Exploring the influence of parents, socioeconomic status and healthy homework on children's activity and body mass index.
Creators: name: Donnelly, Samantha Gallacher
Publisher: name: Zenodo
Year: 2024

description: Childhood obesity is one of the most severe public health problems of the 21st Century, with inactivity proving to be one of leading determinants of obesity prevalence. Parents are known to influence children’s activity and their involvement in interventions aiming to evoke positive health behaviour change is encouraged. Researchers have struggled to recruit parents with low socioeconomic status (SES) to interventions aiming to foster such positive health behaviour and as a result, children with low SES are not exposed to the positive outcomes associated with many interventions. The school setting has been recognised as an ideal environment for health-related population-based interventions for decades, as it provides access and benefit to families from all risk groups, particularly those with limited or no access to play areas and avoids stigmatization of at-risk children. As such, this thesis aimed to capture the perspectives of parents to inform the design of an intervention which will aim to encourage parent involvement from all backgrounds. Furthermore, the thesis aimed to examine the relationship between parent-child PA using robust, novel approaches and the indirect influence SES has on children’s PA and body mass index (BMI) through parental factors. Ultimately, such findings will inform the design of a homework-based intervention theoretically underpinned and informed by end-user’s experiences using mixed-method approaches. The studies within this thesis have adopted various methodological approaches to rigorously explore the issues surrounding previous school-based interventions which aim to foster health-conducive behaviours (e.g., increase PA and healthy eating), however fail to capture less motivated parents of low SES. Additionally, the studies within this thesis aimed to examine the relationship between parent and child PA using novel and robust methods in order to subsequently inform the design of a school-based intervention involving parents, aiming to improve children’s health behaviours. Chapter 4 (Study 1) found that mothers with low SES and low involvement in school-based health activities face several barriers in becoming involved in such activities, particularly due to issues surrounding the parent council and exclusivity of school-based events. Efforts made by the school to promote health activities and involve parents in such activities were revealed, alongside recommendations to improve upon these practices, including parent-child joint activities and home-based activities. Chapter 5 (Study 2) demonstrated that weekend parent and child moderate-tovigorous PA (MVPA) was significantly related, similarly to parent and child BMI. A direct effect of SES on child BMI z-score was observed. A significant negative indirect effect of SES on child BMI z-score via parent BMI was also found. Associations in parent and child MVPA during the weekend were observed however, there were no associations between SES and MVPA in parent or child groups. Use of novel activity metrics were applied to further explore the relationship of parent and child PA using more comparable accelerometry methods in Chapter 6 (Study 3). These metrics included average acceleration (AvAcc) and the intensity gradient (IG) and were used to assess the relationship between parent and child activity. Findings from this chapter showed that girls BMI-z scores were positively associated with parent inactive time and parent BMI. Parent BMI was negatively associated with boy’s inactive time. Parental inactive time, when adjusted, predicted girls BMI-z scores. The activity metrics were not associated with parent BMI, and no independent effects were observed between the metrics. Associations between boys IG and BMI z-score were observed in the unadjusted model, and when adjusted. When the model was adjusted further for the alternative metric, this association was not observed. No independent effects were observed between the two metrics and no significant associations were observed between boys BMI zscore and AvAcc. For girls, no significant associations were observed between AvAcc and IG with BMI z-score and no independent effects were observed between the two metrics. In summary, our study revealed no significant associations in parent-child activity using the AvAcc and IG metrics. However, we found that girls BMI z-score was positively associated with parent inactive time per day and parent BMI. Informed with the findings from the studies outlined in Chapters 4-6, Chapter 7 (Study 4) detailed the feasibility and primary effectiveness of the Happy Homework (HH) intervention. HH was found to improve activity and sedentary behaviour (SB) in children in 8 weeks, with each outcome indicating a large effect size (≥0.14). Furthermore, this intervention was deemed appropriate in the recruitment and retainment of less-involved parents with low SES. Taken together, this thesis contributes original research findings to inform future health-related interventions involving parents further, aiming to bridge the gap between the home and school for health promotion in children.