Những nhận thức về can thiệp lối sống dựa vào gia đình cho trẻ em thừa cân và béo phì: một nghiên cứu định tính về tính bền vững, tự điều chỉnh và tối ưu hóa chương trình

BMC Public Health
Kaila C. Putter1, Ben Jackson2, Ashleigh Thornton3, Claire E. Willis4, Kong Min Bryce Goh2, Mark R. Beauchamp5, Nat Benjanuvatra2, James A. Dimmock6, Timothy Budden6
1Department of Psychology, College of Healthcare Sciences, James Cook University, Townsville, Australia
2School of Human Sciences (Exercise and Sport Science), The University of Western, Perth, Australia
3Division of Paediatrics, Faculty of Health and Medical Sciences, The University of Western, Perth, Australia
4Sports & Exercise Science, La Trobe University, Melbourne, Australia
5School of Kinesiology, The University of British Columbia, Vancouver, Canada
6Telethon Kids Institute, Perth, WA, Australia

Tóm tắt

Tóm tắt Giới thiệu Các can thiệp lối sống dựa vào gia đình (FBLIs) là một phương pháp quan trọng trong việc điều trị các vấn đề về trọng lượng ở trẻ em. Mặc dù được công nhận là một phương pháp can thiệp hiệu quả, cấu trúc tối ưu của những can thiệp này đối với trẻ em thừa cân và béo phì vẫn chưa được xác định. Mục tiêu của chúng tôi là tìm hiểu sâu hơn về (a) cách thức thực hiện các chiến lược hành vi và kết quả dài hạn của người tham gia, (b) nhận thức về cấu trúc tối ưu của FBLIs, và (c) những hiểu biết về các khái niệm tâm lý có thể giải thích sự thành công của các chương trình này. Phương pháp Chúng tôi sử dụng phương pháp lấy mẫu có mục đích để tuyển chọn người tham gia. Chúng tôi đã tiến hành các nhóm tập trung cũng như phỏng vấn một đối một với các bậc phụ huynh (n = 53) và trẻ em (n = 50; trong độ tuổi từ 7–13, M = 9.4 năm, SD = 3.1) ba tháng sau khi tham gia chương trình FBLIs kéo dài 10 tuần, đa thành phần liên quan đến giáo dục và các hoạt động liên quan đến dinh dưỡng lành mạnh, hoạt động thể chất và điều chỉnh hành vi. Sử dụng phương pháp tiếp cận diễn giải, một thiết kế nghiên cứu định tính đã được áp dụng để xem xét trải nghiệm của người tham gia. Kết quả Chúng tôi đã xác định được ba danh mục cao hơn: (a) kinh nghiệm và nhận thức của người tham gia về chương trình, (b) thay đổi lối sống sau chương trình, và (c) các khuyến nghị để tối ưu hóa các chương trình dựa vào gia đình. Các chủ đề được xác định trong các danh mục này bao gồm (a) hỗ trợ, cấu trúc và nội dung, (b) chế độ ăn uống và hoạt động thể chất, và (c) khuyến nghị trong chương trình và khuyến nghị sau chương trình. Kết luận Chúng tôi đã xác định một số thách thức có thể cản trở sự thay đổi hành vi bền vững (ví dụ: tham gia hoạt động thể chất) sau khi tham gia vào một FBLI. Về việc tối ưu hóa những chương trình này, người tham gia nhấn mạnh tầm quan trọng của nội dung vui vẻ, tương tác, sự hỗ trợ trong mối quan hệ, nội dung giáo dục phù hợp và kỹ thuật thay đổi hành vi. Các khái niệm dựa trên lý thuyết động lực có thể giúp giải quyết những yêu cầu về sự thấu hiểu lý thuyết và cơ chế sâu hơn trong FBLIs. Kết quả nghiên cứu có thể hỗ trợ sự phát triển nghiên cứu và giúp các chuyên gia y tế thực hiện tiềm năng của những can thiệp này một cách nhất quán hơn.

Từ khóa


Tài liệu tham khảo

World Health Organization. “Fact sheet on obesity and overweight.” http://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight. Accessed 25 Nov 2020.

Australian Bureau of Statistics. National Health Survey: First Results, Australia 2017–18. Australia: The Australian Bureau of Statistics. Canberra; 2018. https://www.abs.gov.au/AUSSTATS/[email protected]/DetailsPage/4364.0.55.0012017-18?OpenDocument.

Hales CM, Carroll MD, Fryar CD, Ogden CL. Prevalence of obesity among adults and youth: United States, 2015–2016. NCHS data brief, no 288. Hyattsville: MD: National Center for Health Statistics; 2017.

National Health Service Digital. National child measurement programme, England 2018/19 School Year [NS]. United Kingdom: Health and Social Care Information Centre; 2019.

Kelly AS, Barlow SE, Rao G, et al. Severe obesity in children and adolescents: Identification, associated health risks, and treatment approaches. Circ. 2013;128:1689–712. https://doi.org/10.1161/CIR.0b013e3182a5cfb3.

Sanders RH, Han A, Baker JS, Cobley S. Childhood obesity and its physical and psychological co-morbidities: a systematic review of Australian children and adolescents. Eur J Pediatr. 2015;174(6):715–46. https://doi.org/10.1007/s00431-015-2551-3.

Cornette R. The emotional impact of obesity on children. Worldviews on Evid-Based Nurs. 2008;5(3):136–41. https://doi.org/10.1016/B978-0-12-374995-6.10024-6.

Kang NR, Kwack YS. An update on mental health problems and cognitive behavioral therapy in pediatric obesity. Pediatric Gastroenterology, Hepatology & Nutrition. 2020;23(1):15–25. https://doi.org/10.5223/pghn.2020.23.1.15.

Rankin J, Matthews L, Cobley S, Han A, Sanders R, Wiltshire HD, Baker JS. Psychological consequences of childhood obesity: Psychiatric comorbidity and prevention. Adolesc Health Med Ther. 2016;7:125. https://doi.org/10.2147/AHMT.S101631.

Bendor CD, Bardugo A, Pinhas-Hamiel O, Afek A, Twig G. Cardiovascular morbidity, diabetes and cancer risk among children and adolescents with severe obesity. Cardiovasc Diabetol. 2020;19(1):1–79. https://doi.org/10.1186/s12933-020-01052-1.

Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa heart study. Pediatrics. 1999;103:1175–82. https://doi.org/10.1542/peds.103.6.1175.

Puhl RM, Latner JD. Stigma, obesity, and the health of the nation’s children. Psychological Bull. 2007;133:557–80. https://doi.org/10.1037/0033-2909.133.4.557.

Thompson I, Hong JS, Lee JM, Prys NA, Morgan JT, Udo-Inyang I. A review of the empirical research on weight-based bullying and peer victimisation published between 2006 and 2016. Educ Rev. 2020;72(1):88–110. https://doi.org/10.1080/00131911.2018.1483894.

Gow Tee MS, Garnett SP, Baur LA, Aldwell K, Thomas S, Lister NB, Paxton SJ, & Jebeile H. Pediatric obesity treatment, self-esteem, and body image: a systematic review with meta-analysis. Pediatric Obesity. 2020;15(3). https://doi.org/10.1111/ijpo.12600

Wang F, Wild TC, Kipp W, Kuhle S, Veugelers PJ. The influence of childhood obesity on the development of self-esteem. Health Rep. 2009;20:21–7.

Russell-Mayhew S, McVey G, Bardick A, Ireland A. Mental health, wellness, and childhood overweight/obesity. J. Obes. 2012:9 https://doi.org/10.1155/2012/281801

Horesh A, Tsur AM, Bardugo A, Twig G. Adolescent and childhood obesity and excess morbidity and mortality in young adulthood—a systematic review. Curr Obes Rep. 2021;10(3):301–10. https://doi.org/10.1007/s13679-021-00439-9.

Lobstein T, Baur L, Uauy R. Obesity in children and young people: a crisis in public health. Obes Rev. 2004;5(S1):4–85. https://doi.org/10.1111/j.1467-789X.2004.00133.x.

Dong C, Sanchez LE, Price RA. Relationship of obesity to depression: a family-based study. International J Obes and Relat Disord. 2004;28:790–5. https://doi.org/10.1038/sj.ijo.0802626.

Altman M, Wilfley DE. Evidence update on the treatment of overweight and obesity in children and adolescents. J Clin Child & Adolescent Psychology. 2015;44:521–37. https://doi.org/10.1080/15374416.2014.963854.

Latzer Y, Edmunds L, Fenig S, et al. Managing childhood overweight: Behaviour, family, pharmacology, and bariatric surgery interventions. Obes. 2009;17:411–23. https://doi.org/10.1038/oby.2008.553.

Sbruzzi G, Eibel B, Barbiero SM, Petkowicz RO, Ribeiro RA, Cesa CC, Martins CC, Marobin R, Schaan CW, Souza WB, Schaan BD, Pellanda LC. Educational interventions in childhood obesity: A systematic review with meta-analysis of randomized clinical trials. Preventive Medicine. 2013;56:254–64. https://doi.org/10.1016/j.ypmed.2013.02.024.

Cole K, Waldrop J, D’Auria J, Garner H. An integrative research review: Effective school-based childhood overweight interventions. J for Specialists in Pediatric Nurs. 2006;11:166–77. https://doi.org/10.1111/j.1744-6155.2006.00061.x.

Liu Z, Xu HM, Wen LM, Peng YZ, Lin LZ, Zhou S, Li WH, Wang HJ. A systematic review and meta-analysis of the overall effects of school-based obesity prevention interventions and effect differences by intervention components. Int J Behav Nutr Phys Act. 2019;16(1):1–12. https://doi.org/10.1186/s12966-019-0848-8.

Ewald H, Kirby J, Rees K, Robertson W. Parent-only interventions in the treatment of childhood obesity: A systematic review of randomized controlled trials. J Public Health. 2014;36(3):476–89. https://doi.org/10.1093/pubmed/fdt108.

Jansen E, Mulkens S, Jansen A. Tackling childhood overweight: Treating parents exclusively is effective. International J Obes. 2011;35:501–9. https://doi.org/10.1038/ijo.2011.16.

Zarychta K, Mullan B, Luszczynska A. It doesn’t matter what they say, it matters how they behave: Parental influences and changes in body mass among overweight and obese adolescents. Appetite. 2016;96:47–55. https://doi.org/10.1016/j.appet.2015.08.040.

Chai LK, Collins C, May C, Brain K, See DW, Burrows T. Effectiveness of family-based weight management interventions for children with overweight and obesity: An umbrella review. JBI Evidence Synthesis. 2019;17(7):1341–427. https://doi.org/10.11124/JBISRIR-2017-003695.

Jull A, Chen R. Parent-only vs. parent-child (family-focused) approaches for weight loss in obese and overweight children: A systematic review and meta-analysis. Obesity Reviews. 2013;14(9):761–8. https://doi.org/10.1111/obr.12042.

Berge JM, Everts JC. Family-based interventions targeting childhood obesity: a meta-analysis. Child Obes. 2011;7:110–21. https://doi.org/10.1089/chi.2011.07.02.1004.berge.

Pratt KJ, Skelton JA. Family functioning and childhood obesity treatment: a family systems theory-informed approach. Acad Pediatr. 2018;18(6):620–7. https://doi.org/10.1016/j.acap.2018.04.001.

Yackobovitch-Gavan MD, Wolf Linhard N, Nagelberg I, Poraz S, Shalitin M, Phillip M, Meyerovitch J. Intervention for childhood obesity based on parents only or parents and child compared with follow-up alone. Pediatric Obesity. 2018;13(11):647–55. https://doi.org/10.1111/ijpo.12263.

Brown HE, Schiff A, van Sluijs EMF. Engaging families in physical activity research: a family-based focus group study. BMC Public Health. 2015;15(1):1178. https://doi.org/10.1186/s12889-015-2497-4.

Mead E, Brown T, Rees K, et al. Diet, physical activity and behavioural interventions for the treatment of overweight or obese children from the age of 6 to 11 years. Cochrane Database of Systematic Reviews. 2018;6. https://doi.org/10.1002/14651858.CD012651

Sacher PM PM, Kolotourou M M, Chadwick PM, et al. Randomized controlled trial of the MEND program: a family-based community intervention for childhood obesity. Obes. 2010;18(S1):S62–8. https://doi.org/10.1038/oby.2009.433.

Hayes JF, Fowler LA, Balantekin KN, Saelens BE, Stein RI, Perri MG, Welch RR, Epstein LH, Wilfley DE. Children with severe obesity in family-based obesity treatment compared with other participants: conclusions depend on metrics. Obesity. 2021;29(2):393–401. https://doi.org/10.1002/oby.23071.

Vaughan-Johnston TI, Jacobson, JA. Self-efficacy theory. In: Carducci BJ, Nave CS, Mio JS, Riggio, RE, editors. The Wiley encyclopedia of personality and individual differences: Models and theories. Newark: John Wiley & Sons, Ltd; 2020. pp. 375–379. https://doi.org/10.1002/9781119547143.ch62

Ivy VN, PhD., Gaudreault KL, PhD., Baghurst T, PhD. Self-efficacy of overweight and obese youth participating in a multidisciplinary afterschool program. International Journal of Child and Adolescent Health. 2019;12(2):157–170. Available from: https://elibrary.jcu.edu.au/login?url=https://www.proquest.com/scholarly-journals/self-efficacy-overweight-obese-youth/docview/2273102042/se-2?accountid=16285

Teixeira PJ, Silva MN, Mata J, Palmeira AL, Markland D. Motivation, self-determination, and long-term weight control. Int J Behav Nutr PhysActivity. 2012;9:22. https://doi.org/10.1186/1479-5868-9-22.

Ryan RM, Deci EL. Self-determination theory and the role of basic psychological needs in personality and the organization of behaviour. In: John OP, Robins RW, Pervin LA, editors. Handb of personality: Theory and res. New York, NY: The Guilford Press; 2008. p. 654–78.

Sung-Chan P, Sung YW, Zhao X, Brownson RC. Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials. Obes Reviews. 2013;14:265–78. https://doi.org/10.1111/obr.12000.

Epstein LH, Paluch RA, Roemmich JN, Beecher MD. Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. Health Psychol. 2007;26:381–91. https://doi.org/10.1037/0278-6133.26.4.381.

Jones HM, Al-Khudairy L, Melendez-Torres GJ, Oyebode O. Viewpoints of adolescents with overweight and obesity attending lifestyle obesity treatment interventions: a qualitative systematic review. Obes Rev. 2019;20(1):156–69. https://doi.org/10.1111/obr.12771.

Pietrabissa G, Rossi A, Borrello M, Manzoni GM, Mannarini S, Castelnuovo G, Molinari E. Development and validation of a self-determination theory-based measure of motivation to exercise and diet in children. Front Psychol. 2020;11:1299.

Zolotarjova J, ten Velde G, Vreugdenhil ACE. Effects of multidisciplinary interventions on weight loss and health outcomes in children and adolescents with morbid obesity. Obes Reviews. 2018;19:931–46. https://doi.org/10.1111/obr.12680.

Denzin NK, Lincoln YS. Strategies of Qualitative Inquiry. 4th ed. London: Sage; 2013.

Sparkes AC, Smith B. Qualitative research methods in sport, exercise and health: From process to product. Routledge; 2013.

Braun V, Clarke V. Reflecting on reflexive thematic analysis. Qual Res Sport Exerc Health. 2019;11:589–97. https://doi.org/10.1080/2159676X.2019.1628806.

Clarke V, Braun V, Terry G, Hayfield N. Thematic analysis. In: Liamputtong P, editors. Handb. Res. Methods in Health and Soc. Sciences. Singapore: Springer; 2019:843–860. https://doi.org/10.1007/978-981-10-5251-4_103

Adler, K., Salanterä, S., & Zumstein-Shaha, M. Focus group interviews in child, youth, and parent research: An integrative literature review. Int J Qual Methods. 2019;18. https://doi.org/10.1177/1609406919887274

Jones CD, Newsome J, Levin K, Wilmot A, McNulty JA, Kline T. Friends or strangers? a feasibility study of an innovative focus group methodology. The Qualitative Report. 2018;23(1):98–112. https://doi.org/10.46743/2160-3715/2018.2940.

Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qualitative Res Sport Exercise Health. 2021;13(2):201–16. https://doi.org/10.1080/2159676X.2019.1704846.

Birch LL, Ventura AK. Preventing childhood obesity: what works? International J Obes. 2018;33:S74–81. https://doi.org/10.1038/ijo.2009.22.

Sargent GM, Pilotto LS, Baur LA. Components of primary care interventions to treat childhood overweight and obesity: a systematic review of effect. Obes Reviews. 2011;12:e219–35. https://doi.org/10.1111/j.1467-789X.2010.00777.x.

Smith B, McGannon KR. Developing rigor in qualitative research: problems and opportunities within sport and exercise psychology. International Rev Sport and Exercise Psychology. 2018;11:101–21. https://doi.org/10.1080/1750984X.2017.1317357.

Bennett B, Sothern MS. Diet, exercise, behaviour: the promise and limits of lifestyle change. Semin in Pediatric Surg. 2009;18:152–8. https://doi.org/10.1053/j.sempedsurg.2009.04.005.

Skelton JA, Irby MB, Beech BM, Rhodes SD. Attrition and family participation in obesity treatment programs: Clinicians’ perceptions. Acad Pediatr. 2012;12:420–8. https://doi.org/10.1016/j.acap.2012.05.001.

Harrist AW, Swindle TM, Hubbs-Tait L, Topham GL, Shriver LH, Page MC. The social and emotional lives of overweight, obese, and severely obese children. Child Dev. 2016;87:1564–80. https://doi.org/10.1111/cdev.12548.

Salvy SJ, de la Haye K, Bowker JC, Hermans RC. Influence of peers and friends on children’s and adolescents’ eating and activity behaviours. Physiol & Behav. 2012;106:369–78. https://doi.org/10.1016/j.physbeh.2012.03.022.

Nicholas JC, Dimmock JA, Donnelly CJ, Alderson JA, Jackson B. “It’s our little secret… an in-group, where everyone’s in”: Females’ motives for participation in a stigmatized form of physical activity. Psychol Sport Exerc. 2018;36:104–13.

Michie S, Ashford S, Sniehotta FF, Dombrowski SU, Bishop A, French DP. A refined taxonomy of behaviour change techniques to help people change their physical activity and healthy eating behaviours: the CALO-RE taxonomy. Psychol Health. 2011;26:1479–98. https://doi.org/10.1080/08870446.2010.540664.

Deci EL, Ryan RM. Self-determination theory: a macrotheory of human motivation, development, and health. Can Psychol. 2008;49:182–5. https://doi.org/10.1037/a0012801.

Webber KH, Tate DF, Ward DS, Bowling JM. Motivation and its relationship to adherence to self-monitoring and weight loss in a 16-week Internet behavioural weight loss intervention. J Nutr Education and Behav. 2010;42:161–7. https://doi.org/10.1016/j.jneb.2009.03.001.

Dimmock J, Jackson B, Podlog L, Magaraggia C. The effect of variety expectations on interest, enjoyment, and locus of causality in exercise. Motivation and Emot. 2013;37(1):146–53.

Stamatakis E, Wardle J, Cole TJ. Childhood obesity and overweight prevalence trends in England: evidence for growing socioeconomic disparities. International J Obes. 2010;34:41–7. https://doi.org/10.1038/ijo.2009.217.

Clayton, Connelly, J., Ellington, M., Rojas, V., Lorenzo, Y., Trak-Fellermeier, M. A., & Palacios, C. Facilitators and barriers of children's participation in nutrition, physical activity, and obesity interventions: a systematic review. Obesity Reviews. 2021;22(12). https://doi.org/10.1111/obr.13335

Zahry NR, Ling J. Parental perceived facilitators for and barriers to participating in a lifestyle intervention to reduce early childhood obesity: a qualitative evaluation. West J Nurs Res. 2020;42(6):405–14. https://doi.org/10.1177/0193945919866691.

Foster E, Bradley J. Methodological considerations and future insights for 24-hour dietary recall assessment in children. Nutr Res. 2018;51:1–11. https://doi.org/10.1016/j.nutres.2017.11.001.

O’Reilly M, Parker N. ‘Unsatisfactory Saturation’: a critical exploration of the notion of saturated sample sizes in qualitative research. Qualitative Research. 2013;2:190–7. https://doi.org/10.46743/2160-3715/2018.2940.

Budden T, Dimmock JA, Smith B, Beauchamp M, Rosenberg M, Jackson B. Overweight and obese men’s experiences in a sport-based weight loss intervention for men. Psychol Sport Exerc. 2020;50:101750. https://doi.org/10.46743/2160-3715/2018.2940.

Irvine A, Drew P, Sainsbury R. ‘Am I not answering your questions properly?’Clarification, adequacy and responsiveness in semi-structured telephone and face-to-face interviews. Qual Res. 2013;13(1):87–106. https://doi.org/10.1177/1468794112439086.

Rabiee F. Focus-group interview and data analysis. Proceedings of the nutrition society. 2004;63(4):655–60. https://doi.org/10.1079/PNS2004399.

Smith B. Generalizability in qualitative research: Misunderstandings, opportunities and recommendations for the sport and exercise sciences. Qualitative Res in Sport, Exercise and Healt. 2018;10:137–49. https://doi.org/10.1080/2159676X.2017.1393221.

Thông tin
Thông tin xuất bản

BMC Public Health

Thông tin tác giả