| 1. |
- Ek, Anna, et al.
(författare)
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A Parent Treatment Program for Preschoolers With Obesity : A Randomized Controlled Trial
- 2019
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 144:2
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Tidskriftsartikel (refereegranskat)abstract
- Background And Objectives: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST).Methods: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (−0.5) was assessed with risk ratios.Results: A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: −0.45 to −0.15) compared with ST (0.07; 95% CI: −0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (−0.54; 95% CI: −0.77 to −0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST.Conclusion: A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.
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| 2. |
- Eli, Karin, et al.
(författare)
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Water, juice, or soda? : Mothers and grandmothers of preschoolers discuss the acceptability and accessibility of beverages
- 2017
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Ingår i: Appetite. - : Elsevier BV. - 0195-6663 .- 1095-8304. ; 112, s. 133-142
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Tidskriftsartikel (refereegranskat)abstract
- Intake of sugary beverages is strongly associated with weight gain and obesity among children; however, differences between mothers' and grandmothers' attitudes and practices concerning young children's beverage consumption remain unclear. This is notable since about a quarter of families in the US and the UK rely on grandparents as the main providers of informal childcare. The aim of this study is to examine mothers' and maternal grandmothers' attitudes, knowledge, and practices regarding preschool aged children's beverage consumption. The analysis focuses on identifying intergenerational similarities and differences, given the potential impact that such differences might have on young children's beverage consumption habits. Twenty-two semi-structured interviews, representing eleven families, were analyzed using thematic analysis. The sample included all mother – maternal grandmother dyads from The Grandparents Study, which took place in Eugene, Oregon, USA. More than half of mothers and grandmothers met overweight/obesity criteria. Among the children (mean age 4.7 years; five girls and six boys), seven met overweight/obesity criteria. Most mothers and grandmothers were unemployed, and most reported an annual household income below 30,000 USD. The analysis identified three thematic categories: 1) mothers and grandmothers agree about the hierarchy of healthiness between and within beverages, though juice occupies an ambivalent position; 2) mothers and grandmothers cite role modeling and the home environment as important in regulating preschoolers' beverage intake; 3) mothers and grandmothers balance between restricting sugary beverages and using these beverages as treats. The results suggest that when mothers and grandmothers use soda, juice, and juice-drinks as treats, they do so within a wider dynamic of balancing practices, and within two intersecting domains: the hierarchy of beverages, including the still ambivalent status of juice as healthy or unhealthy, and the definition of 'special occasion'.
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| 3. |
- Etminan Malek, Mahnoush
(författare)
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Health promotion and obesity prevention through a school-based parental support programme
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- It is important to find ways to halt the rise in overweight and obesity among children, which are linked not only to physical and mental illness but also to social inequalities. The school is an ideal setting for public health interventions, as all children can be reached, regardless of eating habits, level of physical activity, weight status, cultural background, and family socioeconomic position. Healthy School Start Plus (HSSP) is a parental support programme, conducted in the school setting, aimed to promote healthy dietary and physical activity behaviours in 5-7-year-old children and to prevent overweight and obesity. The overall aim of this thesis was to evaluate the effectiveness of HSSP in disadvantaged areas and identify ways to improve impact and reach of HSSP and similar programmes. Study I explored parents’ experiences of participating in the HSSP programme. We found that it is crucial to consider variations in social and cultural conditions as they may influence the execution of the intervention. Further, the importance of continuous delivery of health information and follow-ups was emphasised as well as that of a functioning interaction between the school and the parents. Study II examined the association between physical activity parenting practices and children’s levels of physical activity during non-school time with structural equation modelling and with the child’s own activity style included as a moderator. No significant association was found that could explain the hypothesised relationship; however, when the child’s activity style was added as a moderating factor the fit of the model improved. This indicates that the child’s activity style should be included as a moderator when exploring the relationship between physical activity parenting practices and child physical activity. Study III evaluated the effects of the HSSP programme on children’s dietary, physical activity and sedentary behaviours and body composition. Significant effects were found on children’s dietary and physical activity behaviours, but no effects were found on children’s body composition. This study confirmed the findings of two previous trials of the programme. Study IV explored children’s experiences of participating in the HSSP programme. We found that children need to be given adequate time to finish the classroom activities. Moreover, the use of health symbols in the material appears beneficial for the home assignments and in practical activities. Additional points emerged, such as the importance of communication through body language and being positive when delivering health information to children. The findings of this thesis indicate that HSSP was appreciated by children and parents and had beneficial effects on children’s dietary and physical activity behaviours. Further, they also suggest better ways to design and implement HSSP and similar programmes and may ultimately contribute to the reduction of social inequalities in health.
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| 4. |
- Etminan Malek, Mahnoush, et al.
(författare)
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Relationships between Physical Activity Parenting Practices and Children's Activity Measured by Accelerometry with Children's Activity Style as a Moderator : A Cross Sectional Study
- 2022
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Ingår i: Children. - : MDPI AG. - 2227-9067. ; 9:2
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to examine the associations between physical activity parenting practices (PAPP) and children’s levels of moderate-to-vigorous physical activity (MVPA), and time spent sedentary (SED) during non-school time in weekdays and weekends when children’s activity style was taken into account. Study participants were 88 children (mean age 6.3 (SD 0.3) years); 51.0% girls) and their parents who took part in A Healthy School Start Plus in Sweden. The independent variables included PAPPs Structure, Neglect/control, and Autonomy promotion and children’s activity style as moderator, assessed through validated parent questionnaires. Dependent variables were the MVPA and SED in minutes, measured by accelerometry. Structural equation modeling was used to examine the associations between PAPPs and children’s MVPA and SED with children’s activity style as a moderator. No significant associations between the PAPPs Structure, Neglect/control, and Autonomy promotion and measures of physical activity were found (p > 0.13). The moderating role of activity style improved the model fit and the final model had a reasonable fit to the data. Our results suggest that in future studies, with the aim to explore the relationship between PAPP and children’s physical activity, the activity style of the children should be included as a moderator.
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| 5. |
- Malek, Mahnoush Etminan, et al.
(författare)
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Children's experiences of participating in a school-based health promotion parental support programme - a qualitative study.
- 2021
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Ingår i: BMC Pediatrics. - : BioMed Central. - 1471-2431. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Children's voices are seldom heard in process evaluations concerning health promotion programmes. A Healthy School Start Plus (HSSP) is a parental support programme, conducted in Sweden, with the aim of promoting healthy diet, physical activity and preventing obesity in preschool class children. The 6-month programme includes: (1) Health information to parents; (2) Motivational Interviewing with parents by school nurses; (3) Classroom activities and home assignments for children; (4) A self-test of type-2 diabetes risk for parents. We aimed to describe children's experiences of the third component regarding barriers and facilitators of participating in and learning from the classroom activities in the HSSP.METHODS: In total 36 children from 7 schools in Sweden, mean age 6 years, participated in 7 focus group discussions. Purposeful sampling with maximum variation was used to collect the data. The focus groups were audio-recorded, transcribed and analysed using qualitative content analysis.RESULTS: Four categories were identified; (1) Time available to work on intervention activities; (2) Others' interest; (3) Abilities and interests in intervention activities; and (4) Practicing the concept of health.CONCLUSIONS: The findings may improve the HSSP and other similar interventions that include classroom-based learning regarding health by highlighting the following points to consider: aiming for homework to be an integrated part of the school-setting to enhance parental involvement; using flexible material, tailored to the children's abilities and giving children adequate time to finish the intervention activities; and making teachers and parents aware of the importance of verbal and body language regarding intervention activities.TRIAL REGISTRATION: The Healthy School Start Plus trial was retrospectively registered in the International Standard Randomised Controlled Trial Number Registry on January 4, 2018 and available online at ClinicalTrials.gov: No. NCT03390725 .
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| 6. |
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| 7. |
- Malek, Mahnoush Etminan, et al.
(författare)
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Parents’ experiences of participating in the Healthy School Start Plus programme : a qualitative study
- 2023
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Ingår i: BMC Public Health. - : Springer Nature. - 1471-2458. ; 23
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Tidskriftsartikel (refereegranskat)abstract
- Background: The rise in overweight and obesity among children is a global problem and effective prevention interventions are urgently required. Parents play an important role in children’s lifestyle behaviours and body weight development and therefore there is a great need to investigate how to involve parents effectively in health promotion and prevention programmes. The aim of the study was to describe parents’ experiences of barriers and facilitators of participating in the Healthy School Start Plus (HSSP) intervention study.Methods: HSSP is a parental support programme, conducted in Sweden, with the aim to promote a healthy diet, physical activity and preventing obesity in 5-7-year-old children starting school. In total 20 parents from 7 schools participated in semi-structured telephone-based interviews. The data was analysed using qualitative content analysis, with a deductive approach based on the Consolidated Framework for Implementation Research (CFIR).Results: Parental experiences of barriers and facilitators informing the implementation of the HSSP intervention were identified within all five domains of the CFIR. Two additional constructs, not included in the CFIR were identified: Social factors and Cooperation. The findings of parental experiences of barriers and facilitators related to the importance of (1) adaptation of the intervention to fit the abilities of the parents with different social and cultural backgrounds; (2) the need for continuous delivery of information related to healthy behaviours; (3) the commitment and efforts of the deliverers of the intervention; (4) the need for repetition of information related to healthy behaviours given by the deliverers of the intervention; (5) encouragement and facilitation of the involvement of the family and key people around them through the intervention activities and by the deliverers of the intervention; (6) awareness of unexpected impacts and social and cultural conditions complicating the execution of the intervention and; (7) cooperation and a well-functioning interaction between parents and school staff.Conclusions: Barriers and facilitators indicated by the parents highlighted that interventions like the HSSP need to be adapted to fit the parents’ abilities, with reminders, follow-ups and delivery of relevant information. Variations in social and cultural conditions need to be taken into consideration. The commitment of the school and the interaction between the school staff and the family as well as key people around them appears to be important.
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