Effect of integrating a video intervention on parenting practices and related parental self-efficacy regarding health behaviours within the Feel4Diabetes-study in Belgian primary schoolchildren from vulnerable families: A cluster randomized trial

Autoři: Vicky Van Stappen aff001;  Sara De Lepeleere aff001;  Nele Huys aff001;  Julie Latomme aff001;  Maïté Verloigne aff002;  Greet Cardon aff001;  Odysseas Androutsos aff004;  Yannis Manios aff004;  Ilse De Bourdeaudhuij aff001;  Marieke De Craemer aff002
Působiště autorů: Department of Movement and Sports Sciences, Ghent University, Ghent, Belgium aff001;  Research Foundation Flanders (FWO), Brussels, Belgium aff002;  Department of Public Health and Primary Care, Ghent University, Ghent, Belgium aff003;  Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, Kallithea, Athens, Greece aff004;  Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium aff005
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0226131



This study aimed to investigate the effect of integrating a video intervention “Movie Models” within the Feel4Diabetes-study on specific parenting practices and related parental self-efficacy regarding children’s physical activity, screen-time and eating behaviour in vulnerable families (i.e. families living in low socioeconomic municipalities and at risk for developing type 2 diabetes). Additionally, there was examination of how the intervention was perceived by the parents.


Within randomly selected low socioeconomic municipalities in Belgium, families were recruited through primary schools. Families at risk for developing type 2 diabetes were identified using the FINDRISC questionnaire (n = 457). Afterwards, the municipalities were randomly assigned to the intervention or control condition. At risk families assigned to the intervention group were invited to participate in six Feel4Diabetes counselling sessions in which families were encouraged to adopt a healthier lifestyle. The “Movie Models” videos were integrated within two sessions by using a face-to-face group discussion approach. Parenting-related factors were assessed before and after the integration of the videos, using a questionnaire. After integrating the videos, some extra evaluation questions were assessed. In total, 126 families were included in a per protocol evaluation and Repeated Measures ANOVAs were conducted to evaluate the potential intervention effects.


Some favourable intervention effects were found on parenting practices and related parental self-efficacy regarding children’s eating behaviours, however almost no effects were found on parenting-related factors regarding children’s physical activity and screen-time. In total, 60.0% of the participants indicated that they applied tips regarding parenting practices and 52.0% indicated that discussions with other participants regarding the videos were useful for them.


The integration of “Movie Models” within the Feel4Diabetes-study was effective in improving some parenting-related factors regarding children’s health behaviours, however most parenting-related factors could not be improved. The implementation of “Movie Models” as a face-to-face group discussion approach was relatively well received and may be a promising way to improve parenting-related factors in vulnerable families.

Trial registration

ClinicalTrials.gov NCT02278809.

Klíčová slova:

Behavior – Behavioral and social aspects of health – Eating habits – Child health – Childhood obesity – Parenting behavior – Physical activity – Questionnaires


1. Organization WH. Obesity and Overweight: Geneve; 2017 [

2. Ahrens W, Pigeot I, Pohlabeln H, De Henauw S, Lissner L, Molnar D, et al. Prevalence of overweight and obesity in European children below the age of 10. Int J Obes (Lond). 2014;38 Suppl 2:S99–107.

3. O’Neill JL, McCarthy SN, Burke SJ, Hannon EM, Kiely M, Flynn A, et al. Prevalence of overweight and obesity in Irish school children, using four different definitions. Eur J Clin Nutr. 2007;61(6):743–51. doi: 10.1038/sj.ejcn.1602580 17180155

4. Branca F NH, Lobstein T. The Challenge of Obesity in the WHO European Region and the Strategies for Response.; 2007.

5. Jimenez-Pavon D, Kelly J, Reilly JJ. Associations between objectively measured habitual physical activity and adiposity in children and adolescents: Systematic review. Int J Pediatr Obes. 2010;5(1):3–18. doi: 10.3109/17477160903067601 19562608

6. Tremblay MS, LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. 2011;8:98. doi: 10.1186/1479-5868-8-98 21936895

7. Maffeis C. Aetiology of overweight and obesity in children and adolescents. Eur J Pediatr. 2000;159 Suppl 1:S35–44.

8. WHOEurope. Recommended levels of physical activity for children aged 5–17 years [http://www.who.int/dietphysicalactivity/factsheet_young_people/en/.

9. Leven VIG. Vlaamse gezondheidsaanbevelingen sedentair gedrag (lang stilzitten) en lichaamsbeweging. 2017.

10. Tremblay MS, Leblanc AG, Janssen I, Kho ME, Hicks A, Murumets K, et al. Canadian sedentary behaviour guidelines for children and youth. Appl Physiol Nutr Metab. 2011;36(1):59–64; 5–71. doi: 10.1139/H11-012 21326378

11. Konstabel K, Veidebaum T, Verbestel V, Moreno LA, Bammann K, Tornaritis M, et al. Objectively measured physical activity in European children: the IDEFICS study. Int J Obes (Lond). 2014;38 Suppl 2:S135–43.

12. Santaliestra-Pasias AM, Mouratidou T, Verbestel V, Bammann K, Molnar D, Sieri S, et al. Physical activity and sedentary behaviour in European children: the IDEFICS study. Public Health Nutr. 2014;17(10):2295–306. doi: 10.1017/S1368980013002486 24103326

13. WHOEurope. Fruit and Vegetables for Health, Report of a Joint FAO/WHO Workshop.

14. Leven VIG. Aanbevelingen voeding per leeftijdsgroep. 2014.

15. Leven VIG. Voeding buiten de voedingsdriehoek [cited 2018.https://www.gezondleven.be/themas/voeding/voedingsdriehoek/overige-producten.

16. Yngve A, Wolf A, Poortvliet E, Elmadfa I, Brug J, Ehrenblad B, et al. Fruit and vegetable intake in a sample of 11-year-old children in 9 European countries: The Pro Children Cross-sectional Survey. Ann Nutr Metab. 2005;49(4):236–45. doi: 10.1159/000087247 16088087

17. Volksgezondheid WI. Gezondheidsenquête. 2013.

18. Brug J, van Stralen MM, Te Velde SJ, Chinapaw MJ, De Bourdeaudhuij I, Lien N, et al. Differences in weight status and energy-balance related behaviors among schoolchildren across Europe: the ENERGY-project. Plos One. 2012;7(4):e34742. doi: 10.1371/journal.pone.0034742 22558098

19. Pawellek I, Grote V, Theurich M, Closa-Monasterolo R, Stolarczyk A, Verduci E, et al. Factors associated with sugar intake and sugar sources in European children from 1 to 8 years of age. Eur J Clin Nutr. 2017;71(1):25–32. doi: 10.1038/ejcn.2016.206 27827398

20. Bammann K, Gwozdz W, Pischke C, Eiben G, Fernandez-Alvira JM, De Henauw S, et al. The impact of familial, behavioural and psychosocial factors on the SES gradient for childhood overweight in Europe. A longitudinal study. Int J Obes (Lond). 2017;41(1):54–60.

21. Fernandez-Alvira JM, Mouratidou T, Bammann K, Hebestreit A, Barba G, Sieri S, et al. Parental education and frequency of food consumption in European children: the IDEFICS study. Public Health Nutr. 2013;16(3):487–98. doi: 10.1017/S136898001200290X 22687743

22. Ventura AK, Birch LL. Does parenting affect children’s eating and weight status? Int J Behav Nutr Phys Act. 2008;5:15. doi: 10.1186/1479-5868-5-15 18346282

23. Xu H, Wen LM, Rissel C. Associations of parental influences with physical activity and screen time among young children: a systematic review. J Obes. 2015;2015:546925. doi: 10.1155/2015/546925 25874123

24. Masse LC, O’Connor TM, Tu AW, Hughes SO, Beauchamp MR, Baranowski T, et al. Conceptualizing physical activity parenting practices using expert informed concept mapping analysis. BMC Public Health. 2017;17(1):574. doi: 10.1186/s12889-017-4487-1 28615050

25. Pinket AS, De Craemer M, De Bourdeaudhuij I, Deforche B, Cardon G, Androutsos O, et al. Can Parenting Practices Explain the Differences in Beverage Intake According to Socio-Economic Status: The Toybox-Study. Nutrients. 2016;8(10).

26. Gerards SM, Sleddens EF, Dagnelie PC, de Vries NK, Kremers SP. Interventions addressing general parenting to prevent or treat childhood obesity. Int J Pediatr Obes. 2011;6(2–2):e28–45. doi: 10.3109/17477166.2011.575147 21657977

27. Golley RK, Magarey AM, Baur LA, Steinbeck KS, Daniels LA. Twelve-month effectiveness of a parent-led, family-focused weight-management program for prepubertal children: A randomized, controlled trial. Pediatrics. 2007;119(3):517–25. doi: 10.1542/peds.2006-1746 17332205

28. Robertson W, Friede T, Blissett J, Rudolf MC, Wallis M, Stewart-Brown S. Pilot of "Families for Health": community-based family intervention for obesity. Arch Dis Child. 2008;93(11):921–6. doi: 10.1136/adc.2008.139162 18463121

29. West F. The Lifestyle Triple P Project. Exploring the link between parenting skills training with healthy lifestyle information to support behaviour modification. Nutrit Dietetics. 2007.

30. Dickin KL, Hill TF, Dollahite JS. The collaboration for health, activity, and nutrition in Children’s environments (CHANCE): a program integrating parenting and nutrtion behavioral education improves food, active play, and parenting practices in low-income families. Experimental Biology. 2010.

31. Dickin KL, Hill TF, Dollahite JS. Practice-based evidence of effectiveness in an integrated nutrition and parenting education intervention for low-income parents. J Acad Nutr Diet. 2014;114(6):945–50. doi: 10.1016/j.jand.2013.09.029 24315130

32. Otterbach L, Mena NZ, Greene G, Redding CA, De Groot A, Tovar A. Community-based childhood obesity prevention intervention for parents improves health behaviors and food parenting practices among Hispanic, low-income parents. BMC Obes. 2018;5:11. doi: 10.1186/s40608-018-0188-2 29610670

33. De Lepeleere S, De Bourdeaudhuij I, Cardon G, Verloigne M. Do specific parenting practices and related parental self-efficay associate with physicacl activity and screen time among primary schoolchildren? Cross-sectional study in Belgium. BMJ Open. 2015;5.

34. Hinyard LJ, Kreuter MWJHE. Using narrative communication as a tool for health behavior change: a conceptual, theoretical, and empirical overview. Behavior 2007;34(5):777–92.

35. De Lepeleere S, DeSmet A, Verloigne M, Cardon G, De Bourdeaudhuij I. What practices do parents perceive as effective or ineffective in promoting a healthy diet, physical activity, and less sitting in children: parent focus groups. BMC Public Health. 2013;13:1067. doi: 10.1186/1471-2458-13-1067 24219513

36. Jackson JL, Chamberlin J, Kroenke K. Predictors of patient satisfaction. Soc Sci Med. 2001;52(4):609–20. doi: 10.1016/s0277-9536(00)00164-7 11206657

37. VanWormer JJ, Martinez AM, Cosentino D, Pronk NP. Satisfaction with a weight loss program: what matters? Am J Health Promot. 2010;24(4):238–45. doi: 10.4278/ajhp.080613-QUAN-92 20232605

38. Wilcox S, Laken M, Parrott AW, Condrasky M, Saunders R, Addy CL, et al. The faith, activity, and nutrition (FAN) program: design of a participatory research intervention to increase physical activity and improve dietary habits in African American churches. Contemp Clin Trials. 2010;31(4):323–35. doi: 10.1016/j.cct.2010.03.011 20359549

39. Manios Y, Androutsos O, C. L, Cardon G, J. L, Annemans L, et al. A school- and community-based intervention to promote healthy lifestyle and prevent type 2 diabetes in vulnerable families across Europe: design and implementation of the Feel4Diabetes-study. Public Health Nutrition. 2018.

40. De Lepeleere S, Verloigne M, Brown HE, Cardon G, De Bourdeaudhuij I. Using the Intervention Mapping Protocol to develop an online video intervention for parents to prevent childhood obesity: Movie Models. Glob Health Promot. 2016.

41. De Lepeleere S, De Bourdeaudhuij I, Cardon G, Verloigne M. The effect of an online video intervention ‘Movie Models’ on specific parenting practices and parental self-efficacy related to children’s physical activity, screen-time and healthy diet: a quasi experimental study. BMC Public Health. 2017;17(1):366. doi: 10.1186/s12889-017-4264-1 28449658

42. VDAB-Arvastat: Vlaamse overheid; [https://arvastat.vdab.be/arvastat_basisstatistieken_werkloosheid.html.

43. Makrilakis K, Liatis S, Grammatikou S, Perrea D, Stathi C, Tsiligros P, et al. Validation of the Finnish diabetes risk score (FINDRISC) questionnaire for screening for undiagnosed type 2 diabetes, dysglycaemia and the metabolic syndrome in Greece. Diabetes Metab. 2011;37(2):144–51. doi: 10.1016/j.diabet.2010.09.006 21144787

44. Schwarz P, Lindström J, Tuomilehto J. Tools for predicting the risk of type 2 diabetes in daily practice. Hormone and Metabolic Research. 2009;42(2):86–97.

45. Saaristo T, Peltonen M, Lindstrom J, Saarikoski L, Sundvall J, Eriksson JG, et al. Cross-sectional evaluation of the Finnish Diabetes Risk Score: a tool to identify undetected type 2 diabetes, abnormal glucose tolerance and metabolic syndrome. Diab Vasc Dis Res. 2005;2(2):67–72. doi: 10.3132/dvdr.2005.011 16305061

46. Lindstrom J, Tuomilehto J. The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725–31. doi: 10.2337/diacare.26.3.725 12610029

47. Organization WH. Waist Circumference and Waist-Hip Ratio—Report of a WHO Expert Consultation. Geneva: World Health Organization; 2008.

48. Trost SG, Sallis JF, Pate RR, Freedson PS, Taylor WC, Dowda M. Evaluating a model of parental influence on youth physical activity. Am J Prev Med. 2003;25(4):277–82. doi: 10.1016/s0749-3797(03)00217-4 14580627

49. Larios SE, Ayala GX, Arredondo EM, Baquero B, Elder JP. Development and validation of a scale to measure Latino parenting strategies related to children’s obesigenic behaviors. The parenting strategies for eating and activity scale (PEAS). Appetite. 2009;52(1):166–72. doi: 10.1016/j.appet.2008.09.011 18845197

50. Sleddens EF, Kremers SP, De Vries NK, Thijs C. Relationship between parental feeding styles and eating behaviours of Dutch children aged 6–7. Appetite. 2010;54(1):30–6. doi: 10.1016/j.appet.2009.09.002 19747513

51. Decker JW. Initial development and testing of a questionnaire of parental self-efficacy for enacting healthy lifestyles in their children. J Spec Pediatr Nurs. 2012;17(2):147–58. doi: 10.1111/j.1744-6155.2012.00330.x 22463475

52. Crespo NC, Elder JP, Ayala GX, Slymen DJ, Campbell NR, Sallis JF, et al. Results of a multi-level intervention to prevent and control childhood obesity among Latino children: the Aventuras Para Ninos Study. Ann Behav Med. 2012;43(1):84–100. doi: 10.1007/s12160-011-9332-7 22215470

53. Lindsay AC, Sussner KM, Greaney ML, Peterson KE. Influence of social context on eating, physical activity, and sedentary behaviors of Latina mothers and their preschool-age children. Health Educ Behav. 2009;36(1):81–96. doi: 10.1177/1090198107308375 18689491

54. Bakeman R. Recommended effect size statistics for repeated measures designs. Behavior research methods. 2005;37(3):379–84. doi: 10.3758/bf03192707 16405133

55. Corder K, Crespo NC, van Sluijs EM, Lopez NV, Elder JP. Parent awareness of young children’s physical activity. Prev Med. 2012;55(3):201–5. doi: 10.1016/j.ypmed.2012.06.021 22766008

56. De Decker E, De Craemer M, De Bourdeaudhuij I, Wijndaele K, Duvinage K, Koletzko B, et al. Influencing factors of screen time in preschool children: an exploration of parents’ perceptions through focus groups in six European countries. Obes Rev. 2012;13 Suppl 1:75–84.

57. Bukman AJ, Teuscher D, Feskens EJ, van Baak MA, Meershoek A, Renes RJ. Perceptions on healthy eating, physical activity and lifestyle advice: opportunities for adapting lifestyle interventions to individuals with low socioeconomic status. BMC Public Health. 2014;14:1036. doi: 10.1186/1471-2458-14-1036 25280579

58. Cleland V, Granados A, Crawford D, Winzenberg T, Ball K. Effectiveness of interventions to promote physical activity among socioeconomically disadvantaged women: a systematic review and meta-analysis. Obes Rev. 2013;14(3):197–212. doi: 10.1111/j.1467-789X.2012.01058.x 23107292

59. Hu FB. Sedentary lifestyle and risk of obesity and type 2 diabetes. Lipids. 2003;38(2):103–8. doi: 10.1007/s11745-003-1038-4 12733740

60. Bernal G, Scharron-del-Rio MR. Are empirically supported treatments valid for ethnic minorities? Toward an alternative approach for treatment research. Cultur Divers Ethnic Minor Psychol. 2001;7(4):328–42. doi: 10.1037/1099-9809.7.4.328 11759270

61. Lakerveld J, Ijzelenberg W, van Tulder MW, Hellemans IM, Rauwerda JA, van Rossum AC, et al. Motives for (not) participating in a lifestyle intervention trial. BMC Med Res Methodol. 2008;8:17. doi: 10.1186/1471-2288-8-17 18402683

62. van der Waerden JE, Hoefnagels C, Jansen MW, Hosman CM. Exploring recruitment, willingness to participate, and retention of low-SES women in stress and depression prevention. BMC Public Health. 2010;10:588. doi: 10.1186/1471-2458-10-588 20920371

63. Teuscher D, Bukman AJ, van Baak MA, Feskens EJM, Renes RJ, Meershoek A. A lifestyle intervention study targeting individuals with low socioeconomic status of different ethnic origins: important aspects for successful implementation. BMC Public Health. 2017;18(1):54. doi: 10.1186/s12889-017-4592-1 28743281

64. Intention to treat analysis and per protocol analysis: complementary information. Prescrire Int. 2012;21(133):304–6. 23373104

65. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part 1). Journal of Epidemiology & Community Health. 2006;60(1):7–12.

66. Zarnowiecki D, Dollman J, Parletta N. Associations between predictors of children’s dietary intake and socioeconomic position: a systematic review of the literature. Obesity reviews. 2014;15(5):375–91. doi: 10.1111/obr.12139 24433310

67. Galobardes B, Shaw M, Lawlor DA, Lynch JW, Smith GD. Indicators of socioeconomic position (part 2). Journal of Epidemiology & Community Health. 2006;60(2):95–101.

Článek vyšel v časopise


2019 Číslo 12
Nejčtenější tento týden