- Title
- The impact of the 'Healthy Dads, Healthy Kids' program for overweight fathers and their children on lifestyle-related parenting
- Creator
- Lloyd, Adam Burton
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2015
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Obesity among children and adolescents is a global health issue and its prevalence has increased substantially over the past three decades. Overweight and obesity is associated with many physiological and psychological health issues and given the high likelihood of paediatric obesity persisting into adulthood, effective behavioural interventions are urgently needed. An unhealthy diet, low levels of physical activity and high levels of screen-time are associated with paediatric overweight and obesity. Interventions to prevent paediatric obesity have been conducted in numerous settings, for example, schools and community centres, but with limited success. Parents have a significant influence over many aspects of children’s lifestyle behaviours and have been identified as key influencers in shaping and changing children’s behaviours. There is, however, uncertainty regarding who to target and how to best involve parents in interventions to prevent paediatric obesity. Additionally, there is a paucity of research investigating the potential influence of fathers on children’s lifestyle behaviours. Objective: This thesis-by-publication presents a novel research project, designed to address the gap in evidence pertaining to fathers’ influence on children’s lifestyle behaviours. The primary aim of the thesis is to investigate the impact of a lifestyle program targeting fathers, delivered in a community setting on diet- and physical activity-related parenting practices. The thesis also presents a series of individual, yet interconnected, studies investigating secondary aims, which are briefly described below. The order that they are presented does not reflect their relative importance but, rather, how each study has informed the paucity of literature exploring paternal influences on child lifestyle behaviours. Methods: A two-armed community randomised controlled trial (RCT) was undertaken with 93 overweight/obese fathers and their primary school-aged children (n=132) in two cohorts from two local government areas (LGAs) from the Hunter Region of New South Wales (NSW), Australia. Families were randomised to either (i) 7-week program or (ii) wait-list control group. There were treatment and control groups at each LGA. The program involved four sessions for fathers only, and three for fathers and children together. Assessments were held at baseline and 14-weeks follow-up. Results: Primary aim: To evaluate the impact of HDHK on key obesity-related parenting variables; It was demonstrated that fathers who participated in the program showed changes to the following parenting practices; limit setting increased (p=0.05, d=0.4), reinforcement increased (p=0.001, d=0.8), and from a sub-group (N= 45 overweight/obese fathers and their primary school-aged children, n=77) role modelling of physical activity increased (p=0.02, d=0.7) and co-physical activity increased (p=0.04, d=0.5). However, exploration of the impact on mothers’ parenting practices (i.e. control, monitoring, discipline, reinforcement and limit setting) revealed no significant changes. This was not surprising as mothers were not directly targeted as part of the intervention. Secondary aim 1: Identify correlates of children’s adiposity, screen-time, diet and physical activity; A cross-sectional analysis was conducted with a sample of 70 families using baseline data from the Healthy Dads, Healthy Kids (HDHK) community RCT (i.e. families with complete data sets) with children (59% boys [41/70], mean age 8.4 [+/-2.4] years). The regression analysis revealed fathers’ BMI and mothers’ control were significantly associated with child weight status and explained 34% of the variance. For screen-time, mothers’ monitoring (p<.001) and children’s individual characteristics (age [p=.01], sex [p=.01], BMI z-score [p=.03]) were significant predictors. Mothers’ parenting practices (limit setting [p=.01], reinforcement [p=.02]) and child screen-time (p=.02) were significantly associated with intake of core foods. Fathers’ reinforcement (p<.01) was significantly associated with child physical activity. Secondary aim 2: Examine differences in maternal and paternal diet and physical activity parenting practices; To investigate this aim, paired samples t-tests were applied to the families identified in the baseline data (HDHK community RCT) that had complete responses from both mother and father in relation to the parenting practices. Three out of five eating and physical activity parenting constructs (i.e. control, monitoring and limit setting) were significantly different between mothers and fathers. Overall, mothers and fathers have different parental influences on their children’s weight status and lifestyle behaviours. Of note, when examining both mothers’ and fathers’ parenting practices within the same family (paired samples correlations), parents within the same household exhibited similar levels of control (pressure to eat) and monitoring. Secondary aim 3: Explore paternal parenting-related mediators of children’s physical activity and dietary behaviour change; Few studies have examined mediators of physical activity and dietary behaviour change in children, and very few have investigated paternal mediators. Thus, to investigate this aim, a sub-group (N= 45 overweight/obese fathers and their primary school-aged children, n=77) of the larger RCT (N=93 families, n=132 children) were included in the analysis. This second cohort of families completed an additional questionnaire focusing on paternal parenting practices. Mediation analysis revealed, co-physical activity mediated children’s physical activity in the intervention (‘mediated effect’ AB=653, 95% CI=4 to 2050) and was responsible for 59.5% of the intervention effect. Fathers’ beliefs (outcome expectations in relation to child dietary intake) mediated children’s percent energy from core foods (AB=1.51, 95% CI=0.05 to 5.55) and accounted for 72.9% of the intervention effect. Conclusion: The study findings presented in this thesis provide evidence that participation in the HDHK program positively impacted on fathers’ lifestyle-related parenting practices which mediated changes in children’s diet and physical activity behaviours. Encouraging fathers to participate in physical activities with their children and changing fathers’ beliefs about the benefits of healthy eating may be a promising strategy to improve children’s lifestyle behaviours. The findings also highlight that maternal parenting practices are likely to also influence child behaviours, particularly dietary intake and screen-time, hence in practice it is imperative that programs designed to enhance children’s lifestyle behaviours engage both fathers and mothers.
- Subject
- parenting; fathers; children; physical activity; diet
- Identifier
- http://hdl.handle.net/1959.13/1310624
- Identifier
- uon:22059
- Rights
- Copyright 2015 Adam Burton Lloyd
- Language
- eng
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