin J: Socialization in the context of the family: parent–child interaction. In Handbook of child psychology. Volume IV. 4th edition. Edited by Mussen P, Hetherington E. Canada: Wiley; 1983:1-103.
• [28]Sleddens EF, Gerards SM, Thijs C, de Vries NK, Kremers SP: General parenting, childhood overweight and obesity-inducing behaviors: a review. Int J Pediatr Obes 2011, 6:e12-e27.
• [29]Hinkley T, Salmon J, Okely AD, Hesketh K, Crawford D: Correlates of preschool children’s physical activity. Am J Prev Med 2012, 43:159-167.
• [30]Wardle J, Carnell S: Parental feeding practices and children’s weight. Acta Paediatr Suppl 2007, 96:5-11.
• [31]Faith MS, Scanlon KS, Birch LL, Francis LA, Sherry B: Parent–child feeding strategies and their relationships to child eating and weight status. Obes Res 2004, 12:1711-1722.
• [32]Nyberg G, Sundblom E, Norman A, Elinder LS: A healthy school start - parental support to promote healthy dietary habits and physical activity in children: design and evaluation of a cluster-randomised intervention. BMC Public Health 2011, 11:185. BioMed Central Full Text
• [33]De Bock F, Fischer JE, Hoffmann K, Renz-Polster H: A participatory parent-focused intervention promoting physical activity in preschools: design of a cluster-randomized trial. BMC Public Health 2010, 10:49. BioMed Central Full Text
• [34]Paineau DL, Beaufils F, Boulier A, Cassuto DA, Chwalow J, Combris P, et al.: Family dietary coaching to improve nutritional intakes and body weight control: a randomized controlled trial. Arch Pediatr Adolesc Med 2008, 162:34-43.
• [35]Thompson D, Baranowski T, Cullen K, Watson K, Liu Y, Canada A, et al.: Food, fun, and fitness internet program for girls: pilot evaluation of an e-Health youth obesity prevention program examining predictors of obesity. Prev Med 2008, 47:494-497.
• [36]West F, Sanders MR, Cleghorn GJ, Davies PS: Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change. Behav Res Ther 2010, 48:1170-1179.
• [37]Patrick K, Calfas KJ, Norman GJ, Zabinski MF, Sallis JF, Rupp J, et al.: Randomized controlled trial of a primary care and home-based intervention for physical activity and nutrition behaviors: PACE+ for adolescents. Arch Pediatr Adolesc Med 2006, 160:128-136.
• [38]Crespo NC, Elder JP, Ayala GX, Slymen DJ, Campbell NR, Sallis JF, et al.: Results of a Multi-level Intervention to Prevent and Control Childhood Obesity among Latino Children: The Aventuras Para Ninos Study. Ann Behav Med 2012, 43:84-100.
• [39]Escobar-Chaves SL, Markham CM, Addy RC, Greisinger A, Murray NG, Brehm B: The Fun Families Study: intervention to reduce children’s TV viewing. Obesity (Silver Spring) 2010, 18(Suppl 1):S99-S101.
• [40]Olds DL, Sadler L, Kitzman H: Programs for parents of infants and toddlers: recent evidence from randomized trials. J Child Psychol Psychiatry 2007, 48:355-391.
• [41]Bandura A: Self-efficacy: the exercise of control. New York: Freeman; 1997.
• [42]Joussemet M, Landry R, Koestner R: A Self-Determination Theory Perspective on Parenting. Canadian Psychology-Psychologie Canadienne 2008, 49:194-200.
• [43]Glanz K, Rimer BK, Lewis FM: Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons; 2002.
• [44]Scott S, Dadds MR: Practitioner review: When parent training doesn’t work: theory-driven clinical strategies. J Child Psychol Psychiatry 2009, 50:1441-1450.
• [45]Bandura A: Social foundations of thougth and action: A social cognitive theory. Englewood Cliffs, N.J: Prentice-Hall; 1986.
• [46]Stice E, Shaw H, Marti CN: A meta-analytic review of obesity prevention programs for children and adolescents: the skinny on interventions that work. Psychol Bull 2006, 132:667-691.
• [47]Deci EL, Ryan RM: The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychol Inq 2000, 11:227-268.
• [48]Deci EL: Why we do wat we do: understanding self-motivation. New York: Penguin; 1995.
• [49]Grolnick WS, Deci EL, Ryan RM: Internalization within the family: the Self-Determination Theory Perspective. In Parenting and children’s internalization of values: A handbook of contemporary theory. Edited by Grusec JE, Kuczynski L. Hoboken, NJ, US: John Wiley & Sons Inc; 1997:135-161.
• [50]Baranowski T, Davis M, Resnicow K, Baranowski J, Doyle C, Lin LS, et al.: Gimme 5 fruit, juice, and vegetables for fun and health: outcome evaluation. Health Educ Behav 2000, 27:96-111.
• [51]Reynolds KD, Franklin FA, Binkley D, Raczynski JM, Harrington KF, Kirk KA, et al.: Increasing the fruit and vegetable consumption of fourth-graders: results from the high 5 project. Prev Med 2000, 30:309-319.
• [52]O’Connor TM, Jago R, Baranowski T: Engaging parents to increase youth physical activity a systematic review. Am J Prev Med 2009, 37:141-149.
• [53]Sleddens EF, Kremers SP, Hughes SO, Cross MB, Thijs C, de Vries NK, et al.: Physical activity parenting: a systematic review of questionnaires and their associations with child activity levels. Obes Rev 2012, 13:1015-1033.
• [54]Bartholomew LK, Parcel GS, Kok G, Gottlieb NH: Planning health promotion programs: an intervention mapping approach. 3rd edition. San Francisco, Calif: Jossey-Bass; 2011.
• [55]Hesketh K, Waters E, Green J, Salmon L, Williams J: Healthy eating, activity and obesity prevention: a qualitative study of parent and child perceptions in Australia. Health Promot Int 2005, 20:19-26.
• [56]Attride-Stirling J: Thematic networks: an analytic tool for qualitative research. Qual Res 2001, 1:385-405.
• [57]Kaminski JW, Valle LA, Filene JH, Boyle CL: A meta-analytic review of components associated with parent training program effectiveness. J Abnorm Child Psychol 2008, 36:567-589.
• [58]Trost SG, Sallis JF, Pate RR, Freedson PS, Taylor WC, Dowda M: Evaluating a model of parental influence on youth physical activity. Am J Prev Med 2003, 25:277-282.
• [59]Davison KK, Cutting TM, Birch LL: Parents’ activity-related parenting practices predict girls’ physical activity. Med Sci Sports Exerc 2003, 35:1589-1595.
• [60]Dowda M, Dishman RK, Pfeiffer KA, Pate RR: Family support for physical activity in girls from 8th to 12th grade in South Carolina. Prev Med 2007, 44:153-159.
• [61]Deci EL, Driver RE, Hotchkiss L, Robbins RJ, Wilson IM: The relation of mothers’ controlling vocalizations to children’s intrinsic motivation. J Exp Child Psychol 1993, 55:151-162.
• [62]Ryan RM, Deci EL: Self-regulation and the problem of human autonomy: does psychology need choice, self-determination, and will? J Pers 2006, 74:1557-1585.
• [63]Borra ST, Kelly L, Shirreffs MB, Neville K, Geiger CJ: Developing health messages: qualitative studies with children, parents, and teachers help identify communications opportunities for healthful lifestyles and the prevention of obesity. J Am Diet Assoc 2003, 103:721-728.
• [64]Sebire SJ, Jago R, Gorely T, Hoyos CI, Biddle SJ: “If there wasn’t the technology then I would probably be out everyday”: a qualitative study of children’s strategies to reduce their screen viewing. Prev Med 2011, 53:303-308.
• [65]Lepper MR, Gilovich T: Accentuating the positive: Eliciting generalized compliance from children through activity-oriented requests. J Pers Soc Psychol 1982, 42:248-259.
• [66]Ryan RM, Deci EL: When rewards compete with nature: The undermining of intrinsic motivation and self-regulation. In Intrinsic and extrinsic motivation: The search for optimal motivation and performance. Volume 19. Edited by Sansone C, Harackiewicz J. San Diego, CA, USA: Academic Press; 2000.
• [67]Gurland ST, Glowacky VC: Children’s theories of motivation. J Exp Child Psychol 2011, 110:1-19.
• [68]Deci EL, Koestner R, Ryan RM: A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol Bull 1999, 125:627-668.
• [69]Pate RR, Mitchell JA, Byun W, Dowda M: Sedentary behaviour in youth. Br J Sports Med 2011, 45:906-913.
• [70]Dorey E, Roberts V, Maddison R, Meagher-Lundberg P, Dixon R, Ni MC: Children and television watching: a qualitative study of New Zealand parents’ perceptions and views. Child Care Health Dev 2010, 36:414-420.
• [71]Haerens L, Craeynest M, Deforche B, Maes L, Cardon G, De Bourdeaudhuij I: The contribution of psychosocial and home environmental factors in explaining eating behaviours in adolescents. Eur J Clin Nutr 2008, 62:51-59.
• [72]Pearson N, Biddle SJ, Gorely T: Family correlates of fruit and vegetable consumption in children and adolescents: a systematic review. Public Health Nutr 2009, 12:267-283.
• [73]Lopez-Dicastillo O, Grande G, Callery P: Parents’ contrasting views on diet versus activity of children: implications for health promotion and obesity prevention. Patient Educ Couns 2010, 78:117-123.
• [74]Birch LL: Obesity and Eating Disorders - A Developmental Perspective. Bull Psychon Soc 1991, 29:265-272.
• [75]Campbell KJ, Crawford DA, Hesketh KD: Australian parents’ views on their 5-6-year-old children’s food choices. Health Promot Int 2007, 22:11-18.
• [76]Davison KK, Birch LL: Childhood overweight: a contextual model and recommendations for future research. Obes Rev 2001, 2:159-171.
• [77]Kroller K, Warschburger P: Associations between maternal feeding style and food intake of children with a higher risk for overweight. Appetite 2008, 51:166-172.
• [78]Musher-Eizenman DR, de Lauzon-Guillain B, Holub SC, Leporc E, Charles MA: Child and parent characteristics related to parental feeding practices. A cross-cultural examination in the US and France. Appetite 2009, 52:89-95.