Evaluation of Parental Acceptability and Use of Intervention Components to Reduce Pre-School Children’s Intake of Sugar-Rich Food and Drinks
Abstract
:1. Introduction
2. Materials and Methods
2.1. Setting and Intervention Design
2.2. Consultation with the School Health Nurse, New Guidelines and the Sugar-Rich Food Screener
2.3. Box with Home-Use Materials and Facebook Community
2.4. Qualitative Interviews and Quantitative Questionnaire
2.5. Data Analysis
3. Results
3.1. Participant Characteristics
3.2. Perception of the Consultation with the School Health Nurse and the Sugar-Rich Food Screener Output
“Well, I must admit, I actually do not really remember what the health nurse said”, father to girl at school A.
“I would say we were probably both in shock because we believe we have a healthy relationship with sweets, so we were very surprised”, mother to girl at school D.
“I was damn proud when we signed up and I thought "we totally got this" and then when we got that pie chart (from the sugar-rich food screener), I was kind of like "oh, okay… the higher you fly, the further you fall”, father to girl at school D.
“I acknowledged her point when she had drawn it in red, which means alarm. Then you think "mayday-mayday." We need to do something”, mother to boy at school B.
“We also had a chat about how it matters to change the little things. It is not like we were supposed to go home and change everything. That is not at all what it is about. But yes, (reducing our intake of) squash may be a good place to start. What would be good alternatives to that, right?”, mother to girl at school D.
“I was surprised it was an issue since he is so skinny. But then again, you also talk about the inside of the body and whether it consists of muscle or fat. So, I still listened, even though I was offended at first”, mother to boy at school B.
“She (interviewee’s daughter) knew very well that “okay it was not just mom”, mother to girl at school C.
“And then the four pieces of candy for her age. That seemed a bit grotesque. I was like "Wow! That is hardly anything!", father to girl at school C.
3.3. The Acceptability and Use of the Intervention Components Used at Home
3.3.1. Quantitative Evaluation
3.3.2. Serving Size Board with Reusable Stickers
“It still hangs out there on the fridge (…) it has worked well because it has been an actual visual thing at her eye level, right. And it has been noticeable in the kitchen, and we could say: “But look. Now you are asking for this, but you already have two stickers, and it is only Friday tomorrow"”, mother to girl at school C.
“And then there were the stickers. They have used them in all sorts of funny ways (laughs), but that is probably just a kid’s thing”, mother to boy at school A.
“It is just, that thing about a six-year-old having to comprehend what she can and cannot have. Well, listen up! The idea is that we present the food she needs. And that is the proper food. Nothing more! And if you eat what we present, then we believe you will get some healthy habits”, father to girl at school C.
“I believe it is my responsibility. Not his”, mother to boy at school A.
“It is very important to me to teach them good habits, so that they learn to make reasonable choices, I mean, do away with this idea of prohibited or bad foods”, mother to girl at school D.
3.3.3. The Inspiration Booklet
“I thought it was nice to receive those tips and tricks because it made me look them up again. Like, "what was the message again?"”, mother to girl at school B.
“It is this one (shows the servings sizes in the inspiration booklet) I think that is the one we have used the most”, mother to girl at school C.
“To me it was a good inspiration booklet. I probably just needed that service check of our habits, "what are we doing?" and it helped me”, mother to girl at school C.
“Not long ago I told my husband to read it as well, so we are in it, like, together”, mother to girl at school B.
3.3.4. Educational Card Game (the Monster Game)
“We used the game a couple of times. We have not played the actual game a lot. We have been more like making up the stories. We used that part of it, the one with making up a true and a false story. And then the part with thinking of alternatives, because it was actually the kids just as much as myself who came up with the idea of having Friday fruit”, mother to girl at school C.
“He loves flipping lottery. I tried to explain to him what we were supposed to do and stuff, but in the end we made it a flipping game instead”, mother to boy at school A.
“I was initially assuming that the kids were to learn about sweets and healthiness and stuff like that, but that was not at all what they were taught. Focus was on capturing the monster and learning how to capture it”, mother to girl at school A.
“There were too many rules. There was, like, too much to comprehend”, father to boy at school C.
“We never really looked at it. It was somehow just forgotten among everything else”, mother to girl at school B.
“I would definitely have spent more time on the game, had it been more of a usual everyday life, as that would also mean more time for it. In the current situation we need to stick to the familiar”, mother to girl at school A.
3.3.5. Read Aloud Children’s Book ‘Anton Og Sukkerdillen’
“[The book] was funny. They really liked it, her little sister as well, also in relation to dentists and such. It is really good”, mother to girl at school A.
“He likes to choose which books to read. It is not one he has asked for”, mother to boy at school A.
“We have read it a couple of times at least. But, like, I think they see it as a story just like any other”, mother to girl at school B.
“The thing with the teeth falling out and "do you remember the crocodile who just suddenly had no teeth". So yes, they got it. It did make an impression on them”, mother to girl at school D.
3.3.6. Educational App with Learning Games and AR-Function
“He liked the app; the one where you can feed it with lots of sugar, or greens and then it, like, got better or did not get better. He thought that was funny. Yeah, and then the fact that it could talk to him”, mother to boy at school A.
“Then we tried that app. He did not find that interesting, the one where those gizmos jump around. He really thought that was boring”, mother to boy at school A.
“I must say, with all this lockdown and corona. It has been incredible with this home-school ing craze and all that technical shit and stuff. So, having to download an app and figuring it out. (tired sigh!) I was just very “no!””, father to girl at school C.
3.3.7. Private Facebook Group
“I do not use Facebook for communication purposes. I simply use it as a tool to look into what people are doing. To probe into people’s lives (laughs)”, father to girl at school C.
“I probably would have done it in another setting where I knew who the members were and then I probably would have chosen the Facebook group that belongs to (child’s name) class. So, like a slightly narrower forum. I only used the Facebook group for inspiration or information. So, only as something for me, not something from me”, mother to girl at school C.
“Yes, but it was nice to have ongoing reminders, because you can easily forget all about it and then get back on the wrong track. Starting again to buy candy, even if you really do not want to. "Why did I do this? There is no reason to do so. ” So it was a really good reminder”, mother to girl at school A.
3.3.8. The Child-Centered Approach as a Basis for a Shared Language
“She understands if we show her: "At your age you should not have more than this". And then she can more easily put it into perspective, and, like, really understand and accept it”, mother to girl at school B.
“We have just discussed it: "But there are simply no biscuits for now because listen, you have four available, and therefore you can have an apple"”, mother to girl at school C.
4. Discussion
4.1. School Health Nurse Consultation and the Sugar-Rich Food Screener
4.2. Components and Materials Used at Home
4.3. Engagement of Families Regarding the Intake of Sugar-Rich Foods and Drinks
4.4. Strength and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Theme | Content | Focal Points | Time Frame |
---|---|---|---|
Introduction | 1. Introduce the aim of the interview 2. Inform about the structure and themes of the interview 3. Inform about anonymity (no individual identities will be disclosed in publications) 4. The audio recording is for internal use only (data protection) 6. Oral consent to participate 5. Do you have any questions? | Present the aim of the interview. Introduce the logic of qualitative interviews (that interviewee’s subjective experiences and perceptions are central, and that their point of view is necessarily right) Inform on confidentiality, withdrawal and data protection Obtain consent of participation | 4 min |
Overall evaluation | How was it to be part of the ’Are you too sweet?’ intervention? | Participant’s top-of-mind evaluation and thoughts? | 3 min |
Behaviour change and motivation | Have you changed any habits or practices? What did the habits and intake of sugar-rich foods and drinks look like in your family before you enrolled? Prompts: Friday night sweets, lunch packs, soft drinks and other sweet drinks, grandparents and afternoon snacks Additional prompts:
| Successful behaviour change in family habits and routines Experienced barriers, facilitators and motivations in relation to behaviour change. | 10 min |
Knowledge on the guidelines for sugar-rich foods and drinks | Did you acquire knowledge through the project that you did not possess beforehand? Prompts: weekly number of maximum servings, portion sizes, definitions of sugar-rich foods and drinks, other? What are your thought on the logic of a maximum number of servings? Did you aim to comply with the guidelines? Did you customize the guidelines? E.g., tailor the number of maximum weekly servings? Other? What are the challenges of complying with the guidelines, if any? | The applicability and relevance of the guidelines How do parents perceive of the recommended maximum number of weekly servings? Experienced barriers, facilitators and motivations in relation to reducing the intake of sugar-rich foods and drinks to the recommended maximum number of weekly servings | 8 min |
Consultation with the school health nurse | What are your thought on the consultation with the school health nurse? Prompt: Sugar-rich food screener output Which family members participated (child, mother, farther, both) in the consultation? | Perception of the consultation with the school health nurse Mode of delivery for main message and intervention components, including the sugar-rich food screener output | 5 min |
Intervention components and tools | If we look at the things in the home-use box with materials, what did you actually use? Prompts:
Did you subscribe to the Facebook group? Did you get notifications on the posts posted? Have you read/seen the posts? What are your thoughts on the content? Did the posts serve as a reminder of your participation in the project? | Practical use of the intervention components, and potential tailoring or innovations Pedagogical usefulness of the intervention components Practical or technical impediments Disapproval or critique of the intervention components | 10 min |
The COVID-19 pandemic, lockdowns and restrictions | How did the COVID-19 pandemic and lockdown affect your family and everyday life? Do you think you would have been more or less involved in the project if lockdown had not happened? Prompt: E.g., used the things in the box with home-use materials more or less? | To what extent and how has the COVID-19 pandemic and lockdown been a barrier or a facilitator concerning behavior change? | 8 min |
Social support | Did you discuss the project with family or friends? Prompts: Other parents from [child’s name] class? Close family members, e.g., aunts, uncles or grandparents? | Family networks, core values and norms | 4 min |
Outro | Do you have anything to add? Things that we did not discuss that are relevant to the evaluation? Do you have any questions? | 3 min |
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Interviewees, n = 24 | Questionnaire Respondents, n = 83 | |
---|---|---|
Sex of participating child; n (%) | ||
Girls | 14 (58%) | 44 (50%) * |
Boys | 10 (42%) | 44 (50%) * |
Interviewees; n (%) | ||
Mother | 17 (71%) | 66 (80%) |
Father | 1 (4%) | 16 (19%) |
Step-mother | 1(4%) | 1 (1%) |
Both parents | 5 (21%) | - |
Parental education; n (%) | ||
Basic school (<12 years) | 3 (13%) | 9 (11%) |
Upper secondary school (12 years) | 0 (0%) | 3 (4%) |
Vocational education (13 years, practical) | 7 (29%) | 19 (23%) |
Short higher (13–14 years) | 4 (17%) | 8 (10%) |
Medium higher (15–16 years) | 5 (21%) | 21 (25%) |
Long higher (≥ 17 years) | 5 (21%) | 23 (28%) |
Ethnicity (maternal); n (%) | ||
Danish | 22 (92%) | 76 (92%) |
Other western and non-western | 2 (8%) | 7 (8%) |
N = 83 | Not Used | Used 1–2 Times | Used 3–5 Times | Used ≥ 6 Times |
---|---|---|---|---|
Serving size board with reusable stickers | 34 (41%) | 21 (25%) | 11 (13%) | 17 (20%) |
The inspiration booklet | 5 (6%) | 48 (58%) | 18 (22%) | 12 (14%) |
Educational card game, The Monster Game | 31 (37%) | 32 (39%) | 15 (18%) | 5 (6%) |
Read aloud children’s book | 16 (19%) | 30 (36%) | 17 (20%) | 20 (24%) |
Educational app with learning games and AR | 43 (52%) | 14 (17%) | 12 (14%) | 14 (17%) |
N | Very Dissatisfied | Dissatisfied | Neither Satisfied Nor Dissatisfied | Satisfied | Very Satisfied | |
---|---|---|---|---|---|---|
Serving size board with reusable stickers | 49 | 0 (0%) | 1 (2%) | 12 (24%) | 17 (35%) | 19 (39%) |
The inspiration booklet | 74 * | 0 (0%) | 1 (1%) | 22 (28%) | 36 (46%) | 15 (19%) |
Educational card game, the Monster Game | 51 ** | 2 (4%) | 3 (6%) | 20 (38%) | 21 (40%) | 5 (10%) |
Read aloud children’s book | 67 | 1 (1%) | 1 (1%) | 8 (12%) | 28 (42%) | 29 (43%) |
Educational app with learning games and AR | 40 | 1 (2%) | 4 (10%) | 8 (20%) | 18 (45%) | 9 (23%) |
Private Facebook group | 44 *** | 0 (0%) | 4 (8%) | 21 (40%) | 17 (33%) | 2 (4%) |
School health nurse consultation | 80 **** | 0 (0)% | 3 (4%) | 10 (12%) | 44 (53%) | 23 (28%) |
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Christensen, B.J.; Bestle, S.M.S.; Trolle, E.; Biltoft-Jensen, A.P.; Matthiessen, J.; Gibbons, S.J.; Lassen, A.D. Evaluation of Parental Acceptability and Use of Intervention Components to Reduce Pre-School Children’s Intake of Sugar-Rich Food and Drinks. Int. J. Environ. Res. Public Health 2022, 19, 7967. https://doi.org/10.3390/ijerph19137967
Christensen BJ, Bestle SMS, Trolle E, Biltoft-Jensen AP, Matthiessen J, Gibbons SJ, Lassen AD. Evaluation of Parental Acceptability and Use of Intervention Components to Reduce Pre-School Children’s Intake of Sugar-Rich Food and Drinks. International Journal of Environmental Research and Public Health. 2022; 19(13):7967. https://doi.org/10.3390/ijerph19137967
Chicago/Turabian StyleChristensen, Bodil Just, Sidse Marie Sidenius Bestle, Ellen Trolle, Anja Pia Biltoft-Jensen, Jeppe Matthiessen, Sarah Jegsmark Gibbons, and Anne Dahl Lassen. 2022. "Evaluation of Parental Acceptability and Use of Intervention Components to Reduce Pre-School Children’s Intake of Sugar-Rich Food and Drinks" International Journal of Environmental Research and Public Health 19, no. 13: 7967. https://doi.org/10.3390/ijerph19137967