Changing children's diets: Developing methods & messages.

Primary school-aged children are an important target for health promotion but their increasing social and financial freedom is unlikely to be matched by an increase in their food control, cognitive abilities or the perceived need required to facilitate healthy behaviours, especially food choice. Thus, indirect attempts at behavioural modification are required, with parents indicated as potentially powerful education intermediaries. This research aimed to take a 'bottom-up' approach to investigate the current motivators and reinforcers for behaviour change within the families of primary school children in the UK. Initial focus group discussions with children and parents were hypothesis generating, highlighting the perceived priorities and required message format of the target audience in relation to children's diet and exercise behaviour. Quantitative depth was added to these findings via the development of a novel tool based upon the Theory of Planned Behaviour. This questionnaire was completed by 199 parents, allowing a rigorous assessment of parental intention to provide a healthy diet for their children. Finally study findings informed the development of a tailored parental nutrition education intervention which was pilot tested with 13 parents, providing valuable information regarding the logistical implications of implementing a health promotion programme within the parent population. Overall, results indicated a general rejection of traditional nutritional messages and sources in favour of a less abstract, more flexible approach with a short term health focus delivered by neutral agencies. Whilst healthy eating was viewed positively, parents tended to perceive unrealistic targets and to have sub optimal nutritional knowledge and an inadequate awareness of their own influence as a model for their child's behaviour. Negative approaches to food control were frequently observed along with practical barriers to education uptake, which need to be addressed. Significant differences in parental attitudes and behaviour were observed between families of different socio-economic status and variations were seen by child gender. Parents appeared to be reinforcing inappropriate gender stereotypes in the domain of food and exercise behaviour. Social support was shown to positively impact on parental intention to provide a healthy diet, indicating the importance of ensuring sufficient environmental support for behaviour change, via family and community cohesiveness. This research has allowed the nutrition education language, priorities and beliefs of the dynamic UK parent and child population to be characterised and quantified and the possibilities for their incorporation into effective, if non-traditional approaches to health promotion are discussed