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Diet and Physical Activity for Children's Health: a Qualitative Study Of Open Access Research BMJ Open: first published as 10.1136/bmjopen-2015-008197 on 8 September 2015. Downloaded from Diet and physical activity for children’s health: a qualitative study of Nepalese mothers’ perceptions Natalia Oli,1,2 Abhinav Vaidya,1 Madhusudan Subedi,3 Gabriele Eiben,4 Alexandra Krettek2,5,6 To cite: Oli N, Vaidya A, ABSTRACT et al Strengths and limitations of this study Subedi M, . Diet and Objectives: Non-communicable diseases account physical activity for children’s for 50% of all deaths in Nepal and 25% result ▪ health: a qualitative study of This study reports for the first time the percep- from cardiovascular diseases. Previous studies in Nepalese mothers’ tions of Nepalese mothers with young children perceptions. BMJ Open Nepal indicate a high burden of behavioural regarding behavioural risk factors such as diet 2015;5:e008197. cardiovascular risk factors, suggesting a low level and physical activity, which are important deter- doi:10.1136/bmjopen-2015- of knowledge, attitude and practice/behaviour minants of non-communicable diseases. 008197 regarding cardiovascular health. The behavioural ▪ Our qualitative research approach ensured that foundation for a healthy lifestyle begins in early study participants generated the views reported ▸ Prepublication history is childhood, when mothers play a key role in their here. ’ available. To view please visit children s lives. This qualitative study, conducted in a ▪ Stratifying focus groups according to educational the journal (http://dx.doi.org/ Nepalese peri-urban community, aimed to explore level allowed us to compare participants’ views 10.1136/bmjopen-2015- mothers’ perception of their children’s diet and according to educational background. 008197). physical activity. ▪ Participants were recruited purposively and Design: We notated, tape-recorded and transcribed all belonged to one particular region of Nepal, Received 15 March 2015 data collected from six focus group discussions, and hence the study population cannot represent all Revised 4 August 2015 used qualitative content analysis for evaluation and Accepted 12 August 2015 mothers of Nepal. interpretation. ▪ Since medical doctors conducted the focus Setting: The study was conducted in the Jhaukhel- group discussions, some participants (particu- Duwakot Health Demographic Surveillance Site in the larly those with less education) may have felt http://bmjopen.bmj.com/ Bhaktapur district of Nepal. inhibited about communicating openly. Participants: Local health workers helped recruit 61 women with children aged 5–10 years. We distributed participants among six different groups according to educational status. INTRODUCTION Results: Although participants understood the Non-communicable diseases (NCDs) are importance of healthy food, they misunderstood its the leading cause of deaths globally and composition, perceiving it as unappetising and occur most commonly in low-income and appropriate only for sick people. Furthermore, on September 29, 2021 by guest. Protected copyright. middle-income countries.12In Nepal, a low- participants did not prioritise their children’s physical activities. Moreover, mothers believed they income country, NCDs account for 50% of had limited control over their children’s dietary all deaths; half of those result from cardiovas- 3 habits and physical activity. Finally, they opined that cular diseases (CVDs). health educational programmes would help Unhealthy diets and low physical activity mothers and recommended various intervention are proven and preventable risk factors for – strategies to increase knowledge regarding a healthy NCDs.4 6 Rapidly changing lifestyles, cur- lifestyle. rently shifting towards high energy-dense Conclusions: Our data reveal that mothers of young diets and low levels of physical activity, children in a peri-urban community of Nepal lack increase the prevalence of diet-related adequate and accurate understanding about the impact chronic diseases both globally78and in – of a healthy diet and physical activity. Therefore, to Nepal.9 11 Moreover, other cardiovascular prevent future cardiovascular disease and other non- For numbered affiliations see behavioural risk factors (eg, tobacco con- end of article. communicable diseases among children, Nepal needs 12 health education programmes to improve mothers’ sumption) are also prevalent in Nepal. cardiovascular health knowledge, attitude and Established in 2010, the Jhaukhel-Duwakot Correspondence to Health Demographic Surveillance Site Dr Natalia Oli; behaviour. [email protected] ( JD-HDSS) is located in the Bhaktapur Oli N, et al. BMJ Open 2015;5:e008197. doi:10.1136/bmjopen-2015-008197 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2015-008197 on 8 September 2015. Downloaded from district, 13 km east of Kathmandu, the capital city. Considering the poor cardiovascular health literacy JD-HDSS aims to collect longitudinal data on the health and high prevalence of cardiovascular risk factors in the status of this peri-urban community, with particular focus general population of Duwakot and Jhaukhel,15 health on cardiovascular health.13 The prevalence of cardiovas- education programmes appear crucial. Indeed, success- cular risk factors such as low fruit and vegetable con- ful intervention requires programmes tailored not only sumption in JD-HDSS is high,14 and cardiovascular to local needs and available resources but also to the tar- health knowledge, attitude and practice/behaviour is geted population.29 Therefore, we designed this qualita- poor.15 Although unhealthy diet is a known cause of tive study to explore mothers’ perceptions of their CVDs, our in-depth interviews with people affected by school age children’s lifestyle, particularly regarding diet cardiometabolic diseases revealed frequent common mis- and physical activity, aiming to increase understanding conceptions regarding the components of a healthy of the facilitators and barriers for maintaining healthy diet.16 Furthermore, interviewees rarely mentioned phys- behaviour, and the perceived roles of mothers in devel- ical inactivity as a risk factor. Additionally, participants’ oping healthy lifestyles for their children. In addition, low perception of susceptibility towards CVDs and the we aimed to explore the relevance and preferred choice benefit of specific action, as described in the health of health educational intervention. This knowledge may belief model,17 were common reasons for continuing be useful for developing future educational programmes unhealthy lifestyles.16 Indeed, the health belief model, to help mothers in peri-urban communities improve along with the social cognitive theory, can be applied children’s diet and physical activity. here to explore cardiovascular health-related behaviour of the community. The health belief model suggests that METHODS an individual’s willingness to modify his/her own behav- Study setting and participants iour is based on constructs such as perceived susceptibil- We conducted focus group discussions (FGDs) between fi ity, perceived severity, perceived bene t and perceived April and August 2013 in the JD-HDSS, which was estab- 17 barriers. Additionally, the social cognitive theory states lished in 2010. JD-HDSS comprises two adjacent and that there is an interaction between personal factors of rapidly urbanising villages, Jhaukhel and Duwakot; these the individual, environmental factors and human behav- villages share similar geoecological, ethnic and cultural fl 17 iour, where each in uences the others. characteristics. According to the baseline census con- Although the atherosclerotic process begins in child- ducted in 2010, JD-HDSS had 2712 households and a hood, children are rarely considered at risk for total population of 13 669.13 18 19 16 CVDs, a misconception that also extends to Nepal. We recruited participants by convenient sampling, However, an alarming increase in both obesity and type enrolling women with school-age children no younger II diabetes among children worldwide suggests that pre- than 5 years of age. Since education influences knowl- 20 ventive programmes should target this population. edge level and perceptions of health,15 30 we stratified http://bmjopen.bmj.com/ Currently, Nepal lacks national data on childhood participants into three categories: no formal education, obesity. However, given the high prevalence of behav- education up to grade 10 (ie, secondary level) and ioural risk factors and an increasing trend towards higher education, (ie, higher than grade 10). We prede- 21 obesity among adults, it is likely that the current adop- termined the date, time, venue and educational status of tion of unhealthy behaviour by Nepalese children may women for each FGD. After ensuring that we included 22 increase childhood obesity. different localities within Duwakot and Jhaukhel, local Parents are largely responsible for creating their chil- health workers prepared a list of possible participants ’ on September 29, 2021 by guest. Protected copyright. dren s environment and lifestyle, and the behavioural and contacted them a few days prior to each FGD. foundations laid during childhood affect offspring Altogether, 61 women participated in the study, and the 23 throughout their lives. Parental knowledge about nutri- number of participants in each FGD varied from 9 to 12. ’ tion, and parent s feeding practices, cooking skills, and All women participated until the end of the discussions. household’s access to food and its availability, along with children’s individual
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