SAN FRANCISCO – The use of "appreciative inquiry" elicited the ways in which families may engage in their adolescents’ weight-management efforts, findings from focus groups of 44 parents or guardians suggested.
The results will inform the design of interventions in a year-long pilot study in 25 obese youths and their families. That will be followed by a three-arm randomized study of weight-management interventions for 360 obese sixth-grade students from urban schools, Shirley M. Moore, Ph.D., said at the annual meeting of the Society of Behavioral Medicine.
She and her associates conducted 16 focus groups involving 44 parents or guardians of obese sixth-graders who were participating in a school-based, YMCA-sponsored exercise program in Cleveland, which perennially vies with Detroit for the title of the poorest U.S. city, said Dr. Moore, professor of nursing at Case Western Reserve University, Cleveland. Of the adults 84% were female, 64% were African American, and 15% were Hispanic; they ranged in age from 39 to 85 years (mean, 43 years). One-fifth of families had incomes of less than $15,000 per year.
Each adult received $50 to attend one of four 2-hour focus group sessions at the local YMCA. Staff running the focus groups were trained in the appreciative inquiry process. They conducted thematic qualitative analyses.
Unlike conventional approaches that tend to elicit from participants information on the barriers, problems, and concerns they face in helping their children manage weight and live healthy lives, the use of appreciative inquiry highlights individuals’ and families’ strengths. It’s an affirmation model versus a deficit model for creating change, Dr. Moore said.
"My experience is the energy that comes from it is so amazing in terms of moving people forward," she said.
Participants were asked, for example, to describe a time when they felt really good about the health of their child and his or her living habits. Focus group leaders then probed deeper. What was good about that experience? What made them feel proud about it? What was it about themselves that made this happen? What was it about others that made this happen? What environmental factors helped make this a positive experience?
Major recurring themes emerged from their answers: Having healthy children is a joy. Becoming healthy is a process. Engaging in healthy habits is a family affair. Acquiring good health can be achieved despite obstacles. Sustaining a child’s interest in maintaining good health habits is a challenge.
Participants indicated that they could promote healthy habits by being role models, through their relationships within the family, and through their communities. "That was one of the big, informing things for us, is how entangled they felt in their communities, and the interrelationship between family and community," Dr. Moore said.
The parents/guardians recognized their potentially great influence as positive role models for their children, which was a bit surprising, given that approximately 80% of the adults seemed to be obese, she added. The power to grow healthy children is a joy and a source of pride, the adults said. The parents/guardians described their personal role in maintaining healthy children as that of a healer, caregiver, village mother, activist, and ambassador. They liked the idea of incorporating health-promoting activities in their daily family routines, from preparing food together to rooting for their children’s sports teams.
Dr. Moore and her associates used the findings in designing the weight-management interventions for the upcoming studies. Reminders to parents to attend group meetings, for example, will employ positive messages thanking them for being role models. The intervention has built-in chances for children to succeed (such as a rock wall climbing session), and gaming strategies so that parents can root for their kids. Ways to engage with communities are built in, too – participants will have to do community projects and some neighborhood and block projects. The investigators hired a chef to come teach healthy ways for parents and kids to shop and cook together.
"Raising healthy children is a great sense of joy for parents, and we should use this energy when designing interventions," Dr. Moore said. Appreciative inquiry, if done properly, can employ the positive aspects in people’s lives to effect change, but it’s a process requiring some training, she added.
Dr. Moore reported having no relevant financial disclosures. The studies are being funded by the National Heart, Lung, and Blood Institute; the Institute of Child Health and Human Development; and the Office of Behavioral and Social Sciences Research.
On Twitter @sherryboschert