Knowledge, attitude and practice on diet and physical activity among mothers with young children in the Jhaukhel-Duwakot Health Demographic Surveillance Site, Nepal

Abstract

The prevalence of cardiovascular diseases is increasing in low and middle-income countries; Nepal’s population shows a high prevalence of behavioral risk factors. Our cross-sectional study in the Jhaukhel-Duwakot Health Demographic Surveillance Site (JD-HDSS), located near the capital Kathmandu, explored knowledge, attitude, and practice (KAP) of mothers with young children regarding diet and physical activity and mothers’ perception of their children’s attitude and behavior toward the same issues. The purpose of our study was to assess needs of the mothers concerning cardiovascular health in general and more specifically regarding diet and physical activity, and to establish a baseline for future intervention in the community by comparing two villages of JD-HDSS. In August–November 2014, nine trained enumerators interviewed all mothers of children aged 1–7 years (N = 962). We scored responses on dietary and physical activity KAP, then categorized the scores based on the percentage obtained out of the maximum possible scores into “poor,” “fair,” and “good.” More highly educated mothers scored higher for KAP (all p<0.001); the children’s behavior score reflected their mother’s education level (p = 0.007). Most respondents were unfamiliar with the concept of healthy and unhealthy food. Overall, 57% of respondents in JD-HDSS had “good” knowledge, 44.6% had “good” attitude, and most (90%) had “poor” practice. We observed no significant differences between the villages regarding mothers’ knowledge and attitude or children’s behavior. Practice score of mothers in Jhaukhel was higher than those in Duwakot regarding diet and physical activity (p<0.001). Mothers’ perceived barriers for improving lifestyle were high cost of healthy food, taste preference of other family members, and lack of knowledge regarding healthy food. Barriers for physical activity were lack of leisure time, absence of parks and playgrounds, busy caring for children and old people, feeling lazy, and embarrassed to be physically active in front of others. Our findings suggest that a health education intervention promoting a healthy lifestyle for mothers and children might improve KAP and also improve cardiovascular health. To address mothers’ gap between knowledge and practice, a future intervention should consider perceived barriers.

Effectiveness of health promotion regarding diet and physical activity among Nepalese mothers and their young children: The Heart-health Associated Research, Dissemination, and Intervention in the Community (HARDIC) trial

“…In families with more than one child aged 1-7 years, the oldest child was selected for data analysis regarding behavior. We scored KAP responses as previously described [27] and combined relevant scores to calculate composite scores for mothers' KAP as well as for children's behavior. Mothers' KAP scores and children's behavior scores were divided into three categories based on a percentage of maximum possible scores: 'good' (76-100%), 'fair' (51-75%), and 'poor' (0-50%).…”

“…Mothers' KAP scores and children's behavior scores were divided into three categories based on a percentage of maximum possible scores: 'good' (76-100%), 'fair' (51-75%), and 'poor' (0-50%). The maximum possible scores for mothers' KAP were 73, 192, and 17, respectively, and the maximum score for children's behavior was 110 [27]. Due to non-normal data distribution, median and interquartile range (IQR) for KAP scores were calculated for diet and physical activity.…”

“…The initial plan called for the recruitment of 40 peer mothers (PM) from 440 eligible mothers in the five intervention wards in Duwakot [27]. The PMs would then reach out to 400 fellow mothers (FMs) at a ratio of 1:10.…”

“…The intervention was based on the findings of the qualitative study with mothers as well as the baseline findings in JD-HDSS, which showed widespread misconceptions about healthy food and the importance of physical activity [21,27]. After reviewing national and international guidelines regarding diet and physical activity and consulting with our international collaborators, finally, the health education intervention program was tailored to the local Nepali context [29,30].…”

“…Using the same questionnaire that was developed and applied for the baseline study and described previously [27], the follow-up survey measured the effect of the intervention on mothers' KAP for diet and physical activity. It also assessed the possible impact of the intervention on children's behavior regarding diet and physical activity, based on the perception of their mothers.…”