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Journal ArticleDOI

Parental perspectives on negotiations over diet and physical activity: how do we involve parents in adolescent health interventions?

TL;DR: In this paper, the authors identify the ways in which parental involvement can be incorporated into interventions to support adolescent health behavior change. But, they need to be aware of the disconnect between public health recommendations and the everyday reality for adolescents and their parents.
Abstract: Objective: To identify the ways in which parental involvement can be incorporated into interventions to support adolescent health behaviour change. Design: Data from semi-structured interviews were analysed using inductive thematic analysis. Setting: Southampton, Hampshire, UK. Participants: A convenience sample of twenty-four parents of adolescents. Results: Parents consider themselves to play an important role in supporting their adolescents to make healthy choices. Parents saw themselves as gatekeepers of the household and as role models to their adolescents but recognised this could be both positive and negative in terms of health behaviours. Parents described the changing dynamics of the relationships they have with their adolescents because of increased adolescent autonomy. Parents stated that these changes altered their level of influence over adolescents’ health behaviours. Parents considered it important to promote independence in their adolescents; however, many described this as challenging because they believed their adolescents were likely to make unhealthy decisions if not given guidance. Parents reported difficulty in supporting adolescents in a way that was not viewed as forceful or pressuring. Conclusions: When designing adolescent health interventions that include parental components, researchers need to be aware of the disconnect between public health recommendations and the everyday reality for adolescents and their parents. Parental involvement in adolescent interventions could be helpful but needs to be done in a manner that is acceptable to both adolescents and parents. The findings of this study may be useful to inform interventions which need to consider the transitions and negotiations which are common in homes containing adolescents.

Summary (5 min read)

Introduction

  • Adolescence is a period often characterised by poor health behaviours including high intake of energy-dense, nutrient-poor food and low levels of physical activity.
  • (4, 5) Although this age group has been identified as a priority group for health improvement, few interventions aiming to improve adolescent diet and physical activity levels show long-term effectiveness. (6) (7) (8) (9) Adolescence is a period of dramatic physical and psychosocial change.
  • (10) Adolescents experience a desire for increased levels of autonomy over decisions in their life.
  • (7, 8, 15, 16) Parents have been incorporated into interventions using multiple 'indirect' and 'direct' strategies.

Design

  • This exploratory qualitative study formed part of the developmental work for the Engaging Adolescents in CHanging Behaviour (EACH-B) study.
  • The EACH-B study is a multi-component intervention aiming to support adolescents to engage in healthy diet and physical activity behaviours.
  • The development of the EACH-B intervention was conducted using a Person Based Approach which adopts user-centred methods to design and refine interventions.
  • This involves in-depth qualitative interviews with stakeholders in order to ensure interventions are appropriate to the target population.
  • (18) Reporting of this study follows COnsolidated criteria for REporting Qualitative research recommendations. (19).

Study Participants

  • A convenience sample of parents, who had at least one adolescent attending secondary school, was recruited from those who were part of an email list following their adolescent's visit to LifeLab.
  • Lifelab is an educational facility based at Southampton General Hospital, UK and is primarily attended by students from Hampshire based secondary schools between the ages of 11-18 years.
  • If they were happy to participate, they were asked to reply to the study email.
  • Parents were excluded if they did not speak English or if they did not have an adolescent aged 11-18 years who was attending secondary school.
  • Prior to participating in the interviews, all parents provided informed written consent.

Setting

  • The study was conducted in 2018 in Southampton, a large city on the south coast of England, ranked the 67th most deprived of the 326 local authorities in England.
  • The interviews were conducted in locations that were convenient for the study participants, including places of work, home and over the telephone for the individual interviews.
  • Group interviews were conducted at a hospital evening event for parents.
  • They were made aware that the research team was aiming to develop an intervention to improve diet and physical activity in adolescents.
  • A semistructured discussion guide was designed to explore parents' views of their adolescent's health and lifestyle, as well as factors which make it difficult for them to engage in healthy behaviours (Table 1 ).

Analysis

  • Interview recordings were analysed thematically using NVivo software (Version 12) (QSR International, version 12) to manage the data.
  • Researchers familiarised themselves with the data by reading the interview transcripts and listening to the recordings.
  • After three transcripts were coded, the researchers met to discuss the similarities and differences between the codes.
  • Themes and sub-themes were compiled together with verbatim quotations and agreed with senior members of the research team (STS, LM, WTL, MEB).
  • This approach was conducted in line with a relativist ontological and subjective epistemic position, following the belief that reality is a matter of individual perspective and based on personal experience and insight.

Results

  • Six individual interviews were conducted via telephone; all other interviews were conducted face-to-face.
  • Six themes, consisting of multiple sub-themes, were identified by the analysis.
  • Figure 1 shows the final coding frame which was used for the thematic analysis.

"I am the one who controls the meals I guess, in the sense that I cook them, I put them on the table"-[Parent Group 1]

  • Parents recognised that promoting independence and encouraging adolescents to make some of their own choices is an important aspect of their parenting role.
  • "More recently I try and give my daughter a bit more control over her food, not because she's requested it but I guess this comes from a kind of teaching background"-[Parent Interview 1].
  • Even though parents viewed promoting independence in their adolescents as important, they described a reluctance to step back fully from their traditional parental role.
  • They discussed ways in which they attempted to be attentive and supervise their adolescent whilst trying not to be directly involved.
  • This involved checking their homework and food choices when out of the home using mobile apps and monitoring their social media use.

"I try to police it, he's got like an Instagram account so I've set one up for me and I can follow him, so I know what he's up to. He's got a Facebook account and again I'm his friend on Facebook so again I can kind of see what he's up to"-[Parent Interview 2]

  • Parents described themselves as role models to their adolescents but acknowledged they did not always model healthy behaviours.
  • They described modelling behaviours in relation to their own actions as well as the actions of other parents.

"If you've got inactive parents, your children aren't gonna be active"-[Parent Interview 6]

  • What I think about health As depicted in Figure 2 , parents recognised that their personal perspective of health influenced how they viewed their role in promoting health in their adolescent.
  • They also outlined the ways in which past experiences influenced their current thoughts about health and leading a healthy lifestyle.
  • Parents described the importance of taking steps to ensure their families' good health, but also acknowledged that this is not always a priority for themselves or their adolescent.
  • "I personally think it's really important, but it's not just about eating.
  • I think it's about exercise as well, and doing them both."-[Parent Interview 6].

My adolescent wants…

  • Parents believed that an important factor in determining adolescents' food choices was convenience and accessibility.
  • Parents believed that adolescents would not go out of their way to make healthy food choices but are open to healthy choices if they are available and convenient.
  • "So, when he comes home from school, he definitely wants food.
  • Parents suggested adolescents were not motivated by health messages which are often perceived as boring.
  • And the authors enjoyed the sunshine, they had time together and walked the dog"-[Parent Interview 9].

"They've gotta enjoy it. You've gotta find something they enjoy"-[Parent Interview 6]

  • Parents recognised the pressure adolescents feel to be accepted and fit in with their peers, and how this can negatively affect their diet and exercise choices.
  • Conversely, friends and peers could also have a positive influence regarding being healthy and active.
  • "She's got some friends who like running….
  • I think parents have got them into cross country club and running clubs, and so in their little group that's acceptable, 'cause there's some kids who do it.
  • Parents believed that when adolescents had autonomy over their health decisions, they made less healthy choices.

"If my son had the choice, he would much rather stay in front of a screen" -[Parent Group 1]

  • Parents recognised the importance of adolescents having the right individuals to provide support and encourage healthy behaviours.
  • Parents specified that not everyone can fulfil these roles and that these people need to be acceptable to their adolescents. ".

Negotiating Control

  • Parents discussed the changing dynamics of control between them and their adolescent, resulting in a culture of compromise between the parent and adolescents which was influenced by several factors inside and outside the home .
  • Parents suggested that their adolescent would ignore or rebel against strict household rules, so they would sometimes relax or modify these in an attempt to maintain control and establish an acceptable compromise.

"If you're too strict with them about what they can eat, then they'll rebel." -[Parent Group 2]

  • "I've learnt that the more you badger, the worse it gets"-[Parent Interview 10].
  • As adolescents gained exposure to factors outside of the family unit, there could be increasing conflict between what is normal for the family and what is normal for others.

"I parent differently, I struggle with that all the way, you know, 'my friends don't have to...' Well, your friends don't live in this house."-[Parent Interview 11]

  • Parents described changes in their adolescents' eating habits which can make mealtimes challenging.
  • To avoid conflict, they provided food they know will be acceptable even if this means cooking less healthy meals.

I don't think they generally take very kindly… or a lot of them don't."-[Parent Interview 10] "I think the most important thing to us is just trying and keep talking with them and I guess as the

  • Parents reported a reciprocal influence in their interactions with their adolescents.
  • While parents could encourage adolescents to eat healthier and be more active, they could also be influenced by adolescents to pursue a healthier lifestyle themselves.

What parents think could help support adolescent health

  • Parents stated that their adolescents appreciated rewards and thought that this could be a useful way to encourage engagement with healthy behaviours.
  • Parents recognised that technology was important to their adolescents and that findings ways in which it could be used to benefit health was important.

Discussion

  • This paper identified an overarching theme describing the changing dynamics between parents and adolescents which concern shifting perceptions of control.
  • This was at the centre of how parents viewed their role in supporting their adolescents to eat healthily and be physical active.
  • Parents recognised that their role in supporting these behaviours was reducing as their adolescents' autonomy and independence increased.
  • Parents recognised that interventions need to be appealing, to fit into their adolescents' lives, and certainly not be viewed as boring.
  • They highlighted that interventions focusing solely on health were unlikely to engage adolescents.

Comparisons with previous literature

  • In line with the 'negotiating control' theme identified in this study, previous qualitative research exploring parent and adolescent attitudes towards sugar-sweetened beverage consumption and screen time has described regular disagreements between parents and adolescents about everyday decisions that influence the behaviours of the family in the household.
  • (25, 26) Parents in the current study recognised that communication with their adolescent was often difficult and "the more they badgered" their adolescent the less likely it was for their advice to be accepted.
  • To date, the majority of parental components in adolescent health interventions have used indirect, but overt, methods to encourage healthy behaviours in adolescents.
  • (30) Public health interventions to encourage more healthful food environments are likely to play a role in promoting healthy dietary choices in adolescents when they are away from the home environment.
  • (9) One potential way of empowering parents with effective communication strategies could be through the delivery of Healthy Conversation Skills training.

Strengths and Limitations

  • The qualitative interviews in this study have provided rich data on parental perspectives of adolescents' lives.
  • This perspective has not often been considered when developing interventions that target adolescents.
  • The difficulty of recruiting fathers to participate in this type of research has been highlighted previously.
  • Most participants in this study were white (representative of locality) and were educated to upper secondary school standard or above.
  • In order to ensure the research findings from this study fairly represented the views of the interviewees, a rigorous process was adopted that involved double-coding of data, with disagreements being resolved through team discussions.

Conclusions

  • This study found that parents recognise and value the importance of promoting good health behaviours in their adolescents but find doing so difficult due to the increasing lack of influence they have over elements of their adolescents' lives.
  • When designing adolescent health interventions that include parental components, researchers need to be aware of the disconnect between public health recommendations and the everyday reality for adolescents and their parents.
  • This research may be useful to inform interventions which need to consider the transitions and negotiations which are common in homes containing adolescents.
  • Researchers designing these health interventions need to recognise that a 'one size fits all' approach is unlikely to produce successful long-term health behaviour change.

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Content maybe subject to copyright    Report

Parental perspectives on negotiations over diet and physical activity: how do we
involve parents in adolescent health interventions?
Shaw, Sarah; Simao, Sara Correia; Jenner, Sarah; Lawrence, Wendy T.; Woods-Townsend,
Kathryn; Vogel, Christina A.; Farrell, David; Inskip, Hazel; Baird, Janice; Morrison, Leanne;
Barker, Mary; Strömmer, Sofia T.; EACH-B Study Group
Published in:
Public Health Nutrition
DOI:
10.1017/S1368980021000458
Publication date:
2021
Document Version
Author accepted manuscript
Link to publication in ResearchOnline
Citation for published version (Harvard):
Shaw, S, Simao, SC, Jenner, S, Lawrence, WT, Woods-Townsend, K, Vogel, CA, Farrell, D, Inskip, H, Baird, J,
Morrison, L, Barker, M, Strömmer, ST & EACH-B Study Group 2021, 'Parental perspectives on negotiations over
diet and physical activity: how do we involve parents in adolescent health interventions?', Public Health Nutrition,
vol. 24, no. 9, pp. 2727–2736. https://doi.org/10.1017/S1368980021000458
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Download date: 10. Aug. 2022

1
Parental perspectives on negotiations over diet and physical activity: how do we involve 1
parents in adolescent health interventions? 2
3
Shaw, S
1,2
, Correia Simao, S
1,2
, Jenner, S
1
, Lawrence, WT
1,2
, Woods-Townsend, K
2,3
, Vogel, 4
CA
1,2
, Farrell, D
2,4
, Inskip,
H
1,2
, Baird, J
1,2
, Morrison, L
5,6
, Barker, M
1,2
, Strömmer, ST
1,2
and the 5
EACH-B study group. 6
1
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General 7
Hospital, Southampton, UK 8
2
NIHR Southampton Biomedical Research Centre, University of Southampton and University 9
Hospital Southampton NHS Foundation Trust, Southampton, UK 10
3
Southampton Education School, Faculty of Social Sciences, University of Southampton, 11
Southampton, UK 12
4
School of Computing, Engineering and Built Environment, Glasgow Caledonian University, 13
Glasgow, UK 14
5
Centre for Clinical and Community Applications of Health Psychology, Southampton, UK 15
6
Primary Care and Population Sciences, Southampton, UK 16
17
Corresponding author: Sarah Shaw, MRC Lifecourse Epidemiology Unit, University of 18
Southampton, Southampton General Hospital, Southampton SO16 6YD. 19
Tel: +44 (0)2380 7640 43 20
Email: ss@mrc.soton.ac.uk 21
22
Short title: Parents and adolescent health interventions 23
24
25
Acknowledgements: In addition to the named authors, the EACH-B study group consists of 26
Millie Barrett, Lyall Campbell, Ross Anderson, Patsy Coakley, Judit Varkonyi-Sepp, Donna 27

2
Lovelock, Lisa Bagust. We thank Daniella Watson for her assistance with conducting the 28
interviews. 29
30
Financial Support: This paper presents independent research from EACH-B funded by the 31
National Institute for Health Research (NIHR) under its Programme Grants for Applied 32
Research Programme (Reference Number RP-PG-0216-20004). This research and the 33
authors of this paper are also supported by the following funding sources UK Medical 34
Research Council (MC_UU_12011/4); National Institute for Health Research Southampton 35
Biomedical Research Centre; Wessex Heartbeat and Public Health England. The views 36
expressed in this publication are those of the author(s) and not necessarily those of the 37
National Health Service, the National Institute for Health Research, the UK Department of 38
Health and Social Care. 39
40
Conflict of Interest: CV has a non-financial research relationship with a food retail company 41
and maintains independence in all evaluation activities. This article, however, is not related 42
to this relationship. All other authors have no conflicts of interest to declare. 43
44
Authorship: MEB and HMI formulated the research questions. MEB, STS and KWT designed 45
the research study, with inputs from HMI, JB, WTL, CV and DF. SS, STS, SJ conducted the 46
qualitative interviews. The thematic analysis was conducted by SS, SCS, SJ and STS with 47
guidance from WTL, LM, MEB. All authors played a role in interpreting the results and all 48
approved the final manuscript. This work was conducted as part of the EACH-B study. 49
50
Ethical Standards Disclosure: This study was conducted according to the guidelines laid 51
down in the Declaration of Helsinki and all procedures involving research study participants 52
were approved by the University of Southampton Faculty of Medicine Ethics Committee 53
[Ethics Number: 30054]. Written informed consent was obtained from all participants 54

3
Abstract
55
Objective: To identify the ways in which parental involvement can be incorporated into 56
interventions to support adolescent health behaviour change. 57
Design: Data from semi-structured interviews were analysed using inductive thematic 58
analysis. 59
Setting: Southampton, Hampshire, UK. 60
Participants: A convenience sample of 24 parents of adolescents. 61
Results: Parents consider themselves to play an important role in supporting their 62
adolescents to make healthy choices. Parents saw themselves as gatekeepers of the 63
household and as role models to their adolescents but recognised this could be both 64
positive and negative in terms of health behaviours. Parents described the changing 65
dynamics of the relationships they have with their adolescents because of increased 66
adolescent autonomy. Parents stated that these changes altered their level of influence 67
over adolescents’ health behaviours. Parents considered it important to promote 68
independence in their adolescents, however, many described this as challenging because 69
they believed their adolescents were likely to make unhealthy decisions if not given 70
guidance. Parents reported difficulty in supporting adolescents in a way that wasn’t viewed 71
as forceful or pressuring. 72
Conclusions: When designing adolescent health interventions that include parental 73
components, researchers need to be aware of the disconnect between public health 74
recommendations and the everyday reality for adolescents and their parents. Parental 75
involvement in adolescent interventions could be helpful but needs to be done in a manner 76
that is acceptable to both adolescents and parents. The findings of this study may be useful 77
to inform interventions which need to consider the transitions and negotiations which are 78
common in homes containing adolescents. 79
Keywords:
80
Adolescent; Health behaviours; Parents; Qualitative methods. 81
82
83

4
Introduction
84
Adolescence is a period often characterised by poor health behaviours including high intake 85
of energy-dense, nutrient-poor food and low levels of physical activity.
(1)
In the UK, many 86
adolescents fail to meet Public Health England’s recommendations for a healthy diet and 87
physical activity levels. Only 8% of UK adolescents aged between 11-18 years eat five 88
portions of fruit and vegetables a day,
(2)
and only 15% of boys and 8% of girls, aged 13-15 89
years, carry-out one hour of moderate to vigorous activity per day.
(3)
Adolescents are the 90
parents of future generations. Thus, intervening during adolescence to improve diet and 91
physical activity has the potential for triple benefit: to the adolescent in the here and now, 92
to the future health of the adolescent, and to the health of the adolescent’s future 93
offspring.
(4, 5)
Although this age group has been identified as a priority group for health 94
improvement, few interventions aiming to improve adolescent diet and physical activity 95
levels show long-term effectiveness.
(6-9)
96
Adolescence is a period of dramatic physical and psychosocial change.
(10)
Adolescents 97
experience a desire for increased levels of autonomy over decisions in their life.
(11)
This new-98
found independence, coupled with increased exposure to factors outside of the family 99
home, can lead to the participation in health-compromising behaviours.
(5)
Nonetheless, 100
parents still play an influential role in adolescents’ day-to-day lives even though capacity for 101
decision-making is increasing. 102
Health behaviour interventions targeting adolescents have been implemented using a 103
number of different approaches with varying degrees of success.
(6-8, 12)
It is argued that 104
many of these health interventions are unsuccessful because they do not address 105
adolescents’ desire to feel respected, and fail to offer opportunities for adolescents to 106
exercise autonomy over their health behaviours.
(9, 13, 14)
107
Evidence indicates that interventions targeting children and adolescents which also involve 108
parents have the potential to be successful, but results have varied.
(7, 8, 15, 16)
Parents have 109
been incorporated into interventions using multiple indirect’ and ‘direct’ strategies.
(15)
110
Indirect parental engagement strategies have been more commonly used in intervention 111
studies to date and often include delivering health information to parents via newsletters 112
and web-platforms. Direct strategies have included parental attendance at educational and 113

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1,114 citations

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Q1. What have the authors contributed in "Parental perspectives on negotiations over diet and physical activity: how do we involve parents in adolescent health interventions?" ?

Shaw et al. this paper discussed the parent perspectives on negotiations over diet and physical activity: how do the authors involve parents in adolescent health interventions ?