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Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood: A Focus on Parents, Results from the IDEFICS Study
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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 [en]
parents, children, obesity, weight perception, registers, prevention, health promotion
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-29130Libris ID: 16409056ISBN: 978-91-628-8926-5 OAI: oai:DiVA.org:hh-29130DiVA: diva2:845054
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
List of papers
1. 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
Open this publication in new window or tab >>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
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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
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-29120 (URN)10.1093/her/cyn033 (DOI)000266115400003 ()18603656 (PubMedID)2-s2.0-67549115199 (Scopus ID)
Note

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

Available from: 2015-08-10 Created: 2015-08-10 Last updated: 2017-12-04Bibliographically approved
2. Parental perceptions of and concerns about child's body weight in eight European countries – the IDEFICS study
Open this publication in new window or tab >>Parental perceptions of and concerns about child's body weight in eight European countries – the IDEFICS study
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2013 (English)In: Pediatric Obesity, ISSN 2047-6302, E-ISSN 2047-6310, Vol. 8, no 2, 118-129 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To evaluate parental perceptions of and concern about child's body weight and general health in children in a European cohort.

DESIGN: Cross-sectional multi-centre study in eight European countries.

PARTICIPANTS: 16,220 children, ages 2-9 years.

METHODS: Parents completed a questionnaire regarding children's health and weight and concern about overweight and underweight. Objective children's weight categories from the International Obesity Task Force were used. Logistic regression models were utilized to identify predictors of accurate weight perception.

RESULTS: Parental weight perception corresponded overall to children's mean body mass index (BMI) z-scores, with important exceptions. About one-third of the total indicated concern about underweight, paradoxically most often parents of children in the overweight or obesity categories. In 63%, parents of children in the overweight category marked 'proper weight'. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z-score (odds ratio [OR] = 7.2, 95% confidence interval [CI] 6.1-8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3-6.0) in Northern Europe and 3.4 (95% CI 2.7-4.2) in Central Europe.

CONCLUSION: Parents of children categorized as being overweight or obese systematically underestimated weight. Parents differed regionally regarding accurate weight perception and concern about overweight and underweight.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell, 2013
Keyword
Cohort of European children, obesity, parent, weight concern, weight perception
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-29118 (URN)10.1111/j.2047-6310.2012.00093.x (DOI)000316328400007 ()23001999 (PubMedID)2-s2.0-84878146826 (Scopus ID)
Note

Funding: The European Community within the sixth Research, Technological Development and Demonstration (RTD) framework programme under contract no. 016181, Food Quality and Safety projects in FP6 (FOOD), Västra Götalandsregionen research funds, Forskningsrådet för arbetsliv och socialvetenskap (FAS), and the Nordic School of Public Health NHV.

Available from: 2015-08-10 Created: 2015-08-10 Last updated: 2017-12-04Bibliographically approved
3. Assessment of selection bias in a health survey of children and families – the IDEFICS Sweden-study
Open this publication in new window or tab >>Assessment of selection bias in a health survey of children and families – the IDEFICS Sweden-study
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2013 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13, 418Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: A health survey was performed in 2007-2008 in the IDEFICS/Sweden study (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) in children aged 2-9 years. We hypothesized that families with disadvantageous socioeconomic and -demographic backgrounds and children with overweight and obesity were underrepresented.

METHODS: In a cross-sectional study, we compared Swedish IDEFICS participants (N=1,825) with referent children (N=1,825) using data from Statistics Sweden population registers. IDEFICS participants were matched for age and gender with a referent child living in the same municipality. Longitudinal weight and height data from birth to 8 years was collected for both populations (n=3,650) from the children's local health services. Outcome measures included the family's socioeconomic and demographic characteristics, maternal body mass index (BMI) and smoking habits before pregnancy, the children's BMI standard deviation score (SDS) at the age of inclusion in the IDEFICS study (BMISDS-index), and the children's BMI-categories during the age-span. Comparisons between groups were done and a multiple logistic regression analysis for the study of determinants of participation in the IDEFICS study was performed.

RESULTS: Compared with IDEFICS participants, referent families were more likely to have lower education and income, foreign backgrounds, be single parents, and have mothers who smoked before pregnancy. Maternal BMI before pregnancy and child's BMISDS-index did not differ between groups. Comparing the longitudinal data-set, the prevalence of obesity was significantly different at age 8 years n= 45 (4.5%) versus n= 31 (2.9%) in the referent and IDEFICS populations, respectively. In the multivariable adjusted model, the strongest significant association with IDEFICS study participation was parental Swedish background (odds ratio (OR) = 1.91, 95% confidence interval (CI) (1.48-2.47) followed by parents having high education OR 1.80, 95% CI (1.02-3.16) and being married or co-habiting OR 1.75 95% CI (1.38-2.23).

CONCLUSION: Families with single parenthood, foreign background, low education and income were underrepresented in the IDEFICS Sweden study. BMI at inclusion had no selection effect, but developing obesity was significantly greater among referents. © 2013 Regber et al.; licensee BioMed Central Ltd.

Place, publisher, year, edition, pages
London: BioMed Central, 2013
Keyword
Selection bias, Children, Obesity, Health survey, Registers
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-29117 (URN)10.1186/1471-2458-13-418 (DOI)000319402900001 ()23634972 (PubMedID)2-s2.0-84876799845 (Scopus ID)
Available from: 2015-08-10 Created: 2015-08-10 Last updated: 2017-12-04Bibliographically approved
4. Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers
Open this publication in new window or tab >>Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers
2013 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 12, 27Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Overweight and obesity in preschool children have increased worldwide in the past two to three decades. Child Health Centers provide a key setting for monitoring growth in preschool children and preventing childhood obesity.

METHODS: We conducted semi-structured interviews with 15 nurses working at Child Health Centers in southwest Sweden in 2011 and 2012. All interviews were tape recorded and transcribed verbatim and imported to QSR N'Vivo 9 software. Data were analyzed deductively according to predefined themes using content analysis.

RESULTS: Findings resulted in 332 codes, 16 subthemes and six main themes. The subthemes identified and described barriers and facilitators for the prevention of childhood obesity at Child Health Centers. Main themes included assessment of child's weight status, the initiative, a sensitive topic, parental responses, actions and lifestyle patterns. Although a body mass index (BMI) chart facilitated greater recognition of a child's deviant weight status than the traditional weight-for-height chart, nurses used it inconsistently. Obesity was a sensitive topic. For the most part, nurses initiated discussions of a child's overweight or obesity.

CONCLUSION: CHCs in Sweden provide a favorable opportunity to prevent childhood obesity because of a systematic organization, which by default conducts growth measurements at all health visits. The BMI chart yields greater recognition of overweight and obesity in children and facilitates prevention of obesity. In addition, visualization and explanation of the BMI chart helps nurses as they communicate with parents about a child's weight status. On the other hand, inconsistent use and lack of quality assurance regarding the recommended BMI chart was a barrier to prevention, possibly delaying identification of overweight or obesity. Other barriers included emotional difficulties in raising the issue of obesity because it was perceived as a sensitive topic. Some parents deliberately wanted overweight children, which was another specific barrier. Concerned parents who took the initiative or responded positively to the information about obesity facilitated prevention activities.

Place, publisher, year, edition, pages
London: BioMed Central, 2013
Keyword
Child, Preschool, Obesity, Health promotion, Prevention, Child health centers
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-29116 (URN)10.1186/1472-6955-12-27 (DOI)24308289 (PubMedID)
Available from: 2015-08-10 Created: 2015-08-10 Last updated: 2017-12-04Bibliographically approved

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