A qualitative study reporting maternal perceptions of the importance of play for healthy growth and development in the first two years of life

Abstract

Background In order for infants and toddlers to meet recommended movement guidelines, their caregivers need to encourage play daily. This study used a qualitative approach to understand how mothers perceive and promote play and physical activity during the first 2 years of life. Methods Mothers with children between 0 and 24 months were recruited from the SAMRC/Wits Developmental Pathways for Health Research Unit in Soweto, South Africa. 19 mothers agreed to participate and were grouped into three focus group discussions (FGDs) by age of the child: 0–6-months, 7–14-months, and 15–24-months. Thereafter, 12 mothers (4 from each FGD) were selected for inclusion in in-depth interviews (IDIs). After coding and theme/sub-theme identification had been completed for all IDIs, a process of cross-cutting theme identification and confirmation across FGDs and IDIs was carried out. Results The mothers were (mean ± SD) 27 (6) years old. All mothers had attended secondary school, but only nine had matriculated. Only one mother was married (and lived with the child’s father), and the majority (n = 15) were unemployed. Most children were male (63%) and were aged 11 (7) months. Four main themes emerged: 1) Physical activity as an indicator for health, 2) Promoting play and development, 3) Gender bias in play, and 4) Screen time. Conclusions This study showed that developmental attainment was the most important outcome for mothers, and so focussing intervention content on the promotion of child development through movement is advised. Screen time was freely available to children, and we recommend educating mothers on the movement guidelines, with a particular focus on the detrimental effects of screen time in this age group. Mothers reported many barriers to promoting play, and these are essential to consider when designing interventions in this context, in order to allow for equal opportunities for play to be provided to all children.

Describing correlates of early childhood screen time and outdoor time in Soweto, South Africa

“…Furthermore, 17% of respondents felt unsafe during the day in their neighbourhood, and 60% felt unsafe at night. Lack of access to outdoor, safe spaces to play or exercise has been reported previously in South Africa (Draper et al, 2018;Prioreschi et al, 2020;Ware et al, 2019).…”

“…While we know that being outdoors is associated with increased play and physical activity in children (Marino et al, 2012) and is thus recommended, given the lack of safety reported in this setting it may actually be of concern that such young children are spending this much time outside and exposed to unsafe environments. In the promotion of outdoor play, it is essential that safety of children be prioritized first (Draper et al, 2019; Draper et al, 2020; Prioreschi et al, 2020). In Soweto, a longitudinal birth cohort study (Birth to 20 Plus) has recently shown that 99% of the sample were exposed to violence in their home, school, and/or community as a child (Richter et al, 2018).…”

“…It has an area of approximately 200 km 2 and a population of around 1.3 million people with a density of 6357 people per square kilometre (Statistics South Africa, 2011). The details of the community sampling is explained in detail elsewhere (Prioreschi et al, 2020), but briefly-an online search provided the geolocations of each church structure in Soweto (n = 104). The churches were then classified using k-means clustering in order to define 30 communities with a 1 km 2 radius each.…”

“…Furthermore, safety is an issue as access to safe, outdoor facilities (such as parks and recreation areas) are limited (Draper et al, 2019; Ware et al, 2019). Data from our research team has shown that mothers of infants in Soweto, South Africa describe perceived safety in their neighbourhood as a barrier to allowing their children to play outside (Prioreschi et al, 2020). All of these contextual factors are likely to influence whether or not children in Soweto are able to adhere to recommended health behaviours.…”

Building knowledge, optimising physical and mental health and setting up healthier life trajectories in South African women (Bukhali): a preconception randomised control trial part of the Healthy Life Trajectories Initiative (HeLTI)

“…The trial was designed following the Standard Protocol Items (Recommendations for Interventional Trials (SPIRIT) 2013 statement). Through extensive qualitative (focus groups, in-depth individual interviews and stakeholder engagement)18–23 and epidemiological research,24–31 we identified our young women (18–28 years) as the target group given that a high proportion these women are already either overweight or obese and most will have their first child during this age range, and developed the intervention package. We initially opted for a cluster randomised study design in order to included community peer group sessions as part of the intervention.…”