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Cheng ER, Moore C, Parks L, Taveras EM, Wiehe SE, Carroll AE. Communicating Risk for Obesity in Early Life: Engaging Parents Using Human-Centered Design Methodologies. Front Pediatr 2022; 10:915231. [PMID: 35837240 PMCID: PMC9273946 DOI: 10.3389/fped.2022.915231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/01/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Pediatricians are well positioned to discuss early life obesity risk, but optimal methods of communication should account for parent preferences. To help inform communication strategies focused on early life obesity prevention, we employed human-centered design methodologies to identify parental perceptions, concerns, beliefs, and communication preferences about early life obesity risk. METHODS We conducted a series of virtual human-centered design research sessions with 31 parents of infants <24 months old. Parents were recruited with a human intelligence task posted on Amazon's Mechanical Turk, via social media postings on Facebook and Reddit, and from local community organizations. Human-centered design techniques included individual short-answer activities derived from personas and empathy maps as well as group discussion. RESULTS Parents welcomed a conversation about infant weight and obesity risk, but concerns about health were expressed in relation to the future. Tone, context, and collaboration emerged as important for obesity prevention discussions. Framing the conversation around healthy changes for the entire family to prevent adverse impacts of excess weight may be more effective than focusing on weight loss. CONCLUSIONS Our human-centered design approach provides a model for developing and refining messages and materials aimed at increasing parent/provider communication about early life obesity prevention. Motivating families to engage in obesity prevention may require pediatricians and other health professionals to frame the conversation within the context of other developmental milestones, involve the entire family, and provide practical strategies for behavioral change.
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Affiliation(s)
- Erika R Cheng
- Department of Pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney Moore
- Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Lisa Parks
- Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Elsie M Taveras
- Kraft Center for Community Health, Massachusetts General Hospital, Boston, MA, United States.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Sarah E Wiehe
- Department of Pediatrics, Division of Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, United States.,Indiana Clinical and Translational Sciences Institute (CTSI), Research Jam, Indianapolis, IN, United States
| | - Aaron E Carroll
- Department of Pediatrics, Center for Pediatric and Adolescent Comparative and Effectiveness Research, Indiana University School of Medicine, Indianapolis, IN, United States
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Huang YD, Luo YR, Lee MC, Yeh CJ. Factors affecting the growth of children till the age of three years with overweight whose mothers have diabetes mellitus: A population-based cohort study. BMC Pediatr 2021; 21:298. [PMID: 34215222 PMCID: PMC8252317 DOI: 10.1186/s12887-021-02768-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/08/2021] [Indexed: 01/23/2023] Open
Abstract
Background The prevalence of diabetes mellitus (DM) during pregnancy and childhood obesity is increasing worldwide. Factors affecting the growth of children with overweight whose mothers had DM are complicated and inconclusive. Few longitudinal studies have focused on the growth of infants with macrosomia born to mothers with DM and the factors influencing their overweight. This study explored risk factors for childhood overweight/obesity (OWOB) among children of mothers with DM. Perinatal, maternal socio-demographic, infant care, and maternal body weight characteristics as well as child growth until age 3 years were analyzed using a longitudinal design. Methods In total, 24,200 pairs of mothers and their children from the Taiwan Birth Cohort Study were included. Combined Taiwan Children Growth Curve report classifications were analyzed for infant growth at birth and at 6, 12, 18, 24, and 36 months old (m/o). A multiple logistic regression analysis with different model settings was used to assess factors affecting the growth of high birth weight children of mothers with diabetic mellitus (HODM). Results Children in the HODM group had a higher average body weight than did those in the non-DM group at different age stages. Relative to the non-DM group, weight gain in the HODM group was slower before 18 m/o but faster from 18 to 36 m/o, particularly after 24 m/o. Maternal DM was a major risk factor for childhood OWOB (odds ratio [OR]: 3.25–3.95). After adjustment for related confounders, the OR was 2.19–3.17. Maternal overweight or obesity and higher gestational weight gain were greater risk factors for childhood OWOB at 3 years old after adjusted maternal DM and other selected confounders (OR: 1.45 and 1.23, respectively). Breastfeeding until 6 m/o was a protective factor against childhood OWOB (OR: 0.95). The HODM and non-DM groups did not differ significantly in perinatal, maternal socio-demographic, or infant care characteristics. Conclusions Maternal DM is a major factor of childhood OWOB. Maternal body weight before and after pregnancy affects childhood OWOB, and this effect increases with the child’s age.
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Affiliation(s)
- Yuan-Der Huang
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan.,Department of Obstetrics and Gynecology, Chia-Yi Hospital, Ministry of Health and Welfare, Chia-Yi, Taiwan
| | - Yun-Ru Luo
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan
| | - Meng-Chih Lee
- Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan. .,Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan. .,College of Management, Chaoyang University of Technology, Taichung, Taiwan.
| | - Chih-Jung Yeh
- Department of Public Health, Chung-Shan Medical University, Taichung, Taiwan.
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Sanders LM, Perrin EM, Yin HS, Delamater AM, Flower KB, Bian A, Schildcrout JS, Rothman RL. A Health-Literacy Intervention for Early Childhood Obesity Prevention: A Cluster-Randomized Controlled Trial. Pediatrics 2021; 147:peds.2020-049866. [PMID: 33911032 PMCID: PMC8086006 DOI: 10.1542/peds.2020-049866] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Children who become overweight by age 2 have greater risk of long-term obesity and health problems. The study aim was to assess the effectiveness of a primary care-based intervention on the prevalence of overweight at age 24 months. METHODS In a cluster-randomized trial, sites were randomly assigned to the Greenlight intervention or an attention-control arm. Across 4 pediatric residency clinics, we enrolled infant-caregiver dyads at the 2-month well-child visit. Inclusion criteria included parent English- or Spanish-speaking and birth weight ≥1500 g. Designed with health-literacy principles, the intervention included a parent toolkit at each well-child visit, augmented by provider training in clear-health communication. The primary outcome was proportion of children overweight (BMI ≥85th percentile) at age 24 months. Secondary outcomes included weight status (BMI z score). RESULTS A total of 459 intervention and 406 control dyads were enrolled. In total, 49% of all children were overweight at 24 months. Adjusted odds for overweight at 24 months (treatment versus control) was 1.02 (95% confidence interval [CI]: 0.63 to 1.64). Adjusted mean BMI z score differences (treatment minus control) were -0.04 (95% CI: -0.07 to -0.01), -0.09 (95% CI: -0.14 to -0.03), -0.19 (-0.33 to -0.05), -0.20 (-0.36 to -0.03), -0.16 (95% CI: -0.34 to 0.01), and 0.00 (95% CI -0.21 to 0.21) at 4, 6, 12, 15, 18, and 24 months, respectively. CONCLUSIONS The intervention resulted in less weight gain through age 18 months, which was not sustained through 24 months. Clinic-based interventions may be beneficial for early weight gain, but greater intervention intensity may be needed to maintain positive effects.
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Affiliation(s)
- Lee M. Sanders
- Division of General Pediatrics, Department of Pediatrics, Center for Policy, Outcomes and Prevention, Stanford University, Stanford, California
| | - Eliana M. Perrin
- Division of Primary Care and Duke Center for Childhood Obesity Research, Department of Pediatrics, Medical Center, Duke University, Durham, North Carolina
| | - H. Shonna Yin
- Department of Pediatrics and Population Health, School of Medicine, New York University and Department of Pediatrics, Bellevue Hospital Center, New York City, New York
| | - Alan M. Delamater
- Department of Pediatrics, School of Medicine, University of Miami, Miami, Florida
| | | | - Aihua Bian
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jonathan S. Schildcrout
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Russell L. Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee; and
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Khalsa AS, Copeland KA, Misik L, Brown CL, Kharofa RY, Ollberding NJ. Maternal Body Dissatisfaction and Accuracy of Infant Weight Perception in Families From Low-Income Backgrounds. Acad Pediatr 2020; 20:793-800. [PMID: 32247669 DOI: 10.1016/j.acap.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/22/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the association between maternal body dissatisfaction and mother's (mis)perception of their infant's weight classification among families from low-income households. METHODS Mother-infant dyads were recruited during well-child visits from 2 urban primary care clinics. Maternal body dissatisfaction was measured using the Stunkard Figure Rating Scale. Perception of infant weight was assessed using a 5-point Likert scale. Infant weight-for-length percentiles were calculated using World Health Organization growth charts. Associations between maternal body dissatisfaction score and mother's (mis)perception of their infant's weight classification were examined using logistic regression allowing for nonlinear associations via restricted cubic splines. RESULTS Mothers (n = 180) were 26.6 ± 5.1 years old and 72% Black; infants were 8.8 ± 2.1 months old. Mean infant weight-for-length percentile was 64 ± 26. On average, mothers wanted to be one body figure smaller than their perceived current body size. Most mothers (82%) accurately perceived their infant's weight classification while few overestimated (7%) or underestimated (11%) their child's weight category. The probability of mothers misperceiving their infant's weight classification increased as maternal body dissatisfaction increased in either extreme in unadjusted (P < .05) and adjusted analysis (P = .06). CONCLUSIONS Increased maternal body dissatisfaction may be associated with mother's misperception of infant weight classification. Future studies should examine this relationship in a heterogeneous population.
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Affiliation(s)
- Amrik Singh Khalsa
- Division of Primary Care Pediatrics, Nationwide Children's Hospital (AS Khalsa), Columbus, Ohio; Department of Pediatrics, The Ohio State University College of Medicine (AS Khalsa), Columbus, Ohio.
| | - Kristen A Copeland
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (KA Copeland), Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine (KA Copeland, RY Kharofa, and NJ Ollberding), Cincinnati, Ohio
| | - Lauren Misik
- Northeast Ohio Medical University, College of Medicine (L Misik), Rootstown, Ohio
| | - Callie L Brown
- Department of Pediatrics, Wake Forest University School of Medicine (CL Brown), Winston-Salem, NC
| | - Roohi Y Kharofa
- Department of Pediatrics, University of Cincinnati College of Medicine (KA Copeland, RY Kharofa, and NJ Ollberding), Cincinnati, Ohio; The Heart Institute, Cincinnati Children's Hospital Medical Center (RY Kharofa), Cincinnati, Ohio
| | - Nicholas J Ollberding
- Department of Pediatrics, University of Cincinnati College of Medicine (KA Copeland, RY Kharofa, and NJ Ollberding), Cincinnati, Ohio; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center (NJ Ollberding), Cincinnati, Ohio
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Saleska JL, Sheppard K, Turner AN, Boone KM, Keim SA. Parental Perceptions and Behaviors Regarding Child Weight Status among Toddlers Born Preterm. Am J Perinatol 2020; 37:525-533. [PMID: 30919396 PMCID: PMC9520429 DOI: 10.1055/s-0039-1683959] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Childhood obesity is a significant determinant of adult obesity. Among children born preterm, rapid "catch-up growth" in infancy increases the risk of later obesity. Parental perceptions of their child's weight status may compound the child's biologically heightened risk of obesity. STUDY DESIGN We performed a secondary analysis of data on parental perceptions of child weight status from a randomized controlled trial (2012-2017, n = 331 toddlers born preterm). We used the Child Feeding Questionnaire (CFQ) to measure parental child feeding behaviors and beliefs. We calculated the prevalence of incorrect weight estimation, and used t-tests and chi-square tests to compare sample characteristics by correct versus incorrect weight estimation. We calculated odds ratios (ORs) for factors associated with parental underestimation of child weight status. RESULTS Most (90%) children were of normal weight, whereas 3% were underweight and 7% were overweight. A majority (75%) of parents correctly estimated their child's weight status. Incorrect weight estimation was only associated with child's actual weight. Parents of overweight children were more likely to underestimate their child's weight status than parents of normal weight children (OR: 2.23, 95% confidence interval: 2.00-2.49). Mean CFQ scores differed by the child's actual weight status but not by the child's estimated weight status. CONCLUSION Among these toddlers born preterm, significantly higher proportions of parents with underweight and overweight children incorrectly estimated their child's weight status relative to parents of normal weight children. Our findings suggest that weight underestimation could be a problem in this population, although it was not associated with changes in feeding practices.
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Affiliation(s)
| | - Kelly Sheppard
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Abigail Norris Turner
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio,Division of Infectious Diseases, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Kelly M. Boone
- Schoenbaum Family Center and Crane Center for Early Childhood Research and Policy, The Ohio State University, Columbus, Ohio
| | - Sarah A. Keim
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio,Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio
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Queally M, Doherty E, Matvienko-Sikar K, Toomey E, Cullinan J, Harrington JM, Kearney PM. Do mothers accurately identify their child's overweight/obesity status during early childhood? Evidence from a nationally representative cohort study. Int J Behav Nutr Phys Act 2018; 15:56. [PMID: 29921288 PMCID: PMC6006594 DOI: 10.1186/s12966-018-0688-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/04/2018] [Indexed: 12/22/2022] Open
Abstract
Background Maternal recognition of overweight/obesity during early childhood is a key determinant in achieving healthy weight status in children. The aim of this study is to 1) investigate maternal perceptions of their child weight, focusing on whether or not mothers accurately identify if their child is overweight or obese at three years old and five years old; 2) identify the factors influencing maternal misperceptions regarding their child’s weight at three years old and five years old, 3) ascertain if a failure to recognize overweight/obesity at three years old is associated with the likelihood of doing so at five years old. Methods Using two waves of the longitudinal Growing Up in Ireland study data regarding child, maternal, and household characteristics as well as healthcare access and utilization variables were obtained for mothers when their children are three and five years old respectively. Multivariate logistic analysis was used to examine the factors associated with mothers inaccurately perceiving their child to be of normal weight status when the child is in fact either clinically overweight or obese. Results In wave 2, 22% of mothers failed to accurately identify their child to be overweight or obese. This inaccuracy decreased to 18% in wave 3. A failure of mothers to identify their child’s overweight/obesity was more likely to occur if the child was a girl (OR: 1.25) (OR: 1.37), had a higher birth weight (OR:1.00), if the mother was obese (OR: 1.50), (OR: 1.72) or working (OR:1.25) (OR:1.16) in wave 2 and wave 3, respectively. Other factors affecting the odds of misperceiving child’s weight include gestation age, income and urban living. Conclusion These findings suggest that mothers of overweight or obese three and five year olds show poor awareness of their child’s weight status. Both child and mother characteristics play a role in influencing this awareness. Mothers unable to accurately identify their child’s overweight or obesity status at three years old are likely to do again when the child is five years old. This study highlights the need for increased support to help improve mothers’ understanding of healthy body size in preschool aged children.
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Affiliation(s)
- Michelle Queally
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland.
| | - Edel Doherty
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | | | - Elaine Toomey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - John Cullinan
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
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Bentley F, Swift JA, Cook R, Redsell SA. "I would rather be told than not know" - A qualitative study exploring parental views on identifying the future risk of childhood overweight and obesity during infancy. BMC Public Health 2017; 17:684. [PMID: 28851331 PMCID: PMC5576317 DOI: 10.1186/s12889-017-4684-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Risk assessment tools provide an opportunity to prevent childhood overweight and obesity through early identification and intervention to influence infant feeding practices. Engaging parents of infants is paramount for success however; the literature suggests there is uncertainty surrounding the use of such tools with concerns about stigmatisation, labelling and expressions of parental guilt. This study explores parents' views on identifying future risk of childhood overweight and obesity during infancy and communicating risk to parents. METHODS Semi-structured qualitative interviews were conducted with 23 parents and inductive, interpretive and thematic analysis performed. RESULTS Three main themes emerged from the data: 1) Identification of infant overweight and obesity risk. Parents were hesitant about health professionals identifying infant overweight as believed they would recognise this for themselves, in addition parents feared judgement from health professionals. Identification of future obesity risk during infancy was viewed positively however the use of a non-judgemental communication style was viewed as imperative. 2) Consequences of infant overweight. Parents expressed immediate anxieties about the impact of excess weight on infant ability to start walking. Parents were aware of the progressive nature of childhood obesity however, did not view overweight as a significant problem until the infant could walk as viewed this as a point when any excess weight would be lost due to increased energy expenditure. 3) Parental attributions of causality, responsibility, and control. Parents articulated a high level of personal responsibility for preventing and controlling overweight during infancy, which translated into self-blame. Parents attributed infant overweight to overfeeding however articulated a reluctance to modify infant feeding practices prior to weaning. CONCLUSION This is the first study to explore the use of obesity risk tools in clinical practice, the findings suggest that identification, and communication of future overweight and obesity risk is acceptable to parents of infants. Despite this positive response, findings suggest that parents' acceptance to identification of risk and implementation of behaviour change is time specific. The apparent level of parental responsibility, fear of judgement and self-blame also highlights the importance of health professionals approach to personalised risk communication so feelings of self-blame are negated and stigmatisation avoided.
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Affiliation(s)
- Faye Bentley
- Anglia Ruskin University, Cambridge, United Kingdom
| | - Judy Anne Swift
- Behavioural Nutrition, University of Nottingham, Nottingham, United Kingdom
| | - Rachel Cook
- Department of Psychology, Anglia Ruskin University, Cambridge, United Kingdom
| | - Sarah A Redsell
- Faculty of Health, Social Care and Education, Anglia Ruskin University, Cambridge, United Kingdom
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