Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Parental recommendations for population level interventions to support infant and family dietary choices: a qualitative study from the Growing Up in Wales, Environments for Healthy Living (EHL) study

Authors: Ashrafunnesa Khanom, Rebecca A Hill, Kelly Morgan, Frances L Rapport, Ronan A Lyons, Sinead Brophy

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Childhood obesity presents a challenge to public health. This qualitative study explored the main barriers to dietary choices faced by parents with infants, and the types of interventions and policy level recommendations they would like to see put in place, to promote a healthier food environment.

Methods

61 semi-structured interviews with prospective parents and parents of infants (61 mothers and 35 fathers) were conducted. Families were selected according to community deprivation levels using the Townsend Deprivation Index to ensure a representative sample from deprived and affluent neighbourhoods. Inductive thematic analysis was used to analyse the data.

Results

Parents identified triggers which led to unhealthy dietary choices such as reliance on fast food outlets due to; shift work, lack of access to personal transport, inability to cook, their own childhood dietary experiences, peer pressure and familial relationships. Parents who made healthy dietary choices reported learning cooking skills while at university, attending community cooking classes, having access to quality food provided by church and community organisations or access to Healthy Start vouchers. They called for a reduction in supermarket promotion of unhealthy food and improved access to affordable and high-quality fresh produce in the local area and in supermarkets. There was a strong message to policy makers to work with commercial companies (food manufactures) as they have resources to lower costs and target messages at a diverse population. Provision of targeted advice to fathers, minority ethnic parents, and tailored and practical advice and information on how to purchase, prepare, store and cook food was requested, along with community cookery classes and improved school cookery lessons.

Conclusions

There is a need for parent directed community/population level interventions that aims to reduce socio-ecological barriers to making healthy dietary choices. Parents desired improvements in meals provided in workplaces, schools and hospitals, as well as increased access to healthy foods by increasing local healthy food outlets and reducing unhealthy, fast food outlets. Knowledge and skills could then be enhanced in line with these improvements, with confidence gained around cooking and storing food appropriately.
Literature
1.
O’Reilly JR, Reynolds RM. The risk of maternal obesity to the long-term health of the offspring. Clin Endocrinol (Oxf). 2013;78(1):9–16.CrossRef
2.
Centre for Maternal and Child Enquiries. Maternal obesity in the UK: findings from a national project. London: CMACE; 2010.
3.
Bogaerts A. Obesity and pregnancy, an epidemiological and intervention study from a psychosocial perspective. Facts Views Vision ObGyn. 2014;6(2):81–95.
4.
Ciampa PJ, Kumar D, Barkin SL, Sanders LM, Yin SH, Perrin EM, et al. Interventions aimed at decreasing obesity in children younger than 2 years: a systematic review. Arch Pediatr Adolesc Med. 2010;164(12):1098–104.PubMedPubMedCentralCrossRef
5.
Freedman DS, Khan LK, Serdula MK, Dietz WH, Srinivasan SR, Berenson GS. The relation of childhood BMI to adult adiposity: the Bogalusa heart study. Pediatrics. 2005;115(1):22–7.PubMed
6.
Guo SS, Wu W, Chumlea WC, Roche AF. Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescence. Am J Clin Nutr. 2002;76(3):653–8.PubMed
7.
Bridges S, Thompson J. Children’s BMI, overweight and obesity. In: Craig R, Mindell J, editors. Health survey for England 2010. London: Health and Social Care Information Centre; 2011. p. 1–21.
8.
9.
10.
National Institute for Health Clinical Excellence. Weight management before, during and after pregnancy: public health guidance 27. London: National Institute for Clinical Excellence (NICE); 2010.
11.
Demory-Luce D, Morales M, Nicklas T, Baranowski T, Zakeri I, Berenson G. Changes in food group consumption patterns from childhood to young adulthood: the Bogalusa heart study. J Am Diet Assoc. 2004;104(11):1684–91.PubMedCrossRef
12.
Kumanyika SK. Environmental influences on childhood obesity: ethnic and cultural influences in context. Physiol Behav. 2008;94(1):61–70.PubMedCrossRef
13.
14.
Loring B, Robertson A. Obesity and inequities: guidance for addressing inequities in overweight and obesity. Copenhagen: World Health Organisation, Regional Office for Europe; 2014.
15.
Gibbs BG, Forste R. Socioeconomic status, infant feeding practices and early childhood obesity†. Pediatr Obes. 2014;9(2):135–46.PubMedCrossRef
16.
Zuercher J, Wagstaff D, Kranz S. Associations of food group and nutrient intake, diet quality, and meal sizes between adults and children in the same household: a cross-sectional analysis of U.S. households. Nutr J. 2011;10(1):131.PubMedPubMedCentralCrossRef
17.
Vanhala M, Laitinen J, Kaikkonen K, Keinanen-Kiukaanniemi S, Korpelainen R. Parental predictors of fruit and vegetable consumption in treatment-seeking overweight children. J Hum Nutr Diet. 2011;24(1):47–53.PubMedCrossRef
18.
Oliveria SA, Ellison RC, Moore LL, Gillman MW, Garrahie EJ, Singer MR. Parent child relationships in nutrient intake: the Framingham Children’s Study. Am J Clin Nutr. 1992;56(3):593–8.PubMed
19.
Goldman RL, Radnitz CL, McGrath RE. The role of family variables in fruit and vegetable consumption in preschool children. J Public Health Res. 2012;1(2):143–8.PubMedPubMedCentralCrossRef
20.
National Centre for Social Research. National diet and nutrition survey: results from years 1–4 (combined) of the rolling programme (2008/2009 – 2011/12). London: Public Health England and Food Standards Agency; 2014.
21.
Statistics for Wales. Welsh health survey 2011. Cardiff: Welsh Assembly Government; 2012.
22.
Vienna Declaration on Nutrition and Noncommunicable Diseases in the Context of Health 2020. WHO european ministerial conference on nutrition and noncommunicable diseases in the context of health 2020. Vienna 4–5 july 2013. Copenhagen: WHO Regional Office for Europe; 2013.
23.
Department for Health. National school fruit and vegetable scheme. London: Department of Health; 2002.
24.
25.
26.
27.
28.
29.
30.
31.
He FJ, Brinsden HC, MacGregor GA. Salt reduction in the United Kingdom: a successful experiment in public health. J Hum Hypertens. 2014;28(6):345–52.PubMedCrossRef
32.
33.
34.
García AL, Raza S, Parrett A, Wright CM. Nutritional content of infant commercial weaning foods in the UK. In: Archives of disease in childhood. 2013.
35.
Tedstone A, Anderson S, Allen R. Sugar reduction responding to the challenge. London: Public Health England; 2014.
36.
Gilmore AB, Savell E, Collin J. Public health, corporations and the new responsibility deal: promoting partnerships with vectors of disease? J Public Health (Oxf). 2011;33(1):2–4.CrossRef
37.
38.
39.
40.
Emrich TE, Qi Y, Mendoza JE, Lou W, Cohen JE, L’Abbé MR. Consumer perceptions of the nutrition facts table and front-of-pack nutrition rating systems. Appl Physiol Nutr Metab. 2013;39(4):417–24.PubMedCrossRef
41.
42.
Howlett S, Kennedy OB. The UK food industry’s views on front of pack nutrition labelling: a quantitative study. Proc Nutr Soc. 2011;70(OCE4):null-null.CrossRef
43.
Adams J, Tyrrell R, Adamson AJ, White M. Effect of restrictions on television food advertising to children on exposure to advertisements for ‘less Healthy’ foods: repeat cross-sectional study. PLoS One. 2012;7(2):e31578.PubMedPubMedCentralCrossRef
44.
de Oliveira MIC, Camacho LAB, Tedstone AE. Extending breastfeeding duration through primary care: a systematic review of prenatal and postnatal interventions. J Hum Lact. 2001;17(4):326–43.PubMedCrossRef
45.
Mulrine H. Interventions to prevent childhood obesity literature review. Cantebury District Health Board: Community and Public Health; 2013.
46.
Fieldhouse P. Food and nutrition: customs and culture. 2nd ed. London: Chapman& Hall; 1995.CrossRef
47.
Devine CM, Connors M, Bisogni CA, Sobal J. Life-course influences on fruit and vegetable trajectories: qualitative analysis of food choices. J Nutr Educ. 1998;30(6):361–70.CrossRef
48.
Slovic P. The perception of risk. London: Earthscan Publishing; 2000.
49.
Egger G, Swinburn B. An “ecological” approach to the obesity pandemic. Br Med J. 1997;315(7106):477–80.CrossRef
50.
51.
Scholthof K-BG. The disease triangle: pathogens, the environment and society. Nat Rev Micro. 2007;5(2):152–6.CrossRef
52.
Lang T, Rayner G. Ecological public health: the 21st century’s big idea? an essay by Tim Lang and Geof Rayner. 345th ed. 2012.
53.
McLeroy K, Bibeau D, Steckler A, Glanz K. An ecologic perspective on health promotion programs. Health Educ Q. 1988;15(4):351–77.PubMedCrossRef
54.
Quick V, Wall M, Larson N, Haines J, Neumark-Sztainer D. Personal, behavioral and socio-environmental predictors of overweight incidence in young adults: 10 yr longitudinal findings. Int J Behav Nutr Phys Act. 2013;10(1):37.PubMedPubMedCentralCrossRef
55.
Bronfenbrenner U. Toward an experimental ecology of human-development. Am Psychol. 1977;32:513–31.CrossRef
56.
Stokols D. Translating social ecological theory into guidelines for community health promotion. Am J Health Promot. 1996;10(4):282–98.PubMedCrossRef
57.
Luepker RV, Murray DM, Jacobs DR, Mittelmark MB, Bracht N, Carlaw R, et al. Community education for cardiovascular disease prevention: risk factor changes in the Minnesota heart health program. Am J Public Health. 1994;84(9):1383–93.PubMedPubMedCentralCrossRef
58.
Merzel C, D’Afflitti J. Reconsidering community-based health promotion: promise, performance, and potential. Am J Public Health. 2003;93(4):557–74.PubMedPubMedCentralCrossRef
59.
Mills PR, Kessler RC, Cooper J, Sullivan S. Impact of a health promotion program on employee health risks and work productivity. Am J Health Promot. 2007;22(1):45–53.PubMedCrossRef
60.
Figueras J, Mckee M. Health systems, health, wealth and societal well-being: assessing the case for investing in health systems. Berkshire: Open University Press; 2011.
61.
Kasza KA, Hyland AJ, Borland R, McNeill AD, Bansal-Travers M, Fix BV, et al. Effectiveness of stop-smoking medications: findings from the International Tobacco Control (ITC) four country survey. Addiction. 2013;108(1):193–202.PubMedCrossRef
62.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. 337th ed. 2008.
63.
Green J, Thorogood N. Qualitative methods for health research. London: Sage; 2004.
64.
Strolla LO, Gans KM, Risica PM. Using qualitative and quantitative formative research to develop tailored nutrition intervention materials for a diverse low income audience. Health Educ Res. 2006;21(4):465–76.PubMedCrossRef
65.
66.
Summerbell CD, Waters E, Edmunds LD, Kelly S, Brown T, KJ C. Interventions for preventing obesity in children. Cochrane Database Syst Rev 2005;(3):CD001871.
67.
Michie S, Fixsen D, Grimshaw J, Eccles M. Specifying and reporting complex behaviour change interventions: the need for a scientific method. Implement Sci. 2009;4(1):40.PubMedPubMedCentralCrossRef
68.
Yam P, Morrison R, Penpraze V, Westgarth C, Ward D, Mutrie N, et al. Children, parents, and Pets Exercising Together (CPET) randomised controlled trial: study rationale, design, and methods. BMC Public Health. 2012;12(1):208.PubMedPubMedCentralCrossRef
69.
Waters E, de Silva-Sanigorski A, Hall BJ, Brown T, Campbell KJ, Gao Y, et al. Interventions for preventing obesity in children. Cochrane Database Syst Rev. 2011;12, CD001871.
70.
Hill R, Brophy S, Brunt H, Storey M, Thomas N, Thornton C, et al. Protocol of the baseline assessment for the Environments for Healthy Living (EHL) wales cohort study. BMC Public Health. 2010;10(1):150.PubMedPubMedCentralCrossRef
71.
72.
73.
Dey I. Qualitative data analysis: a user-friendly guide for social scientists. London: Routledge; 1993.CrossRef
74.
Fontana A, Frey JH. Interviewing the art of science. Sage: London: Lincoln YS; 1994.
75.
Van Manen M. Researching lived experience: human science for an action sensitive pedagogy. London, Ontario: Althouse Press; 1990.
76.
Boyatzis R. Thematic analysis and code development: transforming qualitative information. London and New Delhi: Sage Publications; 1998.
77.
Strauss A, Corbin J, NKDYSL. Grounded theory methodology. In: Handbook of qualitative research. Thousand Oaks, CA: Sage; 1994.
78.
Townsend P, Phillimore P, Beattie A. Health and deprivation: inequality and the North Croom Helm. Croom Helm Ltd, London; 1987 221 pp., ISBN 0-7099-4352-0.
79.
Roux C, Le Couedic P, Durand-Gasselin S, Luquet F-M. Consumption patterns and food attitudes of a sample of 657 low-income people in France. Food Policy. 2000;25(1):91–103.CrossRef
80.
Attree P. Low-income mothers, nutrition and health: a systematic review of qualitative evidence. Matern Child Nutr. 2005;1(4):227–40.PubMedCrossRef
81.
Aylott J, Brown I, Copeland RJ, Johnson D. Tackling obesities: the foresight report and implications for local government. London: Improvement and Development Agency; 2008.
82.
Strzemecka J, Bojar I, Strzemecka E, Owoc A. Dietary habits among persons hired on shift work. Ann Agric Environ Med. 2014;21(1):128–31.PubMed
83.
84.
The National Assembly for Wales. Better health better Wales: investing in a better start: promoting breastfeeding in Wales. 2001.
85.
Health and Safety Executive. New and expectant mothers at work: a guide for employers HSG122 (Second Edition). 2002.
86.
Raine P. Promoting breast-feeding in a deprived area: the influence of a peer support initiative. Health Soc Care Community. 2003;11(6):463–9.PubMedCrossRef
87.
Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5 Suppl 1:4–104.PubMedCrossRef
88.
Patrick H, Nicklas T. A review of family and social determinants of children’s eating patterns and diet quality. J Am Coll Nutr. 2005;24(2):83–92.PubMedCrossRef
89.
90.
Hall L, Collins CE, Morgan PJ, Burrows TL, Lubans DR, Callister R. Children’s intake of fruit and selected energy-dense nutrient-poor foods is associated with fathers’ intake. J Am Diet Assoc. 2011;111(7):1039–44.PubMedCrossRef
91.
Drewnowski A, Specter S. Poverty and obesity: the role of energy density and energy costs. Am J Clin Nutr. 2004;79(1):6–16.PubMed
92.
93.
Nestle M. Food politics. How the food industry influences nutrition and health. 2 edition. Berkeley: University California Press; 2007.
94.
Brownell KD, Farley T, Willett WC, Popkin BM, Chaloupka FJ, Thompson JW, et al. The public health and economic benefits of taxing sugar-sweetened beverages. N Engl J Med. 2009;361(16):1599–605.PubMedPubMedCentralCrossRef
95.
96.
Beeken RJ, Wardle J. Public beliefs about the causes of obesity and attitudes towards policy initiatives in Great Britain. Public Health Nutr. 2013;16(12):2132–7.PubMedCrossRef
97.
Maddock J. The relationship between obesity and the prevalence of fast food restaurants: state-level analysis. Am J Health Promot. 2004;19(2):137–43.PubMedCrossRef
98.
Burgoine T, Forouhi NG, Griffin SJ, Wareham NJ, Monsivais P. Associations between exposure to takeaway food outlets, takeaway food consumption, and body weight in Cambridgeshire, UK: population based, cross sectional study. Br Med J. 2014;348:g1464.CrossRef
99.
Cummins S, Smith DM, Taylor M, Dawson J, Marshall D, Sparks L, et al. Variations in fresh fruit and vegetable quality by store type, urban–rural setting and neighbourhood deprivation in Scotland. Public Health Nutr. 2009;12(11):2044–50.PubMedCrossRef
100.
101.
Thompson C, Cummins S, Brown T, Kyle R. Understanding interactions with the food environment: an exploration of supermarket food shopping routines in deprived neighbourhoods. Health Place. 2013;19:116–23.PubMedCrossRef
102.
Lumeng JC, Gannon K, Appugliese D, Cabral HJ, Zuckerman B. Preschool child care and risk of overweight in 6- to 12-year-old children. Int J Obes (Lond). 2005;29(1):60–6.CrossRef
103.
Pierre B. The forms of capital. In: Richardson JC, editor. The handbook of theory and research for the sociology of education. New York: Greenwood Press; 1986. p. 241–60.
104.
Gao Y, Huang Y, Zhang Y, Liu F, Feng CX, Liu T, et al. Evaluation of fast food behavior in pre-school children and parents following a one-year intervention with nutrition education. Int J Environ Res Public Health. 2014;11(7):6780–90.PubMedPubMedCentralCrossRef
105.
Kingston, PW. The classless society. Stanford University Press. 2000. p. 124.
106.
Martens L, Warde A. Urban pleasure? On the meaning of eating out in a northern city. In: Food, health and identity. 1997. p. 131–50.
107.
Baird J, Fisher D, Lucas P, Kleijnen J, Roberts H, Law C. Being big or growing fast: systematic review of size and growth in infancy and later obesity. BMJ. 2005;331(7522):929.PubMedPubMedCentralCrossRef
108.
109.
Cashdan E. Adaptiveness of food learning and food aversions in children. Soc Sci Inf. 1998;37(4):613–32.CrossRef
110.
Shutts K, Kinzler KD, DeJesus J. Understanding infants’ and children’s social learning about foods: previous research and new prospects. Dev Psychol. 2013;49(3):419–25.PubMedCrossRef
111.
Letarte A, DubÉ L, Troche V. Similarities and differences in affective and cognitive origins of food likings and dislikes. Appetite. 1997;28(2):115–29.PubMedCrossRef
112.
Brophy S, Cooksey R, Gravenor MB, Mistry R, Thomas N, Lyons RA, et al. Risk factors for childhood obesity at age 5: Analysis of the Millennium Cohort Study. BMC Public Health. 2009;9:467.PubMedPubMedCentralCrossRef
113.
Burke L. Healthy eating in the school environment – a holistic approach*. Int J Consum Stud. 2002;26(2):159–63.CrossRef
114.
115.
Marks DF, Evans B, Murray M, Estacio EM. Health psychology theory, research and practice 3edition. London: SAGE Publications Ltd; 2011.
116.
Jardine CG, Driedger SM. ‘Risk communication for empowerment: an ultimate or elusive goal?’. In: Arvai J, Rivers LIII, editors. Effective risk communication. Abingdon, Oxon: Routledge; 2013.
117.
Clark JP. How to peer review a qualitative manuscript. In: Godlee F, Jefferson T, editors. Peer review in health sciences. 2nd ed. London: BMJ Books; 2003. p. 219–35.
118.
119.
120.
Metadata
Title
Parental recommendations for population level interventions to support infant and family dietary choices: a qualitative study from the Growing Up in Wales, Environments for Healthy Living (EHL) study
Authors
Ashrafunnesa Khanom
Rebecca A Hill
Kelly Morgan
Frances L Rapport
Ronan A Lyons
Sinead Brophy
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-1561-4

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Predictors of modern contraceptive use during the postpartum period among women in Uganda: a population-based cross sectional study

Research article

School-based intervention on healthy behaviour among Ecuadorian adolescents: effect of a cluster-randomized controlled trial on screen-time

Research article

A systematic review of the clinical and social epidemiological research among sex workers in Uganda

Research article

Implementation conditions for diet and physical activity interventions and policies: an umbrella review

Research article

Public response to the 2014 chemical spill in West Virginia: knowledge, opinions and behaviours

Research article

Hidden voices: prevalence and risk factors for violence against women with disabilities in Nepal