Health promotion and obesity prevention through a school-based parental support programme

Sammanfattning: It is important to find ways to halt the rise in overweight and obesity among children, which are linked not only to physical and mental illness but also to social inequalities. The school is an ideal setting for public health interventions, as all children can be reached, regardless of eating habits, level of physical activity, weight status, cultural background, and family socioeconomic position. Healthy School Start Plus (HSSP) is a parental support programme, conducted in the school setting, aimed to promote healthy dietary and physical activity behaviours in 5-7-year-old children and to prevent overweight and obesity. The overall aim of this thesis was to evaluate the effectiveness of HSSP in disadvantaged areas and identify ways to improve impact and reach of HSSP and similar programmes. Study I explored parents’ experiences of participating in the HSSP programme. We found that it is crucial to consider variations in social and cultural conditions as they may influence the execution of the intervention. Further, the importance of continuous delivery of health information and follow-ups was emphasised as well as that of a functioning interaction between the school and the parents. Study II examined the association between physical activity parenting practices and children’s levels of physical activity during non-school time with structural equation modelling and with the child’s own activity style included as a moderator. No significant association was found that could explain the hypothesised relationship; however, when the child’s activity style was added as a moderating factor the fit of the model improved. This indicates that the child’s activity style should be included as a moderator when exploring the relationship between physical activity parenting practices and child physical activity. Study III evaluated the effects of the HSSP programme on children’s dietary, physical activity and sedentary behaviours and body composition. Significant effects were found on children’s dietary and physical activity behaviours, but no effects were found on children’s body composition. This study confirmed the findings of two previous trials of the programme. Study IV explored children’s experiences of participating in the HSSP programme. We found that children need to be given adequate time to finish the classroom activities. Moreover, the use of health symbols in the material appears beneficial for the home assignments and in practical activities. Additional points emerged, such as the importance of communication through body language and being positive when delivering health information to children. The findings of this thesis indicate that HSSP was appreciated by children and parents and had beneficial effects on children’s dietary and physical activity behaviours. Further, they also suggest better ways to design and implement HSSP and similar programmes and may ultimately contribute to the reduction of social inequalities in health.