Methods: The qualitative data for this study was obtained from a subsample of participants in the parent mixed methods study that enrolled racially and ethnically diverse parents of preschool children aged 2 to 5 years old. For qualitative data, we subsampled and interviewed parents who reported moderate to high stress (score 14 or higher) on the Perceived Stress Scale (PSS; score range 0-40; 0-13 low stress; 14-26 moderate stress; 27-40 high stress). Semi-structured open-ended questions were asked during the phone interviews, and the duration of interview was 14-27 minutes. All interviews were transcribed verbatim. One interview was conducted in Korean, and codes were translated by a bilingual researcher. A descriptive content analysis was conducted. All text was coded and themes were noted as they emerged. The analysis identified an overarching theme through merging the themes and subthemes.
Results: A total of 13 parents participated in the interviews. The mean age of parents was 33.8 years (range 28.2-40.6 years), and majority (11 out of 13) were mothers. The participants were diverse in terms of race/ethnicity (4 non-Hispanic White; 3 Black; 4 Hispanic; 2 Asian). With regard to stress, most parents were moderately stressed except two parents who reported high-stress. The mean age of children was 3.5 years (range 2.0-5.9 years), and more were boys (8 out of 13). About half (6 out of 13) of the children were overweight or obese (BMI ≥ 85 percentile per Centers for Disease Prevention and Control guideline) based on parent-reported height and weight.
Factors influencing parental practices included two overarching themes: intrinsic vs. extrinsic factors. For intrinsic factors, parents’ own experience as a child was a major influencing factor. They practiced similarly to or differently from how their parents practiced. For example, a father who perceived his parents’ practice did not guide his healthy diet behaviors, practiced differently for his child. Another intrinsic factor is lack of interest to cook. A mother with moderate stress expressed she does not have an internal interest to look up creative recipes, but rather do other things with her time. Finally, perceived stress/fatigue and lack of time play a role in their practices for food preparation. One mother expressed her exhaustion after work interfered with cooking dinner. On stressed days, they are more likely to choose convenient or fast foods. They also perceived lack of time as a main challenge for their cooking practices. After work, they tend to rush to prepare food for dinner, and if they perceive they do not have enough time to cook, then they go to alternative choices.
Extrinsic factors included family members, family environment, and community environment. First of all, the child’s food preferences definitely influences parents’ practices. When parents did not want to argue about food choices, they prepared what children eat well. Other family members, in particular father, influence parents’ practices. For example, if a father does not care about healthy eating or has strong food preferences, it is hard for the mother to integrate healthy choices or to be motivated to cook. Financial restriction also influences their food choice. A moderately stressed mother expressed she usually chose canned food or fast food due to cost although she knows they are not healthy. Factors beyond family environment include limited cultural and ethnic specific resources and distance to grocery stores.
There were positive and negative coping responses to the intrinsic and extrinsic factors. Healthy strategies included reassurance, negotiating with child, asking for help, planning ahead (e.g., preparing during weekend), and strategic shopping (e.g., shopping by myself, buying different items at different stores, or making a list). Under the theme of unhealthy strategies, food as a reward, wishing to avoid their responsibility, juggling between convenience and cost, and set a mommy’s day (e.g., eating out, taking out convenient foods) emerged.
Conclusion: This qualitative analysis identified important indicators for future research to improve parental practices. Parental intrinsic factors, including lack of interest and time, and stress/fatigue, are main influences on their practices. Moreover, we found parents are great role models for their children’s future practices as parents, which are a critical indicator for improving parental practices that influence healthy lifestyle across generation. The importance of family dynamics and environment as well as community environment was also confirmed (Larson, Wall, Story, & Neumark-Sztainer, 2013). Stressed parents used positive and negative coping strategies when faced with different challenges that influence their practices in feeding and food preparation. The contextual factors guided our understanding of the stress-related practices of parents in feeding and food preparation for their children. Future interventions are indicated to help parents manage their stress, utilize resources, and provide social support from other family members and peers.