[SOLVED] How Participation in Play Impact Obesity in Children, assignment help – Health Medical

Summary/ImplicationsSummarize
your main findings and point out how your clinical question was answered or not
answered; what were the gaps in the research; and possible new inquiry
clinical question : How does participation in play impact obesity in children?I attach the 3 articles_______________________________________________________________
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Table of contents
1. Healthy Habits for Children: Leveraging Existing Evidence to Demonstrate Value……………………………….
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Healthy Habits for Children: Leveraging Existing Evidence to Demonstrate Value
Author: Persch, Andrew C; Lamb, Amy J; Metzler, Christina A; Fristad, Mary A
ProQuest document link
Full text: Headnote
MeSH TERMS
* eating habits
* habits
* health promotion
* motor activity
* school health services
* sleep
Headnote
Healthy habits is a psychoeducational construct that refers to the preventive practice of analyzing and then
adapting the sleep, physical, and eating routines of children in ways that enhance health and well-being. This
approach is based on evidence that demonstrates the positive therapeutic value of engaging in proactive,
healthful behaviors. In addressing healthy habits, occupational therapy practitioners have an opportunity
tocontributetotheTripleAimofhealthcarereformwhiledemonstratingthevalueofoccupationaltherapy in educational,
medical, community, and other settings.
In2009, theInstituteof Medicine(IOM) estimated that 45.7 million Americans were living without health insurance.
The consequences of being uninsured are significant and include decreased access to immunizations,
medications, preventive care, ambulatory care, and dental care (IOM, 2009). Children with special health care
needs who do not have health insurance may experience delayed diagnoses, avoidable hospitalizations, and
decreased access to specialists and early intervention. Children without insurance are also more likely to miss
schoolsecondarytoillness(IOM,2009).A lack of insurance often keeps children and families from seeking
appropriate preventive, acute, and long-term care.
The Patient Protection and Affordable Care Act of 2010 (ACA) was passed to extend health care to the many
millions of Americans without health insurance. Under the law’s framework, which is based on the Triple Aim
(Berwick, Nolan, &Whittington, 2008), the health care system is challenged to achieve out comes in terms of (1)
quality, (2) efficiency, and (3) cost-effectiveness, which have not always been valued as priorities in the U.S.
health care system. The concept of the Triple Aim is also reflected in the National Quality Strategy adopted by
the U.S. Department of Health and Human Services (2011).
In passing a law as comprehensive as the ACA, Congress did not limit its purview to traditional models of health
care. Rather, it recognized the importance of expanded primary care, integrative medicine, community-based
health care, and improved access, including access through expanded school-based health centers (SBHCs),
to meet the needs of newly insured people as well as the economic need for cost-effectiveness. For example,
the ACA includes earmarks for more than $11 billion for community health centers and $200 million for SBHCs
(Health Resources and Services Administration, 2015).
As noted by Peterson and Nelson (2003), SBHCs “are federally funded, geographically dispersed . . . programs
designed to integrate health services and educational services for children from economically disadvantaged
settings” (p. 152). Although they are tailored to meet the specific needs of each community, SBHCs typically
provide children with access to immunizations, medications, treatment of acute illness, laboratory services,
counseling, and health education (Health Resources and Services Administration, 2015). Many SBHCs provide
basic dental care, drug and alcohol counseling, reproductive health services, and management of chronic
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conditions. For children in rural, urban, or otherwise disadvantaged communities, SBHCs are often the only
option for primary care (National Conference of State Legislatures, 2011). Evidence has suggested that when
students use SBHCs, they are more likely to receive other care and appropriate preventive care (e.g.,
vaccinations), and they are less likely to use emergency rooms (Allison et al., 2007). SBHCs appear to augment
access to care and quality of care for underserved adolescents compared with traditional outpatient care sites
(Allison et al., 2007) and can thus be a critical component of promoting better participation in health by students.
In SBHCs and in other ways, U.S. schools have an important part to play if the Triple Aim of health care reform
is to be realized. Fortunately, schools already have a variety of trained health care professionals who provide
services in educational settings. The value of occupational therapy in this context extends beyond the usual role
of school-based clinicians. Indeed, occupational therapy practitioners provide a readily
accessiblesourceofexpertiseandcareandcan contribute to the preventive, acute, habilitative, rehabilitative,
behavioral, and mental health care needs of children in schools. Although these roles may be unfamiliar or even
intimidating to some school-based occupational therapy practitioners, existing evidence-based resources are
available to guide expansion of the practice of occupational therapy to improve health and quality of life.
In their column “P4 Medicine and Pediatric Occupational Therapy,” Persch, Braveman, and Metzler (2013)
noted that “within psychoeducational psychotherapy, healthy habits refers to structuring a child’s diet, sleep, and
physical activity in a way that optimizes health” (p. 385). Occupational therapy practitioners, with their advanced
training in activity analysis, have an extraordinary opportunity to deploy healthy habits interventions for children
in schools. Approximately 22% of American Occupational Therapy Association (AOTA) members practice in
school settings (AOTA, 2010) and thus are ideally situated to deploy preventive practices such as healthy
habits. In working to expand their sphere of influence in the schools, clinicians can contribute to overall health,
facilitate patient engagement, and reduce the costs of ill health, all of which are key components of the Triple
Aim.
The purpose of this article is to provide occupational therapy practitioners with evidence that supports the
therapeutic power of healthy habits interventions for children. In doing so, we hope to empower those who seek
to demonstrate the value of occupational therapy in “meeting society’s occupational needs” (AOTA, 2007, p.
613) in the schools and elsewhere. We focus on three critical areas of evidence that can be used to support
appropriate healthy habits interventions: (1) sleep hygiene, (2) physical activity, and (3) healthy nutrition.
Sleep Hygiene
Sleep is a basic need of all children (Mindell, Meltzer, Carskadon, &Chervin, 2009). Indeed, Maslow (1943)
placed sleep at the level of basic physiological needs that motivate human behavior. The time at which typically
developingchildrenawake is generally more consistent than their bedtime (Petta, Carskadon, &Dement, 1984),
reflecting most children’s dependency on their parents to establish a schedule for waking up, getting dressed,
and preparing for the day. In adolescence, children begin to stay up later at night. If their schedule permits, they
also begin to wake later in the morning. The effects of this shift in sleep behavior may be profound (Steinberg,
2010). For example, sleep deprivation in adolescence is known to impair school performance and is related to
decreased physical and mental health (Danner, 2000; Wolfson &Carskadon, 1998).
Differences in sleep behavior are especially relevant for children with disabilities. Sleep disturbances are
commonly observed in children with mental health disorders such as depression (Emslie, Rush, Weinberg,
Rintelmann, &Roffwarg, 1990), bipolar spectrum disorders (Lofthouse et al., 2008), and attention deficit
hyperactivity disorder (Corkum, Tannock, &Moldofsky, 1998). Impaired sleep can exacerbate behavioral,
anxiety, and mood disorders. Similarly, research has indicated that, compared with their typically developing
peers, children with autism (Wiggs &Stores, 2004), Down syndrome, Prader-Willi syndrome, intellectual
disability (Cotton &Richdale, 2010), and cerebral palsy (Newman, O’Regan, &Hensey, 2006) may experience
diminished quantity and quality of sleep. As noted previously, this sleep debt may have negative consequences
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for health and performance of childhood occupations.
Fortunately, good sleep hygiene is a powerful therapeutic tool. For children, sleep hygiene is defined as
“modifiable parent and child practices that promote good sleep quality, allow sufficient sleep duration, and
prevent daytime sleepiness” (Mindell et al., 2009, p. 771). Using sleep screening instruments, it is possible to
identify patterns of disordered sleep and the consequences of getting too little sleep among children (Owens,
Spirito, McGuinn, &Nobile, 2000). When poor sleep routines are noted, an opportunity to intervene arises.
Sadeh, Gruber, and Raviv (2003) demonstrated that school-age children respond to modest (i.e., approximately
1 hr) restriction or extension of sleep. Clinically, these results suggest that children may benefit in terms of
health, wellness, and performance when sleep is extended in a structured manner. Indeed, it is apparent that
efforts to improve the sleep hygiene of children with bipolar spectrum disorders may yield improvements in
mood (Fristad, Goldberg Arnold, &Leffler, 2011). Although sleep hygiene is not a usual focus of school-based
interventions, these data demonstrate the need to consider sleep in the context of school success.
Empoweredwiththesedataand awakened to the opportunity to intervene in sleep hygiene, occupational therapy
practitioners have a valued role in helping children and families achieve better health through improved sleep
hygiene. First, practitioners must develop an awareness of the signs and symptoms of insufficient sleep and
sleep deprivation (Sadeh et al., 2003). These signs and symptoms may include, but are not limited to, fatigue;
irritability; decreased stress tolerance; sickness; blurred vision; changes in appetite; and difficulty concentrating,
remembering, or learning. When these behaviors are observed in natural settings such as the classroom,
occupational therapy practitioners have the opportunity to interveneinsimpleyetconcreteways.
Occupational therapy practitioners can begin by educating children and families about the importance of sleep.
This information provides a good starting point and should be presented in an individualized manner. Next, they
can build awareness of sleep patterns, using either formal sleep screening instruments or informal tools. For
example, parents can use a rubric designed to record a child’s bedtime, the time the child actually fell asleep,
the time the child awoke, nap times, and total sleep time for an entire week (Fristad et al., 2011). Using these
data, clinicians may identify opportunities to improve sleep hygiene and suggest feasible behavioral
modifications. Such suggestions maybeassimpleasturningoffthetelevision an hour earlier each night, putting
pajamas on after dinner, or restricting cell phone usage an hour before bedtime. By considering each person’s
individual needs, the child, family, therapist, and others can collaboratively develop a plan for getting healthy
sleep that may result in improved school participation and success.
Physical Activity
Like sleep hygiene, patterns of physical activity are strongly linked to childhood health and wellness. Among
typically developing children, physical inactivity, especially the amount of television watched per day, is strongly
associated with obesity (Burdette &Whitaker, 2005). Patterns of activity and inactivity developed in
childhoodandadolescencearepredictiveofadult patterns of behavior (Telama et al., 2005). In this context, female
and minority populations experience greater inactivity than do male and nonminority populations (Physical
Activity Guidelines Advisory Committee, 2008). Thus, activities must appeal to a wide variety of children.
The physical activity patterns of children with disabilities warrant special consideration. For example, children
with mood disorders may experience weight gain because increased appetite is a common symptom of
depression. In addition, weight gain is a common side effect of moodstabilizing medication (Fristad et al., 2011).
Physical activity appears to be an especially powerful therapy for this population. Engaging in physical activity
results in fewer depressive symptoms and may help to alleviate dysphoria in children with mental health needs
(Ströhle, 2009; Strong et al., 2005). Similarly, individualized physical activity programs are health promoting for
children with physical disabilities. For example, weight-bearing activities, including standing, are known to have
positive effects on bone density and cardiopulmonary and digestive health in children with cerebral palsy (Chad,
Bailey, McKay, Zello, &Snyder, 1999). Recent evidence has suggested that physical training delays
deterioration of neurological motor function in children who have Duchenne muscular dystrophy (Jansen, van
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Alfen, Geurts, &de Groot, 2013). However, the benefits of physical activity are not limited to these groups.
Clinicians should emphasize the benefits of physical activity for all children, but especially for minorities, girls,
and children with disabilities. When working with families in a school context, occupational therapy practitioners
may seek information about the amount of television a child watches each day and the amount of physical
activity performed each week (Harris, King, &GordonLarsen, 2005). When inactivity or limited activity puts
health at risk, practitioners should consider collaborating with students and families to incorporate physical
activity routines into their plans of care. When intervention is necessary, home- or
schoolbasedexerciseprogramsshouldbegradedto personal needs and capacities, remembering that the justright challenge looks different for each child, and even minimal amounts of activity may be beneficial for a child
with a disability. Incorporating activity trackers, even commercially available health monitors, into daily routines
to monitor, measure, and document performance and progress may enhance these practices.
Healthy Nutrition
Nutrition is a key determinant of energy and obesity in children and in adults (Harris et al., 2005). Although a
healthy diet is beneficial for all children (Fristad et al., 2011), as many as 31.8% of children and adolescents
ages 2-19 are overweight or obese (Ogden, Carroll, Kit, &Flegal, 2012), and many struggle with malnutrition (de
Onis, Blössner, &Borghi, 2012). In the United States, the incidence and prevalence of childhood obesity are,
and have been, increasing for some time (Ogden et al., 2012). This increase is concerning because children
who are overweight or obese have an increased probability of being overweight or obese as adults (Guo, Wu,
Chumlea, &Roche, 2002).
Nutrition becomes a particularly important consideration in the context of children with disabilities. For example,
changes in appetite related to fluctuations of mood and the side effects of prescription medications put children
with mental health disorders at an increased risk for unhealthy eating habits. Children with mood disorders may
have unusually strong carbohydrate cravings (Christensen &Pettijohn, 2001) and risk gaining weight. Childhood
malnutrition may have a negative impact on intellectual development (Brown &Pollitt, 1996). As Crooks (1995)
stated, “Poor health and poor growth are likely to lead to poor school achievement via deficits in cognitive
functioning, behavior . . . and increased absenteeism and school failure” (p. 57). The effects of poor nutritional
habits or resources may be exaggerated in children with disabilities. For example, children with cerebral palsy
often have difficulty maintaining healthy weight (Gisel &Patrick, 1988); children with autism may demonstrate
picky eating behaviors and may require nutritional supplements (Lockner, Crowe, &Skipper, 2008); and tactilely
defensive children may refuse foods on the basis of smell, temperature, texture, and context (Smith, Roux,
Naidoo, &Venter, 2005).
The benefits of a healthy diet are many and may be realized at any point throughout the lifespan. In children, a
healthy diet prevents deficiencies (Suskind &LewinterSuskind, 1993) and facilitates the development and proper
functioning of physiological systems throughout the body. Moreover, proper nutrition enhances cognitive
function (Kretchmer, Beard, &Carlson, 1996) and school performance (Meyers, Sampson, &Weitzman, 1991),
improves self-esteem and resiliency (American Psychological Association, 2013), and decreases the risk of
disease (American Psychological Association, 2013).
Occupational therapy practitioners can help to improve the eating habits of children and families by keeping the
following in mind:First,itisbesttofocusondeveloping positive eating habits and not on dieting or weight loss.
Second, children who eat two or more servings of fruits and vegetables 32 times per week are more likely to
have a lower body mass index, whereas children who eat fast food 32 times per week may experience greater
inactivity and a higher body mass index (Harris et al., 2005). Third, some children may not be ready to learn at
school until after they have eaten (Crooks, 1995; Rampersaud, Pereira, Girard, Adams, &Metzl, 2005).
When any of these issues are present, an occupational therapist can advocate for an individualized education
program modification of the child’s schedule that best positions the child for learning. Occupational therapists
can recommend that children participate in the breakfast and snack programs offered though the school. In
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addition, occupational therapy practitioners could support developing special classes, electives, or
extracurricular activities, such as a school garden, around healthy eating and food preparation. Finally, when
children are obese and require intensive intervention, an occupational therapy practitioner may collaborate with
other health professionals (e.g., physician, registered dietitian) to implement staged interventions such as
Prevention Plus and Structured Weight Management strategies (Spear et al., 2007).
Providing nutritional support to children and families does not have to be difficult. Occupational therapy
practitioners can begin by educating children and families about the benefits of healthy eating. They can use
rubrics and diaries to build awareness of eating patterns, risks, and opportunities to improve health. When
appropriate, practitioners can suggest feasible behavioral modifications that are likely to improve nutritional
status and overall health, and they can provide support, structure, and routines that facilitate healthy choices
and maximize the chances of success (Fristad et al., 2011).
Conclusion
The “powerful, widely recognized, sciencedriven, and evidence-based” efforts of occupational therapy
practitioners (AOTA, 2007, p. 613) can greatly contribute to the United States’ ability to achieve the Triple Aim.
By promoting healthy habits in children, occupational therapy practitioners have an opportunity to leverage
existing evidencebased practices in ways that support the health and wellness of children, families, and
communities. Promoting healthyhabitsisalso aligned with the concept of P4 medicine (Persch et al., 2013) and
with AOTA’s (2007) Centennial Vision. Whether it is used in medical, educational, community, or nontraditional
settings, a focus on healthy habits provides occupational therapy practitioners with a way to demonstrate the
value of their profession, which prevents illness, remediates disability, and restores health by enabling
participation in meaningful occupations. s
Sidebar
Persch, A. C., Lamb, A. J., Metzler, C. A., &Fristad, M. A. (2015). Health Policy Perspectives-Healthy habits for
children: Leveraging existing evidence to demonstrate value. American Journal of Occupational Therapy, 69,
6904090010. http://dx.doi.org/10.5014/ajot.2015.694001
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AuthorAffiliation
Andrew C. Persch, PhD, OTR/L, is Assistant Professor, Division of Occupational Therapy, The Ohio State
University, Columbus; andrew.persch@osumc.edu
Amy J. Lamb, OTD, OTR/L, FAOTA, is Assistant Professor and Program Director, Occupational Therapy
Program, Eastern Michigan University, Ypsilanti.
Christina A. Metzler is Chief Public Affairs Officer, American Occupational Therapy Association, Bethesda, MD.
Mary A. Fristad, PhD, ABPP, is Professor of Psychiatry and Behavioral Health, Psychology, and Nutrition, The
Ohio State University, Columbus.
Publication title: The American Journal of Occupational Therapy
Volume: 69
Issue: 4
Pages: 1-5
Number of pages: 5
Publication year: 2015
Publication date: Jul/Aug 2015
Year: 2015
Section: HEALTH POLICY PERSPECTIVES
Publisher: American Occupational Therapy Association, Inc.
Place of publication: Bethesda
Country of publication: United States
Publication subject: Medical Sciences, Occupational Health And Safety
ISSN: 02729490
Source type: Scholarly Journals
Language of publication: English
Document type: General Information
ProQuest document ID: 1691577168
Document URL: http://search.proquest.com/docview/1691577168?accountid=35796
Copyright: Copyright American Occupational Therapy Association, Inc. Jul/Aug 2015
Last updated: 2015-07-04
Database: ProQuest Central
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Table of contents
1. Parent participation plays an important part in promoting physical activity………………………………………….. 1
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Document 1 of 1
Parent participation plays an important part in promoting physical activity
Author: Lindqvist, Anna-Karin; Kostenius, Catrine; Gard, Gunvor; Rutberg, Stina
ProQuest document link
Abstract: Although physical activity (PA) is an important and modifiable determinant of health, in Sweden only
15% of boys and 10% of girls aged 15 years old achieve the recommended levels of PA 7 days per week.
Adolescents’ PA levels are associated with social influence exerted by parents, friends, and teachers. The
purpose of this study was to describe parents’ experiences of being a part of their adolescents’ empowermentinspired PA intervention. A qualitative interview study was performed at a school in the northern part of Sweden.
A total of 10 parents were interviewed, and the collected data were analyzed with qualitative content analysis.
Three subthemes were combined into one main theme, demonstrating that parents are one important part of a
successful PA intervention. The life of an adolescent has many options and demands that make it difficult to
prioritize PA. Although parents felt that they were important in supporting their adolescent, a successful PA
intervention must have multiple components. Moreover, the parents noted that the intervention had a positive
effect upon not only their adolescents’, but also their own PA. Interventions aimed at promoting PA among
adolescents should include measures to stimulate parent participation, have an empowerment approach, and
preferably be school-based.
Key words: Adolescents, empowerment, interviews, content analysis, school
Citation: Int J Qualitative Stud Health Well-being 2015, 10: 27397 – http://dx.doi.org/10.3402/qhw.v10.27397
Responsible Editor: Soly Erlandsson, University West, Sweden.
Copyright: © 2015 A.-K. Lindqvist et al. This is an Open Access article distributed under the terms of the
Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the
material in any medium or format and to remix, transform, and build upon the material for any purpose, even
commercially, provided the original work is properly cited and states its license.
Accepted: 4 May 2015; Published: 14 August 2015
Competing interests and funding: No conflict of interest. The study was supported by the Department of Health
Sciences at Luleå University of Technology.
Correspondence to: A.-K. Lindqvist, Department of Health Sciences, Luleå University of Technology, SE-971 87
Luleå, Sweden. E-mail: anna-karin.lindqvist@ltu.se
Although physical activity (PA) is an important and modifiable determinant of health (Leech, McNaughton,
&Timperio, 2014), only 15% of boys and 10% of girls at age 15 in Sweden achieve the recommended levels of
PA 7 days per week (Folkhälsomyndigheten, 2014). Moreover, the fact that PA is associated with a substantial
number of health and academic benefits (Basch, 2011; Janssen &LeBlanc, 2010; World Health Organization,
2010) raises controversy associated with the view that schools actually support a sedentary lifestyle (Donnelly
&Lambourne, 2011). Integration of PA interventions in schools can promote both health and learning, and
Ickovics et al. (2014) suggested that schools and families should work together to ensure that students adopt
health-promoting behaviors to achieve higher academic achievements. Schools currently prioritize academic
achievements, and health is often perceived as a secondary priority at best (Basch, 2011). However, children
spend approximately half of their waking hours in school, which provides an opportunity to promote PA for all
children regardless of their life circumstances (Naylor &McKay, 2009). Furthermore, most schools are able to
offer the equipment, facilities, and staffing needed to effectively promote PA (Carson, Castelli, Beighle, &Erwin,
2014).
Adolescents’ PA levels are associated with social influence exerted by parents, friends, and teachers (Beets,
Cardinal, &Alderman, 2010). Parents are in a unique position because adolescents’ health behaviors are largely
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influenced by home-related factors, such as eating patterns at home, PA, and sedentary behaviors (PatinoFernandez, Hernandez, Villa, &Delamater, 2013). Moreover, parent involvement is often recommended as a
part of school-based PA interventions (Birch &Ventura, 2009). Parents’ impact on their adolescents’ PA can
consist of providing different types of social support, for example encouragement and practicing together (Beets
et al., 2010). Another need children expressed was for transportation by parents to sporting facilities and other
arenas to enable their engagement in physical activities (Wright, Wilson, Griffin, &Evans, 2010). According to
Bandura (2004), support from parents can reduce the perceived obstacles, increasing the likelihood of PA.
Moreover, physically active parents can also act as positive role models; observing the behavior and learning
from socially important persons might influence the PA of adolescents (Beets et al., 2010). A review by
Edwardson and Gorely (2010) observed that physically active parents were more likely to have physically active
children. Another review concluded that some effects of parental involvement were found in children’s eating
and PA behaviors but further studies on school-based interventions with parental components are needed (Van
Lippevelde et al., 2012). Although research has shown that parents have an important part in their adolescents’
PA, we were unable to identify any study addressing the perspective of parents’ experiences of participation in
their adolescents’ PA interventions.
Situating this research study
We previously conducted a study where the aim was to explore the possibility of conducting an empowermentinspired intervention and to examine the impact of the intervention in promoting PA among adolescents
(Lindqvist, Mikaelsson, Westerberg, Gard, &Kostenius, 2014). The intervention was school-based and consisted
of three components: contracts, encouraging peer-peer text messages, and a parental brochure. The contents
of these components were created by the adolescents with support from the researchers and the teachers,
using an empowerment-inspired approach. Furthermore, the development of the intervention was guided by
Bandura’s social cognitive theory (Bandura, 2004), which is one of the most frequently used health behavior
theories. The adolescents were divided into pairs by the teachers and were asked to make a mutual written
contract. The contracts included a goal for PA and a promise to support each other’s PA by sending one text
message to each other once each day for 1 month, to encourage PA during school hours and during leisure
time. The parental brochure contained several headlines, for example: “Why is it good to be physically active?”
“The relationship between PA and school performance,” and “How can parents support PA?” The brochure was
sent home to the parents; however, the parents had no obligation to be active in the intervention any further.
Subjective and objective PA data was collected before and after the intervention. The participants in the
intervention group increased their PA compared to the control group, and the study showed that it is possible to
develop and conduct an empowerment-inspired intervention to promote adolescent PA. The data collection, the
content of the intervention, and the results are reported in detail elsewhere (Lindqvist, Mikaelsson, et al., 2014).
As parents are known to influence their adolescents’ PA, it is valuable to explore their experiences of being a
part of a school-based intervention aimed at promoting PA among adolescents.
Aim
The aim of this study was to describe parents’ experiences of being a part of their adolescents’ empowermentinspired PA interventions.
Method
Methodological framework
This study was the last part in a set of four studies with the overall aim of exploring the development of a healthpromoting intervention that uses empowerment and information and communication technology, to examine the
impact of the intervention, and to describe adolescents’ and parents’ experiences of the intervention. These
studies applied both qualitative and quantitative methods and, according to Mengshoel (2012), mixed methods
research involves the combination of qualitative and quantitative research in a single study or set of studies.
The use of mixed methods research is advocated in physiotherapy, with both quantitative measurements of
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physical functioning and interviews about individuals’ personal experiences (Mengshoel, 2012; Rauscher
&Greenfield, 2009). In this study, interviews were carried out in accordance with Kvale and Brinkmann (2009).
Participants
This study was part of a school development and research project in one municipality of approximately 17,000
inhabitants in the northern part of Sweden. All of the staff members at the municipality’s secondary school were
informed about the forthcoming studies by two of the authors, and two seventh grade teachers were invited to
participate as coordinators. In the first study of the project, 28 students from the two classes (13 boys and 15
girls), aged 13 and attending the seventh grade, participated in focus groups (Lindqvist, Kostenius, &Gard,
2012). The ideas of the students themselves were used to create an intervention. When the students began
ninth grade, 27 students (14 boys and 13 girls) participated in the intervention group in a second study. The
goals of this study were to explore the possibility of conducting an empowerment-inspired intervention and to
examine the impact of the intervention in promoting PA among adolescents. After completion of the second
study, all parents of the students in the intervention group were invited to participate in a qualitative study; 10
parents (four fathers and six mothers) agreed to be interviewed. These were the parents of six boys and four
girls with varying PA levels. Three parents described their adolescents as being very active, two said that their
adolescents were inactive, and the rest said that their adolescents were somewhere in-between. The 10
participating parents were between 40 and 55 years of age and had education levels varying from high school
to higher academic education. The parents had diverse PA levels: two parents described themselves as being
very active, three said that they were inactive, and the rest said that they were somewhere in-between.
Procedure
We followed the WMA Declaration of Helsinki–Ethical Principles for Medical Research Involving Human
Subjects concerning informed consent. The research ethics committee in Umeå, Sweden, approved the study
before the start of the research project (date of issue: February 11, 2011; application registration number: dnr
2010-337-31Ö). Data was collected using individual interviews. We constructed a guide with questions
concerning the intervention, in which the first question was “Let’s pretend I know nothing. Could you please tell
me about the intervention?” Examples of other questions were “What expectations did you have before?” and
“In what way have you supported your adolescents’ PA?” In accordance with the recommendations of Kvale
and Brinkmann (2009), follow-up questions (e.g., “Could you tell me more?” “How did you experience that?”)
were posed to obtain richer material. The interviews were carried out in a room without distractions at the
location the parent preferred: at the children’s school, at the parents’ worksite, or at home. All interviews were
conducted within 2 months of the conclusion of the intervention study. Author AKL, who had no professional
connection with the students, performed the interviews, which lasted between 30 and 60 min. The interviews
were sound-recorded and transcribed verbatim.
Data analysis
The transcribed data material from the interviews was analyzed as a whole. An inductive qualitative approach
was used (Elo &Kyngäs, 2008). The qualitative latent content analysis was performed according to Graneheim
and Lundman (2004), and all authors took an active part in the following procedure: (1) The written material was
first read through several times to obtain a sense of the overall data; (2) The text was divided into meaning units
and condensed; (3) In the abstraction process, the condensed meaning units were coded and the codes were
compared, contrasted, and sorted into preliminary categories. During this process, the authors strove to be
close to the text; (4) By going back and forth among the preliminary categories, the codes and the text
categories were identified; (5) The underlying meaning of the categories was interpreted and formulated into
three subthemes, which in turn formed one main theme.
Results
The results were formulated into one main theme and three subthemes and representative quotations from the
transcribed text were used. The quotes are labeled with the number of the participant (1-10) and marked with F
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for female or M for male.
Parents are one important part of a successful PA intervention
The three subthemes were combined in one main theme that shows parents having an important part to play in
order for the intervention to be successful in increasing the PA of their adolescents. Adolescents have many
options and demands in life that make it difficult to prioritize PA even if they know they should be physically
active. Although parents stated that they felt they were important in supporting their adolescents’ PA level in
general, our results show that a successful PA intervention should consist of multiple components. Furthermore,
it was the parents’ experience that the intervention had a positive effect upon both their adolescents’ and their
own PA.
PA is not always a priority
The parents recognized the advantages PA brought to their adolescents. They noted as well the obstacles
faced by the children, such as lack of time and the need to prioritize PA ahead of other appealing tasks; they
noted that their adolescents do not have an easy choice to make. The parents described being interested in
their adolescents’ PA and recognizing several benefits of PA, such as longer and healthier life, better stamina,
strength, and fitness. The parents had also noted disadvantages for their adolescents related to physical
inactivity, such as being overweight, getting headaches, and being irritable. Parents feared that their
adolescents would not have the physical capacity to master a physically demanding job in the future. The
parents perceived that their adolescents needed support concerning their PA and emphasized the importance
of creating a healthy lifestyle at a young age, because it is difficult to change behavior later in life.
M3: They are mostly inactive. I told my kid, you will have problems later on being so sedentary now. And the
habits you create at a young age will stick, it is hard to change a habit.
Parents who had athletically active adolescents stated that they were not so worried for their own adolescents’
PA but were concerned about the young generation overall. Even some parents of adolescents who were very
active in sports noted that their adolescents had a problem with physical inactivity, for example, on days when
they did not have a training session or were off-season for their sport. The parents stated that they were more
physically active during their own childhood relative to their children; they recognized barriers to their children’s
PA due to several changes that have occurred within society since their childhood. Examples that were
mentioned included technology such as television, computers, and smart phones; lack of spontaneous physical
activities, such as playing hockey in the street or going fishing; and less active transportation to school and
other places.
M7: They have lost spontaneous sport. It does not exist today. There are many other things that attract;
computers and mobile phones take up a lot of time. TV, for that matter: when I was growing up we had one
channel, and now …. They have no easy choices to make.
Other factors that negatively influence PA include a strong commitment and heavy workload at school; some
parents also noted that the girls prioritized spending time with their boyfriends over being physically active. The
parents identified factors such as tight time schedules and difficulties in solving the “puzzle of life in the family”
as barriers for their adolescents’ PA. Some also mentioned that lack of money and a tight budget might be a
problem. The parents stated that adolescents do not always have the ability to know what is best for them and
do not have the capacity to understand the long-term consequences of their actions. They believed that this
could also contribute to why adults are needed to support adolescents in PA.
I am important, but only one piece of the puzzle
The parents were very positive about the intervention, were pleased to be included, and stated that they were
mainly responsible for their adolescents’ PA in general. Simultaneously, they expressed their awareness that
they were only one part of a successful PA intervention. In addition to their own support, they mentioned school
and sports clubs as other important authorities. The parents felt that school was the right context for a PA
intervention, because it reached every adolescent regardless of their other life circumstances, and they stated
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that the adolescents might listen more to an “outsider.”
F10: Oh, how perfect, I thought when I heard about this. A health project at school, someone from the outside
saying the same thing as I am. Then maybe he will be more physically active. The teachers are annoying,
parents are annoying and nagging. It is simply a new voice.
The parents thought that they were important in encouraging their adolescents’ PA. They noted that their own
PA behavior had an impact on their adolescents and they wanted to act as positive role models. Furthermore,
they felt that it was more effective to act as a positive role model than to attempt to convince an adolescent with
facts or to nag them into being physically active. Another part of being a supportive parent was to help with
practical things, such as driving the adolescents to practices and games, assisting with funds for training
equipment, and arranging for adequate food for active children. The parents’ responsibility also included setting
limits in areas such as time spent at the computer. When reading the parental information brochures, parents
were impressed by their adolescents’ knowledge and their ability to find the right details to include in the
brochures. They also felt empowered, because the intervention provided several opportunities to communicate
about PA with their adolescents, as well as suggestions for what they as parents could do to support their
adolescents’ PA. Some of the parents also experienced a feeling of self-efficacy and a confirmation that their
previous attitude and actions had been correct.
F1: When I read this [the parental information brochure], I thought, how funny, we have done this, intuitively we
have done the right thing. It was like a confirmation; instead of feeling old-fashioned, I felt up-to-date.
One successful factor mentioned by the parents was that the intervention was built on their adolescents’ own
ideas and their own choice of PA. The parents mentioned that it was an advantage that the adolescents were
part of the project from start to finish, for example, that they were presented with the final results of the studies.
They felt that listening and giving the adolescents responsibility was the correct approach to addressing
adolescents and PA.
F6: This is great. And above all that you have listened to them, taken advantage of their expertise, given power
to them. Cooperation and involvement makes it fun.
Another contributing factor, according to the parents, was that the intervention included everyone instead of
targeting only the least physically active children. The involvement of the majority became a unifying factor in
the class and PA became a topic of conversation. The parents perceived that “fun” was an important factor in
motivating adolescents to be physically active. It was important that the adolescents found an activity they
perceived to be enjoyable. Some parents also stated that the young generation is driven too much by
enjoyment, which might become a threat to their health. The parents perceived that measuring PA had
contributed to their adolescents’ motivation to be physically active. According to the parents, a focus on
competitions and challenges might be a way of further enhancing the effect of a PA intervention for adolescents.
Regarding rewards, experiences differed among the parents. Although some parents had used rewards with
success, others were negative towards rewarding their adolescents when they were physically active. According
to some parents, rewards might be effective in the early stages of behavioral change. The parents feared that
using rewards would lead to inflation (i.e., the prize for a desired action could get higher and higher), and felt
that one should focus on the inner feeling of satisfaction gained from PA. Parents suggested introducing the PA
intervention at an earlier stage and also implementing long-term follow-ups as a part of a successful PA
intervention.
The intervention had a positive impact on my child and on me
The third subtheme showed that, according to the parents, the intervention had a positive effect regarding their
adolescents’ PA during and after the intervention period.
M2: My kid used to go by scooter but this fall he used it once; the rest of the time he has taken the bike. You
can see that it has had an effect. I asked him why he does not drive to school. He said he preferred to get a little
exercise in the morning.
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In some cases, the increased PA level came sometime after the end of the intervention. The parents also
mentioned that they had noticed that the increased PA had led to positive effects on their adolescents’ energy
levels, their ability to concentrate and learn in school, enhanced self-confidence, and improved mood. According
to the parents this was because PA enhanced the adolescents’ endurance, motivation, focus, and skillfulness at
planning their time, while some activities taught the adolescents to function well in cooperation with others.
F8: She feels that school works better. I have not had to “crack the whip” as much as earlier this year. She
takes much more responsibility concerning school. She says that she feels soggy if she is not physically
inactive. She plans for exercise when she is meeting her friends.
The parents reported that even though the intervention targeted PA it had also produced positive effects on their
adolescents’ diets; they were more aware of what constitutes a good diet and more inclined to choose healthy
options and cut down on sugar. However, a few parents expressed that it was a balancing act for their
adolescents to not do too much PA; in some cases parents had tried to persuade their adolescents to take a
day off from PA.
As well as the effect among the adolescents, the parents experienced some effects for themselves. They
reported that their adolescents’ participation in the intervention had led to an increase in their own PA. PA had
become a topic of conversation at home and they felt motivated to be more active, both with their adolescents
and on their own. The intervention’s impact on their own PA was unexpected, but the parents noted it with
pleasure and reported that their adolescents also had made remarks concerning their enhanced PA levels.
F9: I have started to be more physically active this fall. I go to the gym, so it has rubbed off on me.
Discussion of methods
We chose a qualitative approach, through individual interviews and content analysis, to describe parents’
experiences of being a part of their adolescents’ empowerment-inspired PA intervention. According to Öhman
(2005), credibility can be increased by triangulation; the research problem is viewed from various angles by a
research team with different professional backgrounds. To make use of this technique, the authors took an
active part in the analysis of the data. We also used peer debriefing: the preliminary results were discussed with
colleagues with experience of working with qualitative methods (Öhman, 2005). To enhance the credibility, we
moved between the theme, subtheme, and the interview text to ensure that we included all data in the study and
to ensure that our interpretations are reasonable. To help the readers consider our interpretations and to further
give examples of different aspects, we included quotations in the results. Participants included mothers, fathers,
boys, and girls, all with varying PA levels. This variety ensured that there was a good possibility that light would
be shed on different aspects of the topic under investigation, thereby strengthening the credibility of the study
(Graneheim &Lundman, 2004). We used an interview guide comprised of a few main questions with follow-up
questions and kept an open dialogue within the research team, which according to Graneheim and Lundman
(2004) strengthens the dependability of the data collection. Both positive and negative experiences were
revealed, which suggests openness from the participants. Although these results are based on a small sample
(only 10 out of 27 parents agreed to participate), the rich information in the interviews displayed a variety of
experiences and was judged as sufficient to answer the aim of this study. In order to facilitate transferability, the
research process, the participants, and the results have been described in detail. Authors can offer suggestions
concerning the transferability; however, as stated by Graneheim and Lundman (2004), the transferability of the
results to other contexts has to be considered by the reader.
Discussion of results
Increasing adolescents’ PA can be difficult, especially when adolescents have many appealing competing
priorities and different levels of interest in PA. The results of this study showed that the parents experienced the
intervention as successful and that parents are an important part of increasing the PA of their adolescents.
Therefore, parental involvement in the PA of adolescents should not be ignored. This finding is in line with
earlier research (Edwardson &Gorely, 2010; Van Lippevelde et al., 2012), and this study outlines one way of
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including parents in an intervention to increase adolescents’ PA. In addition, we report an unexpected benefit of
promoting the parents’ own PA.
Swedish adolescents of today do not reach an adequate PA level (Folkhälsomyndigheten, 2014). The findings
of the present study indicate that there is a discrepancy between the actual PA performed by the adolescents
and the level the parents think they ought to reach. The parents stated that they were more physically active
when they were young, and this statement might be supported by the fact that there was a decline in
cardiovascular fitness in Swedish 16-year-olds between 1987 and 2007 (Ekblom, Ekblom Bak, &Ekblom, 2011).
We found that parents emphasized how their adolescents face greater challenges in prioritizing PA compared to
their own childhoods and that this is due to societal changes. According to the results, adolescents spend a
considerable amount of time with sedentary activities such as computers and mobile phones. This is in line with
findings from other studies (Tercyak, Abraham, Graham, Wilson, &Walker, 2009) and consistent with an earlier
focus group study with the students whose parents participated in this current study (Lindqvist et al., 2012). The
results show that limited time acts as a barrier to prioritizing PA, which is in line with other studies (PatinoFernandez et al., 2013; Thompson et al., 2010). Furthermore, a study of the connection between screen time
and PA showed that every additional hour committed to PA was associated with 32 min less screen time and
that this relationship was more pronounced in obese adolescents, who averaged 56 min less screen time (Olds,
Ferrar, Gomersall, Maher, &Walters, 2012). Therefore, we argue that adolescents of today need support in
choosing to participate in PA and that parents should be involved in providing this support.
The parents felt that it was mainly their responsibility to support their adolescents’ PA. This finding is in contrast
with the findings of Patino-Fernandez et al. (2013), who reported that parents felt the school should provide
children with participation in PA, while the school staff stated that it was the parents’ primary responsibility.
However, the study concluded that there is a need for comprehensive school-based interventions emphasizing
parent and school staff collaboration, and this is in line with our findings. The parents felt that school was the
right context for a PA intervention, because it reached every adolescent regardless of their other life
circumstances. This is consistent with the conclusions of other studies that state that most school settings
provide the opportunity, equipment, facilities, and staffing needed to effectively promote PA (Carson et al.,
2014; Naylor &McKay, 2009). This is also supported by social cognitive theory, which extends the conception of
individuals to the collective, as people do not operate as isolated individuals, but work together to improve their
health (Bandura, 2004). Even though health-promoting interventions should be implemented in school, they
should not be performed solely by school staff. School-based health-promoting interventions could benefit from
integrating support from home, the community, and society at large (Bandura, 2004). We agree with Bandura
that school is the appropriate place to implement a health-promoting intervention that aims to reach children and
adolescents. Still, this matter is not without complications. Society tends to focus on areas that are evaluated,
and schools are not graded on health promotion (Bandura, 2004). Furthermore, promoting health might appear
to be an added burden when the primary focus of schools is to meet academic standards; PA is sometimes
seen as a competitor to academic studies, because the time devoted to PA could instead be devoted to
academic work (Ickovics et al., 2014).
The parents in this study noted how their own PA behavior and actions as a positive role model influenced their
adolescents’ PA. The connection between the parents’ level of PA and their children’s level of PA is also
mentioned by Khanolkar, Byberg, and Koupil (2012), who stated that children can benefit if their parents adopt a
healthy lifestyle. In addition, encouragement and help with practical issues and logistics also impacted their
adolescents’ PA, which is consistent with the review by Edwardson and Gorely (2010) and other studies
(Cheng, Mendonça, &De Farias Júnior, 2014; Khanolkar et al., 2012). Furthermore, the support provided by
parents included limit setting on sedentary behavior, which they stated to be important not only with smaller
children but also with adolescents, which is in agreement with other studies (Alia, Wilson, St George, Schneider,
&Kitzman-Ulrich, 2013; Ramirez et al., 2011). Moreover, the parents emphasized the importance of creating a
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healthy lifestyle at a young age, since according to them it is difficult to change behavior later in life. Two
reviews on tracking of PA from childhood to adulthood support this statement and conclude that enhancement
of PA in children is of great importance for the promotion of public health (Craigie, Lake, Kelly, Adamson,
&Mathers, 2011; Telama et al., 2014), a conclusion this study supports.
Moreover, we argue that the support of PA needs to be coordinated to fit within the adolescents’ reality as
“digital natives.” Prensky (2001) reported that adolescents think and process information fundamentally
differently from their predecessors as a result of being surrounded by new technology. These digital natives are
compared with the older generation of “digital immigrants,” who are learning and adopting new technology
(Prensky, 2001). An empowerment element in an intervention can contribute to the extent to which the
intervention fits the end users’ priorities and values (Fraser &Galinsky, 2010). According to the parents, it was
an advantage that the intervention was empowerment-inspired and built on the adolescents’ own ideas; they
believed that this design might enhance the possibility of sustainability. It is possible to draw parallels between
this study and the findings of Puolakka and colleagues, who concluded that engaging students not only made
them more confident but also contributed to their health (Puolakka, Haapasalo-Pesu, Konu, Åstedt-Kurki,
&Paavilainen, 2014). As a result of their project, the physical condition and social relationships of the students
improved, and future interventions were planned (Puolakka et al., 2014). Furthermore, the present study
showed that the parents felt empowered after reading the parental information brochure made by their
adolescents, which increased self-efficacy and confirmed that some of their previous attitudes and actions had
been correct. This impact is important, because a feeling of helplessness and lack of control may disempower
parents and ultimately lead to behaviors that are unsupportive of their adolescents (Patino-Fernandez et al.,
2013). Interestingly, the parents who stated that their adolescents do not always have the ability to know what is
best for them or have the capacity to understand the long-term consequences of their actions were impressed
by their adolescents’ knowledge and their ability to find the right details to create the parental information. Taken
together, the results of this study suggests that empowerment and the forming of partnerships between
significant adults and adolescents is a promising avenue for developing PA interventions, which echoes social
cognitive theory (Bandura, 2004). However, further research will be needed to clarify this point.
The parents found that the intervention had a positive effect upon their adolescents’ PA. This observation is
consistent with the findings from our previous quantitative study, which showed an increase in PA of 4.9 min per
day (Lindqvist, Mikaelsson, et al., 2014). Furthermore, this is in line with the results from our previous interview
study with adolescents (Lindqvist, Kostenius, &Gard, 2014). The interviews were performed 2 and 8 weeks after
the intervention had ended for adolescents and their parents, respectively, suggesting the possibility of a lasting
effect for the intervention. Moreover, the parents reported that, although the intervention targeted PA, it had also
had a positive effect upon their adolescents’ diet. Clustering of health-related behaviors is known to result in
synergistic effects, when a change in one behavior affects the prevalence of another, although the relationship
is complex and requires further research (Busch, Van Stel, Schrijvers, &De Leeuw, 2013; Leech et al., 2014).
Knowledge of health behavioral clustering can be used to design more effective school-based interventions
using transfer-oriented learning, thus targeting multiple behaviors simultaneously (Busch et al., 2013).
The effect of the intervention was also transmitted from the adolescents to the parents, because the parents
experienced that the intervention had led to an increase in their own PA. To our knowledge, this phenomenon
has not been previously reported. PA became a topic of conversation at home in our study. This factor echoes
the key messages of Thompson et al. (2010), who stated that participating in a PA intervention that includes a
family component can enhance parent-child communication and social interaction among family members.
Conclusions
In this study, parents observed that the intervention positively affected their adolescents’ PA, an effect that
continued after the end of the intervention and additionally benefitted the parents’ own PA. The findings indicate
that the parents were important as role models, providing encouragement and tangible support. Therefore, we
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suggest that interventions aimed at promoting PA among adolescents should include actions to stimulate
participation of parents or other significant adults. Preferably, the intervention should be school-based and have
an empowerment approach to ensure a solution implemented to fit within the adolescents’ reality.
Acknowledgements
We would like to express our gratitude to the parents who participated in the study. We are also grateful for the
time and cooperation of the adolescents, the principal, and the teachers.
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Full text: Responsible Editor: Soly Erlandsson, University West, Sweden.
Copyright: ©2015 A.-K. Lindqvist et al. This is an Open Access article distributed under the terms of the
Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the
material in any medium or format and to remix, transform, and build upon the material for any purpose, even
commercially, provided the original work is properly cited and states its license.
Accepted: 4 May 2015; Published: 14 August 2015
Competing interests and funding: No conflict of interest. The study was supported by the Department of Health
Sciences at Luleå University of Technology.
Correspondence to: A.-K. Lindqvist, Department of Health Sciences, Luleå University of Technology, SE-971 87
Luleå, Sweden. E-mail: anna-karin.lindqvist@ltu.se
Although physical activity (PA) is an important and modifiable determinant of health (Leech, McNaughton,
&Timperio, 2014), only 15% of boys and 10% of girls at age 15 in Sweden achieve the recommended levels of
PA 7 days per week (Folkhälsomyndigheten, 2014). Moreover, the fact that PA is associated with a substantial
number of health and academic benefits (Basch, 2011; Janssen &LeBlanc, 2010; World Health Organization,
2010) raises controversy associated with the view that schools actually support a sedentary lifestyle (Donnelly
&Lambourne, 2011). Integration of PA interventions in schools can promote both health and learning, and
Ickovics et al. (2014) suggested that schools and families should work together to ensure that students adopt
health-promoting behaviors to achieve higher academic achievements. Schools currently prioritize academic
achievements, and health is often perceived as a secondary priority at best (Basch, 2011). However, children
spend approximately half of their waking hours in school, which provides an opportunity to promote PA for all
children regardless of their life circumstances (Naylor &McKay, 2009). Furthermore, most schools are able to
offer the equipment, facilities, and staffing needed to effectively promote PA (Carson, Castelli, Beighle, &Erwin,
2014).
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Adolescents’ PA levels are associated with social influence exerted by parents, friends, and teachers (Beets,
Cardinal, &Alderman, 2010). Parents are in a unique position because adolescents’ health behaviors are largely
influenced by home-related factors, such as eating patterns at home, PA, and sedentary behaviors (PatinoFernandez, Hernandez, Villa, &Delamater, 2013). Moreover, parent involvement is often recommended as a
part of school-based PA interventions (Birch &Ventura, 2009). Parents’ impact on their adolescents’ PA can
consist of providing different types of social support, for example encouragement and practicing together (Beets
et al., 2010). Another need children expressed was for transportation by parents to sporting facilities and other
arenas to enable their engagement in physical activities (Wright, Wilson, Griffin, &Evans, 2010). According to
Bandura (2004), support from parents can reduce the perceived obstacles, increasing the likelihood of PA.
Moreover, physically active parents can also act as positive role models; observing the behavior and learning
from socially important persons might influence the PA of adolescents (Beets et al., 2010). A review by
Edwardson and Gorely (2010) observed that physically active parents were more likely to have physically active
children. Another review concluded that some effects of parental involvement were found in children’s eating
and PA behaviors but further studies on school-based interventions with parental components are needed (Van
Lippevelde et al., 2012). Although research has shown that parents have an important part in their adolescents’
PA, we were unable to identify any study addressing the perspective of parents’ experiences of participation in
their adolescents’ PA interventions.
Situating this research study
We previously conducted a study where the aim was to explore the possibility of conducting an empowermentinspired intervention and to examine the impact of the intervention in promoting PA among adolescents
(Lindqvist, Mikaelsson, Westerberg, Gard, &Kostenius, 2014). The intervention was school-based and consisted
of three components: contracts, encouraging peer-peer text messages, and a parental brochure. The contents
of these components were created by the adolescents with support from the researchers and the teachers,
using an empowerment-inspired approach. Furthermore, the development of the intervention was guided by
Bandura’s social cognitive theory (Bandura, 2004), which is one of the most frequently used health behavior
theories. The adolescents were divided into pairs by the teachers and were asked to make a mutual written
contract. The contracts included a goal for PA and a promise to support each other’s PA by sending one text
message to each other once each day for 1 month, to encourage PA during school hours and during leisure
time. The parental brochure contained several headlines, for example: “Why is it good to be physically active?”
“The relationship between PA and school performance,” and “How can parents support PA?” The brochure was
sent home to the parents; however, the parents had no obligation to be active in the intervention any further.
Subjective and objective PA data was collected before and after the intervention. The participants in the
intervention group increased their PA compared to the control group, and the study showed that it is possible to
develop and conduct an empowerment-inspired intervention to promote adolescent PA. The data collection, the
content of the intervention, and the results are reported in detail elsewhere (Lindqvist, Mikaelsson, et al., 2014).
As parents are known to influence their adolescents’ PA, it is valuable to explore their experiences of being a
part of a school-based intervention aimed at promoting PA among adolescents.
Aim
The aim of this study was to describe parents’ experiences of being a part of their adolescents’ empowermentinspired PA interventions.
Method
Methodological framework
This study was the last part in a set of four studies with the overall aim of exploring the development of a healthpromoting intervention that uses empowerment and information and communication technology, to examine the
impact of the intervention, and to describe adolescents’ and parents’ experiences of the intervention. These
studies applied both qualitative and quantitative methods and, according to Mengshoel (2012), mixed methods
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research involves the combination of qualitative and quantitative research in a single study or set of studies.
The use of mixed methods research is advocated in physiotherapy, with both quantitative measurements of
physical functioning and interviews about individuals’ personal experiences (Mengshoel, 2012; Rauscher
&Greenfield, 2009). In this study, interviews were carried out in accordance with Kvale and Brinkmann (2009).
Participants
This study was part of a school development and research project in one municipality of approximately 17,000
inhabitants in the northern part of Sweden. All of the staff members at the municipality’s secondary school were
informed about the forthcoming studies by two of the authors, and two seventh grade teachers were invited to
participate as coordinators. In the first study of the project, 28 students from the two classes (13 boys and 15
girls), aged 13 and attending the seventh grade, participated in focus groups (Lindqvist, Kostenius, &Gard,
2012). The ideas of the students themselves were used to create an intervention. When the students began
ninth grade, 27 students (14 boys and 13 girls) participated in the intervention group in a second study. The
goals of this study were to explore the possibility of conducting an empowerment-inspired intervention and to
examine the impact of the intervention in promoting PA among adolescents. After completion of the second
study, all parents of the students in the intervention group were invited to participate in a qualitative study; 10
parents (four fathers and six mothers) agreed to be interviewed. These were the parents of six boys and four
girls with varying PA levels. Three parents described their adolescents as being very active, two said that their
adolescents were inactive, and the rest said that their adolescents were somewhere in-between. The 10
participating parents were between 40 and 55 years of age and had education levels varying from high school
to higher academic education. The parents had diverse PA levels: two parents described themselves as being
very active, three said that they were inactive, and the rest said that they were somewhere in-between.
Procedure
We followed the WMA Declaration of Helsinki–Ethical Principles for Medical Research Involving Human
Subjects concerning informed consent. The research ethics committee in Umeå, Sweden, approved the study
before the start of the research project (date of issue: February 11, 2011; application registration number: dnr
2010-337-31Ö). Data was collected using individual interviews. We constructed a guide with questions
concerning the intervention, in which the first question was “Let’s pretend I know nothing. Could you please tell
me about the intervention?” Examples of other questions were “What expectations did you have before?” and
“In what way have you supported your adolescents’ PA?” In accordance with the recommendations of Kvale
and Brinkmann (2009), follow-up questions (e.g., “Could you tell me more?” “How did you experience that?”)
were posed to obtain richer material. The interviews were carried out in a room without distractions at the
location the parent preferred: at the children’s school, at the parents’ worksite, or at home. All interviews were
conducted within 2 months of the conclusion of the intervention study. Author AKL, who had no professional
connection with the students, performed the interviews, which lasted between 30 and 60 min. The interviews
were sound-recorded and transcribed verbatim.
Data analysis
The transcribed data material from the interviews was analyzed as a whole. An inductive qualitative approach
was used (Elo &Kyngäs, 2008). The qualitative latent content analysis was performed according to Graneheim
and Lundman (2004), and all authors took an active part in the following procedure: (1) The written material was
first read through several times to obtain a sense of the overall data; (2) The text was divided into meaning units
and condensed; (3) In the abstraction process, the condensed meaning units were coded and the codes were
compared, contrasted, and sorted into preliminary categories. During this process, the authors strove to be
close to the text; (4) By going back and forth among the preliminary categories, the codes and the text
categories were identified; (5) The underlying meaning of the categories was interpreted and formulated into
three subthemes, which in turn formed one main theme.
Results
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The results were formulated into one main theme and three subthemes and representative quotations from the
transcribed text were used. The quotes are labeled with the number of the participant (1-10) and marked with F
for female or M for male.
Parents are one important part of a successful PA intervention
The three subthemes were combined in one main theme that shows parents having an important part to play in
order for the intervention to be successful in increasing the PA of their adolescents. Adolescents have many
options and demands in life that make it difficult to prioritize PA even if they know they should be physically
active. Although parents stated that they felt they were important in supporting their adolescents’ PA level in
general, our results show that a successful PA intervention should consist of multiple components. Furthermore,
it was the parents’ experience that the intervention had a positive effect upon both their adolescents’ and their
own PA.
PA is not always a priority
The parents recognized the advantages PA brought to their adolescents. They noted as well the obstacles
faced by the children, such as lack of time and the need to prioritize PA ahead of other appealing tasks; they
noted that their adolescents do not have an easy choice to make. The parents described being interested in
their adolescents’ PA and recognizing several benefits of PA, such as longer and healthier life, better stamina,
strength, and fitness. The parents had also noted disadvantages for their adolescents related to physical
inactivity, such as being overweight, getting headaches, and being irritable. Parents feared that their
adolescents would not have the physical capacity to master a physically demanding job in the future. The
parents perceived that their adolescents needed support concerning their PA and emphasized the importance
of creating a healthy lifestyle at a young age, because it is difficult to change behavior later in life.
M3: They are mostly inactive. I told my kid, you will have problems later on being so sedentary now. And the
habits you create at a young age will stick, it is hard to change a habit.
Parents who had athletically active adolescents stated that they were not so worried for their own adolescents’
PA but were concerned about the young generation overall. Even some parents of adolescents who were very
active in sports noted that their adolescents had a problem with physical inactivity, for example, on days when
they did not have a training session or were off-season for their sport. The parents stated that they were more
physically active during their own childhood relative to their children; they recognized barriers to their children’s
PA due to several changes that have occurred within society since their childhood. Examples that were
mentioned included technology such as television, computers, and smart phones; lack of spontaneous physical
activities, such as playing hockey in the street or going fishing; and less active transportation to school and
other places.
M7: They have lost spontaneous sport. It does not exist today. There are many other things that attract;
computers and mobile phones take up a lot of time. TV, for that matter: when I was growing up we had one
channel, and now …. They have no easy choices to make.
Other factors that negatively influence PA include a strong commitment and heavy workload at school; some
parents also noted that the girls prioritized spending time with their boyfriends over being physically active. The
parents identified factors such as tight time schedules and difficulties in solving the “puzzle of life in the family”
as barriers for their adolescents’ PA. Some also mentioned that lack of money and a tight budget might be a
problem. The parents stated that adolescents do not always have the ability to know what is best for them and
do not have the capacity to understand the long-term consequences of their actions. They believed that this
could also contribute to why adults are needed to support adolescents in PA.
I am important, but only one piece of the puzzle
The parents were very positive about the intervention, were pleased to be included, and stated that they were
mainly responsible for their adolescents’ PA in general. Simultaneously, they expressed their awareness that
they were only one part of a successful PA intervention. In addition to their own support, they mentioned school
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and sports clubs as other important authorities. The parents felt that school was the right context for a PA
intervention, because it reached every adolescent regardless of their other life circumstances, and they stated
that the adolescents might listen more to an “outsider.”
F10: Oh, how perfect, I thought when I heard about this. A health project at school, someone from the outside
saying the same thing as I am. Then maybe he will be more physically active. The teachers are annoying,
parents are annoying and nagging. It is simply a new voice.
The parents thought that they were important in encouraging their adolescents’ PA. They noted that their own
PA behavior had an impact on their adolescents and they wanted to act as positive role models. Furthermore,
they felt that it was more effective to act as a positive role model than to attempt to convince an adolescent with
facts or to nag them into being physically active. Another part of being a supportive parent was to help with
practical things, such as driving the adolescents to practices and games, assisting with funds for training
equipment, and arranging for adequate food for active children. The parents’ responsibility also included setting
limits in areas such as time spent at the computer. When reading the parental information brochures, parents
were impressed by their adolescents’ knowledge and their ability to find the right details to include in the
brochures. They also felt empowered, because the intervention provided several opportunities to communicate
about PA with their adolescents, as well as suggestions for what they as parents could do to support their
adolescents’ PA. Some of the parents also experienced a feeling of self-efficacy and a confirmation that their
previous attitude and actions had been correct.
F1: When I read this [the parental information brochure], I thought, how funny, we have done this, intuitively we
have done the right thing. It was like a confirmation; instead of feeling old-fashioned, I felt up-to-date.
One successful factor mentioned by the parents was that the intervention was built on their adolescents’ own
ideas and their own choice of PA. The parents mentioned that it was an advantage that the adolescents were
part of the project from start to finish, for example, that they were presented with the final results of the studies.
They felt that listening and giving the adolescents responsibility was the correct approach to addressing
adolescents and PA.
F6: This is great. And above all that you have listened to them, taken advantage of their expertise, given power
to them. Cooperation and involvement makes it fun.
Another contributing factor, according to the parents, was that the intervention included everyone instead of
targeting only the least physically active children. The involvement of the majority became a unifying factor in
the class and PA became a topic of conversation. The parents perceived that “fun” was an important factor in
motivating adolescents to be physically active. It was important that the adolescents found an activity they
perceived to be enjoyable. Some parents also stated that the young generation is driven too much by
enjoyment, which might become a threat to their health. The parents perceived that measuring PA had
contributed to their adolescents’ motivation to be physically active. According to the parents, a focus on
competitions and challenges might be a way of further enhancing the effect of a PA intervention for adolescents.
Regarding rewards, experiences differed among the parents. Although some parents had used rewards with
success, others were negative towards rewarding their adolescents when they were physically active. According
to some parents, rewards might be effective in the early stages of behavioral change. The parents feared that
using rewards would lead to inflation (i.e., the prize for a desired action could get higher and higher), and felt
that one should focus on the inner feeling of satisfaction gained from PA. Parents suggested introducing the PA
intervention at an earlier stage and also implementing long-term follow-ups as a part of a successful PA
intervention.
The intervention had a positive impact on my child and on me
The third subtheme showed that, according to the parents, the intervention had a positive effect regarding their
adolescents’ PA during and after the intervention period.
M2: My kid used to go by scooter but …
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