Meta-synthesis of qualitative studies to explore fathers' perspectives of their influence on children's obesity-related health behaviors.

BACKGROUND: In nursing research and practice, there is a paucity of information about how fathers perceive their role in shaping their children's health behaviors. Most studies on the parental factors affecting children's health behaviors have focused on the role of mothers. However, recent studies showed that fathers' health behaviors can influence those of their children. Therefore, the aim of this study was to synthesize existing qualitative studies to explore fathers' perspectives regarding how they influence children's obesity-related health behaviors. METHODS: We conducted a descriptive meta-synthesis. To retrieve relevant articles, we used databases including PubMed, CINAHL, and Web of Science. Only qualitative studies published in English-language peer-reviewed journals, targeting fathers of children aged 2-18 years, and focusing on fathers' perspectives were included. All the quotes collected from the studies were reviewed and coded, and thematic analysis was used to derive themes. RESULTS: Article screening and review yielded a total of 13 qualitative studies, from which the following themes emerged: (1) fathers' parenting practices and role-modeling behaviors, (2) fathers' roles in their relationships with their family members, and (3) fathers' resource-seeking behaviors and contributions to their home food environment. Fathers were aware that their parenting practices and role-modeling behaviors could influence their children's health behaviors. Furthermore, fathers recognized the importance of their relationships with family members, which was reflected in their family roles; that is, whether they took responsibility for childcare and household work, whether their parenting practices were similar to those of their spouses, and whether they involved their children in their activities. Fathers also reported their resource-seeking behaviors as well as their contribution to the home food environment, which affected their children's health behaviors. CONCLUSION: Fathers' perspectives on their influence on children's health behaviors reveal their unique paternal role in influencing children's health behaviors. Fathers' perspectives could be incorporated into future nursing research to examine the relationship between fathers' roles and children's health behaviors to develop better health intervention programs.

Mediating effect of the parent-child relationship on the association between parenting stress and children's eating behaviors.

BACKGROUND: Emerging evidence suggests that parenting stress plays a significant role in children's eating behavior. However, the nature of the relationship between parenting stress and children's health behaviors is still not well understood, possibly because there is limited understanding of the mediating factors. The purpose of this study was to examine the mediating effect of the parent-child relationship on the association between parenting stress and children's eating behaviors in families with young children. METHODS: Using a cross-sectional study design, we recruited mothers of families with children aged four to six years in the United States. We asked the mothers select one child if she has more than one eligible child. Mothers answered well-validated questionnaires regarding parenting stress, the parent-child relationship, and children's eating behaviors. We utilized a structural equation model to analyze the mediating factors. RESULTS: A total of 172 mothers of children participated in this study. The children's mean age was 4.92 (SD 0.89) years; 50% of children were female and 71.2% were non-Hispanic Whites. Parenting stress was associated with subcategories of the parent-child relationship (satisfaction with parenting [b* = - 0.69, p < .01], communication [b* = 0.45, p < 0.01], and limit setting [b* = - 0.82, p < .01]). The subcategories of communication and limit setting were negatively associated with food responsiveness in children (b* = - 0.24, p < .01; b* = - 0.46, p < .01, respectively). Limit setting was negatively associated with emotional overeating in children (b* = - 0.49, p < .01). Communication mediated the association between parenting stress and food responsiveness in children (b* = - 0.11, p < .01). The mediating role of limit setting was established in the association between parenting stress and food responsiveness as well as in the association between parenting stress and emotional overeating (b* = 0.38, p < .01; b* = 0.40, p < .01, respectively). CONCLUSIONS: The parent-child relationship is an important component in improving children's eating behaviors in families that have parents with higher parenting stress levels.

Recruitment and enrollment of participants in an online diabetes self-management intervention in a virtual environment.

Effective recruitment of research participants is essential for successful randomized controlled trials and remains one of the most challenging and labor-intensive aspects of conducting research. The purpose of this manuscript is to describe recruitment methods for this two-group, internet-based intervention trial and enrollment status in relation to recruitment methods, accounting for accrual rates and recruitment costs and to discuss our recruitment results and limitations informed by the Clinical Trials Transformation Initiative (CTTI) team's evidence and expert-based recommendations for recruitment. The primary study was a two-group randomized controlled trial designed to evaluate the efficacy of a virtual environment, Diabetes LIVE©, compared to a traditional website format to provide diabetes self-management education and support to adults with type 2 diabetes. Our recruitment experience was labor-intensive, multimodal, and required multiple iterations throughout the study to meet recruitment goals. To allow for more efficient and realistic budgets aligned with funding, researchers should engage stakeholders in recruitment planning and monitor and report personnel time and cost by recruitment methods. To allow for more efficient and effective recruitment into meaningful clinical trials and of interest to participants, researchers should use a participative approach during all study phases, including question development.

The Relationships Between Parental Stress, Home Food Environment, and Child Diet Patterns in Families of Preschool Children.

PURPOSE: Home food environment, including home food availability and parental food preparation practices, plays a significant role in child diet patterns. Recent evidence suggests that parental psychological stress is related to parental food preparation practices; however, there is limited information about the relationship between parental psychological stress and home food availability. The purpose of the study is to examine the relationships between parental stress, home food availability, child diet patterns, and body mass index (BMI) in families with young children. DESIGN: A secondary data analysis from a mixed-methods design study. SETTING: The parent study was conducted in both local and online communities using a web-based survey. PARTICIPANTS: Participants were 256 parents of children aged 2 to 5 years (53.4% white; 41.5% of overweight or obese children). MEASURES: Parents completed well-validated self-report questionnaires. ANALYSIS: We used latent structural equation modeling using Bayesian analysis. RESULTS: There was a negative relationship between parents' general stress and healthy food availability at home (ß* = -.20, P < .001 for fruits; ß* = -.23, P < .001 for vegetables; and ß* = -.24, P < .001 for healthy beverage) and a positive relationship between parenting stress and healthy snack and healthy beverage availability (ß = .13, P = .03; ß = .14, P = .02, respectively). There was no relationship between parental stress and unhealthy food availability at home while unhealthy food availability was significantly associated with child's unhealthy eating pattern (ß* = .86, P < .01 for unhealthy snack; ß* = .51, P < .01 for unhealthy beverage). There was no moderating effect of children's health insurance on the relationships between parental stress and home food availability. Furthermore, child diet patterns were not associated with child BMI. CONCLUSION: Parental psychological stress is a potentially important intervention target point for improving home food environment and child diet patterns.

Relationships of Obesity-Related Behavior Patterns With Socioeconomic Status and Acculturation in Korean American Women.

There is limited understanding about the obesity-related behaviors of diet, physical activity, and sedentary behavior in Korean American women. The purpose of this study was to cluster obesity-related behavior patterns of Korean American women and to examine group differences in acculturation, socioeconomic status (SES), and body mass index (BMI). A secondary analysis from a cross-sectional study was conducted using two-step cluster analysis for clustering groups. A total of 137 Korean American women (M age = 42.7 years, SD = 3.9 years; MBMI = 23.1 kg/m2, SD = 3.1 kg/m2; 47.7% BMI ⩾ 23 kg/m2) participated. Three clusters were identified: healthy lifestyle, unhealthy lifestyle, and low physical activity but healthy diet group. The unhealthy lifestyle group was more likely to have high acculturation compared with other groups (p = .03). SES and BMI were not significantly different between groups. Further intervention is needed to improve obesity-related behaviors of acculturated Korean American women.

Different types of parental stress and childhood obesity: A systematic review of observational studies.

Different types of parental stress may influence children's health behaviors and weight. The aim of this review was to systematically examine the relationships between parental stress and child obesity. We reviewed 27 studies published through December 2018 and classified parental stress as parents' general stress, parenting role stress, and life event stress. There were positive relationships of parents' general stress and parenting role stress with child obesity among families with younger children and in longitudinal studies. The relationship between life event stress and child obesity differed by measures. We found that parenting role stress may be associated with unhealthy parenting practices. Contextual factors such as children's and parents' sex, race or ethnicity, socioeconomic status, and family structure appeared to play a moderating role in the relationship between parents' stress and child obesity, which warrant cautious interpretation. Our recommendations for future research include clarifying further the types of parental stress that influence child obesity, evaluating long-term relationship between parental stress and child obesity, and identifying possible mediating factors to support the relationship between parents' stress and child obesity. Researchers may also consider developing stress management programs for parents to address child obesity.

Socioeconomic Status and Racial or Ethnic Differences in Participation: Web-Based Survey.

BACKGROUND: Web-based survey data collection has been widely used because of its advantages, although attaining and retaining participants can be challenging. There are several factors associated with successful Web-based survey participation; yet little is known regarding racial or ethnic and socioeconomic differences in the progress of a Web-based survey. OBJECTIVE: This study aimed to examine racial or ethnic and socioeconomic status (SES) differences in participation in a Web-based survey. METHODS: We conducted a secondary data analysis of a study dataset containing information on parents of preschool children. We used 2 phases of Web-based surveys: (1) screening questions including race or ethnicity information and (2) full survey with a consent form. Once potential participants submitted the screening questions, including their racial or ethnic information, the team sent the full survey link to potential participants who met study eligibility criteria. We calculated the proportion of racial or ethnic groups in each of the following areas: consent, partial survey completion, and total survey completion. RESULTS: A total of 487 participants (236 non-Hispanic white, 44 Hispanic, 137 black, and 70 Asian) completed initial screening questions, and a total of 458 participants met study eligibility criteria. Compared with black participants, non-Hispanic white and Asian participants were more likely to consent to participate in the study (odds ratio [OR] 1.73, 95% CI 1.08-2.78, P=.02; OR 2.07, 95% CI 1.04-4.13, P=.04, respectively). There was no racial or ethnic difference with respect to the completion of demographic questions or completion of a partial survey. Finally, compared with black participants, non-Hispanic white participants were more likely to complete the entire survey (OR 3.36, 95% CI 1.51-7.06, P<.001). With respect to SES, less educated non-Hispanic white participants were less likely to complete the survey compared with their counterparts with more education (OR 0.15, 95% CI 0.50-1.48, P<.001). CONCLUSIONS: We found a significant difference among racial or ethnic groups as well as different education levels in Web-based survey participation. Survey researchers need to consider the SES and racial or ethnic differences in Web-based survey participation and develop strategies to address this bias in participation and completion in their research.

Relationships Among Parental Psychological Distress, Parental Feeding Practices, Child Diet, and Child Body Mass Index.

BACKGROUND: Parents often play a main role in establishing the dietary patterns of preschool children, but there is no clear understanding about the relationship between parental psychological distress and child diet and body mass index (BMI). OBJECTIVE: The aim of this study was to examine the relationships among parental psychological distress, parental feeding practices, child diet, and child BMI in families with young children. METHODS: We conducted a mixed-methods study with families (parent-child dyad) of children aged 2-5 years. Measures included demographic data, parental general stress, parenting stress, parental sleep quality, parental depressive symptoms, social support for parents, mealtime environment, child feeding practice, child diet, and child BMI, with well-validated questionnaires completed by parents. Using structural equation models, we examined the path relationships of these factors. We also interviewed a subsample of 13 parents. RESULTS: A total of 256 families participated. Higher parental psychological distress was associated with higher parental unhealthy feeding practices (B = 0.31, p < .01). However, a parental unhealthy practice in feeding was not associated with child's unhealthy diet or BMI. There was no direct relationship between parental psychological distress and child BMI. Social support for parents was significantly inversely related to parental psychological distress (B = -11.59, p < .01), and the relationship between social support for parents and parental unhealthy feeding practices approached significance (B = 6.11, p = .05). A main theme from analysis of parent interview was that parent stress and fatigue influenced their feeding and food preparation. DISCUSSION: Parental psychological distress is a critical influential factor in parental feeding practices. This finding highlights potential foci in intervention programs to address parental psychological distress.

Intervention fidelity in Qigong randomized controlled trials: A method review.

Intervention fidelity has important implications for the reliability and validity of a study. Despite the widely reported health benefits of Qigong exercise interventions, the quality of intervention fidelity is less clear. The purpose of this paper is to use a valid intervention fidelity assessment tool to evaluate how intervention fidelity has been addressed in five areas-design, training, delivery, receipt, and enactment-in Qigong randomized controlled studies. A total of 86 articles were drawn from CINAHL, PubMed, AMED, and Scopus, and 32 were selected for the review. The adherence to intervention fidelity strategies within the intervention design, training, delivery, receipt, and enactment was 0.66, 0.32, 0.22, 0.12, and 0.21, respectively. The findings suggest that intervention fidelity is inadequately implemented or reported in published Qigong studies. Developing a consistent intervention fidelity plan for Qigong interventions is needed. To this aim, we propose a treatment fidelity plan specific to Qigong research.

Church-Based Recruitment to Reach Korean Immigrants: An Integrative Review.

Although the Korean church has been frequently used to recruit Korean immigrants in research, little is known about the specific strategies and process. The purpose of this integrative review was to describe recruitment strategies in studies of Korean immigrants and to identify the process of Korean church-based recruitment. Thirty-three studies met inclusion criteria. Four stages of church-based recruitment were identified: initiation, endorsement, advertisement, and implementation. This review identified aspects of the church-based recruitment process in Korean immigrants, which are different from the Black and Hispanic literature, due to their hierarchical culture and language barriers. Getting permission from pastors and announcing the study by pastors at Sunday services were identified as the key components of the process. Using the church newsletter to advertise the study was the most effective strategy for the advertisement stage. Despite several limitations, church-based recruitment is a very feasible and effective way to recruit Korean immigrants.

Obesity-risk behaviours and their associations with body mass index (BMI) in Korean American children.

AIMS AND OBJECTIVES: To describe obesity-risk behaviours (diet, physical activity and sedentary behaviour) and examine the relationships of the obesity-risk behaviours with body mass index (BMI) in school-aged Korean American children. BACKGROUND: Korean American children have a risk of becoming overweight or obese and developing obesity-related complications; however, there is limited research about obesity-risk behaviours in Korean American children. DESIGN: A cross-sectional study. METHODS: Obesity-risk behaviours of children were assessed with well-validated self-report questionnaires (i.e., Elementary-level School-based Nutrition Monitoring Questionnaire) from children and their mothers. Height and weight of children were measured. Data were analysed with bivariate and multivariate analyses using mixed effects models to incorporate the correlation within siblings. RESULTS: A total of 170 Korean American children (mean age 10.9 [2.0] years; 52.4% girls; mean BMI 19.3 [3.2]; 28.7% ≥85 percentiles) participated in the study. Only 38.3% of Korean American children met established recommendations of five fruits/vegetables per day; 56.5% met recommendations for more than 3 days per week of vigorous physical activity; and 40.8% met recommendations for <2 hr of recreational screen time per day. Sixty per cent and 88.8% of children met the recommendation of sleep on a weekday and weekend, respectively. Only screen time was positively associated with child BMI z-score (ß = 0.08; p < .03). CONCLUSION: Healthcare providers need to be aware of the increased rate of overweight and obesity in Korean American children and initiate clinical interventions to improve obesity-risk behaviours, especially sedentary behaviour, in Korean American children. RELEVANCE TO CLINICAL PRACTICE: Clinical assessment and management of the risk of developing overweight and obesity as well as obesity-related behaviours are important to improve obesity-related complications in overall Korean Americans.

Participation of Racial and Ethnic Minorities in Technology-Based Interventions to Self-Manage Type 2 Diabetes: A Scoping Review.

PURPOSE: Strategies to decrease societal and cultural barriers for ethnic minorities to participate in health research are well established. However, limited data are available regarding participation of ethnic minorities in mobile and Internet technology-based interventions to self-manage type 2 diabetes where health disparities are predominant. Thus, the purpose was to understand the participation of ethnic minorities in technology-based intervention programs to manage type 2 diabetes. DESIGN/METHOD: A scoping review was used to review a total of 21 intervention studies containing participant information about ethnic minorities and one qualitative study discussing participation of ethnic minorities. FINDINGS: There was limited enrollment and participation of ethnic minorities. Technological barriers in addition to existing societal and cultural barriers were identified. Strategies to decrease the barriers were recommended. CONCLUSIONS: Technological barriers were identified on top of the societal and cultural barriers in traditional interventions. Further research to reduce the barriers is warranted.

Factors associated with school-aged children's body mass index in Korean American families.

AIMS: To examine factors associated with children's body mass index and obesity-risk behaviours in Korean American families. BACKGROUND: Limited data are available about family factors related to overweight and obesity in Korean American children. DESIGN: A cross-sectional study. METHODS: Convenient sampling was employed to recruit Korean American families in the Northeast of the United States between August 2014 and January 2015. Child, family and societal/demographic/community factors were measured with self-report questionnaires completed by mothers and children. Height and weight were measured to calculate body mass index. Data were analyzed using mixed effects models incorporating within-group correlation in siblings. RESULTS: The sample included 170 Korean American children and 137 mothers. In bivariate analyses, more child screen time, number of children in the household, greater parental underestimation of child's weight and children's participation in the school lunch program were significantly associated with higher child body mass index. In multivariate analyses that included variables showing significant bivariate relationship, no variable was associated with child body mass index. CONCLUSION: There were no child, family and societal/demographic/community factors related to child body mass index in Korean American families in the multivariate analysis, which is contrary to research in other racial/ethnic groups. In bivariate analyses, there is evidence that some factors were significantly related to child body mass index. Further research is needed to understand the unique behavioural, social and cultural features that contribute to childhood obesity in Korean American families.

Evaluating Intervention Programs Targeting Parents to Manage Childhood Overweight and Obesity: A Systematic Review Using the RE-AIM Framework.

Intervention programs targeting parents to manage childhood overweight and obesity have emerged based on parents influence on the health behaviors of their children. The purpose of this review was to systematically evaluate intervention programs targeting parents to manage childhood overweight and obesity using the Reach, Efficacy, Adopt, Implementation, and Maintenance (RE-AIM) framework. There was a moderate risk of bias across all studies. The overall proportion of studies (n=7) reporting on each dimension of the RE-AIM framework ranged from 78.6% (reach) to 23.8% (maintenance). The majority of intervention programs demonstrated improvement in child BMI. However intervention programs did not reach families of diverse race/ethnicity, were provided by highly trained professionals, and demonstrated high attrition, thus limiting generalizability.

Methods for knowledge synthesis: an overview.

OBJECTIVES: To highlight recent advances in knowledge synthesis methods and reporting guidelines. BACKGROUND: Knowledge synthesis is critical to advancing practice, research, and policy, but synthesizing knowledge from an often-heterogeneous body of literature is challenging. METHODS: A review of knowledge synthesis methods and reporting guidelines for health sciences research was completed using Google Scholar, Medline, CINAHL, and PsycInfo. Relevant information was critiqued and summarized for applicability to health science and practice. RESULTS: Recent advances and guidelines pertaining to systematic reviews, meta-analysis, qualitative synthesis, mixed studies reviews, integrative reviews, scoping reviews, RE-AIM reviews, and umbrella reviews are discussed and examples of the application of each method to cardiopulmonary research are provided. Methods of quality appraisal are also presented. CONCLUSIONS: Advancements in knowledge synthesis and reporting guidelines enhance the quality, scope, and applicability of results; thus improving health science and clinical practice, and advancing health policy.

Implementation of a school-based internet obesity prevention program for adolescents.

OBJECTIVE: To evaluate the reach, adoption, and implementation of HEALTH[e]TEEN, a school-based Internet obesity prevention program, and examine differences in student participation and satisfaction by school, gender, age, and race/ethnicity. DESIGN: Concurrent mixed method evaluation. SETTING: Three public high schools in Connecticut. PARTICIPANTS: Three hundred eighty-four adolescents, 8 teachers. INTERVENTION(S): HEALTH[e]TEEN vs HEALTH[e]TEEN plus coping skills training. MAIN OUTCOME MEASURE(S): Demographic and state-available data, measurements of student satisfaction and participation, interviews with school administrators and teachers. ANALYSIS: Mixed and logistic models, content analysis. RESULTS: The sample (n = 384) was diverse (35% white), with a mean age of 15.3 years and mean body mass index of 24.7 kg/m(2). Student participation (83% of lessons completed) and satisfaction (mean 3.6 out of 5) was high. Schools implementing the program in class had higher satisfaction and participation compared with schools that implemented the program as homework (P ≤ .001 and < .001, respectively). Girls had higher satisfaction and participation compared with boys (P = .02 and .03, respectively). Younger students had higher participation compared with older students, but no difference in satisfaction was noted (P = .03). CONCLUSIONS AND IMPLICATIONS: Two school-based Internet programs to decrease obesity reached diverse adolescents, and were adopted and implemented with high student satisfaction and participation. Implementation of the intervention was influenced by setting (classroom vs homework), teacher characteristics, student age, and gender.

Psychological experience of parents of children with type 1 diabetes: a systematic mixed-studies review.

PURPOSE: The purpose of this review is to describe the prevalence of psychological distress in parents of children with type 1 diabetes (T1DM), the relationship between parental psychological distress and health outcomes, and parents' psychological experience of having a child with T1DM. Clinical and research implications are presented. METHOD: A systematic mixed-studies review was undertaken to review the quantitative and qualitative research on the parental experience of having a child with T1DM. A total of 34 articles met the inclusion criteria and were included in the review. RESULTS: The prevalence of parental psychological distress across all studies ranged from 10% to 74%, with an average of 33.5% of parents reporting distress at diagnosis and 19% of parents reporting distress 1 to 4 years after diagnosis. Parental psychological distress in parents of children with T1DM, regardless of how it was defined, was associated with higher child self-report of stress and depressive symptoms, more problematic child behavior, and lower child self-report of quality of life. Parental psychological distress also had negative effects on diabetes management. Themes of the qualitative synthesis indicated that parents perceived T1DM as a difficult diagnosis that contributed to significant family disruption. Adjustment occurred over time; however, ongoing stress was experienced. CONCLUSIONS: Screening for psychological distress in parents of children with T1DM is indicated, and preventive interventions are needed.

Overweight, obesity, and metabolic syndrome in adults and children in South Korea: a review of the literature.

Overweight, obesity, and metabolic syndrome are increasing in South Korea dramatically. This review of the literature summarizes published studies on the prevalence of overweight, obesity, and metabolic syndrome in South Korean adults and children; summarizes studies related to obesity management and prevention in South Korean adults and children; and identifies gaps in the literature for further research. A PubMed, CINAHL, and Google Scholar search identified articles published between January 1, 2000, and June 30, 2010, using the following key search terms: overweight, obesity, adult, children, adolescent, metabolic syndrome, prevention, and South Korea. Inclusion criteria included articles published in English or Korean, and primary or secondary research that measured the prevalence and characteristics of overweight and obesity or described a management or prevention program. Twelve articles met the inclusion criteria and were categorized into either adult or child studies. In adults, the prevalence of overweight and obesity has increased as South Korea has moved from an agricultural to a modern society. In children, there were associations between infant feeding patterns, familial relationships, and dietary and physical activity patterns. There were few programs to manage or prevent overweight. Further research is needed to develop effective strategies to prevent and manage overweight and obesity in adults and children, using family-based interventions that include multigenerational family members.