Using formative research to develop the healthy eating component of the CHANGE! school-based curriculum intervention

BMC Public Health

Stuart J Fairclough²  Laura Houghton²  Kelly A Mackintosh¹  Genevieve L Warburton¹  Ian G Davies¹  Zoe R Knowles²  Lynne M Boddy² 

[1] The Faculty of Education, Community and Leisure, Liverpool John Moores University, IM Marsh Campus, Barkhill Road, Liverpool, L17 6BD, UK;The Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Tom Reilly Building, Byrom Street, Liverpool L3 3AF, UK

关键词: Schools;    Health;    Pen-profiles;    Childhood obesity;    Nutrition;   

Others  :  1163191
DOI  :  10.1186/1471-2458-12-710

 received in 2012-04-12, accepted in 2012-08-23,  发布年份 2012

【 摘 要 】

Background

Childhood obesity is a significant public health concern. Many intervention studies have attempted to combat childhood obesity, often in the absence of formative or preparatory work. This study describes the healthy eating component of the formative phase of the Children’s Health Activity and Nutrition: Get Educated! (CHANGE!) project. The aim of the present study was to gather qualitative focus group and interview data regarding healthy eating particularly in relation to enabling and influencing factors, barriers and knowledge in children and adults (parents and teachers) from schools within the CHANGE! programme to provide population-specific evidence to inform the subsequent intervention design.

Methods

Semi-structured focus group interviews were conducted with children, parents and teachers across 11 primary schools in the Wigan borough of North West England. Sixty children (N = 24 boys), 33 parents (N = 4 male) and 10 teachers (N = 4 male) participated in the study. Interview questions were structured around the PRECEDE phases of the PRECEDE-PROCEED model. Interviews were transcribed verbatim and analysed using the pen-profiling technique.

Results

The pen-profiles revealed that children’s knowledge of healthy eating was generally good, specifically many children were aware that fruit and vegetable consumption was ‘healthy’ (N = 46). Adults’ knowledge was also good, including restricting fatty foods, promoting fruit and vegetable intake, and maintaining a balanced diet. The important role parents play in children’s eating behaviours and food intake was evident. The emerging themes relating to barriers to healthy eating showed that external drivers such as advertising, the preferred sensory experience of “unhealthy” foods, and food being used as a reward may play a role in preventing healthy eating.

Conclusions

Data suggest that; knowledge related to diet composition was not a barrier per se to healthy eating, and education showing how to translate knowledge into behavior or action is required. The key themes that emerged through the focus groups and pen-profiling data analysis technique will be used to inform and tailor the healthy eating component of the CHANGE! intervention study.

Trial registration

Current Controlled Trials ISRCTN03863885

【 授权许可】

   
2012 Boddy et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

Figure 6.

【 参考文献 】

• [1]Boddy LM, Hackett AF, Stratton G: Changes in fitness, body mass index and obesity in 9–10 year olds. J Hum Nutr Diet 2010, 23(3):254-259.
• [2]Ebbeling CB, Pawlak DB, Ludwig DS: Childhood obesity: public-health crisis, common sense cure. Lancet 2002, 360(9331):473-482.
• [3]Canoy D, Buchan I: Challenges in obesity epidemiology. Obes Rev 2007, 8(Suppl 1):1-11.
• [4]Gibson S: Trends in energy and sugar intakes and body mass index between 1983 and 1997 among children in Great Britain. J Hum Nutr Diet 2010, 23(4):371-381.
• [5]Department of Health: Choosing a better diet. London; 2005.
• [6]Holt EM, Steffen LM, Moran A, Basu S, Steinberger J, Ross JA, Hong CP, Sinaiko AR: Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents. J Am Diet Assoc 2009, 109(3):414-421.
• [7]Williams CL, Hayman LL, Daniels SR, Robinson TN, Steinberger J, Paridon S, Bazzarre T: Cardiovascular health in childhood: A statement for health professionals from the committee on Atherosclerosis, Hypertension, and Obesity in the Young (AHOY) of the council on Cardiovascular Disease in the Young, American Heart Association. Circulation 2002, 106(1):143-160.
• [8]Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ: Tracking of childhood overweight into adulthood: a systematic review of the literature. Obes Rev 2008, 9(5):474-488.
• [9]De Bourdeaudhuij I, Van Cauwenberghe E, Spittaels H, Oppert JM, Rostami C, Brug J, Van Lenthe F, Lobstein T, Maes L: School-based interventions promoting both physical activity and healthy eating in Europe: a systematic review within the HOPE project. Obes Rev 2011, 12(3):205-216.
• [10]NICE: Behaviour change at population, community and individual levels. London: NICE; 2007.
• [11]Cole RE, Horacek T: Applying precede-proceed to develop an intuitive eating nondieting approach to weight management pilot program. J Nutr Educ Behav 2009, 41(2):120-126.
• [12]Lean M, Lara J, Hill JO: Strategies for preventing obesity. In ABC of obesity. Edited by Sattar , Lean M. Oxford: Blackwell Publishing; 2007.
• [13]Mackintosh KA, Knowles ZR, Ridgers ND, Fairclough SJ: Using formative research to develop change!: a curriculum-based physical activity promoting intervention. BMC Publ Health 2011, 11:831. BioMed Central Full Text
• [14]Green LW, Kreuter MW, Deeds SG, Partridge KB: Health education planning: A diagnostic approach. California: Mayfield; 1980.
• [15]Porcellato L, Dugdill L, Springett J: Using focus groups to explore children's perceptions of smoking: reflections on practice. Health Educ 2002, 102(6):310-320.
• [16]Ridgers ND, Knowles ZR, Sayers J: Ecouraging play in the natural environment a child-focused case study of Forest school. Children's Geographies 2012, 10(1):49-65.
• [17]Knowles ZR, Parnell D, Ridgers ND, Stratton G: Learning from the experts: exploring playground experience and activities using a write and draw technique. J Phys Act HealthIn Press
• [18]Vereecken CA, De Henauw S, Maes L: Adolescents' food habits: results of the health behavior in School-aged Children survey. Br J Nutr 2005, 94(3):423-431.
• [19]Keyte J, Harris S, Margetts B, Robinson S, Baird J: Engagement with the National Healthy Schools Programme is associated with higher fruit and vegetable consumption in primary school children. J Hum Nutr Diet 2011, 25(2):155-160.
• [20]Krolner R, Rasmussen M, Brug J, Klepp KI, Wind M, Due P: Determinants of fruit and vegetable consumption among children and adolescents: a review of the literature part II: qualitative studies. Int J Behav Nutr Phys Act 2011, 8:112. BioMed Central Full Text
• [21]Khunti K, Stone MA, Bankart J, Sinfield P, Pancholi A, Walker S, Talbot D, Farooqi A, Davies MJ: Primary prevention of type-2 diabetes and heart disease: action research in secondary schools serving an ethnically diverse UK population. J Public Health (Oxf) 2008, 30(1):30-37.
• [22]COMA: Dietary reference values for food energy and nutrients for the United Kingdom. 10th edition. 1991.
• [23]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(2–2):e12-27.
• [24]Scaglioni S, Arrizza C, Vecchi F, Tedeschi S: Determinants of children's eating behavior. Am J Clin Nutr 2011, 94(6 Suppl):2006S-2011S.
• [25]Brown KA, Ogden J, Vogele C, Gibson EL: The role of parental control practices in explaining children's diet and BMI. Appetite 2008, 50(2–3):252-259.
• [26]Ogden J, Reynolds R, Smith A: Expanding the concept of parental control: a role for overt and covert control in children's snacking behavior? Appetite 2006, 47(1):100-106.
• [27]Wansink B, Payne C, Werle C: Consequences of belonging to the "clean plate club". Arch Pediatr Adolesc Med 2008, 162(10):994-995.
• [28]Birch LL, Fisher JO, Grimm-Thomas K, Markey CN, Sawyer R, Johnson SL: Confirmatory factor analysis of the Child Feeding Questionnaire: a measure of parental attitudes, beliefs and practices about child feeding and obesity proneness. Appetite 2001, 36(3):201-210.
• [29]Savage JS, Fisher JO, Birch LL: Parental influence on eating behavior: conception to adolescence. J Law Med Ethics 2007, 35(1):22-34.
• [30]Shunk JA, Birch LL: Girls at risk for overweight at age 5 are at risk for dietary restraint, disinhibited overeating, weight concerns, and greater weight gain from 5 to 9 years. J Am Diet Assoc 2004, 104(7):1120-1126.
• [31]Birch LL, Fisher JO: Mothers' child-feeding practices influence daughters' eating and weight. Am J Clin Nutr 2000, 71(5):1054-1061.
• [32]Campbell K, Andrianopoulos N, Hesketh K, Ball K, Crawford D, Brennan L, Corsini N, Timperio A: Parental use of restrictive feeding practices and child BMI z-score. A 3-year prospective cohort study. Appetite 2010, 55(1):84-88.
• [33]Neumark-Sztainer D: Preventing the broad spectrum of weight-related problems: working with parents to help teens achieve a healthy weight and a positive body image. J Nutr Educ Behav 2005, 37(Suppl 2):S133-140.
• [34]Jaballas E, Clark-Ott D, Clasen C, Stolfi A, Urban M: Parents' perceptions of their children's weight, eating habits, and physical activities at home and at school. J Pediatr Health Care 2011, 25(5):294-301.
• [35]Lloyd JJ, Logan S, Greaves CJ, Wyatt KM: Evidence, theory and context–using intervention mapping to develop a school-based intervention to prevent obesity in children. Int J Behav Nutr Phys Act 2011, 8:73. BioMed Central Full Text
• [36]Watson PM, Dugdill L, Pickering K, Bostock S, Hargreaves J, Staniford L, Cable NT: A whole family approach to childhood obesity management (GOALS): relationship between adult and child BMI change. Ann Hum Biol 2011, 38(4):445-452.
• [37]Dazeley P, Houston-Price C, Hill C: Should healthy eating programmes incorporate interaction with foods in different sensory modalities? A review of the evidence. Br J Nutr 2012. FirstView Article:1–9
• [38]McKinley MC, Lowis C, Robson PJ, Wallace JM, Morrissey M, Moran A, Livingstone MB: It's good to talk: children's views on food and nutrition. Eur J Clin Nutr 2005, 59(4):542-551.
• [39]Coulthard H, Blissett J: Fruit and vegetable consumption in children and their mothers moderating effects of child sensory sensitivity. Appetite 2009, 52(2):410-415.
• [40]Carruth BR, Ziegler PJ, Gordon A, Barr SI: Prevalence of picky eaters among infants and toddlers and their caregivers' decisions about offering a new food. J Am Diet Assoc 2004, 104(1 Suppl 1):s57-64.
• [41]Osborne CL, Forestell CA: Increasing children's consumption of fruit and vegetables: does the type of exposure matter? Physiol Behav 2012, 106(3):362-368.
• [42]Crawford DA, Ball K, Cleland VJ, Campbell KJ, Timperio AF, Abbott G, Brug J, Baur LA, Salmon JA: Home and neighbourhood correlates of BMI among children living in socioeconomically disadvantaged neighbourhoods. Br J Nutr 2012, 107(7):1028-1036.
• [43]Dixon HG, Scully ML, Wakefield MA, White VM, Crawford DA: The effects of television advertisements for junk food versus nutritious food on children's food attitudes and preferences. Soc Sci Med 2007, 65(7):1311-1323.
• [44]Marquis M, Filion YP, Dagenais F: Does eating while watching television influence children's food-related behaviours? Can J Diet Pract Res 2005, 66(1):12-18.
• [45]Wood F, Robling M, Prout H, Kinnersley P, Houston H, Butler C: A question of balance: a qualitative study of mothers' interpretations of dietary recommendations. Ann Fam Med 2010, 8(1):51-57.