Weight-determining behaviours of primary school-aged children from socioeconomically-disadvantaged families in Malta: exploring the influence of the family environment

Abstract

Maltese children from families with lower socioeconomic status have been shown to experience the highest prevalence of overweight and obesity. The growing recognition of the formative role of the family environment in affecting children's weight-determining behaviours provides the rationale for this exploratory study aiming to examine the influence of the family environment on socioeconomically-disadvantaged children's eating habits, physical activity levels and screen-time. The study utilises a qualitative approach in the form of a multi-site case study. Fifteen face-to-face interviews were held with the main caregivers of primary school-aged children from socioeconomically-disadvantaged families who make use of ACCESS services. Interviews were recorded, transcribed, coded inductively and analysed. Additionally, the semi-quantitative method of qualitative comparative analysis (QCA) was applied, with the aim of elucidating combinations of conditions leading to the outcomes of interest. Parenting practices, caregiver knowledge and beliefs relating to nutrition, physical activity and screen-time, barriers to healthy patterns of behaviour and family resilience resulted as the most important influences on children's weight-determining behaviours. Parenting practices emerged as an important influence on children's outcomes in all QCA models. Coercive and permissive feeding practices were common while authoritative practices were less common. Many caregivers restricted or completely disallowed children from unsupervised outdoor play. Few parents set screen-time limits. There was a poor level of nutrition-related knowledge in most participants and this emerged as a central factor in the QCA model for diet. Most participants viewed physical activity positively, the most common belief being that it improved children's mood and mental well-being. Participants held mixed views about children's screen-time. Of those who expressed concerns, few of these centred around health or weight. Barriers also featured strongly in all models, reflecting the significant hurdles these families face to achieve healthy patterns of weight-determining behaviour in the context of an obesogenic environment. Important barriers include financial limitations, time limitations, the neighbourhood environment and caregiver pain and illness. Family resilience emerged as an influencing factor for physical activity and screen-time, supporting previous theories suggesting that family resilience acts as a moderator between the obesogenic environment and children's weight-determining behaviours. This study has succeeded in identifying key factors in the family environment of socioeconomically-disadvantaged families in Malta. These factors may be amenable to modification through interventions and policy change, resulting in healthier patterns of weight-determining behaviour in disadvantaged children.