Health related lifestyle habits of Swedish schoolchildren : Studies on knowledge, conception and behaviour

Aim The overall aim of this thesis was to evaluate the effects of the health education programme ‘An adventure with Pelle Pump’. Further the aim was to provide knowledge of importance for the development of future programmes aiming to promote a healthy lifestyle in children by studying predictors for health behaviours, and the impact of time and age on health behaviours in Swedish schoolchildren. Methods To evaluate the impact of the health education programme ‘An adventure with Pelle Pump’ on knowledge and behaviour and determine what predictors were of importance for health behaviours, a 45 item questionnaire was answered by 1 422 12-year old children. To study conceptions of health and health behaviour in children, 16 children were face-to-face interviewed and the interviews were analysed using a phenomenographical method. To study the impact of time trends and age on health behaviours in Swedish school children results from the questionnaires were compared to results from the WHO-based ‘Health Behaviour in School-Aged Children’ studies. Results ‘An adventure with Pelle Pump’ had a positive impact on knowledge and conceptions of health and health behaviours. However, two years after programme implementation it did not result in any change in health behaviours, i.e. physical activity, healthy food choices and refrain from tobacco, of these children. Secular trends, from 1993 to 2003, had a positive influence on physical activity and sedentary behaviours, while negative time trends were observed in dietary habits and smoking. Increased age of two years had a statistically significant negative influence on physical activity, dietary habits and tobacco use. To perceive your family, yourself or someone else as a source of inspiration to be physically active was related to a high physical activity level. Paternal and maternal attention to the use of tobacco was of importance for children to refrain such habit. To live in a socio economically wealthy area was of importance for healthy food choices and physical activity. Children from rural areas were more physically active than children from urban areas. Conclusion The evaluation of the impact of a knowledge-based health education programme with the intention to influence three important life style habits; physical activity, healthy food choices and refrain from tobacco, reveals that knowledgebased interventions implemented in school settings can improve knowledge and attitudes towards a healthy lifestyle. However, such programme, implemented as a sole effort does not influence health behaviours. Importantly, this thesis demonstrated that the window of opportunity for promoting health behaviours in children is narrow and, to be successful, interventions need to be implemented at an early age and repeated over time. Interventions to promote a healthy lifestyle may target children within the school setting, but parents need to be involved since parental support is of utmost importance for children to make healthy life choices. Interventions should, with support from the present findings, not be limited to knowledgebased education but include a substantial proportion of practical, behaviour focused actions.