Quantitative Critical Appraisal - 4 pages

Criteria

Article 1

Article 2

Article 3

APA-Formatted Article Citation with Permalink

Marsh, S., Taylor, R., Galland, B., Gerritsen, S., Parag, V., & Maddison, R. (2020). Results of the 3 Pillars Study (3PS), a relationship-based programme targeting parent-child interactions, healthy lifestyle behaviours, and the home environment in parents of preschool-aged children: A pilot randomised controlled trial. PLoS ONE, 15(9), 1–16. https://doi-org.lopes.idm.oclc.org/10.1371/journal.pone.0238977

Laura Otterbach, Noereem Z. Mena, Geoffrey Greene, Colleen A. Redding, Annie De Groot, & Alison Tovar. (2018). Community-based childhood obesity prevention intervention for parents improves health behaviors and food parenting practices among Hispanic, low-income parents. BMC Obesity, 5(1), 1–10. https://doi-org.lopes.idm.oclc.org/10.1186/s40608-018-0188-2

Luesse, H. B., Paul, R., Gray, H. L., Koch, P., Contento, I., & Marsick, V. (2018). Challenges and Facilitators to Promoting a Healthy Food Environment and Communicating Effectively with Parents to Improve Food Behaviors of School Children. Maternal & Child Health Journal, 22(7), 958–967. https://doi-org.lopes.idm.oclc.org/10.1007/s10995-018-2472-7

How Does the Article Relate to the PICOT Question?

This article reported on an intervention created to help parents promote healthy nutritional behaviors at home.

This article looked at parental feeding behaviors in the Hispanic population and investigated the link between childhood obesity.

This article looked at barriers to parents promoting healthy behaviors which can help show the superiority of parenting behaviors over outside influences.

Quantitative, Qualitative (How do you know?)

Quantitative because it is a randomized trial and discussing the methods and results of an intervention.

Qualitative because it uses pre/post surveys to understand the effects of an intervention.

Qualitative because no experimentation was done and focus groups were held to determine themes.

Purpose Statement

An attachment-based, relational approach may also help address some of the common barriers encountered in childhood obesity prevention programs.

To reduce the racial/ethnic disparities, obesity prevention programs and interventions for Hispanic parents are urgently needed.

To investigate the challenges and facilitators to promoting a healthy environment at home and to identify communication preferences to inform intervention strategies for effectively reaching low-income urban minority families.

Research Question

Can this approach potentially avoid the use of negative and counterproductive parenting practices, while addressing a number of the key barriers to implementing healthy lifestyle recommendations?

Do parents influence their child’s health behaviors through the home environment and their parenting practices?

Do parents shape their children’s health-related practices through their modeling of healthful practices; their knowledge of nutrition, and the meal structure and eating patterns established in the home?

Outcome

There was no significant difference between the groups at 6 and 12 weeks with respect to the proportions of children meeting screen time recommendations (<1 hour/day), meeting sleep guidelines (>11 hours/day), eating at least 2 servings of fruit per day, eating at least 2 servings of vegetables per day, and parents reporting bedtime as being ‘very easy’ or ‘easy’. Further, a significantly greater proportion of children in the intervention group versus control group were classified as only waking rarely during the night (i.e. 1–3 nights per month or less) at both 6 and 12 weeks follow-up (54% vs 22% and 35% vs 64% participants, respectively), and sleeping either ‘well’ or ‘very well’ at 12 weeks (84% vs 50%;

Fifty-two, primarily Hispanic (93%) parents completed the intervention (39% attrition rate). For parents who completed the intervention, there was a significant increase in one of the feeding practice subscales: encouragement of balance and variety (p = 0.01). There were significant improvements in several parent and child diet and activity outcomes (p ≤ 0.01).

Analyses yielded the following major themes in parents’ perceptions about the home-food environment related to parents’ outcome expectations and social environment: (1) the importance of parents modeling desired behaviors; and (2) coping with satisfying children’s dislike of vegetables.

Setting

(Where did the study take place?)

In the family home of participants in Auckland, New Zealand.

Parents living in Olneyville and South Providence, Rhode Island

Four focus groups with parents of elementary-aged children attending public elementary schools in low SES communities of New York City.

Sample

54 participants randomized to the intervention (n = 27) or wait-list control (n = 27) groups

Participants were eligible to participate if they were a parent or primary caregiver of a child between 3 and 11 years of age at the beginning of enrollment and spoke English or Spanish. During the first year, 44 parents enrolled, 50 in year two (N = 94), with a total of nine groups of parents completing the intervention over the 2-year period.

16 parents, 4 in each group

Method

Descriptive

Nonexperimental pre/post survey

Focus group interviews

Key Findings of the Study

All measures improved in the hypothesized direction for the intervention group.

Although attrition rates were high, parents completing the study reported enjoying and being satisfied with the intervention. For parents who completed the intervention, reported ‘encouragement of balance and variety’, in addition to several health behaviors significantly improved.

The most common barriers to parents providing healthy foods to their children were accommodating child preferences and familial opposition. Parents showed intentionality to engage in healthy behaviors, and often shared procedural knowledge for reaching health goals. The analyses of desired communication channels yielded major preferences: tailored information, information provided through multiple mediums, appropriate duration/frequency of messages, and presented from a voice of authority.

Recommendations of the Researcher

A larger study is warranted.

Larger studies utilizing an experimental design, should further explore the impact of the HCHF curriculum on improving certain FPPs and health behaviors that contribute to obesity.

Multi-media supports such as workshops, flyers, and text messaging may be useful to facilitate the sharing of information to minimize the tensions between intentionality and reaching desired goals to be healthy. Some parents thought that information received through text messaging could be easily shared and would act as a voice of authority to support child behavior change.

Criteria

Article 4

Article 5

Article 6

APA-Formatted Article Citation with Permalink

Fuller, A. B., Byrne, R. A., Golley, R. K., & Trost, S. G. (2019). Supporting healthy lifestyle behaviours in families attending community playgroups: parents’ perceptions of facilitators and barriers. BMC Public Health, 19(1), 1–11. https://doi-org.lopes.idm.oclc.org/10.1186/s12889-019-8041-1

Somaraki, M., Eli, K., Sorjonen, K., Ek, A., Sandvik, P., & Nowicka, P. (2020). Changes in parental feeding practices and preschoolers’ food intake following a randomized controlled childhood obesity trial. Appetite, 154. https://doi-org.lopes.idm.oclc.org/10.1016/j.appet.2020.104746

E. Whitney Evans, Rena R. Wing, Denise F. Pierre, Whitney C. Howie, Morgan Brinker, & Elissa Jelalian. (2020). Testing the effect of summer camp on excess summer weight gain in youth from low-income households: a randomized controlled trial. BMC Public Health, 20(1), 1–10. https://doi-org.lopes.idm.oclc.org/10.1186/s12889-020-09806-y

How Does the Article Relate to the PICOT Question?

This article investigated problems that parents reported regarding promoting healthy behaviors and looked for ways to support parents. Parents being the focus again shows their superiority in modeling behaviors for their children.

This study specifically shows how changing parenting behaviors can reduce childhood obesity.

This article looks at outside behaviors to determine whether they can combat poor parental behaviors to reduce childhood obesity.

Quantitative, Qualitative (How do you know?)

Qualitative because a focus group was held to discover themes.

Qualitative because it is a randomized trial

Quantitative because it is a randomized controlled trial.

Purpose Statement

The aim of the study was to identify barriers and facilitators to using autonomy supporting parenting practices. A secondary aim was to determine parent preferences in respect to an intervention program to be delivered in community playgroups.

To analyze secondary outcomes of the More and Less study (ML study), a randomized controlled trial (RCT) assessing obesity interventions for preschool-age children.

To determine the feasibility and preliminary effectiveness of summer camp in preventing excess summer weight gain among youth from low-income households.

Research Question

Is autonomy supporting parenting practices crucial for the development of self-regulation and the internalization of healthy behaviors in children?

Will better insight into how family subsystems affect behaviors that drive changes in child weight status inform more effective and tailored obesity interventions?

In the absence of the routine and structure provided by the school day, can children have greater engagement in obesogenic behaviors?

Outcome

Qualitative content analysis was used to analyze the focus group data, using NVivo 12. The main categories were the SCT constructs of parental behavioral capability and parental self-efficacy and the SDT construct of autonomy promoting parenting practices. The generic categories were the facilitators and barriers within each main category. When participants discussed parenting practices, knowledge of guidelines or knowledge of supportive parenting practices was coded as a facilitator of behavioral capability. If a comment demonstrated a lack of knowledge, then it was coded to a barrier to behavioral capability. Comments that inferred confidence in parenting, optimism, or receiving support as a parent were coded as facilitators of parental self-efficacy. Comments related to feeling stressed, tired or guilty were coded a barriers. The coding of facilitators and barriers to autonomy promoting parenting practices centered around comments about positive or negative factors in the home environment, family influences, support from peers, parent intentions to use supportive parenting practices, and specific examples of either autonomy-promoting or non-autonomy-promoting parenting practices.

Background characteristics were compared across the three treatment groups at baseline using one-way ANOVA and chi-squared test. On average, children were 5.2 years old and had a BMI SDS of 3.0 at baseline. Their mothers and fathers reported higher restriction (3.8 and 3.5) and monitoring (4.0 and 3.8) compared to pressure to eat (2.1 and 2.3) at baseline, respectively. As compared to mothers, fathers reported lower levels of restriction (3.5 vs. 3.8) and monitoring (3.8 vs. 4.0).

Ninety-four participants were randomized to CAMP (n = 46) or SAU (n = 48), of whom 93.0 and 91.6% completed end of school and end of summer assessments, respectively. While CAMP participants attended only 50% of camp days offered, on average, they lost − 0.03 BMIz units while those in SAU gained 0.07 BMIz units over the summer (b = 0.10; p =.02). Group differences in change in energy intake from the school year to summer were borderline significant, as energy intake remained relatively unchanged in CAMP participants but increased among participants in SAU (p = 0.07).

Setting

(Where did the study take place?)

Parents were recruited through Playgroup Queensland (PGQ), a not-for-profit organization in Brisbane, Australia.

Stockholm County, Sweden

This randomized controlled trial was carried out in two low-income communities in the Northeast paret of the US during summers 2017 and 2018.

Sample

Five focus groups with parents (n = 30) were conducted in May 2018. Most of the participants were mothers [1], and the majority (76%) had a child at playgroup aged between 2 and 4 years.

174 children with obesity and their parents

A total of 96 participants enrolled in this study and were randomized to CAMP (n = 48) or to SAU (n = 48).

Method

Focus group interviews

Experimentation, randomized controlled trial

Experimentation, randomized controlled trial

Key Findings of the Study

Barriers included beliefs around the need to use rewards to encourage child eating, beliefs around the need for screens as babysitters, and feeling disempowered to change sleep behaviors. Parents were enthusiastic about a potential program that would leverage off the existing playgroup support networks, but they did not want to be "educated", or to lose their "playgroup time" to an intervention. Rather they wanted strategies and support to deal with the frustrations of food, screen and sleep parenting.

The researchers conducted this study to understand whether the greater decrease in child weight status in the parent support programs group could be explained by changes in parental feeding practices. However, their hypothesis was not confirmed.

Randomizing children to attend summer day camp or experience an unstructured summer as usual was effective in this low-income sample. The findings support the potential for summer camps in mitigating excess summer weight gain.

Recommendations of the Researcher

Studies exploring the feasibility and potential efficacy of a peer-facilitated childhood obesity prevention intervention, delivered in a community playgroup setting, are warranted.

Because intermediary processes involving parenting practices and parent-child interactions may be important, future studies should examine whether general parenting practices moderate the effect of feeding practices on child weight status.

A larger randomized trial is needed explore efficacy, cost-effectiveness and longer-term effects of attending summer camp on weight and weight-related behaviors.