Theoretical Background and research questions/hypothesis: Many preschoolers are not meeting dietary and physical activity guidelines.[i] Establishing healthy diet and physical activity habits at an early age is critical to lifelong health.[ii] Home and childcare are two important spheres of influence that shape young children’s behaviors.[iii] Interventions that engage both spheres in a coordinated effort would ensure that children receive consistent health messages.[iv] Surprisingly, few childcare-based interventions have included a parent component.[v] Social marketing principles encourage identification of audience segments needed to bring about behavior change, and development and testing of tools that emphasize benefits and overcome barriers. This study, grounded in Social Cognitive Theory and Theory of Planned Behavior, examined parent and provider perceptions of influence on children’s diet and physical activity habits, benefits and barriers of role-modeling, and usefulness of parent-provider partnerships around child health.
Methods: Four focus groups were conducted with parents of 3- to 4-year old children (n=20) and three with childcare providers (n=17) in North Carolina. Discussions were recorded and transcribed with transcripts independently reviewed by two team members to identify emergent themes.
Results: Parents and providers recognized healthy eating and physical activity as important habits that support the development of the “whole child”, benefitting physical, emotional, and mental health. Parents were mixed in confidence to teach healthy eating, citing cost of food, lack of time, personal preferences, and eating schedules. Parents expressed guilt over not consistently doing what they knew they should to promote healthy eating. Parents prioritized role-modeling of healthy eating over physical activity due to perceptions that children were already active and lack of energy, scheduling, and natural ability. Parents recognized the importance of parent-provider partnerships, and noted capitalizing on preschool activities to encourage healthy habits at home. Providers felt responsibility for instilling healthy habits and many believed their contributions surpass those of parents. Parents were more open to general recommendations distributed school-wide than personal references, which raised concerns about feeling singled-out or judged.
Conclusions: Consistent activities at home and childcare should reinforce adoption of children’s healthy habits. While there is great potential for parent-provider partnerships, careful communication will be critical to avoid triggering feelings of guilt among parents and perceptions of superiority among providers.
Implications for research and/or practice: Findings guided the development of the Healthy Me, Healthy We campaign. Concept-testing demonstrated program resonance and feasibility with childcare center directors, providers and parents. The intervention, funded by the NIH, will commence fall 2015.