ORIGINAL ARTICLE

Engaging parents in child obesity prevention: Supportpreferences of parentsjpc_1776 4..6

Luke Wolfenden,1 Colin Bell,1,2 John Wiggers,1,2 Michelle Butler,2 Erica James1,3 and Kelly Chipperfield1

1Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Callaghan, and 2Hunter New England Population Health and 3Centre for

Health Research & Psycho-oncology (CHeRP), Wallsend, New South Wales, Australia

Abstract: Helping parents engage in practices that are likely to prevent childhood obesity is a considerable challenge for health professionals,policy makers and researchers. The aim of the study was to determine who is likely to use services designed to help parents prevent overweightand obesity and what types of services they prefer. Two hundred and forty randomly selected parents of children 4–15 years from the HunterNew England region of New South Wales completed a 15 min telephone survey. Most parents would use a service to help them prevent obesityin their children but particularly parents of households from higher socioeconomic areas, female parents, parents of younger children andparents of children who are not consuming sufficient serves of fruits and vegetables, or are less active. Parents preferred personalised mailedprint materials (85%), specialist appointments (61%) and emailed information (58%). Parents are interested in using a range of services to supportthem to encourage their children to eat healthily and be active. Researchers should test the efficacy of promising services.

Key words: child; intervention; method; obesity; parent.

Introduction

In addition to developmental and psychosocial benefits, physicalactivity and healthy eating can reduce the risk of excessiveweight gain among children.1 Parents, and home and familyenvironments are among the strongest influences on children’sdiet, physical activity and weight status2 and are importantintervention targets in efforts to curb the growing burden ofdisease associated with child obesity.3 Despite their influence, anumber of barriers including lack of time, knowledge and skillshinder the ability of parents to encourage child healthy eatingand physical activity.3,4

With support, parents can overcome such barriers and reducethe risk of excessive weight gain.5 While research in this field isaccumulating, most child obesity prevention interventions have

been conducted in settings such as schools, and included limitedstrategies to engage and support parent behavioural change.3

Obesity interventions that have involved parents and familieshave reported high participant drop out, particularly ininstances where parents and children are required to travel toreceive intervention support.6 As such, engaging parents inchild obesity initiatives represents a considerable challenge6,7

and the provision of support to parents through more accessibleand acceptable means has been suggested.6

Identifying programme preferences is an important aspect ofdesigning effective health promotion programmes, and mayfacilitate the development of effective child obesity preventioninterventions targeting parents. In an effort to identify accept-able means to support parents to encourage their children to eathealthily and be active, the aim of this study was to determinewho is likely to use services designed to help parents preventoverweight and obesity and determine what types of servicesthey prefer.

Method

The research was approved and monitored by the Hunter NewEngland Human Research Ethics Committee.

Sample, design and procedure

In 2007, a random household telephone survey of 937 parents(78% response rate) of children 2–15 years was conducted inthe Hunter New England region of New South Wales, Australia.The region has a population of 837 000 and encompassesregional cities, rural and remote towns. Ninety-eight percent of

Key Points

1 Parents report an interest in variety of support services toencourage their child to eat healthily and be active.

2 The use of computer or telephone-based support strategiesappear to be a promising means of engaging parents of chil-dren who may be behaviourally at risk of weight gain.

3 Interventions to support parents to encourage their childrento eat healthily and be active are likely to require a variety ofstrategies to maximise parental engagement.

Correspondence: Dr Luke Wolfenden, Faculty of Health, School ofMedicine and Public Health, The University of Newcastle, University Drive,Callaghan NSW 2308, Australia. Fax: +61 2 4924 6215; email: luke.wolfenden@hnehealth.nsw.gov.au

Accepted for publication 2 February 2010.

doi:10.1111/j.1440-1754.2010.01776.x

Journal of Paediatrics and Child Health 48 (2012) E4–E6© 2010 The Authors

Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians)

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telephone survey participants agreed to be approached forfuture health surveys. Of this cohort, 273 randomly selectedparent households of children 4–15 years were invited to par-ticipate in a 15-min telephone survey conducted by trainedinterviewers in 2008. Data from the latter telephone survey wasutilised in this study.

Measures

Demographics and child health behaviours

Demographic and child health behaviour data were collected todescribe the sample and determine if such characteristics pre-dicted likely service use. As a crude assessment of child healthyeating and physical activity behaviours, parents completed itemsassessing the reference child’s usual daily consumption of fruitsand vegetables, and the time they spend in organised and unor-ganised physical activity outside of school hours. These itemshave been used in other population health surveys.8

Preferred support service

Service preference was assessed by asking parents to indicate ona 4 point Likert scale (very unlikely, unlikely, likely, very likely)the likelihood that they would use a range of hypotheticalservices. They were told that the service would be offered free ofcharge and would provide them with information and supportto encourage their reference children to eat healthily and beactive.

Analysis

Data were analysed in SAS version 8.2 (SAS Institute Inc., Cary,NC, USA) and JMP 7.0 statistical software (SAS Institute Inc.,Cary, NC, USA). Descriptive statistics were used to describe theparent and child demographics and child health behaviours. TheAustralian Guide to Healthy Eating recommendations wereused to identify parents of children not consuming the recom-mended serves per day of fruits and vegetables. To assessremoteness, residential postcodes were classified as urban(regional cities, inner regional areas) or rural (outer regional,remote and very remote areas) based on The Australian Stan-dard Geographical Classification. To assess socioeconomic disad-vantage, postcodes ranked in the top 50% of New South Walesaccording to the 2007 Socio-Economic Indices for Areas wereclassified as ‘higher socioeconomic areas’. The proportion ofparents likely (very likely and likely) to use each hypotheticalsupport services was calculated and reported with 95% confi-dence intervals. A logistic multiple regression was performed todetermine if demographic, child health behaviour, remotenessor socioeconomic disadvantage characteristics predicted likelyservice utilisation.

Results

Demographic and child health behaviours

Two hundred and forty of the 273 parents approached (88%)completed the telephone survey. The mean age of participants

was 39.7 years, 84% were female and 26% had a university orother tertiary qualification. The mean age of reference childrenwas 9.9 years, 50% were girls, 69% resided in urban and 31%in higher socioeconomic areas, 31% consumed the recom-mended serves of both fruits and vegetables and 83% partici-pated in at least 60 min of organised or unorganised physicalactivity each day.

Preferred services

The likely utilisation of the various parental support strategies isdescribed in Table 1. The majority of parents reported that theywould use support services given the chance. A personalisedmail support service was the most popular. SMS text messageservices and interactive voice response telephone services werethe least preferred services.

Predictors of likely service use

The significant predictors of likely service use can be seen inTable 2. A number of services were more likely to be utilised byfemale parents; parents of younger children (4–12 years);parents of children not consuming sufficient service of fruits andvegetables and parents of children participating in less than60 min of organised and unorganised physical activity per day.

Discussion

The findings of the study indicate that parents report interest inusing a range of support service to assist them to encourage theirchildren to eat healthily and be active. Consistent with pro-gramme preferences for adult obesity initiatives,9,10 low inten-sity interventions, such as the provision of information throughmail or email were among the services most likely to be utilisedby parents. While tailored health messages are popular, andhave been demonstrated to be effective and acceptable in thepromotion of physical activity among adults,11 the capacity ofsuch interventions to modify parent behaviour as a lone strategyis likely to be limited.12

Table 1 Parent report of likely support service use

Support modality Likely support service

modality use

n % 95% CI

Tailored print information delivered via mail 205 85.4 (81.0–89.9)

A personal appointment with a specialist 147 61.3 (55.1–67.4)

A proactive email service 139 57.9 (51.7–64.2)

Internet-based programme 128 53.3 (47.0–59.6)

Reactive telephone help line 92 38.8 (32.6–44.9)

Group-based programme 79 32.9 (27.0–38.9)

Proactive telephone support service 73 30.4 (24.6–36.2)

SMS text messages 68 28.3 (22.6–34.0)

Interactive voice response telephone service 28 11.7 (7.6–15.7)

L Wolfenden et al. Engaging parents in obesity prevention

Journal of Paediatrics and Child Health 48 (2012) E4–E6© 2010 The AuthorsJournal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians)

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Surprisingly, given previously reported barriers such as timeand transportation difficulties, an appointment with a specialistand participation in group-based programmes were nominatedas services likely to be utilised by 61% and 33% of parents,respectively. Such face-to-face contact may be particularly effec-tive in improving child diet and increasing physical activitygiven the capacity of experts to deliver intensive and tailoredintervention support to parents during such sessions. Telephoneand Internet-based services, which can reach large numbers ofparents and also provide intensive and interactive support werereported by up to 54% or parents as services they would belikely to use. Such services have appealing public health appli-cation given evidence that telephone and Internet-basedapproaches may be more cost-effective than support requiringface-to-face contract.13,14 These services were also those morelikely to be used by parents of children who are less active or arenot consuming adequate serves of fruits or vegetables, indicat-ing that they represent a promising means of delivering supportto parents of children who may be most in need of such support.

For a number of services, female parents, and parents ofyounger children were more likely to report service utilisationto encourage healthy eating and activity habits of their children.As both mothers and fathers are influential in shaping thehealth behaviours of young children and adolescents,3,15 futureresearch identifying strategies to target fathers and parents ofadolescent children is warranted.

The primary limitation of the study is the reliance on parentreports of perceived service use. Actual service use is likely to belower.9 However, based on rank order, perceived programmepreferences for community-based adult obesity services have

been found to correspond closely with actual programme use.9

Nonetheless, the findings of the study provide useful informa-tion for child obesity researchers, health professionals and policymakers regarding the likely utility of child obesity interventionsinvolving parents.

Acknowledgement

The study was supported by funding from NSW Health throughthe Hunter Medical Research Institute.

References

1 King L, Hector D. Building Solutions for Preventing Childhood Obesity.Overview Module. Sydney: NSW Centre for Overweight and Obesity,2008.

2 Golan M, Crow S. Parents are key players in the prevention andtreatment of weight-related problems. Nutr. Rev. 2004; 62: 39–50.

3 Lindsay AC, Sussner KM, Kim J, Gortmaker S. The role of parents inpreventing childhood obesity. Future Child 2006; 16: 169–86.

4 Hesketh K, Waters E, Green WJ, Salmon L, Williams J. Healthy eating,activity and obesity prevention: a qualitative study of parent and childperceptions in Australia. Health Promot. Int. 2005; 20: 19–26.

5 Campbell KJ, Hesketh KD. Strategies which aim to positively impact onweight, physical activity, diet and sedentary behaviours in childrenfrom zero to five years. A systematic review of the literature. Obes.Rev. 2007; 8: 327–38.

6 Oude Luttikhuis H, Baur L, Jansen H et al. Interventions for treatingobesity in children. Cochrane Database Syst. Rev. 2009; Art. No.:CD001872. DOI: 10.1002/14651858.CD001872.pub2.

7 Kelsey KS, Campbell MK, Vanata DF. Parent and adolescent girls’preferences for parental involvement in adolescent health promotionprograms. J. Am. Diet Assoc. 1998; 98: 906–7.

8 Centre for Epidemiology and Research. 2005–2006 Report on ChildHealth from the New South Wales Population Health Survey. Sydney:NSW Department of Health, 2008.

9 Sherwood NE, Morton N, Jeffery RW, French SA, Neu-mark-Sztainer D,Falkner NH. Consumer preferences in format and type of communitybased weight control programs. Am. J. Health Promot. 1998; 13:12–8.

10 Esters ON, Boeckner LS, Hubert M et al. Educator and participantperceptions and cost analysis of stage-tailored educational telephonecalls. J. Nutr. Educ. Behav. 2008; 40: 258–64.

11 Smeets T, Brug J, de Vries H. Effects of tailoring health messages onphysical activity. Health Educ. Res. 2008; 23: 402–13.

12 Marshall AL, Owen N, Bauman AE. Mediated approaches forinfluencing physical activity: update of the evidence on mass media,print, telephone and website delivery of interventions. J. Sci. Med.Sport Suppl. 2004; 7/1: 74–80.

13 Cobiac LJ, Vos T, Barendregt JJ. Cost-effectiveness of interventions topromote physical activity: a modelling study. PLoS Med. 2009; 6:e1000110. doi:10.1371/journal.pmed.1000110.

14 Graves N, Barnett AG, Halton KA, et al. Cost-effectiveness of atelephone-delivered intervention for physical activity and diet. PLoSONE 2009; 4: e7135. doi:10.1371/journal.pone.0007135.

15 Davison KK, Birch LL. Obesigenic families: parents’ physical activityand dietary intake patterns predict girls’ risk of overweight. Int. J.Obes. 2002; 26: 1186–93.

Table 2 Significant predictors of likely support service use

Odds ratio 95% CI P

Group based program

Female parent 2.93 1.23, 8.14 0.02

Child age 4–12 years 2.14 1.11, 4.33 0.03

Internet-based programme

Higher socioeconomic areas 1.92 1.09, 3.44 0.02

Child consuming less fruits and

vegetables than recommended

1.99 1.02, 4.02 0.05

Child age: 4–12 years 2.05 1.06, 4.11 0.04

A reactive telephone help line

Child physical activity <60 min/day 2.78 1.40, 5.68 <0.01

Print information delivered via mail

Female Parent 3.02 1.30, 6.78 0.01

SMS text messages

Child consuming less fruits and

vegetables than recommended

1.98 1.08, 3.58 0.03

A proactive email service

Child physical activity <60 min/day 2.52 1.21, 5.69 0.02

Engaging parents in obesity prevention L Wolfenden et al.

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Journal of Paediatrics and Child Health © 2010 Paediatrics and Child Health Division (Royal Australasian College of Physicians)

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