Influence of the Mother-Child Relationship on Nutrition and Physical Activity in Soweto, South Africa Open Access

Kirschner, Marcie (2015)

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Background: Childhood obesity is the leading nutritional issue for South African children. Overweight and obesity have a strong intergenerational link in families. However, no studies in South Africa have examined how mothers make health decisions for themselves and their children, which is pivotal because establishing healthy behaviors and attitudes in children has lifelong implications.

Objective: This study examined what individual, relationship, community, and societal-level factors affect South African mother's nutrition and physical activity decisions for her self and her child, and investigated where mothers received health information. Differences were compared between mothers whose child had a normal BMI-for-age compared to a child with an at-risk of being overweight and overweight BMI-for-age.

Methods: This qualitative study utilized individual interviews (n=22) with mothers who were participants of the Birth to 20 research study. The interview guide investigated a mother's habits and attitudes about nutrition and physical activity at the time of the interview, habits and attitudes about nutrition and physical activity over her lifetime (including while raising her child), and perceptions about nutrition and physical activity. Thematic analysis was used to determine findings that emerged from the data. Findings were compared in groups by the child's weight status.

Results: Influential information sources for mothers included health-focused professionals and classes, family members, people outside of the family, and media sources. Participants felt healthy eating had beneficial physiological effects on the body and exercise helped a person lose weight and get in shape. Doctors and health personnel were most influential to women whose children had a normal BMI-for-age whereas women with children who had an at-risk or overweight BMI-for-age found their mothers to be most influential. Mothers who had a child at-risk or overweight BMI-for-age breastfed less frequently and indicated less self-responsibility for health than mothers whose child had a normal BMI-for-age,

Discussion: By understanding the context in which Soweto's mothers make health decisions that impact herself and her children, more effective interventions can be made to target them. There is a necessity for interventions that can both increase a mother's self-efficacy regarding nutrition and exercise, while also targeting the family and community.

Table of Contents

Distribution Agreement. i

Abstract. iv

Acknowledgements. v

I. Introduction. 1

II. Review of the Literature. 5

III. Methodology. 17

IV. Results. 27

Sample Characteristics. 27

Information Sources. 29

Factors that Affect Decision-Making by Theory Level. 33

Unique Qualities of Group 1. 43

Unique Qualities of Group 2. 45

Unique Qualities of Group 3. 46

V. Discussion. 49

VI. References. 55

VII. Appendices. 62

Appendix A: Table 1. Progression of Eligibility Criteria. 62

Appendix B: Demographic Questionnaire. 63

Appendix C: Interview Guide. 66

Appendix D: Code Tree and Codebook used for Analysis. 71

Appendix E: Table 2. Continuous Characteristics of Interviewed Members of the Birth to 20 Cohort as a whole and by Group. 75

Appendix F: Table 3. Categorical Characteristics of Interviewed Members of Birth to 20 Cohort as a whole and by Group. 76

Appendix G: Figure 1. Thematic Mapping of Factors that Affect Mother's Decision-Making. 77

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