An Ecological Approach to Understanding Health Promoting Behaviors of Children from Low-Income Families: A Multi-Level Analysis

Purpose: 'Health disparity' is becoming a serious issue worldwide. The practice of health promoting behaviors (HPB) among childhood is influenced not only by individual factors but also by diverse environmental factors including family, peer relationship, school, and community organization. The purpose of this study was to investigate the ecological factors influencing HPB of children from low income families.  

Methods: Participants of the study included 297 fourth to sixth grade elementary school students from low-income families, 297 caregivers, and 68 community children center teachers. Data was collected by structured self-report survey, and a multi-level regression analysis was conducted.

Results: The mean score of HPB of children was 3.16, and the highest point was in injury prevention whereas the lowest point was in exercise. The factors that influence HPB of children were as follows: self-efficacy and self-regulation among intrapersonal factors; caregivers’ health instruction behaviors and peer relationship among interpersonal factors; and the period of operation, perceived environments by children, and disabled children/teacher ratio among institutional factors.

Conclusion: This study emphasized the importance of creating healthy environment for promoting health of children from vulnerable social groups and suggested that multi-level interventions would be more effective than interventions targeting a single level.