Diet and physical activity for children's health: a qualitative study of Nepalese mothers’ perceptions

Abstract

ObjectivesNon-communicable diseases account for 50% of all deaths in Nepal and 25% result from cardiovascular diseases. Previous studies in Nepal indicate a high burden of behavioural cardiovascular risk factors, suggesting a low level of knowledge, attitude and practice/behaviour regarding cardiovascular health. The behavioural foundation for a healthy lifestyle begins in early childhood, when mothers play a key role in their children's lives. This qualitative study, conducted in a Nepalese peri-urban community, aimed to explore mothers’ perception of their children's diet and physical activity.DesignWe notated, tape-recorded and transcribed all data collected from six focus group discussions, and used qualitative content analysis for evaluation and interpretation.SettingThe study was conducted in the Jhaukhel-Duwakot Health Demographic Surveillance Site in the Bhaktapur district of Nepal.ParticipantsLocal health workers helped recruit 61 women with children aged 5–10 years. We distributed participants among six different groups according to educational status.ResultsAlthough participants understood the importance of healthy food, they misunderstood its composition, perceiving it as unappetising and appropriate only for sick people. Furthermore, participants did not prioritise their children's physical activities. Moreover, mothers believed they had limited control over their children's dietary habits and physical activity. Finally, they opined that health educational programmes would help mothers and recommended various intervention strategies to increase knowledge regarding a healthy lifestyle.ConclusionsOur data reveal that mothers of young children in a peri-urban community of Nepal lack adequate and accurate understanding about the impact of a healthy diet and physical activity. Therefore, to prevent future cardiovascular disease and other non-communicable diseases among children, Nepal needs health education programmes to improve mothers’ cardiovascular health knowledge, attitude and behaviour.

High prevalence of prehypertension in mothers of young children in peri-urban Nepal

“…Those who are prehypertensive must be fi rmly and unambiguously advised to practice lifestyle modifi cation to reduce their risk of developing hypertension in the future 42 . This is particularly true for the mothers in our study, because maintaining an unhealthy lifestyleis likelyto not only adversely affect their own health but may also negatively infl uence their children's choices regarding diet and physical activity 25 .…”

“…Cardiovascular health emerged as an important but neglected issue in this community, particularly from the primary prevention perspective [22][23][24] . The aim of this paper was to specifi cally focus on mothers with children aged 1-7 years as mothersare the ones who are most involved in their children's behaviours related to cardiovascular risk factors including diet and physical activity 25 . We therefore estimated the extent of high blood pressure among mothers with emphasis on the concept of prehypertension and its association with obesity parameters.…”

Preference of Food-items and Physical Activity of Peri-urban Children in Bhaktapur

“…Likewise, we put the upper cut off at ten years as the mothers in our focus groups had expressed that it was very difficult to influence dietary and physical activity behaviour of those above 10 years or so. 14 We intended to include all these households in our sample.…”

“…14 Indeed, many factors determine children's eating habits and physical activity, 15,16 of which their preference for a particular food and activity can be a strong determinant. 17 This aspect has been studied mainly in high-income countries.…”

Mothers’ perceptions of their own diets and the diets of their children at 2–3 years of age

“…Even though mothers may know that factors such as quality, quantity, and variety are important to a healthy diet, it is possible to think that they are not always able to identify what kind of food are really healthy, what are the appropriate quantities recommended for themselves or their children, and how varied a diet should be to be effectively considered healthy. In this direction, a qualitative study conducted with mothers of school children, with a socio-economic level similar to those of the present study, identified that, although the mothers recognized the importance of healthy lifestyle habits and a healthy diet for their own health and that of their children, they had considerable difficulty in identifying what was contemplated within this concept, regardless of their educational level (Oli, Vaidya, Subedi, Eiben, & Krettek, 2015). In that study, they showed to have some appropriate concepts, such as considering ultra-processed foods to be incompatible with a healthy diet, also observed in the present study, as well as others that were inappropriate or contradictory, such as considering a healthy diet to be bland or appropriate only for sick people (Oli et al, 2015).…”