Title: Kuwaiti Mothers’ Food Parenting Styles, Practices, and Food-Environments in the Context of Living With or Without Extended Family - A Mixed Methods Study
Description: Background and Objectives: Childhood obesity and its comorbidities are an emerging health problem among the Kuwaiti population and their neighboring countries. The food environment and parental role are among the key determinates of eating behavior in children. Parents influence their children's eating through both their food parenting styles (FPS) during meal and snack times, and their goal-directed food parenting practices (FPP). The majority of studies have examined nuclear families; however, with the increased cost of daily living and women in the workforce, many mothers are feeding their children in multigenerational or extended family households. This study aimed to examine the prevalence of FPS and FPP among Kuwaiti mothers with school-age children and the demographic variables associated with them; and to further explore the mothers' benefits, challenges, and strategies of child feeding between those who live with their in-laws, those who live independently, and during Zwara the weekly family gatherings.

Methods: Using a sequential explanatory design, this mixed-methods study consisted of two distinct phases. Phase 1 (quantitative): 1625 Kuwaiti mothers with children aged 6 to 12 years completed a cross-sectional electronic survey including the Caregiver Feeding Styles Questionnaire (CFSQ), five constructs from the Comprehensive Feeding Practices Questionnaire (CFPQ) and a range of socioeconomic and living situations. Phase 2 (qualitative): 32 mothers took part in a follow-up in-person semi-structured interview about benefits, challenges, and strategies of child feeding within two groups - 16 living with in-laws, and 16 living independently; each group consisted of equal numbers of Authoritative and Indulgent feeding styles. Conclusion: Phase 1: The mother's perception of child weight was the only factor associated with both FPSs and FPPs, indicating that it as a key influential factor. The mother's education level and childbirth order were associated with FPPs, implying their direct influence on specific goal-directed practices of child-eating.

Whereas, living arrangements, number of hired help, living district, and child age were associated with FPSs, suggesting their indirect influence on the parent-child interaction. Phase 2: The benefits, challenges, and strategies of child feeding differed between the living arrangements, and the Indulgent and Authoritative feeding styles differed only by the strategies used. Also, the Kuwaiti mothers were more prone to follow the Indulgent style during the weekend gatherings, despite being more likely to use the Authoritative style during the weekday. Likewise, Kuwaiti Grandparents were perceived to have Indulgent feeding styles tendencies with Grandchild, which has been linked with higher child weight in other studies. These differences in usage of FPPs and FPSs in different settings suggest that there is a need to develop and implement nutrition interventions to improve maternal feeding practices based on their household arrangements.