manoj sharma, mbbs, ches, ph.d. associate professor, university of cincinnati
Post on 30-Dec-2015
13 Views
Preview:
DESCRIPTION
TRANSCRIPT
Developing and testing an instrument to evaluate childhood obesity prevention behaviors based on social cognitive theory
Manoj Sharma, MBBS, CHES, Ph.D.Associate Professor, University of Cincinnati
Donald I. Wagner, HSDProfessor, University of Cincinnati
Session 4190, Board 1, November 7 (T), 2:30 pm
Background
Since 1980 the prevalence of overweight has doubled for children and tripled for adolescents
The national health care expenditures related to overweight and obesity in adults are estimated between $98 billion to $129 billion
In the Healthy People 2010 Report, the goal for reducing overweight and obesity in children and adolescents is aimed at 5 percent from the 1988-94 baseline of 11 percent
Problems with Childhood Obesity
The Bogalusa Heart Study found that by age 10 years, 60% of overweight children have at least one biochemical or clinical cardiovascular risk factor and 25% have more than two
Childhood obesity is associated with several short term medical consequences such as adverse blood lipid profile, altered glucose metabolism, obstructive sleep apnea and long term effects such as higher risk of hypertension, diabetes, cardiovascular disease, gall bladder disease, and osteoarthritis in adulthood
Public health strategies to combat childhood obesity
Promoting breastfeedingLimiting television viewingEncouraging physical activityIncreasing fruit and vegetable intakeControlling portion sizeLimiting soft drink consumption
Purposes of this study
The purpose of this study was to develop and test an instrument that reified the constructs of expectations, self-efficacy and self control for four common behaviors modulated in childhood obesity prevention programs, namely: television viewing physical activity fruit/vegetable intake water consumption.
Secondarily, to examine the extent to which selected social cognitive theory constructs (expectations, self-efficacy, and self control) can predict the four behaviors of: Daily moderately intense physical activity of 30 minutes Limiting television viewing to two hours per day Increasing water consumption to eight glasses per day Increasing fruit and vegetable intake to five or more servings
per day in upper elementary children.
Methodology
Design: Cross-sectionalStudy conducted in December 2004 Institutional Review Board (IRB)
permission from the University was obtained
Parental permission was obtained Child’s assent obtained before filling
the questionnaire
Instrumentation
A 52-item scale was developed and validated for face and content validity by a panel of six experts in a two round process
Administered to 159 fifth graders Confirmatory factor analysis confirmed one
factor solution for each of the components measuring outcome expectations, outcome expectancies and self-efficacy for each of the four behaviors
Cronbach’s alpha and test-retest reliability coefficients for all the subscales were found to be over 0.70
Demographics of the sample
Age: 69.9% - 10 yr olds 27.9% - 11 yr olds 2.2% - 12 yr olds
Gender: 47% - boys 53% - girls
Ethnicity: 64.7% - Caucasian 22.8% - African American 2.2% - American Indian 7.4% - Other race
Previous exposure
Exposure to sessions about healthy eating in school : 68.4% - 3 or more 19.1% - 2 5.9% - 1 5.9% - None
Exposure to sessions about engaging in physical activity or exercise at home: 69.9% - 3 or more 14.0% - 2 9.6% - 1 5.9% - None
Means and standard deviations of behavioral variables
n Minimum
Maximum Mean Std. Deviatio
n
Number of minutes exercised at home in past 24 hours
134 0 240 29.99 42.09
Number of hours watched TV in past 24 hours
135 0 10 2.51 2.36
Number of glasses of water consumed in past 24 hours
133 0 15 3.59 2.78
Number of servings of fruits ate in past 24 hours
132 0 6 1.87 1.51
Number of servings of vegetables ate in past 24 hours
132 0 6 1.81 1.55
Number of fruits and vegetables consumed in the past 24 hours
131 0 11 3.67 2.61
Means and standard deviations of SCT variables for exercise
n Minimum Maximum Mean Std. Deviatio
n
Expectations for exercising 30 min daily
127 0 60 30.46 15.07
Self-efficacy for
exercising 30 min daily 132 0 12 6.72 3.48
Self control to set goals for exercising 30 min. daily
135 0 4 2.66 1.34
Means and standard deviations of SCT variables for TV watching
n Minimum Maximum Mean Std. Deviatio
n
Expectations for watching less than 2
hours of TV daily
125 0 64 24.98 16.69
Self-efficacy for watching less than 2 hours of TV daily
129 0 12 5.93 3.76
Self-control for restricting TV watching to less
than 2 hours daily
134 0 4 2.16 1.57
Means & standard deviations of SCT variables for drinking water
n Minimum Maximum Mean Std. Deviatio
n
Expectations for drinking 8 or more glasses of water per day
130 0 64 34.20 15.78
Self-efficacy for drinking 8 glasses of water per day
130 0 12 7.05 3.51
Self control for drinking 8 glasses of water per day
134 0 4 2.57 1.44
Means & standard deviations of SCT variables for fruits/veg.
n Minimum Maximum Mean Std. Deviatio
n
Expectations for eating five or more servings of fruits and vegetables daily
133 0 64 36.18 17.18
Self-efficacy for eating five or more servings of fruits and vegetables daily
134 0 12 6.71 3.59
Self control for eating five or more servings of fruits & vegetables daily
132 0 4 2.56 1.45
Final regression model for exercising (adjusted R2 0.072)
Unstandardized Coefficients B
Std.
Error Standardized Coefficients Beta
t p-value
(Constant) -11.706 13.721
-.853
Number of times taught in school to do physical activity/exercise at home
10.033 4.431 .205 2.264 .026
Self-efficacy for exercising 30 min daily at home
2.532 1.122 .205 2.256 .026
Final regression model for TV watching (adjusted R2 0.055 )
Unstandardized Coefficients B
Std.
Error Standardized Coefficients Beta
t p-value
(Constant) 4.819 .830 5.809
Number of times taught in school about healthy eating
-.610 .279 -.201 -2.190 .031
Self-control through goal setting for restricting TV watching to less than 2 hours per day
-.301 .146 -.189 -2.062 .042
Final regression model for water drinking (adj. R2 0.091)
Unstandardized Coefficients B
Std.
Error Standardized Coefficients Beta
t p-value
(Constant) 1.576 .605 2.606
Expectations for drinking 8 or more glasses of water per day
5.608E-02 .016 .315 3.528 .001
Final regression model for fruits/veg. (adj. R2 0.137)
Unstandardized Coefficients B
Std.
Error Standardized Coefficients Beta
t p-value
(Constant) 1.747 .479 3.647
Self-efficacy for eating five or more servings of fruits and vegetables daily
.275 .062 .380 4.420 .000
Main conclusions
In the case of physical activity, the number of sessions of physical education (p<0.026) and self-efficacy for exercising (p<0.026) were significant predictors
In the case of watching TV, the number of times taught about healthy nutrition (p<0.03) and self control for watching less than two hours of TV (p<0.04) were significant predictors.
Main conclusions…2
In the case of drinking water, the only significant predictor was expectations for drinking eight or more glasses of water (p<0.001).
In the case of fruit and vegetable consumption, the only significant predictor was self-efficacy to eat five or more servings of fruits and vegetables (p<0.0001).
Implications for Practice
More health education programs in upper elementary children are needed that promote: Daily moderate intensity physical activity of 30 minutes Limit television viewing to two hours per day Increase water consumption to eight glasses per day Increase fruit and vegetable intake to five or more
servings per day Social cognitive theory (SCT) - excellent
framework to design such interventions SCT interventions can be implemented by health
and physical education teachers
Implications for Practice…2
Self-efficacy can be built through using credible role models. Boosted by focusing on specific tasks, breaking down
complex tasks into simple steps, inculcating participatory practice that leads to mastery
To influence self control, students must be encouraged to set goals to accomplish desired behaviors and reward themselves upon accomplishing the goal.
More needs to be done with regard to understand behavioral determinants of childhood obesity and designing and evaluating behavior change interventions
Limitations
The study did not use random selection of subjects which introduced sampling bias
One-day recall was employed to measure the primary dependent variables. While it offers advantage in accuracy of recall it may not accurately depict the typical day for the participant
The instrument was all self-report and that too introduces measurement bias. However, the instrument was read to the participants to account for varying levels of readability and reduce measurement bias.
The design of this study was cross-sectional and as such nothing can be said about temporality of association
top related