Posted: April 24th, 2023

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 23

C hildhood obesity has become a serious health issue in the United States. According to the Centers for Disease Con –

trol and Prevention (CDC) (2019), roughly 18.5% of children are obese. The CDC (2019) also reports that obese children may begin to present signs of obesity and develop comor- bidities as early as preschool age. Studies have found that obese chil- dren are more likely to advance to chronic diseases, such as hyperten- sion, diabetes, depression, and joint problems, earlier in life than children who are not obese. Identifying deter- minants that contribute to obesity in children may guide health care providers in the prevention and con- trol of obesity (Alexander et al., 2015; Rune et al., 2015).

A significant association between parental influence and childhood obesity has been identified in the lit- erature (Hansen et al., 2014; Moore et al., 2012; Rune et al., 2015). In many circumstances, a child’s diet and physical activity were dependent on the discretion of the parent. Identifying parental perceptions and attitudes of childhood obesity can provide guidance in formulating evi- dence-based interventions to prevent and control childhood obesity (Abela et al., 2014).

Continuing Nursing Education

Assessing Parental Perceptions on Childhood Obesity: An Educational

Intervention Felicia Renales, Kelli Whitted, and Noreen Lennen

Felicia Renales, DNP, FNP-BC, is an Helpant Professor, Troy University, Phenix City, AL.

Kelli Whitted, DNP, FNP-BC, APRN-BC, is an Associate Professor, Troy University, Phenix City, AL.

Noreen Lennen, PhD, RN, is an Helpant Professor, Troy University, Phenix City, AL.

The correlation between a child’s weight and the parents’ perception of their child’s weight affected a child’s risk of becoming obese (White et al., 2016). Parents who displayed concern about their child’s weight were more likely to control environmental fac- tors, such as screen time and physical activity. Children were more success- ful and compliant with weight control when their parents were supportive and proactive in the practice of adopt- ing healthy habits (Alexander et al.,

2015; Black et al., 2015; Moore et al., 2012; Rune et al., 2015).

Evidence suggests that assessments related to parental knowledge and per- ception of their child’s weight status could decrease the risk of obesity by allowing the opportunity for providers to discuss weight concerns and ideas with parents. Assessment of parents’ perception of their child’s weight and education from a health care provider has been successful in preventing obe- sity in children and identifying those

Renales, F., Whitted, K., & Lennen, N. (2021). Assessing parental perceptions on childhood obesity: An educational intervention. Pediatric Nursing, 47(1), 23- 29, 51.

Background: Parental influence on children’s health behaviors has been recog- nized as significantly impacting childhood obesity.

Objective: The objective of the study was to examine the impact of an education intervention on the perceptions and attitudes that parents of school-aged chil- dren displayed on childhood obesity.

Method: A random sample of 30 parents was recruited to complete a survey before and after reviewing an educational pamphlet on childhood obesity. The survey assessed parental perceptions, knowledge, and importance of obesity risk factors and obesity prevention strategies. The survey also addressed parental perceptions of their children’s weight status and their children’s environ- ment.

Results: The education intervention brought awareness that parental percep- tions and attitudes can influence children’s obesity risk factors. This measurable finding indicates that an educational pamphlet can serve as a valuable tool to Help parents with choosing healthier lifestyles for their children.

Conclusion: Health care providers and parents play vital roles in the wellness and health promotion of children. Informing parents by means of an educational pamphlet can improve parents’ awareness about childhood obesity and positive- ly impact the health of their children.

Key Words: Pediatric obesity, parental perception, parents’ knowledge, risk factors, body mass index, parental concern.

Instructions for CNE Contact Hours

PNJ 2104 Continuing nursing education (CNE)

contact hours can be earned for completing the learning activity

associated with this article. Instructions are available at pediatricnursing.net

Deadline for submission: February 28, 2023 1.3 contact hour(s)

24 PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1

at risk (Rune et al., 2015). Brief educa- tional interventions about the child’s weight can increase parental knowl- edge (Rune et al., 2015).

Purpose The purpose of this study was to

examine the effectiveness of an edu- cational intervention on the percep- tions and attitudes of childhood obe- sity among parents of school-aged children. The expected outcome was that implementation of a written edu- cational program would promote healthier attitudes.

Methods

Study Design A pretest-posttest research design

was used for the study. Following Institutional Review Board approval, participants were recruited from an after-school day care facility that serv- ices children ages 6 weeks to 12 years.

Sample A convenience sample of 30 indi-

vidual parents were recruited for the study. Parents 18 years of age or greater whose child attended the after-school day care facility and who could read and write in English were included in the study. Data were col- lected over a four-month timeframe during the Fall of 2017.

Procedures After participants signed the con-

sent form, a pre-intervention survey was administered to parents. Upon completion of the pre-intervention survey, parents were given an educa- tional pamphlet on childhood obesity and a post-intervention survey to com- plete at their convenience. Parents were instructed to return the post- intervention survey within one week to the after-school day care facility.

Instruments A modified version of a question-

naire developed by Alexander and colleagues (2015) was used for the study. Guided by the social ecological model and the social cognitive theo- ry, the survey was used to assess parental perceptions of risk factors, child’s weight status, and importance of prevention strategies relating to childhood obesity. Reliability and validity of the survey was previously established through interrater reliabil-

Parental Perception of Risk Factors Associated with Childhood Obesity

In both the pre-intervention and post-intervention groups, parents agreed that lack of physical activity, food advertising, watching television, eating foods, and parental eating and exercise habits were risk factors associ- ated with childhood obesity (see Table 2). Following the educational intervention, parental perception that food advertising, watching television, and parental eating habits was reduced. Perceptions that eating foods or food choices increased, indicating appropriate inference from the educa- tional pamphlet; however, the differ- ences were not statistically signifi- cant.

Complications Associated with Childhood Obesity

Parents were asked to identify spe- cific complications associated with childhood obesity (see Table 3). Post- intervention scores increased for identifying physiologic complications associated with childhood obesity. However, more than 30% of the par-

ity, internal consistency reliability (0.71 to 0.82), face validity, and con- tent validity.

For this study, five primary sub- scales were used to examine changes in parental perception following the educational intervention. Pre-inter- vention and post-intervention analy- sis examined parental perception of risk factors associated with childhood obesity, complications of childhood obesity, their child’s weight, the play environment, prevention strategies, and importance of prevention strate- gies. Cronbach’s alpha for this study was 0.86.

Results The sample consisted of 30 partici-

pants aged 19 to 44 years. There was a 100% return of post-test surveys with all 30 participants completing the pre- test and post-test surveys. Demo – graphic information is presented in Table 1. A majority of the respondents were female (76.7%), White (56.7%), held a high school degree or equiva- lent (30%), and were currently married or in a domestic partnership (70%).

Table 1. Description of the Sample

Characteristics n %

Gender

Female 23 76.7 Male 7 23.3

Race

White 17 56.7 Hispanic or Latino 1 3.3 Black or African American 9 30.0 More than one race 3 10.0

Highest degree

High school or equivalent 9 30.0 Some college, no degree 5 16.7 Trade 3 10.0 Associate 4 13.3 Bachelor 6 20.0 Master 3 10.0

Marital status

Single 5 16.7 Married or domestic partnership 21 70.0 Widowed 1 3.3 Divorced 3 10.0

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 25

Table 2. Frequencies of Pre-Intervention and Post-Intervention Risk Factors for Childhood Obesity

Variable

Pre-Intervention Post-Intervention n % n %

Do you disagree, neither, or agree that the following are risk factors of childhood obesity? Lack of physical activity

Disagree 4 13.3 3 10.0 Neither 0 0.0 1 3.3 Agree 26 86.7 26 86.7

Food advertising Disagree 1 3.3 3 10/0 Neither 6 20.0 8 26.7 Agree 23 76.7 19 63.3

Watching TV Disagree 1 3.3 2 6.7 Neither 7 23.3 7 23.3 Agree 22 73.3 21 70.0

Eating foods Disagree 1 3.3 2 6.7 Neither 5 16.7 3 10.0 Agree 24 80.0 25 83.3

Parent’s eating habits Disagree 1 3.3 3 10.0 Neither 2 6.7 1 3.3 Agree 27 90.0 26 86.7

Parent’s exercise habits Disagree 0 0.0 0 0.0 Neither 3 10.0 3 10.0 Agree 27 90.0 27 90.0

Table 3. Frequencies of Pre-Intervention and Post-Intervention Complications of Childhood Obesity

Variable

Pre-Intervention Post-Intervention n % n %

Do you disagree, neither, or agree that the following are complications of childhood obesity? Asthma

Disagree 8 26.7 6 20.0 Neither 6 20.0 4 13.3 Agree 16 53.3 20 66.7

Diabetes Disagree 2 6.7 2 6.7 Neither 3 10.0 1 3.3 Agree 25 83.3 27 90.0

Bone and joint problems Disagree 4 13.3 1 3.3 Neither 6 20.0 5 16.7 Agree 20 66.7 24 80.0

Irregular menstrual cycle Disagree 2 6.7 2 6.7 Neither 13 43.3 8 26.7 Agree 15 50.0 20 66.7

26 PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1

Table 4. Frequencies of Pre-Intervention and Post-Intervention Parental Perception of Child’s Weight Status

Variable

Pre-Intervention Post-Intervention n % n %

Do you disagree, neither, or agree that the following regarding your child’s weight? Concern about weight

Disagree 14 46.7 13 43.3 Neither 4 13.3 4 13.3 Agree 12 40.0 13 43.3

Appropriate weight Disagree 4 13.3 3 10.0 Neither 7 23.3 4 13.3 Agree 19 63.3 23 76.7

My child is overweight Disagree 21 70.0 20 66.7 Neither 4 13.3 6 20.0 Agree 5 16.7 4 13.3

My child is underweight Disagree 21 70.0 18 60.0 Neither 7 23.3 10 33.3 Agree 2 6.7 2 6.7

Doctor discusses weight Disagree 13 43.3 12 50.0 Neither 3 10.0 5 16.7 Agree 14 46.7 13 43.3

Parental influence Disagree 3 10.0 1 3.3 Neither 5 16.7 3 10.0 Agree 22 73.3 26 86.7

ents either disagreed or neither agreed nor disagreed post-intervention that asthma and an irregular menstrual cycle were potential complications of childhood obesity. Additionally, post- intervention scores indicated that 20% of the parents disagreed or nei- ther agreed nor disagreed that bone and joint problems were a potential complication of childhood obesity, and 10% disagreed or neither agreed nor disagreed that diabetes was a potential complication.

Parental Perception of Their Child’s Weight Status

Parents were surveyed for percep- tion of their child’s weight status (see Table 4). There was a noted difference in parental perception of whether their child’s weight was appropriate. In the pre-intervention sample, 63% felt their child was of an appropriate weight. Post-intervention, 76.7% of the parents felt their child was of an appropriate; however, data did not

indicate whether the parent felt their child was underweight or overweight pre-intervention. Surprisingly, more than 50% of the sample indicated the health care provider did not discuss their child’s weight with the parent.

Parental Perception of Their Child’s Play Environment

Following the intervention, pa – rental perception of the child’s envi- ronment indicated the environment was less safe than in the pre-interven- tion scoring (see Table 5). This is evi- denced by an increase in scores for the presence of stray dogs, not enough play areas, and lack of programs. Parents who agreed that stray dogs affected their child’s environment increased from the pre-intervention group (26.7 %) to the post-interven- tion group (50%). Parental perception of not enough play areas increased from 43.3% pre-intervention to 56.7% post-intervention, and parents who agreed that lack of programs affected

their child’s environment increased from the pre-intervention (26.7%) to the post-intervention (46.7%). Paired sample t tests were also used to exam- ine differences in the child’s play envi- ronment. There was a significant dif- ference in pre-intervention and post- intervention parental perception for the application of stray dogs (t

(29) = –

02.23, p < 0.05, 95% CI = -0.42 to 0.16) and lack of programs (t

(29) = -2.16, p <

0.05, 95% C. I. -0.65 to -0.02) associat- ed with the child’s environment. A statistically significant difference was also identified in parental perception of environmental traffic (t

(29) = -2.36, p

< 0.05, 95% CI = -0.68 to -0.05). Among the pre-intervention sample, 50% of participants felt traffic impact- ed their child’s ability to play. Post- intervention, this decreased to 23.3%.

Parental Perception of Prevention Strategies

There was an increase in the num- ber of participants who agreed schools

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 27

Table 5. Frequencies of Pre-Intervention and Post-Intervention Parental Perception of Child’s Play Environment

Variable

Pre-Intervention Post-Intervention n % n %

Do you disagree, neither, agree that the following apply to the environment for your child to play? Safe in community

Disagree 2 6.7 4 13.3 Neither 0 0.0 0 0.0 Agree 28 93.3 26 86.7

Stray dogs Disagree 7 23.3 6 20.0 Neither 15 50.0 9 30.0 Agree 8 26.7 15 50.0

Not enough areas Disagree 9 30.0 9 30.0 Neither 8 26.7 4 13.3 Agree 13 43.3 17 56.7

Traffic Disagree 10 33.3 6 20.0 Neither 5 16.7 2 6.7 Agree 15 50.0 22 23.3

Lack of programs Disagree 14 46.7 10 33.3 Neither 8 26.7 6 20.0 Agree 8 26.7 14 46.7

Present health programs Disagree 5 16.7 8 26.7 Neither 12 40.0 9 30.0 Agree 13 43.3 13 43.3

Motivate Disagree 5 16.7 4 13.3 Neither 4 13.3 4 13.3 Agree 21 70.0 22 73.3

and the child’s doctor were useful in preventing childhood obesity. Parents who agreed that schools played a role in childhood obesity increased from pre-intervention (60%) to post-inter- vention (70%). Parents who agreed their child’s doctor positively impact- ed the prevention of obesity in their child also increased from pre-interven- tion (63.3%) to post-intervention (76.7%) (see Table 6).

Importance of Prevention Strategies

There was an increase in parental perception on the importance of lim- iting portion size and reading nutri- tion labels. The number of parents who felt that limiting portion size was not at all important in preventing

childhood obesity decreased from five to one, and the number of parents who felt reading nutrition labels was not at all important decreased from three to zero. Additionally, the num- ber of parents who felt that limiting portion sizes was extremely important increased from 40% in the pre-inter- vention sample to 56.7% in the post- intervention sample. There were sig- nificant changes in pre-intervention and post-intervention parental per- ception on the importance in the pre- vention strategies of limiting portion sizes (t

(29) = -2.13, p < 0.05, 95% CI = –

1.24 to -0.03) and pre-intervention and post-intervention limiting high calorie foods (t

(29) = -2.09, p < 0.05,

95% CI = -0.86 to -0.01) (see Table 7).

Discussion Exploring and understanding the

sources of obesity in children are ini- tial steps to reducing the prevalence of childhood obesity. Influences related to parents’ perceptions and attitudes on their child’s diet, concern about child’s weight, limits on a child’s eat- ing, and the amount of physical activ- ity were factors ob served in this study. Researchers have used qualitative sur- veys and questionnaires to evaluate parents’ perception and knowledge on obesity. By im plementing an educa – tional inter vention, such as a pam – phlet on child hood obesity, health care providers can improve parental perception and attitudes on childhood obesity. Pa rents globally can be encouraged to promote healthier

28 PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1

Table 6. Frequencies of Pre-Intervention and Post-Intervention Parental Perception of Prevention Strategies

Variable

Pre-Intervention Post-Intervention n % n %

Do you disagree, neither, or agree that the following are strategies of childhood obesity prevention? Schools

Disagree 4 13.3 6 20.0 Neither 8 26.7 3 10.0 Agree 18 60.0 21 70.0

My child’s doctor Disagree 3 10.0 3 10.0 Neither 8 26.7 4 13.3 Agree 19 63.3 23 76.7

My community Disagree 4 13.3 3 10.0 Neither 11 36.7 12 40.0 Agree 15 50.0 15 50.0

Drink water Disagree 0 0.0 1 3.3 Neither 0 0.0 0 0.0 Agree 30 100.00 29 96.7

Provide education Disagree 0 0.0 0 0.0 Neither 0 0.0 2 6.7 Agree 30 100.0 28 93.3

Provide low-fat meals Disagree 1 3.3 2 6.7 Neither 4 13.3 4 13.3 Agree 25 83.3 24 80.0

Income Disagree 3 10.0 3 10.0 Neither 5 16.7 7 23.3 Agree 22 73.3 20 66.7

lifestyle habits for their children by increasing their awareness of child- hood obesity.

Despite successful results, there were limitations to the research. Project findings could have been lim- ited due to the small sample size of 30 participants from one geographic loca- tion. Furthermore, the tool was origi- nally developed for African American families in Georgia; however, in this study a multiethnic population was used, which did not seem to have affected the implementation of this study.

Recommendations/ Implications for Practice

Sustaining the best choices to pro- vide an opportunity for every child to live the healthiest life possible has

been a central incentive in the preven- tion of childhood obesity in pediatric nursing. By detecting influential risk factors and causes of obesity in chil- dren, health care providers can play a role in reducing rates of childhood obesity. Employing an effective plan of care that targets perceptions and attitudes of parents may help increase children’s compliance and adoption of healthier lifestyle habits. Com – prehending misperceptions that par- ents have on childhood obesity can guide health care providers in formu- lating appropriate resources to admin- ister to parents of patients who are obese or at risk. Health care providers must remain current with recent rec- ommendations and guidelines to accurately inform parents. With the Helpance of health care providers uti-

lizing educational interventions, the goal is to alter negative parental per- ceptions and attitudes on childhood obesity into positive outcomes.

References Abela, S., Bagnasco, A., Arpsella, M.,

Vandoni, M., & Sasso, L. (2014). Childhood obesity: An observational study. Journal of Clinical Nursing, 23, 2990-2992. https://doi.org/10.1111/ jocn.12357

Alexander, D.S., Alfonso, M.L, & Hansen, A.R. (2015). Childhood obesity perceptions among African American caregivers in a rural Georgia community: A mixed methods approach. Journal of Com – munity Health, 40, 367-378. https://doi. org/10.1007/s10900-014-9945-4

continued on next page

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 29

Table 7. Frequencies of Pre-Intervention and Post-Intervention Parental Perception on

Importance of Prevention Strategies

Variable

Pre-Intervention Post-Intervention

n % n % How important do you feel the following factors are for your child? Limit screen time

Not at all important 0 0.0 0 0.0 Slightly important 3 10.0 2 6.7 Somewhat important 5 16.7 5 16.7 Moderately important 6 20.0 5 16.7 Extremely important 16 53.3 18 60.0

Limit portion size Not at all important 5 16.7 1 3.3 Slightly important 4 23.3 2 6.7 Somewhat important 2 6.7 4 13.3 Moderately important 7 23.3 6 20.0 Extremely important 12 40.0 17 56.7

Provide healthy snacks Not at all important 0 0.0 0 0.0 Slightly important 0 0.0 0 0.0 Somewhat important 3 10.0 3 10.0 Moderately important 7 23.3 7 23.3 Extremely important 20 66.7 20 66.7

Exercise with my child Not at all important 0 0.0 0 0.0 Slightly important 0 0.0 1 3.3 Somewhat important 5 16.7 3 10.0 Moderately important 4 13.3 5 20.0 Extremely important 21 70.0 20 66.7

Read nutrition labels Not at all important 3 10.0 0 0.0 Slightly important 3 10.0 3 10.0 Somewhat important 6 20.0 6 20.0 Moderately important 8 26.7 5 16.7 Extremely important 10 33.3 16 53.3

Limit high-calorie foods Not at all important 0 0.0 1 3.3 Slightly important 2 6.7 1 3.3 Somewhat important 10 33.3 3 10.0 Moderately important 8 26.7 8 26.7 Extremely important 10 33.3 17 56.7

Health professional Not at all important 2 6.7 0 0.0 Slightly important 1 3.3 4 13.3 Somewhat important 4 13.3 5 16.7 Moderately important 8 26.7 6 20.0 Extremely important 15 50.0 15 50.0

continued on page 51

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 51

Assessing Parental Perceptions continued from page 29 Black, J., Park, M., Gregson, J., Falconer, C.L., White, B., Kessel, A.S.,

Saxena, S., Viner, R.M., & Kinra, S. (2015). Child obesity cut-offs as derived from parental perceptions: Cross-sectional question- naire. British Journal of General Practice, 65(633), e234-e239. https://doi.org/10.1038/sj.bdj.2015.887

Centers for Disease Control and Prevention (CDC). (2019). Childhood obesity facts. https://www.cdc.gov/obesity/data/childhood.html

Hansen, A.R., Duncan, D.T., Tarasenko, Y.N., Yan, F., & Zhang, J. (2014). Generational shift in parental perceptions of overweight among school-aged children. Pediatrics, 134(3), 481-488. https://doi.org/10.1542/peds.2014-0012

Moore, L.C., Harris, C.V., & Bradlyn, A.S. (2012). Exploring the relation- ship between parental concern and the management of child- hood obesity. Maternal & Child Health Journal, 16, 902-908. https://doi.org/10.1007/s10995-011-0813-x

Rune, K.T., Mulgrew, K., Sharman, R., & Lovell, G.P. (2015). Effect of an obesity pamphlet on parental perception and knowledge of excess weight on their children: Results of a randomized con- trolled trial. Health Promotion Journal of Australia, 26(2), 129- 132.

White, D.A., Rofey, D.L., Kriska, A.M., Venditti, E.M., Gibbs, B.B., Gallagher, J.D., & Jakicic, J.M. (2016). Parental influences on child weight: Perception, willingness to change, and barriers. Journal of Obesity & Weight Loss Therapy, 6(1), 293.

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