Feeding-Related Knowledge, Attitudes, and Practices among Grandparents in Singapore

Abstract

Childhood obesity is a growing concern worldwide. Though multifactorial, the family environment exerts significant influence on children’s eating habits. Grandparents are increasingly involved as caregivers and they can significantly influence their grandchildren’s eating habits. Yet, literature on this topic is lacking. This exploratory sequential mixed methods study (qualitative interview and interviewer-administered questionnaire) aims to understand grandparents’ knowledge, attitudes, and practices on the feeding of their grandchildren in Singapore. A total of 11 interview participants and 396 questionnaire respondents with at least one grandchild, aged 12 years and below were included. Qualitative interviews informed the questionnaire development. Responses to interview questions about knowledge, attitudes, and practices revealed sub-themes such as knowledge on the impact of feeding, attitude toward feeding role, and challenges to feeding. Of the 396 participants, 35% were primary caregivers (defined as the person who spends the most time with the grandchild and performs most of the caregiving tasks). Nutritional knowledge was fair (median score 5/8), with misconceptions centered around healthy feeding practices. Grandparents who were primary caregivers, female, Malay, and younger than 70 years old believed that they played an important role in feeding their grandchild (p < 0.05). Overall, 47.2% of the grandparents rarely or never set a maximum limit on the amount of unhealthy food eaten, of which 77.1% are non-primary caregivers. In comparison, primary caregivers tend to set a maximum limit to the amount of unhealthy food their grandchildren eat and choose a wide variety of food (p < 0.05). These findings support the need for further improvement of grandparents’ feeding knowledge and practices as part of tackling childhood obesity.

Influencias familiares en las prácticas de alimentación materna a niños preescolares de familias vulnerables de la Región Metropolitana de Chile

“…Además, las abuelas se involucraron más directamente en la alimentación de sus nietos, preparando comidas caseras típicas o del agrado del niño, ofreciendo nuevos alimentos, incorporando alimentos saludables en diversas preparaciones e involucrando al preescolar en la preparación de alimentos. Estudios previos concuerdan con estos resultados, al destacar el rol que tienen los abuelos para diversificar la alimentación de sus nietos 60 y el rol específico de las abuelas como cuidadoras y transmisoras del conocimiento adquirido por su propia experiencia, sobre la alimentación en niños 57 , promoviendo así entornos alimentarios más saludables 61 .…”

The influence of grandparents on grandchildren. Scoping review.

“…Childhood obesity is associated with an increased risk of chronic diseases, such as cardiovascular disease and diabetes mellitus and also has a profoundly negative effect on children's psychological health 3,18,20,26 . Several sociodemographic and family environment characteristics, such as prenatal practice, socioeconomic status, and parental behavior, were found to be associated with the risk of obesity/overweight among children 3,19,21,24,27 .…”

“…The eating habits of children up to 12 years of age are significantly influenced by the family 26 . The family's eating environment includes the children's actual feeding practices, their eating habits, as well as the beliefs and attitudes they verbally convey about healthy nutrition and promoted eating behavior 3,27,30,31 .…”

“…3 he grandparents declared in these families that the child was strong, happy and healthy and not fat 3 , a situation also reported in the study by Li et al 19 . This characteristic was more accentuated when the grandparents were of low educational level and had little knowledge about healthy eating 3,26 . The higher level of education of those responsible for children is a protective factor against childhood obesity 33 .…”

“…Examples of this disparity are evidenced in American and Australian studies of migrant groups and indicate that people born in Italy and several other European countries are more likely to be overweight and obese compared to migrants from China and other Asian countries 18 . Still, grandparents widely play a crucial role in shaping the food environment in families of three generations living together 3,14,24,43 , and some are quite aware of their responsibility 26 . The sensation produced by the food and the care provided by the grandmothers are fixed in the grandchildren's memories surprisingly and can leave important marks in their life, making them safer, more affective, and healthier 14 .…”