Background
The benefits of physical activity (PA) in adults have been well documented and include decreased risk of obesity, type-2-diabetes and all cause mortality [
1‐
3]. Among children, PA has been associated with improved mental well-being [
4] and lower levels of cardiovascular disease risk-factors [
5,
6]. Research suggests that children do not engage in the recommended amount of 60 minutes moderate-to-vigorous PA per day [
7,
8]. The early primary school years (6–8 years) is a critical time for physical skill development [
9,
10] and is the period in which PA behaviour is formed [
11]. There is evidence that PA behaviours in childhood track into adulthood [
12,
13] and therefore establishing healthy behaviours in early childhood is important for the current and future health of children.
Increasing children’s PA levels is a key UK government public health policy target [
14] but presents a major challenge for public health practitioners and promoters. The majority of interventions to increase PA in children are school-based [
15‐
17] and reviews highlight that many school-based interventions have had limited success [
16,
18].
Parents are able to influence their children’s behaviour and play an important role in encouraging children to be physically active [
19]. Research has shown that parental support (i.e., parental self-efficacy associated with child PA, parents’ PA behaviour, and parents’ perceptions of the value of PA) [
15,
20,
21] and logistic support (i.e., providing equipment for PA and taxiing children to activities) [
22‐
24] are important correlates of PA levels in children. Parenting programmes have shown to be effective in preventing childhood obesity [
25‐
27] but parenting interventions to promote children’s PA is an understudied area of research. There may be particular parenting skills which would encourage increased PA in children and working with parents is a potential intervention route.
Parents’ poor recognition of children’s PA levels could present an important barrier to behaviour change [
28,
29]. However, we do not currently know how parents’ assess their child’s PA. This may be particularly important for interventions as parents with inactive children have been reported to overestimate their child’s PA [
30]. In addition, parents’ perceived barriers to PA have been consistently negatively associated with child PA [
20] and may be important issues to address within the content of an intervention. Reported parental barriers have included lack of time [
31,
32], monetary cost [
32,
33], lack of opportunities to be active [
33], the local environment, safety concerns, increasing distances between homes and school, home distractions and peer pressure for sedentary activities (e.g. screen-viewing) [
31].
The UK’s Medical Research Council provides a development-evaluation-implementation model to guide the development and testing of complex interventions [
34]. A key element of this process is the developmental stage in which intervention elements are developed based on existing evidence and pilot research. The present study is situated at the developmental stage and the information arising from it will be used to inform the content of a pilot randomised-controlled trial consisting of a parenting intervention aimed at increasing the PA among 6–8 year old children. Interviews were held with parents to examine factors that may influence their child’s PA levels, specifically: a) parents’ awareness of their 6–8 year old child’s PA; b) the parents’ perceived barriers to their 6–8 year old child’s PA.
Results
Thirty-two parents were interviewed, 15 (47%) from the low-SES area and 17 (53%) from the mid-SES area (Table
1). The majority of parents interviewed were female (90%) and most of the children within the 6 to 8 year age criteria were also female (62%). Six (40%) parents from the low-SES area and one (6%) of the parents from mid-SES were lone parents.
Table 1
Demographic characteristics of parents (n = 32)
Age (years) | 38.2 | 25.5 – 48.0 |
Low-SES | 35.8 | 25.5 – 47.1 |
Mid-SES | 40.3 | 26.8 – 48.0 |
Number of children in household
| 2.2 | 1-4 |
Low-SES | 2.1 | 1-4 |
Mid-SES | 2.2 | 1-4 |
|
N
|
%
|
Gender (female) | 29 | 90.6 |
Low-SES | 15 | 100 |
Mid-SES | 14 | 82.3 |
Lone parent
| 7 | 21.9 |
Low-SES | 6 | 40.0 |
Mid-SES | 1 | 5.9 |
This paper focuses on factors that were identified during the analysis that would need to be considered when developing a parenting intervention to increase children’s PA. These included parents’ awareness of their child’s PA levels, barriers to their child’s PA, and parental support for their child’s PA.
Parents’ awareness of their child’s PA levels
The majority of the parents felt that their child was either active or very active. Some parents felt that their child was fairly active but had room for improvement, the majority of these respondents were from the mid-SES area. Only a small number of parents reported that their child had low levels of PA.
A couple of parents from the mid-SES area indicated that it was difficult to judge whether children were getting enough PA. One parent showed some dissonance between believing that her child is active enough and being uncertain that they actually are.
“
I know that
[
Child
’
s name
]
gets enough but you know
,
do I really know
?” (
Mother
,
Mid SES
)
Another parent highlighted their understanding of a desirable amount of PA for children yet she was uncertain of the recommendations.
“
I can
’
t quantify very well how much exercise my children get
…
and what would the desirable
,
I have no idea about whether they
’
re doing
(
enough
)…
so I
’
d be really interested in knowing what
,
where we
’
re at on that kind of thing
” (
Mother
,
Mid SES
)
Parents gauged their child’s activity levels by using a combination of visible cues. For instance, they frequently suggested that their child was active because they perceived them to have high levels of energy or always being ‘on the go’.
“
Very
,
very
,
very active
…
at home he can
’
t sit still
,
he doesn
’
t sit still
” (
Mother
,
Low SES
)
“
She
’
s on the go all the time
,
doesn
’
t sit down for long
.
Got loads of energy
.” (
Mother
,
Low SES
)
Many parents placed emphasis on PA’s role in weight management and associated their child’s activity levels with their weight or size. An active child was equated with them being slim and an inactive child was equated with having excess weight.
“
Yeah
,
she
’
s quite slim as well
…
You can tell she
,
she can fit into 5 to 6 year old skirts
,
so she
’
s quite a slim child
…
Oh yeah she burns it as quick as she eats it
.” (
Mother
,
Mid SES
)
“
He doesn
’
t do much of anything and he
’
s put on quite a bit of weight
.” (
Mother
,
Low SES
)
A small number of parents reported their child was sufficiently active because their fitness levels were good, and felt that if they were physically fit, they were active enough.
“…
he is very strong
,
and his ability to walk for miles on end is quite remarkable
.” (
Mother
,
Mid SES
)
Children’s interest or enjoyment of PA was also linked to them being active.
“
Oh he
’
s very active
,
his favourite lesson in school is PE
,
so yeah he likes to be active
.” (
Mother
,
Low SES
)
Some parents who described their child as active felt that their child might need their activity to be moderated.
“…
so it
’
s not as if it
’
s a case of me for instance
, “
well let
’
s do this
,
let
’
s do that
”,
it
’
s the other way round
,
and it
’
s trying to maybe sometimes reign her in
.” (
Mother
,
Low SES
)
Screen-viewing was seen as an indicator for low levels of PA, and parents gave descriptions of the child’s screen-viewing behaviours as well as their preference for it.
“
Well
,
if you said to
[
child
’
s name
], “
do you want to go and play out at the park
,
or do you want to go on your Xbox
?”
he will play on the Xbox
.” (
Mother
,
Low SES
)
“
She is at home a lot and all she
’
s into just watching DVDs
,
she
’
s really into princesses and fairies and
…
you know
.” (
Mother
,
Low SES
)
Parents’ perceived barriers and facilitators to their child’s PA
The child’s personality and enjoyment of PA appeared to influence how active their parent perceived them to be. For instance, some parents found that their child’s preferences made it difficult to encourage activity.
“
That
’
s pretty much all he likes
.
He doesn
’
t like football
.
None
,
none of mine are into football
,
they prefer the computer
.” (
Mother
,
Low SES
)
“…
once he
’
s up and doing it he
’
s alright
,
but like walking and things like that he moans all the time
.” (
Mother
,
Mid SES
)
Whereas others found that their child naturally wants to be active.
“
She likes being out in the garden or she wants to go to the park and if we go to the park she
’
ll be on her scooter
.” (
Mother
,
Mid SES
)
On many occasions parents reported their child’s enjoyment and enthusiasm for a particular organised PA led the parent to choose that activity for their child. However, in other instances barriers prevented the child from engaging in their preferred PA. For instance, the cost of organised activities and a lack of provision of a specific organised activity proved to be a barrier.
“
He always want to play football in a club
.
He ask me
,
he keep asking me every
,
every time and I say I can
’
t afford
.” (
Father
,
Mid SES
)
“
She used to do dance classes
,
but they don
’
t seem to do that at the Juniors
.” (
Mother
,
Low SES
)
When talking about how to increase children’s PA, many parents instinctively talked about increasing organised activities for their child and how additional activities would be problematic because of the parents’ work, existing commitments for parents and the child, and shortage of time.
“
Yeah
,
erm just the start time and if I
’
m at work
…
because I
,
I work three days a week until six in the evening
…
because some things just start too early and I don
’
t like having to ask other people to take her
.” (
Mother
,
Low SES
)
“
Er
,
erm
,
she
’
s mentioned dancing but to be quite honest
…
we can
’
t really fit it in
.” (
Mother
,
Mid SES
)
Managing several children, especially of different ages, was also mentioned as a difficulty by some parents, in that preparing to go out for the day is difficult, that different age stages made it difficult to do things as a family, and siblings’ organised activities made it difficult to do things as a whole family.
“
I might think in the morning
,
right we
'
re going to do so
,
and so
,
and so and so after school today and then it gets to that point and someone says
,
oh yeah well I
'
ve got to go wee and then you
’
ve got them going in and back and forth and the whole plan just goes out the window
.” (
Mother
,
Low SES
)
“…
making a two year old run here
,
there and everywhere after her older sister all the time is
…
a real genuine tension that gets worse as the younger one grows up
…” (
Mother
,
Mid SES
)
Some parents described barriers to their child’s participation in PA that related to their own priorities or capacity to facilitate PA which related to their circumstances.
“
He wanted to do and he was meant to
[
play rugby
]…
it wasn
’
t within our area
,
erm
,
and a friend
…
he was going to go with a friend
.
We couldn
’
t sort out the transport
,
and you know the kids talk amongst theirselves
,
they kind of arranged it and it couldn
’
t come off with us adults I
’
m afraid
.” (
Mother
,
Low SES
)
“
Well she likes going to the park
,
but again it will more or likely probably we have to do it when I
’
m really tired
,
because I
’
m the only parent here
,
so that again sometimes impedes you know
.” (
Mother
,
Low SES
)
Other barriers that parents said prevented their child’s PA included lack of safe outdoor space, transport, location of activity, and bad weather.
“
Yeah and she used to do swimming after school as well but then it goes to winter time and getting the bus back from the swimming baths at 5 on a night when they
’
re soaking wet isn
’
t very good either
.” (
Mother
,
Low SES
)
“
Well we bought a trampoline back in the summer and he does love that
,
but of course it
’
s been out of bounds with it being so wet and cold
.” (
Mother
,
Low SES
)
“
You know
,
is just
,
you know
,
because we live in an area there
’
s always car
,
you know parking
,
is not safe
,
you know to even play football
.” (
Father
,
Mid SES
)
Parents also suggested potential solutions to some of these barriers. For instance, some parents’ mentioned that PA doesn’t necessarily have to bear a financial cost.
“
Just go out and discover what is around you
.
I think a lot of mums think we have got to spend money but you don
’
t you know
…
I would probably recommend going to some lovely local parks where it cost you no money
.” (
Mother
,
Mid SES
)
Many parents utilised after school activity provision and one parent highlighted that perhaps children mind less about bad weather than parents.
“
I mean it doesn
’
t hurt the kids to at a park running around if you
’
re just sat there watching them
…
you know they don
’
t mind and they don
’
t care what weather it is
,
they really don
’
t care
[
laughs
].” (
Mother
,
Low SES
)
While juggling the needs of siblings was reported as making some activities problematic, peer support for children was reported to be an important facilitator for activity. Some parents reported that having either a sibling or friend attending an activity was a positive reason for their child attending the same activity.
“…
the thing is of course having a big sister they always want to do what the older one does don
’
t they
?” (
Mother
,
Mid SES
)
“
It
’
s the peer thing even at that age it
’
s a big issue
,
you know
.
If you
’
ve got a couple of friends going then you
’
re more likely to get them
…” (
Mother
,
Mid SES
)
Parental support of their child’s PA
Parents from the low-SES area often reported providing support and encouragement for unorganised activity and active play, whereas parents from the mid-SES area more commonly reported providing support for organised activities and groups. It became evident that parents’ felt that for their child, parental support and staying close to their mother was important.
“
The only thing is
,
erm
,
is getting my children to take part in after school activities is more difficult because they like coming home
.” (
Mother
,
Mid SES
)
“
I think
…
if it was something that we did together
,
erm
,
I think I
’
d do okay
,
but he lacks confidence to
…
do something independently from me
.” (
Mother
,
Low SES
)
“
She
’
s quite shy
,
when she first starts new things
,
I think if I weren
’
t to stay with her the first couple of times then she probably wouldn
’
t want to do it
.” (
Mother
,
Low SES
)
Parents commonly reported providing logistic support to facilitate their child’s PA, such as encouraging a particular PA and providing PA equipment (including parents from the low-SES area who had reported that a lack of money was a barrier). However, this external motivation appeared to have limited success in encouraging the targeted PA. These parents tended not to talk about their child’s own motivation or preference for PA in the interview.
“
I did get him to think about joining the football club but that just quite didn
'
t happen for some reason but I can
'
t remember why
.” (
Mother
,
Low SES
)
“
No she
’
s quite lazy actually
,
I
’
ve got to sort of push her to even go out on the trampoline in the garden and even go on the Wii fit
.
You know she
’
s quite happy doing nothing
…
I mean we bought her a bike last year
,
and she didn
’
t even get on it and ride it
,
she just hasn
’
t got any interest in things like that
,
so it is quite hard
.” (
Mother
,
Low SES
)
There was an acknowledgment by some parents of the importance of child-led play and supporting a child’s motivation to be active.
“
I like my two to be able to play without being sort of like guided on how to do it
.” (
Mother
,
Mid SES
)
“
Well I guess you
’
ve got to offer them things that they
’
re interested in
.” (
Mother
,
Low SES
)
Table
2 summarises the key findings of this paper and the implications for a PA/SV parenting programme.
Table 2
Implications of results for parenting interventions to increase PA in children
Improving parents’ awareness of child’s PA levels | • Improving understanding of the PA recommendations | • PA recommendations for children |
• What are the benefits of PA? |
• Increasing parents’ perceived need for more PA | • What is PA and what counts? |
• Tools to monitor PA |
• Overcoming barriers to PA and increasing opportunities to be active | • Providing parents with ideas and skills for motivating their children to engage in PA | • Providing local activity directory |
• Trouble-shooting common barriers such as cost/lack of provision/weather | • Supporting active travel and lifestyle activity |
• Providing parents with skills to deal with conflict around PA to avoid negative associations with PA | • Generating ideas for low-cost/free, and wet weather games and activities |
• Discussion around how modern living and today’s culture affects PA and sedentary behaviour |
• Balancing boundaries and autonomy with risk and safety |
• Scheduling and planning activities |
• Managing conflict around PA (parenting skills including giving choice, setting boundaries, positive discipline and praise) |
Helping parents’ to support children’s intrinsic motivation to be active | • Supporting the development of children’s physical skills and confidence to be active | • How parents can practically support their child’s PA development (e.g. game modification) |
• Developing children’s self confidence and independence | • Importance of physical skills development |
• Supporting parents’ confidence and competence in supporting their child’s PA | • Developmental stages for physical skills for children and having appropriate expectations |
• Encouraging activity and supporting fun and enjoyment | • Using praise and positive discipline |
• How can parents emotionally support their child’s PA confidence, independence and autonomy) |
• Making activities fun |
• Generating ideas for family activities |
Authors’ contributions
The study was designed by RJ, SJS, PJL, KRF, SSB and KMT. The interviews were collected and analysed by GFB and JKG under the supervision of RJ and KMT. The first draft of the paper was written by GFB and all authors provided critical revisions for intellectual content. All authors have approved the final manuscript.