Barriers and Facilitators of Health Promotion and Obesity Prevention in Early Childhood: A Focus on Parents Results from the IDEFICS Study

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. Keywords: parents, children, obesity, weight perception, registers, prevention, health promotio

Improved Learning Support with Minor Costs and Little Efforts : Students with a Disability in Higher Education and Their Perspectives of the Learning Support

In line with the sustainable development goals of Agenda 2030, the higher education institutions strive to achieve the values of an accessible and inclusive higher education for all students. The number of students with disabilities in higher education is rising in several countries. Studies exploring the students’ perspectives of the learning support are lacking. This study explored the students’ perspectives of the learning support provided for students with disabilities in higher education. Interviews with twelve students with various disabilities studying at a university in Sweden were held between 2018 and 2020. Data were analyzed using content analysis. Findings resulted in four categories: 1) A need for specific learning support based on each individual disability, 2) A satisfaction with the given learning support, 3) The student’s disability in relation to their work-based internship, 4) The students’ proposals to ease the study journey. In general, students appreciated having a mentor, a note taker, being able to sit in a smaller room during exams or having extended examination time. The students suggested improvements that could be realized with minor costs and small efforts. To meet the criteria of an inclusive and accessible higher education institution, a good learning support is of great importance. © 2021 by author(s) and Scientific Research Publishing Inc.Funding: The Federation of Nurses Educated at Sahlgrenska Academy, Gothenburg, Sweden (Kamratförbundet Sahlgrensringen).</p

Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers

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

Assessment of selection bias in a health survey of children and families – the IDEFICS Sweden-study

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

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

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

Formative research to develop the IDEFICS physical activity intervention component : findings from focus groups with children and parents

Background: The current study aimed at describing influencing factors for physical activity among young children to determine the best approaches for developing the IDEFICS community based intervention. Methods: In 8 European sites a trained moderator conducted a minimum of 4 focus groups using standardized questioning guides. A total of 56 focus groups were conducted including 36 focus groups with parents and 20 focus groups with children, of which 74 were boys and 81 girls. Key findings were identified through independent reviews of focus group summary reports using content analysis methods. Findings: Findings were generally consistent across countries. The greatest emphasis was on environmental physical (eg, seasonal influences, availability of facilities and safety), institutional (eg, length of breaks at school), and social factors (eg, role modeling of parents). Most cited personal factors by parents were age, social economical status, and perceived barriers. Both children and parents mentioned the importance of children's preferences. Conclusions: To increase physical activity levels of young children the intervention should aim at creating an environment (physical, institutional, social) supportive of physical activity. On the other hand strategies should take into account personal factors like age and social economical status and should consider personal barriers too

Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children on behalf of the IDEFICS and I Family consortia

INTRODUCTION: This study aims to evaluate a potential selection effect caused by exclusion of children with non-identifiable infancy peak (IP)and adiposity rebound (AR) when estimating associations between age and body mass index (BMI) at IP and AR and later weight status. SUBJECTS AND METHODS: In 4744 children with at least 4 repeated measurements of height and weight in the age interval from 0 to 8 years (37 998 measurements) participating in the IDEFICS (Identification and Prevention of Dietary-and Lifestyle-Induced Health Effects in Children and Infants)/I.Family cohort study, fractional polynomial multilevel models were used to derive individual BMI trajectories. Based on these trajectories, age and BMI at IP and AR, BMI values and growth velocities at selected ages as well as the area under the BMI curve were estimated. The BMI growth measures were standardized and related to later BMI z- scores (mean age at outcome assessment: 9.2 years). RESULTS: Age and BMI at IP and AR were not identifiable in 5.4% and 7.8% of the children, respectively. These groups of children showed a significantly higher BMI growth during infancy and childhood. In the remaining sample, BMI at IP correlated almost perfectly (r >= 0.99) with BMI at ages 0.5, 1 and 1.5 years, whereas BMI at AR correlated perfectly with BMI at ages 4-6 years (r >= 0.98). In the total study group, BMI values in infancy and childhood were positively associated with later BMI z- scores where associations increased with age. Associations between BMI velocities and later BMI z- scores were largest at ages 5 and 6 years. Results differed for children with non-identifiable IP and AR, demonstrating a selection effect. CONCLUSIONS: IP and AR may not be estimable in children with higher-than-average BMI growth. Excluding these children from analyses may result in a selection bias that distorts effect estimates. BMI values at ages 1 and 5 years might be more appropriate to use as predictors for later weight status instead