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Liselotte Schafer Elinder - One of the best experts on this subject based on the ideXlab platform.
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Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study
The Journal of Primary Prevention, 2020Co-Authors: Helena Bergström, Elinor Sundblom, Liselotte Schafer Elinder, Åsa Norman, Gisela NybergAbstract:Health-related behaviours in children can be influenced by Parental Support programmes. The aim of this study was to explore barriers to and facilitators for the implementation of a Parental Support programme to promote physical activity and healthy dietary habits in a school context. We explored the views and experiences of 17 coordinating school nurses, non-coordinating school nurses, and school principals. We based the interview guide on the Consolidated Framework for Implementation Research. We held four focus group discussions with coordinating and non-coordinating school nurses, and conducted three individual interviews with school principals. We analysed data inductively using qualitative content analysis. We identified “Creating commitment in an overburdened work situation” as an overarching theme, emphasising the high workload in schools and the importance of creating commitment, by giving Support to and including staff in the implementation process. We also identified barriers to and facilitators of implementation within four categories: (1) community and organisational factors, (2) a matter of priority, (3) implementation Support, and (4) implementation process. When implementing a Parental Support programme to promote physical activity and healthy dietary habits for 5- to 7-year-old children in the school context, it is important to create commitment among school staff and school nurses. The implementation can be facilitated by political Support and additional funding, external guidance, use of pre-existing resources, integration of the programme into school routines, a clearly structured manual, and appointment of a multidisciplinary team. The results of this study should provide useful guidance for the implementation of similar health promotion interventions in the school context.
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a healthy school start plus for prevention of childhood overweight and obesity in disadvantaged areas through Parental Support in the school setting study protocol for a parallel group cluster randomised trial
BMC Public Health, 2018Co-Authors: Liselotte Schafer Elinder, Gisela Nyberg, Emma Patterson, Åsa NormanAbstract:Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children’s health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through Parental Support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study. Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with Parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context. The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health. The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov : No. NCT03390725 .
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effectiveness of a universal Parental Support programme to promote health behaviours and prevent overweight and obesity in 6 year old children in disadvantaged areas the healthy school start study ii a cluster randomised controlled trial
International Journal of Behavioral Nutrition and Physical Activity, 2016Co-Authors: Gisela Nyberg, Elinor Sundblom, Åsa Norman, Zangin Zeebari, Liselotte Schafer ElinderAbstract:There is increasing evidence for the effectiveness of Parental Support programmes to promote healthy behaviours and prevent obesity in children, but only few studies have been conducted among groups with low socio-economic status. The aim of this study was to develop and evaluate the effectiveness of a Parental Support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas. A cluster-randomised controlled trial was carried out in disadvantaged areas in Stockholm. Participants were six-year-old children (n = 378) and their parents. Thirty-one school classes from 13 schools were randomly assigned to intervention (n = 16) and control groups (n = 15). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary intake and screen time with a questionnaire, body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 5months follow-up. Group effects were examined using Mixed-effect Regression analyses adjusted for sex, Parental education and baseline values. Fidelity to all three intervention components was satisfactory. Significant intervention effects were found regarding consumption of unhealthy foods (p = 0.01) and unhealthy drinks (p = 0.01). At follow-up, the effect on intake of unhealthy foods was sustained for boys (p = 0.03). There was no intervention effect on physical activity. Further, the intervention had no apparent effect on BMI sds for the whole sample, but a significant difference between groups was detected among children who were obese at baseline (p = 0.03) which was not sustained at follow-up. The Healthy School Start study shows that it is possible to influence intake of unhealthy foods and drinks and weight development in obese children by providing individual Parental Support in a school context. However, the effects were short-lived. Therefore, the programme needs to be prolonged and/or intensified in order to obtain stronger and sustainable effects. This study is an important contribution to the further development of evidence-based Parental Support programmes to prevent overweight and obesity in children in disadvantaged areas.
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one size does not fit all qualitative process evaluation of the healthy school start Parental Support programme to prevent overweight and obesity among children in disadvantaged areas in sweden
BMC Public Health, 2015Co-Authors: Åsa Norman, Liselotte Schafer Elinder, Gisela Nyberg, Anita BerlinAbstract:Parental Support interventions have shown some effectiveness in improving children’s dietary and physical activity habits and preventing overweight and obesity. To date, there is limited research on barriers and facilitators of school-based Parental Support interventions targeting overweight and obesity. This study aimed to describe barriers and facilitators influencing implementation of the Healthy School Start (HSS) intervention in disadvantaged areas in Stockholm, Sweden, from the perspective of parents and teachers. Focus groups and individual interviews with teachers (n = 10) and focus groups with parents (n = 14) in the intervention group of the HSS were undertaken, guided by the Consolidated Framework for Implementation Research (CFIR). Transcriptions were analysed using qualitative content analysis in two steps: deductive sorting in two domains of the CFIR (intervention characteristics and process), and subsequent inductive analysis. The overarching theme “tailoring the intervention to increase participant engagement” was found. Among teachers, barriers and facilitators were related to how the intervention was introduced, perceptions of the usefulness of the classroom material, preparation ahead of the start of the intervention, cooperation between home and school and children’s and parents’ active engagement in the intervention activities. For parents, barriers and facilitators were related to the perceived relevance of the intervention, usefulness of the material, experiences of the Motivational Interviewing (MI) sessions, the family member targeted by the intervention, cooperation between home and school and parents’ ability to act as good role models. It seems important to tailor the intervention to the abilities of the target group in order to increase participant engagement. Including activities that focus on parents as role models and cooperation between parents seems important to bring about changes in the home environment. It also appears important to include activities that target cooperation between home and school.
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effectiveness of universal Parental Support interventions addressing children s dietary habits physical activity and bodyweight a systematic review
Preventive Medicine, 2015Co-Authors: Manzur Kader, Elinor Sundblom, Liselotte Schafer ElinderAbstract:Abstract Objectives The evidence regarding effectiveness of Parental Support interventions targeting children's health behaviours is weak. We aimed to review: 1) effectiveness of universal Parental Support interventions to promote dietary habits, physical activity (PA) or prevent overweight and obesity among children 2–18 years and 2) effectiveness in relation to family socio-economic position. Methods Thirty five studies from 1990 to 2013 were identified from major databases. Quality was assessed by four criteria accounting for selection and attrition bias, fidelity to intervention, and outcome measurement methodology, categorizing studies as strong, moderate or weak. Results Four intervention types were identified: face-to-face counselling, group education, information sent home, and telephone counselling. Face-to-face or telephone counselling was effective in changing children's diet, while there was only weak evidence for improvement in PA. Sending home information was not effective. Concerning body weight, group education seemed more promising than counselling. Intervention effectiveness was generally higher in younger compared to older children. In groups with low socio-economic position, group-based approaches appeared promising. Conclusion In the future efforts should be made to improve reporting of intervention content, include a power calculation for the main outcome, the use of high quality outcome assessment methodology, and a follow-up period of at least 6 months.
Gisela Nyberg - One of the best experts on this subject based on the ideXlab platform.
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Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study
The Journal of Primary Prevention, 2020Co-Authors: Helena Bergström, Elinor Sundblom, Liselotte Schafer Elinder, Åsa Norman, Gisela NybergAbstract:Health-related behaviours in children can be influenced by Parental Support programmes. The aim of this study was to explore barriers to and facilitators for the implementation of a Parental Support programme to promote physical activity and healthy dietary habits in a school context. We explored the views and experiences of 17 coordinating school nurses, non-coordinating school nurses, and school principals. We based the interview guide on the Consolidated Framework for Implementation Research. We held four focus group discussions with coordinating and non-coordinating school nurses, and conducted three individual interviews with school principals. We analysed data inductively using qualitative content analysis. We identified “Creating commitment in an overburdened work situation” as an overarching theme, emphasising the high workload in schools and the importance of creating commitment, by giving Support to and including staff in the implementation process. We also identified barriers to and facilitators of implementation within four categories: (1) community and organisational factors, (2) a matter of priority, (3) implementation Support, and (4) implementation process. When implementing a Parental Support programme to promote physical activity and healthy dietary habits for 5- to 7-year-old children in the school context, it is important to create commitment among school staff and school nurses. The implementation can be facilitated by political Support and additional funding, external guidance, use of pre-existing resources, integration of the programme into school routines, a clearly structured manual, and appointment of a multidisciplinary team. The results of this study should provide useful guidance for the implementation of similar health promotion interventions in the school context.
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a healthy school start plus for prevention of childhood overweight and obesity in disadvantaged areas through Parental Support in the school setting study protocol for a parallel group cluster randomised trial
BMC Public Health, 2018Co-Authors: Liselotte Schafer Elinder, Gisela Nyberg, Emma Patterson, Åsa NormanAbstract:Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children’s health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through Parental Support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study. Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with Parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context. The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health. The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov : No. NCT03390725 .
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effectiveness of a universal Parental Support programme to promote health behaviours and prevent overweight and obesity in 6 year old children in disadvantaged areas the healthy school start study ii a cluster randomised controlled trial
International Journal of Behavioral Nutrition and Physical Activity, 2016Co-Authors: Gisela Nyberg, Elinor Sundblom, Åsa Norman, Zangin Zeebari, Liselotte Schafer ElinderAbstract:There is increasing evidence for the effectiveness of Parental Support programmes to promote healthy behaviours and prevent obesity in children, but only few studies have been conducted among groups with low socio-economic status. The aim of this study was to develop and evaluate the effectiveness of a Parental Support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas. A cluster-randomised controlled trial was carried out in disadvantaged areas in Stockholm. Participants were six-year-old children (n = 378) and their parents. Thirty-one school classes from 13 schools were randomly assigned to intervention (n = 16) and control groups (n = 15). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary intake and screen time with a questionnaire, body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 5months follow-up. Group effects were examined using Mixed-effect Regression analyses adjusted for sex, Parental education and baseline values. Fidelity to all three intervention components was satisfactory. Significant intervention effects were found regarding consumption of unhealthy foods (p = 0.01) and unhealthy drinks (p = 0.01). At follow-up, the effect on intake of unhealthy foods was sustained for boys (p = 0.03). There was no intervention effect on physical activity. Further, the intervention had no apparent effect on BMI sds for the whole sample, but a significant difference between groups was detected among children who were obese at baseline (p = 0.03) which was not sustained at follow-up. The Healthy School Start study shows that it is possible to influence intake of unhealthy foods and drinks and weight development in obese children by providing individual Parental Support in a school context. However, the effects were short-lived. Therefore, the programme needs to be prolonged and/or intensified in order to obtain stronger and sustainable effects. This study is an important contribution to the further development of evidence-based Parental Support programmes to prevent overweight and obesity in children in disadvantaged areas.
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one size does not fit all qualitative process evaluation of the healthy school start Parental Support programme to prevent overweight and obesity among children in disadvantaged areas in sweden
BMC Public Health, 2015Co-Authors: Åsa Norman, Liselotte Schafer Elinder, Gisela Nyberg, Anita BerlinAbstract:Parental Support interventions have shown some effectiveness in improving children’s dietary and physical activity habits and preventing overweight and obesity. To date, there is limited research on barriers and facilitators of school-based Parental Support interventions targeting overweight and obesity. This study aimed to describe barriers and facilitators influencing implementation of the Healthy School Start (HSS) intervention in disadvantaged areas in Stockholm, Sweden, from the perspective of parents and teachers. Focus groups and individual interviews with teachers (n = 10) and focus groups with parents (n = 14) in the intervention group of the HSS were undertaken, guided by the Consolidated Framework for Implementation Research (CFIR). Transcriptions were analysed using qualitative content analysis in two steps: deductive sorting in two domains of the CFIR (intervention characteristics and process), and subsequent inductive analysis. The overarching theme “tailoring the intervention to increase participant engagement” was found. Among teachers, barriers and facilitators were related to how the intervention was introduced, perceptions of the usefulness of the classroom material, preparation ahead of the start of the intervention, cooperation between home and school and children’s and parents’ active engagement in the intervention activities. For parents, barriers and facilitators were related to the perceived relevance of the intervention, usefulness of the material, experiences of the Motivational Interviewing (MI) sessions, the family member targeted by the intervention, cooperation between home and school and parents’ ability to act as good role models. It seems important to tailor the intervention to the abilities of the target group in order to increase participant engagement. Including activities that focus on parents as role models and cooperation between parents seems important to bring about changes in the home environment. It also appears important to include activities that target cooperation between home and school.
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effectiveness of a universal Parental Support programme to promote healthy dietary habits and physical activity and to prevent overweight and obesity in 6 year old children the healthy school start study a cluster randomised controlled trial
PLOS ONE, 2015Co-Authors: Gisela Nyberg, Elinor Sundblom, Åsa Norman, Benjamin Bohman, Jan Hagberg, Liselotte Schafer ElinderAbstract:Objective To develop and evaluate the effectiveness of a Parental Support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in Swedish children. Methods A cluster-randomised controlled trial was carried out in areas with low to medium socio-economic status. Participants were six-year-old children (n = 243) and their parents. Fourteen pre-school classes were randomly assigned to intervention (n = 7) and control groups (n = 7). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary and physical activity habits and Parental self-efficacy through a questionnaire. Body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 6-months follow-up. Group differences were examined using analysis of covariance and Poisson regression, adjusted for gender and baseline values. Results There was no significant intervention effect in the primary outcome physical activity. Sub-group analyses showed a significant gender-group interaction in total physical activity (TPA), with girls in the intervention group demonstrating higher TPA during weekends (p = 0.04), as well as in sedentary time, with boys showing more sedentary time in the intervention group (p = 0.03). There was a significantly higher vegetable intake (0.26 servings) in the intervention group compared to the control group (p = 0.003). At follow-up, sub-group analyses showed a sustained effect for boys. The intervention did not affect the prevalence of overweight or obesity. Conclusions It is possible to influence vegetable intake in children and girls’ physical activity through a Parental Support programme. The programme needs to be intensified in order to increase effectiveness and sustain the effects long-term. These findings are an important contribution to the further development of evidence-based Parental Support programmes to prevent overweight and obesity in children. Trial Registration Controlled-trials.com ISRCTN32750699
Åsa Norman - One of the best experts on this subject based on the ideXlab platform.
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Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study
The Journal of Primary Prevention, 2020Co-Authors: Helena Bergström, Elinor Sundblom, Liselotte Schafer Elinder, Åsa Norman, Gisela NybergAbstract:Health-related behaviours in children can be influenced by Parental Support programmes. The aim of this study was to explore barriers to and facilitators for the implementation of a Parental Support programme to promote physical activity and healthy dietary habits in a school context. We explored the views and experiences of 17 coordinating school nurses, non-coordinating school nurses, and school principals. We based the interview guide on the Consolidated Framework for Implementation Research. We held four focus group discussions with coordinating and non-coordinating school nurses, and conducted three individual interviews with school principals. We analysed data inductively using qualitative content analysis. We identified “Creating commitment in an overburdened work situation” as an overarching theme, emphasising the high workload in schools and the importance of creating commitment, by giving Support to and including staff in the implementation process. We also identified barriers to and facilitators of implementation within four categories: (1) community and organisational factors, (2) a matter of priority, (3) implementation Support, and (4) implementation process. When implementing a Parental Support programme to promote physical activity and healthy dietary habits for 5- to 7-year-old children in the school context, it is important to create commitment among school staff and school nurses. The implementation can be facilitated by political Support and additional funding, external guidance, use of pre-existing resources, integration of the programme into school routines, a clearly structured manual, and appointment of a multidisciplinary team. The results of this study should provide useful guidance for the implementation of similar health promotion interventions in the school context.
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a healthy school start plus for prevention of childhood overweight and obesity in disadvantaged areas through Parental Support in the school setting study protocol for a parallel group cluster randomised trial
BMC Public Health, 2018Co-Authors: Liselotte Schafer Elinder, Gisela Nyberg, Emma Patterson, Åsa NormanAbstract:Systematic reviews conclude that interventions to prevent overweight and obesity in children obtain stronger effects when parents are involved. Parenting practices and parent-child interactions shape children’s health-related behaviours. The Healthy School Start Plus intervention aims to promote healthy dietary habits and physical activity and prevent obesity in children through Parental Support in disadvantaged areas with increased health needs, delivered by teachers and school nurses. This protocol describes the design, outcome and process evaluation of the study. Effectiveness of the intervention is compared to standard care within school health services. The 6-month programme, based on Social Cognitive Theory, consists of four components: 1) Health information to parents regarding the child; 2) Motivational Interviewing with the parents by the school nurse concerning the child; 3) classroom activities for the children by teachers; and 4) a web-based self-test of type-2 diabetes risk by parents. Effects will be studied in a cluster randomised trial including 17 schools and 352 six-year old children. The primary outcome is dietary intake of indicator foods, and secondary outcomes are physical activity, sedentary behaviour and BMI. Outcomes will be measured at baseline, at 6 months directly after the intervention, and at follow-up 18 months post baseline. Statistical analysis will be by mixed-effect regression analysis according to intention to treat and per protocol. Mediation analysis will be performed with Parental self-efficacy and parenting practices. Quantitative and qualitative methods will be used to study implementation in terms of dose, fidelity, feasibility and acceptability. The hypothesis is that the programme will be more effective than standard care and feasible to perform in the school context. The programme is in line with the cumulated evidence regarding the prevention of childhood obesity: That schools should be a focal point of prevention efforts, interventions should involve multiple components, and include the home environment. If effective, it will fill a knowledge gap concerning evidence-based health promotion practice within school health services to prevent obesity, and in the long term reduce social inequalities in health. The trial was retrospectively registered on January 4, 2018 and available online at ClinicalTrials.gov : No. NCT03390725 .
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effectiveness of a universal Parental Support programme to promote health behaviours and prevent overweight and obesity in 6 year old children in disadvantaged areas the healthy school start study ii a cluster randomised controlled trial
International Journal of Behavioral Nutrition and Physical Activity, 2016Co-Authors: Gisela Nyberg, Elinor Sundblom, Åsa Norman, Zangin Zeebari, Liselotte Schafer ElinderAbstract:There is increasing evidence for the effectiveness of Parental Support programmes to promote healthy behaviours and prevent obesity in children, but only few studies have been conducted among groups with low socio-economic status. The aim of this study was to develop and evaluate the effectiveness of a Parental Support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas. A cluster-randomised controlled trial was carried out in disadvantaged areas in Stockholm. Participants were six-year-old children (n = 378) and their parents. Thirty-one school classes from 13 schools were randomly assigned to intervention (n = 16) and control groups (n = 15). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary intake and screen time with a questionnaire, body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 5months follow-up. Group effects were examined using Mixed-effect Regression analyses adjusted for sex, Parental education and baseline values. Fidelity to all three intervention components was satisfactory. Significant intervention effects were found regarding consumption of unhealthy foods (p = 0.01) and unhealthy drinks (p = 0.01). At follow-up, the effect on intake of unhealthy foods was sustained for boys (p = 0.03). There was no intervention effect on physical activity. Further, the intervention had no apparent effect on BMI sds for the whole sample, but a significant difference between groups was detected among children who were obese at baseline (p = 0.03) which was not sustained at follow-up. The Healthy School Start study shows that it is possible to influence intake of unhealthy foods and drinks and weight development in obese children by providing individual Parental Support in a school context. However, the effects were short-lived. Therefore, the programme needs to be prolonged and/or intensified in order to obtain stronger and sustainable effects. This study is an important contribution to the further development of evidence-based Parental Support programmes to prevent overweight and obesity in children in disadvantaged areas.
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one size does not fit all qualitative process evaluation of the healthy school start Parental Support programme to prevent overweight and obesity among children in disadvantaged areas in sweden
BMC Public Health, 2015Co-Authors: Åsa Norman, Liselotte Schafer Elinder, Gisela Nyberg, Anita BerlinAbstract:Parental Support interventions have shown some effectiveness in improving children’s dietary and physical activity habits and preventing overweight and obesity. To date, there is limited research on barriers and facilitators of school-based Parental Support interventions targeting overweight and obesity. This study aimed to describe barriers and facilitators influencing implementation of the Healthy School Start (HSS) intervention in disadvantaged areas in Stockholm, Sweden, from the perspective of parents and teachers. Focus groups and individual interviews with teachers (n = 10) and focus groups with parents (n = 14) in the intervention group of the HSS were undertaken, guided by the Consolidated Framework for Implementation Research (CFIR). Transcriptions were analysed using qualitative content analysis in two steps: deductive sorting in two domains of the CFIR (intervention characteristics and process), and subsequent inductive analysis. The overarching theme “tailoring the intervention to increase participant engagement” was found. Among teachers, barriers and facilitators were related to how the intervention was introduced, perceptions of the usefulness of the classroom material, preparation ahead of the start of the intervention, cooperation between home and school and children’s and parents’ active engagement in the intervention activities. For parents, barriers and facilitators were related to the perceived relevance of the intervention, usefulness of the material, experiences of the Motivational Interviewing (MI) sessions, the family member targeted by the intervention, cooperation between home and school and parents’ ability to act as good role models. It seems important to tailor the intervention to the abilities of the target group in order to increase participant engagement. Including activities that focus on parents as role models and cooperation between parents seems important to bring about changes in the home environment. It also appears important to include activities that target cooperation between home and school.
-
effectiveness of a universal Parental Support programme to promote healthy dietary habits and physical activity and to prevent overweight and obesity in 6 year old children the healthy school start study a cluster randomised controlled trial
PLOS ONE, 2015Co-Authors: Gisela Nyberg, Elinor Sundblom, Åsa Norman, Benjamin Bohman, Jan Hagberg, Liselotte Schafer ElinderAbstract:Objective To develop and evaluate the effectiveness of a Parental Support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in Swedish children. Methods A cluster-randomised controlled trial was carried out in areas with low to medium socio-economic status. Participants were six-year-old children (n = 243) and their parents. Fourteen pre-school classes were randomly assigned to intervention (n = 7) and control groups (n = 7). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary and physical activity habits and Parental self-efficacy through a questionnaire. Body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 6-months follow-up. Group differences were examined using analysis of covariance and Poisson regression, adjusted for gender and baseline values. Results There was no significant intervention effect in the primary outcome physical activity. Sub-group analyses showed a significant gender-group interaction in total physical activity (TPA), with girls in the intervention group demonstrating higher TPA during weekends (p = 0.04), as well as in sedentary time, with boys showing more sedentary time in the intervention group (p = 0.03). There was a significantly higher vegetable intake (0.26 servings) in the intervention group compared to the control group (p = 0.003). At follow-up, sub-group analyses showed a sustained effect for boys. The intervention did not affect the prevalence of overweight or obesity. Conclusions It is possible to influence vegetable intake in children and girls’ physical activity through a Parental Support programme. The programme needs to be intensified in order to increase effectiveness and sustain the effects long-term. These findings are an important contribution to the further development of evidence-based Parental Support programmes to prevent overweight and obesity in children. Trial Registration Controlled-trials.com ISRCTN32750699
Elinor Sundblom - One of the best experts on this subject based on the ideXlab platform.
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Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study
The Journal of Primary Prevention, 2020Co-Authors: Helena Bergström, Elinor Sundblom, Liselotte Schafer Elinder, Åsa Norman, Gisela NybergAbstract:Health-related behaviours in children can be influenced by Parental Support programmes. The aim of this study was to explore barriers to and facilitators for the implementation of a Parental Support programme to promote physical activity and healthy dietary habits in a school context. We explored the views and experiences of 17 coordinating school nurses, non-coordinating school nurses, and school principals. We based the interview guide on the Consolidated Framework for Implementation Research. We held four focus group discussions with coordinating and non-coordinating school nurses, and conducted three individual interviews with school principals. We analysed data inductively using qualitative content analysis. We identified “Creating commitment in an overburdened work situation” as an overarching theme, emphasising the high workload in schools and the importance of creating commitment, by giving Support to and including staff in the implementation process. We also identified barriers to and facilitators of implementation within four categories: (1) community and organisational factors, (2) a matter of priority, (3) implementation Support, and (4) implementation process. When implementing a Parental Support programme to promote physical activity and healthy dietary habits for 5- to 7-year-old children in the school context, it is important to create commitment among school staff and school nurses. The implementation can be facilitated by political Support and additional funding, external guidance, use of pre-existing resources, integration of the programme into school routines, a clearly structured manual, and appointment of a multidisciplinary team. The results of this study should provide useful guidance for the implementation of similar health promotion interventions in the school context.
-
effectiveness of a universal Parental Support programme to promote health behaviours and prevent overweight and obesity in 6 year old children in disadvantaged areas the healthy school start study ii a cluster randomised controlled trial
International Journal of Behavioral Nutrition and Physical Activity, 2016Co-Authors: Gisela Nyberg, Elinor Sundblom, Åsa Norman, Zangin Zeebari, Liselotte Schafer ElinderAbstract:There is increasing evidence for the effectiveness of Parental Support programmes to promote healthy behaviours and prevent obesity in children, but only few studies have been conducted among groups with low socio-economic status. The aim of this study was to develop and evaluate the effectiveness of a Parental Support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in six-year-old children in disadvantaged areas. A cluster-randomised controlled trial was carried out in disadvantaged areas in Stockholm. Participants were six-year-old children (n = 378) and their parents. Thirty-one school classes from 13 schools were randomly assigned to intervention (n = 16) and control groups (n = 15). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary intake and screen time with a questionnaire, body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 5months follow-up. Group effects were examined using Mixed-effect Regression analyses adjusted for sex, Parental education and baseline values. Fidelity to all three intervention components was satisfactory. Significant intervention effects were found regarding consumption of unhealthy foods (p = 0.01) and unhealthy drinks (p = 0.01). At follow-up, the effect on intake of unhealthy foods was sustained for boys (p = 0.03). There was no intervention effect on physical activity. Further, the intervention had no apparent effect on BMI sds for the whole sample, but a significant difference between groups was detected among children who were obese at baseline (p = 0.03) which was not sustained at follow-up. The Healthy School Start study shows that it is possible to influence intake of unhealthy foods and drinks and weight development in obese children by providing individual Parental Support in a school context. However, the effects were short-lived. Therefore, the programme needs to be prolonged and/or intensified in order to obtain stronger and sustainable effects. This study is an important contribution to the further development of evidence-based Parental Support programmes to prevent overweight and obesity in children in disadvantaged areas.
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effectiveness of universal Parental Support interventions addressing children s dietary habits physical activity and bodyweight a systematic review
Preventive Medicine, 2015Co-Authors: Manzur Kader, Elinor Sundblom, Liselotte Schafer ElinderAbstract:Abstract Objectives The evidence regarding effectiveness of Parental Support interventions targeting children's health behaviours is weak. We aimed to review: 1) effectiveness of universal Parental Support interventions to promote dietary habits, physical activity (PA) or prevent overweight and obesity among children 2–18 years and 2) effectiveness in relation to family socio-economic position. Methods Thirty five studies from 1990 to 2013 were identified from major databases. Quality was assessed by four criteria accounting for selection and attrition bias, fidelity to intervention, and outcome measurement methodology, categorizing studies as strong, moderate or weak. Results Four intervention types were identified: face-to-face counselling, group education, information sent home, and telephone counselling. Face-to-face or telephone counselling was effective in changing children's diet, while there was only weak evidence for improvement in PA. Sending home information was not effective. Concerning body weight, group education seemed more promising than counselling. Intervention effectiveness was generally higher in younger compared to older children. In groups with low socio-economic position, group-based approaches appeared promising. Conclusion In the future efforts should be made to improve reporting of intervention content, include a power calculation for the main outcome, the use of high quality outcome assessment methodology, and a follow-up period of at least 6 months.
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effectiveness of a universal Parental Support programme to promote healthy dietary habits and physical activity and to prevent overweight and obesity in 6 year old children the healthy school start study a cluster randomised controlled trial
PLOS ONE, 2015Co-Authors: Gisela Nyberg, Elinor Sundblom, Åsa Norman, Benjamin Bohman, Jan Hagberg, Liselotte Schafer ElinderAbstract:Objective To develop and evaluate the effectiveness of a Parental Support programme to promote healthy dietary and physical activity habits and to prevent overweight and obesity in Swedish children. Methods A cluster-randomised controlled trial was carried out in areas with low to medium socio-economic status. Participants were six-year-old children (n = 243) and their parents. Fourteen pre-school classes were randomly assigned to intervention (n = 7) and control groups (n = 7). The intervention lasted for 6 months and included: 1) Health information for parents, 2) Motivational Interviewing with parents and 3) Teacher-led classroom activities with children. Physical activity was measured by accelerometry, dietary and physical activity habits and Parental self-efficacy through a questionnaire. Body weight and height were measured and BMI standard deviation score was calculated. Measurements were conducted at baseline, post-intervention and at 6-months follow-up. Group differences were examined using analysis of covariance and Poisson regression, adjusted for gender and baseline values. Results There was no significant intervention effect in the primary outcome physical activity. Sub-group analyses showed a significant gender-group interaction in total physical activity (TPA), with girls in the intervention group demonstrating higher TPA during weekends (p = 0.04), as well as in sedentary time, with boys showing more sedentary time in the intervention group (p = 0.03). There was a significantly higher vegetable intake (0.26 servings) in the intervention group compared to the control group (p = 0.003). At follow-up, sub-group analyses showed a sustained effect for boys. The intervention did not affect the prevalence of overweight or obesity. Conclusions It is possible to influence vegetable intake in children and girls’ physical activity through a Parental Support programme. The programme needs to be intensified in order to increase effectiveness and sustain the effects long-term. These findings are an important contribution to the further development of evidence-based Parental Support programmes to prevent overweight and obesity in children. Trial Registration Controlled-trials.com ISRCTN32750699
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a healthy school start Parental Support to promote healthy dietary habits and physical activity in children design and evaluation of a cluster randomised intervention
BMC Public Health, 2011Co-Authors: Gisela Nyberg, Elinor Sundblom, Åsa Norman, Liselotte Schafer ElinderAbstract:Childhood obesity is multi-factorial and determined to a large extent by dietary habits, physical activity and sedentary behaviours. Previous research has shown that school-based programmes are effective but that their effectiveness can be improved by including a Parental component. At present, there is a lack of effective Parental Support programmes for improvement of diet and physical activity and prevention of obesity in children. This paper describes the rationale and design of a Parental Support programme to promote healthy dietary habits and physical activity in six-year-old children starting school. The study is performed in close collaboration with the school health care and is designed as a cluster-randomised controlled trial with a mixed methods approach. In total, 14 pre-school classes are included from a municipality in Stockholm county where there is large variation in socio-economic status between the families. The school classes are randomised to intervention (n = 7) and control (n = 7) groups including a total of 242 children. The intervention is based on social cognitive theory and consists of three main components: 1) a health information brochure; 2) two motivational interviewing sessions with the parents; and 3) teacher-led classroom activities with the children. The primary outcomes are physical activity in the children measured objectively by accelerometry, children's dietary and physical activity habits measured with a parent-proxy questionnaire and parents' self-efficacy measured by a questionnaire. Secondary outcomes are height, weight and waist circumference in the children. The duration of the intervention is six months and includes baseline, post intervention and six months follow-up measurements. Linear and logistic regression models will be used to analyse differences between intervention and control groups in the outcome variables. Mediator and moderator analysis will be performed. Participants will be interviewed. The results from this study will show if it is possible to promote a healthy lifestyle and a normal weight development among children from low-income districts with relatively limited efforts involving parents. Hopefully the study will provide new insights to the further development of effective programmes to prevent overweight and obesity in children. ISRCTN: ISRCTN32750699
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Parental Support of the canadian 24 hour movement guidelines for children and youth prevalence and correlates
BMC Public Health, 2019Co-Authors: Ryan E Rhodes, Tanya R Berry, Guy Faulkner, Amy E Latimercheung, Norman Oreilly, Mark S Tremblay, John C Spence, Leigh M VanderlooAbstract:To explore the prevalence of Parental Support for meeting the Canadian 24-Hour Movement Guidelines for Children and Youth, identify key interactive Support profiles among the four movement behaviors, and investigate subsequent sociodemographic and social cognitive correlates of these profiles. A sample of Canadian parents (N = 1208) with children aged 5 to 17 years completed measures of the theory of planned behavior (TPB), and Support of the four child movement behaviors via questionnaire. Differences in the proportion of parents Supporting these four health behaviors were explored and demographic and social cognitive (attitude and perceived control) correlates of combinations of Parental Support for the four health behaviors were evaluated. Child and youth sleep behavior had the highest Parental Support (73%) and moderate to vigorous physical activity Support had the lowest prevalence (23%). Interactive profiles of the four movement behaviors yielded six primary clusters and comprised wide variation from parents who Supported none of these behaviors (19%), to parents who Supported all four behaviors (14%). These profiles could be distinguished by the age of the child (younger children had higher Support) and the gender of the parent (mothers provided more Support), as well as constructs of the TPB, but TPB cognitions were more specific predictors of each health behavior rather than general predictors of aggregate health behavior clusters. Teenagers and fathers may represent key targets for Parental Support intervention of the 24-Hour Movement Guidelines. Intervention content may need to comprise the underlying foundations of attitude and perceived behavioral control to change Parental Support while considering the unique features of each health behavior to maximize related intervention effectiveness.
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application of the multi process action control framework to understand Parental Support of child and youth physical activity sleep and screen time behaviours
Applied Psychology: Health and Well-being, 2019Co-Authors: Ryan E Rhodes, Tanya R Berry, Guy Faulkner, Amy E Latimercheung, Norman Oreilly, Mark S Tremblay, Leigh M Vanderloo, John C SpenceAbstract:BACKGROUND The purpose of this paper was to apply a framework designed to evaluate the intention-behaviour gap, known as multi-process action control (M-PAC), to understand Parental Support for the Canadian 24-Hour Movement Guidelines for Children and Youth. METHOD Parents (N = 1,208) of children 5-17 years of age, completed measures of reflective (attitudes, perceived control), regulatory (planning), and reflexive (identity, habit) processes as well as intention and Support behaviours. RESULTS Parents had significantly (p < .01) higher intentions in descending order to Support sleep (86%), reduce screen time (62%), or Support physical activity (65% to 61%). Translation of these intentions into behaviour was also significantly (p < .01) higher in a descending pattern for sleep Support (80%), screen time reduction (68%), and physical activity Support (56% to 31%). Congruent with M-PAC, a discriminant function analysis of the results showed that the translation of Parental Support intentions into behaviour was associated with a combination of reflective, regulatory, and reflexive antecedents but these varied by the behaviours. CONCLUSION The majority of parents have positive intentions to Support child and youth health behaviours, yet many fail to enact this Support. Translation of intention into action was associated with attitudinal aspects, control over Support, self-regulation skills, and Parental habits and identity.
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predicting Parental Support and Parental perceptions of child and youth movement behaviors
Psychology of Sport and Exercise, 2019Co-Authors: Ryan E Rhodes, Jodie A Stearns, Tanya R Berry, Guy Faulkner, Amy E Latimercheung, Norman Oreilly, Mark S Tremblay, Leigh M Vanderloo, John C SpenceAbstract:Abstract Objectives In light of a shift to considering the integration of movement behaviors, the purpose of this study was to examine an extended multi-component theory of planned behavior (TPB) framework to predict parent Support and parent perceived behavior of the Canadian 24-h movement behaviors in children and youth including light physical activity (LPA), moderate to vigorous physical activity (MVPA), sleep, and screen-time. Design Cross-sectional survey. Method A representative sample of Canadian parents (N = 1208) with children aged 5–17 years of age, completed measures of TPB, Support behaviors, and the four child health behaviors via a panel survey. Results Controlling for child age, structural equation models showed that child health behavior was predicted by Parental Support of that behavior (10–27% of variance explained) and intention and perceived capability to Support explained Support behaviors (42–53% variance explained). The TPB antecedents of intention, however, differed by each health behavior. Conclusions Parental Support behaviors are related to perceived child/youth behavior. Parental Support is partly dependent on intention and perceptions of Parental capability but the interventions to promote the underlying social cognitions behind Parental Support may be different for MVPA, LPA, sleep, and screen time restriction.
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understanding action control of Parental Support behavior for child physical activity
Health Psychology, 2016Co-Authors: Ryan E Rhodes, Tanya R Berry, Guy Faulkner, Amy E Latimercheung, Norman Oreilly, John C Spence, Sameer Deshpande, Mark S TremblayAbstract:OBJECTIVE Parental Support is the critical family-level variable linked to child physical activity (PA), yet the antecedents of Support are poorly understood, and its relationship with intention is modest. The purpose of this study was to apply a framework designed to evaluate the intention-behavior gap, known as multiprocess action control (M-PAC), to understand Parental Support for regular child PA. METHOD Mothers (N = 1,253) with children 5-12 years of age completed measures of attitudes, perceived control over Support, behavioral regulation tactics (e.g., planning, self-monitoring), and intention to Support. Over half (58%) reported on subsequent Support behaviors 6 months later. RESULTS Three intention-behavior profiles emerged: (a) nonintenders (26.4%; n = 331), (b) unsuccessful intenders (36.6%; n = 458), and (c) successful intenders (33%; n = 414). Congruent with M-PAC, a discriminant function analysis showed that affective attitude about Support (r = .18), perceived behavioral control over Support (r = .55), and behavioral regulation (r = .55) distinguished between all 3 intention-behavior profiles. A disaggregated analysis of specific behavioral regulation tactics showed that most distinguished all 3 profiles, yet planning, information seeking, and monitoring were the critical correlates of the discriminant function. CONCLUSION The majority of mothers had positive intentions to Support regular child PA, yet over half failed to enact this Support. Difficulty of intention translating into Support behavior arises from compromised control over Support, self-regulation skills, and perceptions that the Support experience is unenjoyable. Interventions aimed at strengthening these factors are recommended to improve Parental Support action control.
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predicting changes across 12 months in three types of Parental Support behaviors and mothers perceptions of child physical activity
Annals of Behavioral Medicine, 2015Co-Authors: Ryan E Rhodes, Tanya R Berry, Guy Faulkner, Amy E Latimercheung, Norman Oreilly, John C Spence, Sameer Deshpande, Mark S TremblayAbstract:Parental Support has been established as the critical family-level variable linked to child physical activity with encouragement, logistical Support, and parent-child co-activity as key Support behaviors. This study aims to model these Parental Support behaviors as well as family demographics as mediators of mothers’ perceptions of child physical activity using theory of planned behavior (TPB) across two 6-month waves of longitudinal data. A representative sample of Canadian mothers (N = 1253) with children aged 5 to 13 years of age completed measures of TPB, Support behaviors, and child physical activity. Autoregressive structural equation models showed that intention and perceived behavioral control explained Support behaviors, yet child age (inverse relationship) and family income were independent predictors. The three Support behaviors explained 19–42 % of the variance in child physical activity between participants, but analyses of change showed much smaller effects. Mothers’ Support behaviors are related to perceived child physical activity, but Support is dependent on perception of control, child age, and family income.
