Thesis title: Promoting healthy eating in young children. The use of a communication tool about diet in public health nurses’ counselling: A complex intervention study.
Trial lecture title: Complex interventions or complex systems? Implications for evaluation of interventions in health care.
The ordinary opponents are:
- First opponent: Professor Helena Leino-Kilpi, University of Turku, Finland
- Second opponent: Professor John Roger Andersen, Western Norway University of Applied Sciences, Campus Førde
- Leader of the evaluation committee: Professor Mirjam Lukasse, OsloMet
The leader of the public defense is Professor Lisbeth Gravdal Kvarme, OsloMet.
The main supervisor is Professor Kari Glavin, VID Specialized University, Oslo.
The co-supervisors are Vice-Dean for Research and Development, Professor Sølvi Helseth, Faculty of Health Sciences, OsloMet and Head of Department Lene Frost Andersen, Institute of Basic Medical Sciences, University of Oslo.
Abstract
Counselling on food and feeding practices by public health nurses at child health centers is the focus of this thesis. The public health nurses in this complex intervention study used a communication tool about diet in their counselling of families of under-school-aged children.
The overall aim of the study was to contribute to the children’s healthy diet, particularly their intake of vegetables, based on counselling. A prerequisite was that this intervention should be sustainable, fitting into the time frames of the existing consultations.
The study consists of papers I–IV comprising four subsequent sub-studies.
Paper I
Paper I, a modified scoping review, presents updated information about counselling of parents of children aged 0–2 years on the child’s healthy diet in preventive health care settings.
The results of this paper indicate that dietary counselling should be anticipatory and adapted to the particular child and family.
Paper II
Paper II, a cross sectional study, investigated whether there is an association between children’s diet and the parents reporting that they avoided giving appropriate food items to their 10-month-old because of their fear that the child might react with allergy or hypersensitivity.
The results in paper II were based on semi-quantitative food frequency questionnaires that the parents completed before attending the 10-month consultation at the child health centre.
A statistically significant relationship emerged between parental avoidance of introducing some food items due to fears of allergy and hypersensitivity in their child and the parents’ desire for more information about food for their child.
This was not associated with any dietary restrictions regarding their child.
Paper III
Paper III was based on individual interviews and used an interpretive description approach.
It aimed at investigating the parents’ experience of attending child health center consultations when their child was aged 10–18 months and the use of a communication tool about diet in the consultations.
The findings in paper III indicated that parents who were positive to the health authorities’ dietary recommendations before visiting the child health center were most satisfied with the perceived dietary counselling.
Parents who addressed questions related to issues such as the child’s food allergy or breastfeeding often experienced limited support.
Paper IV
Paper IV, presenting a cluster randomized controlled trial, investigated the effect of a communication tool about diet concerning the child’s diet at two years of age.
The communication tool was used in consultations at the child health center and compared with standard consultations.
In paper IV, the conclusion was that the intervention did not significantly impact the predefined outcome measures – the child’s daily intake of vegetables and saturated fat or the body mass index.
However, the intervention positively affected the parents’ desire for information about their child’s diet.
Public health nursing policy and -research should be aware that parents might perceive counselling about food and feeding practices positively, however without changing components of their child’s diet in a healthier direction.
