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Introduction to the Project
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Obesity is a serious public health concern in the United States that puts millions of children and adolescents at risk of having poor health. Despite the intentions to control and prevent this condition among the chosen population, its prevalence remains high, and certain improvements are expected from various perspectives. For example, about 18.5% of American youth are reported to be obese, including approximately 21% of adolescents (12-19 years), 18% of school-aged children (6-11 years), and 14% of preschool-aged children (2-5 years) (Hales, Carroll, Fryar, & Ogden, 2017). The investigations of Ogden, Carroll, Kit and Flegal (2014) showed that there were no considerable changes in childhood obesity prevalence between 2003 and 2012, and additional surveillance is required. Because obesity has long-term health and financial consequences, new efforts must be addressed this kind of epidemic.
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One of the possible solutions to obesity-related problems is the engagement of parents in prevention. Many studies were developed to prove the role of parents in the adoption of healthy behaviors and lifestyles, physical activities, and dietary habits among obese children (Davidson & Vidgen, 2017; Lauricella, Wartella, & Rideout, 2015; Lee et al., 2017). The majority of investigations demonstrated the importance of improved awareness of obesity, parental involvement in childrens education, and multiple steps to be taken to predict and reduce the causes of obesity in families (Liu et al., 2018; Muthuri et al., 2016). This project aims at investigating childhood obesity in a specific population (low-income Latino families) and the implementation of educational sessions about physical activities among parents measured certain assessment tools. Quantitative research will be developed with a quasi-experimental design as the main research instrument and self-reported body weight (SRBW) measurements and a physical activity questionnaire as the major assessment tools to prove the worth of educational sessions for parents.
In this chapter, an overall introduction of the project will be given to explain the goals and methods of research. The background of the project focuses on past studies and achievements made in the field of childhood obesity. Problem and purpose statements will show how this direct practice involvement (DPI) project may contribute to the chosen field and finding out the solution to the problem.
A list of clinical questions will help to narrow the focus of the study and identify the most crucial aspects of childhood obesity and parents education. There are also several additional sections in this chapter, including advancing scientific knowledge and the projects significance, that identify and justify the gaps and needs of the current investigation. Finally, the rationale for methodology and design enhances the development of the project and the definition of important terms, limitations, and assumptions.
Background of the Project
During the last several decades, the problem of childhood obesity has been frequently discussed in many healthcare and academic facilities in the United States. The Centers for Disease Control and Prevention and the US Department of Health and Human Services are the main organizations that discuss the etiology and prevalence of obesity in different populations.
Davis, Wojcik, and DeWaele (2016) explained that the rate of obesity in children and adolescents changed from 5% to 21%, giving rise to such major health problems as diabetes, cancer, and cardiovascular diseases. Risk factors caused by obesity include physical inactivity, high levels of cholesterol in the blood, excess weight, and shortness of breath (Sahoo et al., 2015). Therefore, the improvement of a physical condition of a child turns out to be an evident contribution to the progress of childhood obesity statistics, and parental involvement cannot be ignored in this discussion.
The demography and population structure have to be taken into consideration in obesity research as such factors as gender and ethnicity have specific roles in obesity prevalence and epidemiology. The Centers for Disease Control and Prevention (2015) traced the statistics of overweight and obese children and adolescents from 1971 until 2012 and indicated the rise of overweight children from 10% to 15% and obese children from 5% to 17%. Among these numbers, there were (Centers for Disease Control and Prevention, 2015):
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10% of overweight boys in 1971 and 15.4% in 2012;
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5% of obese boys in 1971 and 16.7% in 2012;
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10% of overweight girls in 1971 and 14.5% in 2012;
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5% of obese girls in 1971 and 17.2% in 2012.
Population race and ethnicity factors also define the frequency and severity of obesity-related problems in children. The investigation of Kimm et al. (as cited in Fradkin, Wallander, Elliott, Cuccaro, & Schuster, 2016) proved that African American and Hispanic children are twice affected by obesity compared to White children because of the inability to keep to healthy lifestyles, low-income levels in families, and poorly developed education and prevention programs.
In Hispanic families, low awareness of the threats of fast food and sweetened-beverage consumption is observed, contributing to serious changes in the body mass index (BMI), which results in obesity increase (Guerrero et al., 2016). Today, parental support programs are developed around the whole globe. Even though many of them prove the long-term positive effects of vegetable intake on obesity prevention, its efficacy in different ethnic groups remains unknown (Nyherg et al., 2015). Changes in parents education about the threats of obesity and fast-food lifestyles in children can be promoted to support parents with different origins in the same racially unbiased way.
Problem Statement
Being a critical nutritional disorder, obesity leads to several changes in health care, family finances, and communities. Regarding current social norms, living principles, and peoples interests, its morbidity, incidence, and persistence are hard to control. Besides, weight regulation is usually predetermined by various genetic, environmental, and development factors, so these mechanisms vary between populations (Pandita et al., 2016).
Obesity can be rooted in a childs behavior, family traditions and customs, and social activities. According to Chesi and Grant (2015), abnormal fat accumulation is a trait that is originated from environmental and genetic factors. For example, when the body consumes an extensive amount of calories through uncontrolled or poorly organized food consumption or sweetened beverages, it is hard to burn them and maintain the required BMI (Xu & Xue, 2016).
In some children, genetic factors play a crucial role, and even regular physical activities and exercises are not enough to predict body changes and the work of physiological mechanisms (Chesi & Grant, 2015). Therefore, a childs weight, height, and other vital signs have to be controlled either by a healthcare provider or a parent, or another caregiver.
Parental responsibilities in regards to their childrens health are thoroughly evaluated in primary care settings, family planning facilities, and other organizations. Parents understand the worth of their influence on children because of the necessity to guide, support, and become good examples from legal and humane points of view (Wolfson, Gollust, Niederdeppe, & Barry, 2015). In modern media, there are many cases when parents are accused of having obese children (Wolfson et al., 2015).
Questions and concerns about the quality of care parents are raised in families with low incomes. When people become parents for the first time, they can be lost in a variety of information about infant feeding, further physical training, and adaptations to social needs and expectations (Love, Laws, Litterbach, & Campbell, 2018). In Hispanic, Latino, and African American families, children have high BMI from an early age, and parents must know how to protect their kids regardless of their genetics, environment, and other issues (Guerrero et al., 2016). To avoid unpredictable financial complications and physical or mental impairment, the idea to improve peoples awareness about obesity, and the necessity to control BMI will be developed.
Still, not many parents are eager to be educated about the physical, nutritional, and genetic peculiarities of their children when those are at schools. People expect that school teachers, the medical staff, and administration are responsible for the development of any child in terms of their knowledge as well as physiology. It is not known how education sessions may influence parental involvement in controlling their childrens physical activities and BMI. Especially, little information is available about childhood obesity prevention in Hispanic families with low incomes, and there is a need to clarify weight changes in children due to education for parents.
In their sessions, educators need to emphasize both eating habits and exercise. Information about healthy eating should provide parents with both a theoretical basis (nutritional value, micro-, and macroelements) and practical tools. Tips on introducing exercise should be age-appropriate and fit different lifestyles. It is easy to imagine that mothers and fathers might be experiencing pushback from their children unwilling to commit to making changes as well as criticism from other parents. Thus, the contents of educational sessions should not only include dry facts but also offer guidance and emotional support.
Purpose of the Project
The purpose of this quantitative quasi-experimental DPI project is to see to what degree such factors as parental education levels, family affluence scale, and family economic status will help to define obesity problems and physical activities in elementary school children in Hispanic low-income families. The quality improvement project will be developed into three main stages. During pre-test activities, it is expected to gather information about participants (their gender, age, and social statuses) and mention all the necessary indicators in the intervention, including the number of physical activities and obesity-related problems.
The intervention itself occurs next during which the participants receive education and improve their knowledge about obesity in children for one month. Parents will be educated about the energy balance, the role of dietary habits, and the worth of physical activities at an early age (Brown, Halvorson, Cohen, Lazorick, & Skelton, 2015). During sessions, it is important to explain why parental involvement in childhood obesity prevention is critical for families. Finally, post-test activities and questions will be developed to clarify the results and develop discussion.
It is planned to cooperate with local hospitals and review the records of patients who were diagnosed as overweight or obese at the age of 5 to 11 and choose families with obese children for participation. Measurement of BMI is an important stage of this project. Olfert et al. (2018) recommended self-reported height and weight as simple and economic tools to track changes in a childs body weight over time.
These measurements may be taken at home and reported to a research team or obtained via surveys without direct measurements and specific measuring tools (Olfert et al., 2018). In this project, surveys for participants will be developed to gather enough credible information about childrens physical conditions and vital signs that help to recognize obesity as a serious disease. Besides, the Physical Activity Questionnaire for Older Children (PAQ-C) will be used. Parents will answer the questions from the questionnaire relying on the results of their children and the observations made.
Clinical Questions
Many studies support the idea of parents education to prevent and control childhood obesity. For example, the researchers from the Centers for Disease Control and Prevention (2018), parents as guardians to childs health should balance calories consumed by a child, be in charge of the quality of food and beverages taken, and promote physical activities to stay active during a day not at expense of other health conditions. Some many technological advances and applications encourage parents to maintain their childrens healthy lifestyles (Avis et al., 2015).
Financial aspects and personal challenges may prevent the use of knowledge, and families need to be ready to combine their experiences to achieve the best results in reducing the weight of children. At the same time, parents education and income have to be the two separate issues (Liu et al., 2018). Children from low-income families should not suffer or be reduced in the opportunities just because of their financial statuses, and the task of parents is to overcome the barriers and promote equal health-related conditions.
Clinical questions to be answered in this DPI project depend on the variables chosen for the quantitative quasi-experimental research that include parental education levels, family affluence scale, and subjective family economic status. The intervention lasts for one month to make sure that new knowledge is obtained, certain evaluations are made, and some changes occur. It is not enough to offer a new idea and expect that parents accept it with ease. Assessment tools, evaluations, and evident examples have to be used in the study. The following list of clinical questions helps to identify the main variables and predictive statements:
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Question 1 (the major PICOT question): For parents of elementary school-aged children from Hispanic low-income families, will an education session about physical activities and reduced caloric intake compared to no session be effective in controlling and preventing childhood obesity within one month?
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Question 2: What are the effects of family affluence scale results on the development of childhood obesity?
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Question 3: What are the differences between obesity in Hispanic and White children with different levels of education among parents?
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Question 4: What the connection between obesity prevention and family economic status is?
Advancing Scientific Knowledge
In modern society, several norms and principles on how to control and treat childhood obesity have already been established and approved. In Europe, schools are defined as the key places where people learn how to recognize and treat obesity and develop new intervention studies (Clarke et al., 2015). School-based programs for children and parents result in a considerable decrease in childrens and parents BMI in case all follow-up behavioral and dietary recommendations and protocols are taken into consideration during the entire education process (Pablos, Nebot, Vañó-Vincent, Ceca, & Elvira, 2017; Quattrin et al., 2014).
However, there is still a considerable gap in studying the role of parents in preventing childhood obesity regarding the social and economic statuses of families. There is a need for investigations about Hispanic families and the challenges or opportunities they have to predict and control childhood obesity.
In this project, the decision to use the social cognitive theory as a major theoretical framework is made. According to McGee, Richardson, Johnson, and Johnson (2017), the social cognitive theory (SCT) is a perfect solution to explore and evaluate perceptions and beliefs that are related to healthy lifestyles and physical activities in children. This model predicts social expectations and recommendations to achieve the desired behavioral change.
There are seven important components in this theory, including self-efficacy (the belief), behavioral capability (an understanding), expectations (outcomes), expectancies (values), self-control (monitoring), observational learning (modeling), and reinforcements (incentives) ( Social cognitive theory, n.d.). In terms of this theory, the researcher will be able to understand certain motivational factors of parents and children to decrease body weight and avoid obesity-related complications in the future.
This project covers the problems of obese children and the participation of parents in BMI control. Weihrauch-Blüher et al. (2018) developed the guidelines to prevent obesity in children and adolescents, and education on physical activities, behaviors, and dietary habits were the parts of the program. Advanced scientific knowledge of this DPI project is to focus on the importance of parents education on physical activities for children and the intentions to control calories and the quality of food, regarding their social and financial statuses at the moment of the intervention.
Significance of the Project
Despite numerous attempts to control and prevent obesity in children, this disorder is still a burning issue in health care. This project is addressing childhood obesity through parents education about physical activities, the number of calories, chosen food and beverages, and behaviors. At the end of this project, it is expected that each of the research questions is answered. In the case of Question 1, it is implied that there will be evidence or the lack thereof on the efficacy of school-based interventions.
As for the remaining questions, researchers seek to establish a correlation between such variables as family economic status and parents education levels and health outcomes in children. In case strong associations are found, educators and policymakers will have a more sophisticated theoretical basis for developing intervention strategies.
Although this project focuses on parents and children, the role of nurses and caregivers cannot be ignored. Laws et al. (2015) admitted that regardless of their preparedness, many nurses lack confidence and experience in raising sensitive lifestyle issues. Therefore, it is important to support education sessions and integrate obesity prevention interventions into real-life practices.
Another benefit of this project is the possibility to improve the knowledge of families about obesity and its further impact on a childs health. Parental involvement interventions strengthen the relationships between children, parents, and medical workers. However, the findings developed by Kim, Park, Park, Lee, and Ham (2016) showed that five weeks could hardly be enough for involvement programs to observe significant changes in childrens health and weight. In this DPI project, the task is not to achieve a considerable BMI decrease but to improve parents awareness of obesity and prove the effectiveness of education sessions in Hispanic low-income families.
The findings of the project will add value to the Hispanic population in terms of health improvement and parent-child cooperation to accomplish the same goal and understand the worth of physical activities and healthy lifestyles. Obesity is a disorder that leads to a variety of diseases and complications, and education sessions must prepare parents for such changes and explain how they can protect their children. Practical application includes the exchange of experience, professional communication between parents and healthcare workers, and new tips for maintaining a healthy weight.
Rationale for Methodology
The choice and justification of methodology is a crucial step in any project because it determines the way of how information should be gathered and analyzed. A quantitative approach that is framed in terms of user numbers, pre-determined methods, and statistical analysis and interpretation are chosen for this DPI project (Creswell, 2014). In medical or nursing research, quantitative data contributes to describing recent literature findings and identify the gaps in research to address them in the future (Gicevic et al., 2016).
To answer the main clinical question, it is expected to compare different situations and analyze the results and the conditions of dependent variables regarding the chosen independent variables. In other words, it is necessary to examine the relationship between dependent and independent variables mathematically using statistical analysis. These are the main characteristics of quantitative methods that prove the correctness of the chosen methodology.
In this DPI project, quantitative information is based on the review of the results that are independent of the writers opinion, observations, and attitudes towards the problem of childhood obesity in low-income families. Therefore, the chosen approach promotes increased objectivity and biased-free results. In the majority of cases, quantitative data is defined as more credible and reliable for decision-making and evaluations compared to qualitative one (Creswell, 2014).
The investigations by Hales et al. (2017) and Muthuri et al. (2016), as well as the results of the Centers for Disease Control and Prevention (2015), demonstrate how effective statistical data is when the analysis of the disease, its prevalence, and control are required. A quantitative approach is a good opportunity for the researcher to gather the already available information about childhood obesity in a specific population, identify influential factors for parental involvement and education, and clarify further improvements.
The aforementioned methods of data analysis will be of use when answering each of the research questions. The first research question implies that a controlled trial will be conducted. In this case, quantitative methodology and statistical analysis will help compare and contrast the percentage of children who gained weight in two groups within one month. The remaining three research questions deal with a correlation between two variables: family influence and the likelihood of childhood obesity, parents levels of education and obesity rates in children, and prevention outcomes and economic status respectively. Thus, the quantitative methodology will help calculate and interpret the coefficient r.
Nature of the Project Design
A quasi-experimental design resembles an experimental design with the only distinctive feature that is the lack of randomization. It is frequently used to evaluate the effectiveness of treatment or interventions when an independent variable may be manipulated because a dependent variable is measured (Creswell, 2014). Regarding the goals of the project and the necessity to clarify the effectiveness of an education session for parents, a quantitative quasi-experimental pretest-posttest design is chosen.
The strengths of this methodological approach include the identification of specific trends in the study, the possibility not to limit sample size, and the evaluation of the same issue within a different time frame. Peters et al. (2016) used the same design to identify and assess the capacities of low-income communities in their intentions to create appropriate environments and prevent childhood obesity. The same approach with new validated instruments and assessment tools will be developed in this project to understand the worth of parental involvement through an education session about physical activities.
It is planned to choose 40 families with obese or overweight children (the major inclusive criterion) whose parents agree to participate in the intervention and take several lessons about obesity, physical activities, and body weight control. The participants should be the residents of the Southeast region, Charlotte, NC. They will receive written consent forms via email or personally in their clinical settings. As soon as they sign the form, they will be provided with survey questions to check their knowledge and abilities to self-report on body weight and height (Olfert et al., 2018). After starting the intervention, several education sessions will be organized for a group of parents for one month. In the end, the same tests and self-reported surveys will be offered to gather final results and begin data analysis based on SPSS software.
Definition of Terms
The analysis and assessment of obesity-related problems begin with the identification of the most important terms. The participants of this project are the parents from Hispanic low-income families, and many of them may lack an understanding of obesity terms and definitions. Therefore, it is necessary to clarify all words that may require an additional explanation to avoid confusion or misinterpretation. The following terms will be operationally used in this DPI project:
Overweight
It is a condition that is characterized by excessive fat mass that influences a persons health and contributes to the development of new diseases. The BMI level of overweight people is usually higher than 25 kg/m2 but lower than 30 kg/m2 (World Health Organization, 2018). Overweight is usually a critical sign of obesity in children and adults.
Obesity
It is a disorder that involves abnormal body fat that leads to an increase in new health problems and complications. Obesity is a multi-factorial disorder that may have genetic or environmental origins (Chesi & Grant, 2015). This condition is identified if a person has a BMI that is equal to or greater than 30 kg/m2 (World Health Organization, 2018). Regarding the levels of BMI, obesity may be classified as severe and morbid.
Body mass index (BMI)
It is an important screening tool that is used to measure obesity. BMI is the result of the measurement of a persons weight in kilograms divided by height in meters squared (Ogden et al., 2014). This comparison is closely related to an understanding of body fatness and measuring weight and height across populations.
Fat mass
It is the actual weight of fat in a persons body. The percentage of body fat can be measured by several methods, including underwater weighing, also known as densitometry, or multi-frequency bioelectrical impedance analysis (BIA) (Sahoo et al., 2015). Fat mass excludes the mass of muscles, human organs, and bones.
Self-reported body weight and height (SRBW and SRBH)
It is a simple, economical method to measure the changes in body weight and height over time (Olfert et al., 2018). These measurements can be of two categories: those taken in the home environment and then reported to researchers or other involved medical experts and those without direct measurements but obtained from surveys (Olfert et al., 2018). SRBW and SRBW are credible and valid tools to be used within different periods.
Assumptions, Limitations, Delimitations
Two main assumptions can be done in this DPI project. Firstly, it is assumed that an education session that will be offered to parents during one month would be organized as per recent credible studies and guidelines developed by the Centers for Disease Control and Prevention and meet all the care standards and pedagogical techniques. Secondly, it is believed that the participants would give honest and definite answers to all the questions in the PAQ-C and report on weight and height measurements obtained from their children.
The main limitation of the project is the time spent on educational intervention. Kim et al. (2016) already reported about the impossibility to observe evident changes in body weight after a five-week intervention. Another limitation includes small sample size and the necessity to cooperate with the representatives of one ethnic group (Hispanics) only. The limit of the demographic sample can be improved in further investigations in case at least minimal changes would be recognized. Finally, the data collection methods involve the opinions of parents who may be biased or prejudiced to a researcher or the idea of obesity in children. Therefore, it is recommended to tape communication between the researcher and participants to identify possible biases.
Delimitations are the things that help to control the project despite the existing limitations and unpredictable assumptions. In this case, the location of the DPI project (local hospitals and communities in Charlotte, NC) is the major delimitation that promotes the possibility to choose people, postpone or plan decisions, and consider the environment. Another benefit includes the chosen quantitative methodology and the possibility to surf the web and find new sources with guidelines and recommendations for education sessions.
Summary and Organization of the Remainder of the Project
In this DPI project, the main task is to understand the effects of education sessions that may be organized for parents in their intentions to prevent and control obesity in their children. McGee et al. (2017) explained the role of ethnic differences among the participants, and Chesi and Grant (2015) focused on the genetic peculiarities of this nutritional disorder. The necessity to promote parental involvement in monitoring a childs BMI and the quality of food and beverage intake cannot be ignored in any family, including those with low incomes. The study will have implications for health practitioners, nurses included, as the findings might constitute a theoretical basis for school-based interventions.
Direct communication with parents and their awareness about obesity threats and associated challenges are the core aspects of this project. In addition to the fact that the participants have to share self-reported measurements and demonstrate their level of knowledge, they need to understand their roles in their childrens lives. This chapter helped the researcher to clarify the major aspects of future work and identify the questions and available resources.
A new theoretical background, a quantitative method, and a quasi-experimental design are the major characteristics of this project. In this chapter, an overall introduction of the work and evidence of the worth of the chosen topic and intervention were given. In the following chapters, a detailed discussion will be developed: the literature review on the chosen topic (Chapter Two), the methodology and design (Chapter Three), data collection/analysis procedures (Chapter Four), and the results of the intervention (Chapter Five).
Literature Review
This quantitative quasi-experimental DPI project is aimed at examining the effect of education on physical activity received by parents on obesity levels observed in school-aged children residing in the Southeast region of the United States. Therefore, this chapter provides a review of the existing literature on a variety of interventions and approaches that are currently applied by parents and professionals to address the issue of childhood obesity.
The chapter includes the background information on the problem of obesity in school-aged children and parental involvement, the section on theoretical foundations guiding this quality improvement project, and the literature review section. This major section is divided into subsections discussing key themes identified in the literature and related to the project variables: childhood obesity, parental involvement, parents awareness, interventions, ethnic and cultural diversity, community, and family involvement.
The recently published literature on the problem of obesity in school-aged children as well as interventions and programs for parents has been reviewed and analyzed for this study. The following databases and resources were used to search for, survey, and retrieve appropriate articles from peer-reviewed journals: Google Scholar, PubMed, ScienceDirect, EBSCOhost, and CINAHL database. The keywords used during the search included different combinations of the following words: school-aged, children, obesity, parents,
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