Experiences and Perspectives of Hispanic Mothers of Overweight Toddlers About Everyday Routines: A Narrative Approach

Monday, 17 September 2018

Katelyn Therese Clements, MSN
Emily Jean Hauenstein, PhD, LCP, FAAN
School of Nursing, University of Delaware, Newark, DE, USA

Childhood obesity is an epidemic in the United States affecting over 12 million children aged 2-19 years old (Center for Disease Control and Prevention, 2017). The prevalence of obesity increases as a child grows from toddlerhood (13.9%) to school-aged (18.4%) and into adolescence (20.6%) (Hales, Carroll, Fryar, & Ogden, 2017). It is known that obese children will likely remain obese throughout their childhood (Graziano, Calkins, & Keane, 2010; Guo, Wu, Chumlea, & Roche, 2002) and into adulthood (Gordon-Larsen, The, & Adair, 2010) increasing their risk for serious health conditions, such as type 2 diabetes, heart disease, musculoskeletal disorders, and cancer (Jensen et al., 2014). Recently, research has shown promise in obesity prevention in the toddler years (Anderson, Sacker, Whitaker, & Kelly, 2017; Koulouglioti, Cole, McQuillan, Moskow, Kueppers, & Pigeon, 2013; Taveras et al., 2012).

Self-regulation, an individual’s inner abilities to self-correct and override impulses (Vohs & Baumesiter, 2016), is established during toddlerhood, and difficulties with self-regulation have been associated with an increased risk for later childhood obesity (Anderson et al., 2017; Graziano et al., 2010; Graziano, Kelleher, Calkins, Keane, & Brien, 2013). Parenting practices, “…specific, goal-directed behaviors through which parents perform their parental duties…” (Darling & Steinberg, 1993, p. 488), are essential for children to develop self-regulatory skills (Kopp, 1982). Parenting practices that incorporate sensitivity (LeCuyer & Houck, 2006), responsiveness (LeCuyer & Houck, 2006), and routines (Anderson et al., 2017) have been associated with self-regulation. Routines can be defined as recurring behaviors that occur on a daily or weekly basis involving a child and a supervisory adult (Sytsma, Kelley, & Wymer, 2001). Currently, obesity prevention research is beginning to focus on the intersection of household routines, parenting practices, and the development of self-regulation in the toddler years (Anderson et al., 2017; Bater & Jordan, 2017).

Research efforts of these processes should focus on the Hispanic population, as this is the population most at risk for obesity affecting 25.8% of children aged 2-19 years (Hales et al., 2017). The Hispanic population is associated with the intersecting disadvantages of poverty and ethnicity (Viruell-Fuentes, Miranda, & Abdulrahim, 2012), which influences access to healthy foods (Kumanyika & Grier, 2006), space for physical activity (Kumanyika & Grier, 2006), employment or education opportunities (Viruell-Fuentes et al., 2012), and access to healthcare (Viruell-Fuentes et al., 2012). These disadvantages are critical as mothers try to foster healthful environments for their children (Power, O’Connor, Orlet Fisher, & Hughes, 2015; Robinson et al., 2007). A mother’s behavior, such as feeding practices (Power et al., 2015), physical activity (Hnatiuk, DeDecker, Hesketh, & Cardon, 2017), weight status (Salahuddin et al., 2017), perception of obesity (Mejia de Grubb et al., 2017; Martinez, Rhee, Blanco, & Boutelle, 2017), and maternal-child relationship (Anderson, Gooze, Lemeshow, & Whitaker, 2012) can significantly impact her child’s behavior and influence her child’s weight status or risk factors for obesity. Additionally, the traditional Hispanic view, machismo, the opinion that men are the head of the household (Galanti, 2003), plays a role in parenting decisions influencing a child’s weight status (Parada, Ayala, Horton, Ibarra, & Arredondo, 2016).

The multifactorial origins of obesity including these interpersonal, physiological, social, and cultural processes can be explained using Bronfenbrenner’s ecological system’s theory, which provides a comprehensive framework with bidirectional relationships among nested levels of the individual, family, and social environment offering a flexible way to describe human behavior, human development, and promotion of health (Bronfenbrenner, 1979; Grzywacz & Fuqua, 2000). The literature is rich with evidence of qualitative research examining the Hispanic culture and parenting practices regarding obesity risk factors (Del Rio Rodriguez, Hilmers, & O'Connor, 2013; Lindsay, Sussner, Greaney, Peterson, 2011; O’Connor et al., 2013; Martinez et al., 2017; Mejia de Grubb et al., 2018; Woo Baidel et al., 2015). However, there is no evidence that the researcher is aware of describing a narrative design exploring the parenting practices and daily routines from the perspective of a Hispanic mother with an overweight or obese toddler. Furthermore, there is a gap in literature examining how Hispanic cultural practices and beliefs may influence the intersecting processes of routines, parenting practices, and self-regulation as it relates to childhood obesity prevention. As the Hispanic population continues to rise in the United States (Colby & Ortman, 2014; United States Census Bureau, n.d.), healthcare providers should better understand the beliefs and practices of Hispanic mothers, who play a significant role in their children’s development (Martinez et al., 2017; Parada et al., 2016; Power et al., 2015). Increased awareness of Hispanic mothers’ views and daily circumstances will assist in the establishment of culturally directed interventions that target obesity prevention.

The purpose of this study is to explore the experiences and perspectives of Hispanic mothers of overweight three to five-year-old children about their everyday routines. The main question this study aims to answer is: What are the experiences and perspectives of Hispanic mothers of overweight three to five-year-old children about their everyday routines? Verbal recruitment at the Latin American Community Center in Wilmington, DE with purposeful sampling is in progress and will be completed when there is data saturation. Face-to-face interviews are scheduled to begin next week. Using Riessman’s (2008) narrative approach, the researcher will explore the lived experience and restorying of personal accounts as told by the participants. A semi-structured interview approach with an open-ended question guide will be used during the audio-recorded sessions. Participants will also fill out a demographic questionnaire prior to the interview. The interviews will be transcribed and a narrative thematic analysis will be used to analyze the data. Themes related to the mothers’ daily circumstances, everyday routines, and parenting practices will emerge from the narratives, allowing for the researcher to provide a restorying of the accounts. The principle investigator will discuss the analysis with the co-investigator until intercoder agreement is achieved, supporting the study’s dependability (Lincoln & Guba, 1985). Participants will meet with the researcher for review of the results and feedback once the data has been analyzed and prior to the researcher moving onto the final written report. This meeting will also be audio-recorded and transcribed for review. Collaboration with participants will improve credibility of the data and an accurate restorying of the lived experience. The final report will include details of the purposeful sampling strategy and a detailed description of the research methods to enhance transferability of the findings (Lincoln & Guba, 1985). The report will also include details of the study’s procedures and agreement process between the principle investigator and co-investigator to establish confirmability (Lincoln & Guba, 1985). Conclusions will be drawn from the data analysis and emergence of themes imparting culturally appropriate interventions for health care providers to better target obesity prevention in the Hispanic population.