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Developing the IDEFICS community-based intervention program to enhance eating behaviors in 2- to 8-year-old children: findings from focus groups with children and parents
Research Foundation-Flanders, Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
Research Foundation-Flanders, Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium.
Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy.
Department of Public health and Community Medicine, Göteborg University, Göteborg, Sweden.
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2009 (English)In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 24, no 3, 381-393 p.Article in journal (Refereed) Published
Abstract [en]

One purpose of 'identification and prevention of dietary- and lifestyle-induced health effects in children and infants' (IDEFICS) is to implement a standardized community-based multi-component healthy eating intervention for younger children in eight different countries. The present study describes important influencing factors for dietary behaviors among children aged 2-8 years old in order to determine the best approaches for developing the dietary components of the standardized intervention. Twenty focus groups with children (74 boys, 81 girls) and 36 focus groups with 189 parents (28 men, 161 women) were conducted. Only in two countries, children mentioned receiving nutrition education at school. Rules at home and at school ranged from not allowing the consumption of unhealthy products to allowing everything. The same diversity was found for availability of (un)healthy products at home and school. Parents mentioned personal (lack of time, financial constraints, preferences), socio-environmental (family, peer influences), institutional (school policies) and physical-environmental (availability of unhealthy products, price, season) barriers for healthy eating. This focus group research provided valuable information to guide the first phase in the IDEFICS intervention development. There was a large variability in findings within countries. Interventions should be tailored at the personal and environmental level to increase the likelihood of behavioral change.

Place, publisher, year, edition, pages
Cary, NC: Oxford University Press, 2009. Vol. 24, no 3, 381-393 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-29120DOI: 10.1093/her/cyn033ISI: 000266115400003PubMedID: 18603656Scopus ID: 2-s2.0-67549115199OAI: oai:DiVA.org:hh-29120DiVA: diva2:845038
Note

Funding: European Community within the Sixth RTD Framework Programme [0106181 (FOOD)].

Available from: 2015-08-10 Created: 2015-08-10 Last updated: 2015-08-11Bibliographically approved
In thesis
1. Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood: A Focus on Parents, Results from the IDEFICS Study
Open this publication in new window or tab >>Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood: A Focus on Parents, Results from the IDEFICS Study
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Childhood obesity has increased dramatically during the past thirty years. Parents are key persons in their children’s lives and their efforts to create healthy lifestyles are very important. However, social and economic determinants of health also affect parents’ opportunities to promote a healthy lifestyle.

Aims: To explore barriers and facilitators in promoting healthy lifestyles and preventing childhood obesity, focusing on parental roles.

Methods and main findings: Three studies originated from the Identification and Prevention of Dietary- and Lifestyle-induced health Effects in Children and InfantS (IDEFICS) study of determinants for two to nine-year-old children’s health in eight European countries. The fourth study was a qualitative interview study conducted in southwest Sweden.

Paper I: In focus group discussions (20 focus groups with children and 36 with parents), parents described lack of time, financial constraints, availability and food marketing techniques as barriers for promoting healthy eating. School policies about food varied; only Sweden and Estonia provided free school lunches. Children described great variation in the availability of unhealthy foods and beverages in their homes.

Paper II: Objectively measured Body Mass Index (BMI) of children (n=16 220) were compared to parents’ perception of and concern for their children’s health and weight status. In all weight categories and all countries, a substantial proportion of parents failed to accurately judge their child’s weight status. In general, parents considered their children to be healthy, irrespective of their weight status. Parents of children with overweight or obesity systematically underestimated their children’s weight status across eight European countries. Accurate parental weight perception in Europe differed according to geographic region.

Paper III: Swedish IDEFICS participants (n=1825) were compared with an age- and sex-matched referent population (n=1825), using registers from Statistics Sweden and the Swedish Medical Birth Register. Longitudinal child growth data (n=3650) were collected from child health centers and school health services. Families with low income, less education, foreign background or single parenthood were underrepresented in the IDEFICS study. BMI at inclusion had no selection effect but, at eight years of age, the obesity prevalence was significantly greater among referents.

Paper IV: A qualitative content analysis was used to interpret the findings from interviews with nurses (n=15) working at child health centers in the southwest of Sweden. The BMI Chart to identify overweight and obesity in children facilitated greater recognition but nurses used it inconsistently, a barrier to prevention. Other barriers were obesity considered a sensitive issue and that some parents wanted overweight children.

Conclusion: Parents may not perceive their child’s growth trajectory from overweight to obesity, and the preschool years may pass without effort to change lifestyle. Therefore, objective measurement and information of children’s BMI weight status by healthcare professionals is of great importance. To reach all parents and avoid selection bias, health surveys or health promoting activities must be tailored. Health promoting activities at the family level as well as the societal level should start early in children’s lives to prevent childhood obesity.

Place, publisher, year, edition, pages
Göteborg: Department of Public Health and Community Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, 2014. 75 p.
Keyword
parents, children, obesity, weight perception, registers, prevention, health promotion
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-29130 (URN)978-91-628-8926-5 (ISBN)
Public defence
2014-02-28, Aulan, Nordic School of Public Health NHV, Nya Varvet, Fredrik Bloms väg 25, Göteborg, 13:00 (Swedish)
Opponent
Supervisors
Projects
IDEFICS (EU-project)
Available from: 2015-08-11 Created: 2015-08-10 Last updated: 2015-08-11Bibliographically approved

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