3) Action strategies to promote/sustain behavioral change

PARENT TESTED…PARENT APPROVED? LESSONS LEARNED FROM THE HEALTHY ACTIVE LIVING FOR FAMILIES FOCUS GROUPS

Linda Radecki1, Jeanne Lindros2, Amy Pirretti2 and Alison Baker2

1Department of Research, 2Department of Community and Specialty Pediatrics American Academy of Pediatrics, Elk Grove Village IL

Background: Early childhood is recognized as a critical period for obesity prevention. Literature identifies several key strategies for establishing and maintaining health weight in young children including decreased/zero consumption of sugary beverages, increased activity, and decreased screen time. Little is known about the most effective approaches to convey such information in ways that are meaningful and actionable for families. The Healthy Active Living for Families…Right from the Start (HALF) project was created to develop, test and disseminate messages for families with infants, toddlers, and preschoolers for use within and beyond the clinical setting. Objectives: Test a series of messages incorporating elements of the 5,2,1,0 health promotion model plus breastfeeding and general obesity prevention and examine what contributes to or detracts from message endorsement. Methodology: 18 focus groups at nine locations around the U.S. with diversity in parent background. At each primary site, we conducted two groups based on child age (Parents of Infants [birth-11 mos] and Parents of Toddlers/Preschoolers [12-59 mos]). Participants completed questionnaires and reviewed draft messages. Results: 113 parents, 92% mothers, 37% African American, 24% Hispanic; 72% of children publicly insured. 85% of parents described childhood obesity as a very/somewhat serious problem. 90% assessed their own child’s weight as “just right.” Messages were not uniformly supported by parents. Elements detracting from endorsement included: 1) use of “obesity language,” especially regarding infants, 2) guidance focused on future outcomes, 3) limited knowledge of recommendations, and 4) disconnect between professional guidance and personal experience. Components that promoted endorsement included: 1) respect for the parent role, 2) focus on the “why” behind recommendations and 3) action strategies to promote and support behavior change. Conclusions: Focus group findings suggest that parent perceptions and behaviors are often incongruous with expert guidelines and standard anticipatory guidance. Obtaining the parent perspective is critical in developing messages and materials that resonate with families of young children.

OBJECTIVES ABSTRACT RESULTS (con’t)

LIMITATIONS

BACKGROUND

• Parent perceptions and actions may often be incongruent with expert guidelines and guidance.

• Additional action strategies – positive, tried and true suggestions – to foster implementation of new behaviors are needed. Parents valued “how to“ and “what works” ideas from other parents.

• Rethinking traditional methods of information delivery may be necessary to reach young families in ways that are meaningful and support change.

• Parents valued information that can be individualized to meet their unique needs.

• 113 parents in 18 groups 92% mothers <1/3 first time parents

• Race/ethnicity

African American = 37% Hispanic = 24% White = 45%

• 75% of children were publicly insured

• >85% of parents described childhood obesity as a serious or

somewhat serious problem; 90% assessed their own child’s weight as “just right”

• Test a series of messages with parents incorporating elements of the 5,2,1,0 health promotion model plus breastfeeding and general obesity prevention

• Examine what contributes to or detracts from message endorsement

• Childhood obesity is a health concern that touches even the youngest children. According to the Institute of Medicine’s report, Early Childhood Obesity Prevention Policies, almost 10% of infants and toddlers have high weight for length; over 20% of children age 2-5 years are overweight or obese.

• Early childhood provides opportunities to establish healthy eating practices, good physical activity habits and optimal sleep routines before unhealthy patterns are engrained.

• Pediatricians are positioned to provide guidance on early obesity prevention during well child visits as outlined in the Bright Futures Guidelines but a 2009 AAP needs assessment of pediatricians identified gaps in preparedness to address such issues.

• In response, in 2010 the AAP initiated the Healthy Active Living for Families…Right from the Start (HALF) project to:

1) develop, test, and implement a series of positive, family focused obesity prevention messages for families with infants, toddlers, and preschoolers and 2) provide supporting materials for parent distribution and use at pediatric well visits to foster dialogue between families and health professionals

• A hallmark of the HALF project is the commitment to a parent driven approach, with messaging and materials designed to “meet parents where they are.”

• To assess parent perspective, a series of focus groups were conducted – first to inform content and then to provide critical review of the messages created.

CONCLUSIONS

ACKNOWLEDGEMENTS

• Special thanks to our parent focus group participants who shared their ideas and experiences

• HALF Project Editorial Board: Co-Chairs Sandra G. Hassink, MD, FAAP and Paula Duncan, MD, FAAP; members Nwando Anyaoku, MD, MPH, FAAP, Kim Avila Edwards, MD, FAAP, Jon Korfmacher, PhD, Ms Tamela Milan, and Elsie Taveras, MD, MPH, FAAP

Funding for the HALF project is provided to the American Academy of Pediatrics by a grant from the Nestlé Nutrition Institute

• Focus group participants were self-selected and may not be representative of all parents with young children

Parent-Reported Behaviors and Lifestyle Surrounding Healthy Active Living and Early Childhood Obesity Prevention

% yes Child ever breastfed 65 Child eats breakfast everyday 91 Child eats ≥5 fruits and vegetables each day 52 Child drinks ≥1 soda, juice or sugar sweetened drink each day

36

Family eats dinner together every day in a typical week

51

TV in child’s bedroom 45 Child in child care at least 1 hr per day 69 Pediatrician is child’s usual provider of well child care

90

METHODOLOGY • 18 parent focus groups in NM, IL, LA, AL, NY & PA. At each site, at

least 2 groups were conducted based on child age [Parents of Infants (ages birth-11 mos) & Parents of Toddlers and Preschoolers (ages 1-5 years)]. Project approved by AAP’s Institutional Review Board.

• Parents were recruited through flyers and word of mouth. Groups were held at sites familiar to families (eg, libraries, local health centers).

• Sessions lasted ∼ 90 minutes; parents completed questionnaires and reviewed draft messages. To determine whether messages resonated with parents, we obtained feedback on specific wording and content (eg, Did the message provide new information? Would the message promote changes in knowledge, attitude, or behavior?) and gathered action strategies to facilitate implementation.

• All messages did not resonate with parents!

1) Use of “obesity language” – especially related to infants

2) Guidance focused on future outcomes

3) Limited knowledge of recommendations

4) Disconnect between guidance and personal experience

1) Respect for parents’ expertise The message “Being a parent is an important job! When you set a good example, your baby learns healthy habits. She watches what you eat and do to stay healthy” was ranked as the MOST IMPORTANT message by parents in EVERY GROUP 2) Explanation of the “why” behind recommendations

I don’t want to hear obesity prevention …it doesn’t apply from birth to 1…they’re supposed to be

chubby babies

I don’t think I’m buying into obesity at under a

year…that would just make me sad

I’m thinking about being a busy mom…I did not have time to

introduce peas 15 times. It was ‘well, he didn’t like it, let’s move on

to something else…’

My son has a TV in his room and he’s not

obese

My kid gets juice all the time…that’s how he gets his fruit for the day… I give my son WIC and they always give me

juice so I feel like they don’t give ‘em anything else unhealthy, why would they give ‘em juices?

How do you teach a baby to be active? That’s very

hard!

RESULTS

regardless of what’s said, they’re gonna do whatever it takes to get that baby to

sleep [response to message discouraging cereal in the bottle]

A list of good snacks would be

helpful…I struggle with that!

They don’t really teach you how to keep your kid

active in the 1st year

What does a TV have to do with obesity?

I did not think that 100% fruit juice would harm their teeth!

I’m a big proponent of making it fun…we make smiley faces with the vegetables and they [the children] help me prepare things. That’s a huge thing. When they take part in making it, it’s like

oh, I want to eat this.

RESULTS (con’t)

This information is good because it’s telling you that when your baby cries, it

doesn’t always mean that they’re hungry…so I can’t always just give my

baby a bottle, just to be quiet

What contributed to message endorsement?

What detracted from message endorsement?