The aim of this investigation was to develop, using Ecological Systems Theory (EST) as a contextual framework to determine influencing factors and desired outcomes, a family management model to prevent preschoolers from becoming overweight. A three-phase participatory action research (PAR) design was implemented with stakeholders in a public primary school in Thailand. In the first phase, 327 families with preschoolers were assessed, by way of a self-administered questionnaire, about factors that influence weight gain. The second phase consisted of two workshops, involving 59 stakeholders, and home visits to 27 families conducted for the purpose of developing the model. The final phase evaluated the effects of the model. Both quantitative and qualitative methods were used. A repeated measure ANOVA was performed to analyze the quantitative data, while content analysis was utilized to evaluate the qualitative data.
A three component model (family, school and public health) for family management of overweight prevention in urban preschoolers emerged. The family component consisted of: a) family management processes: preparing a family’s readiness, acting or managing behaviors, and observing and modifying behaviors; and, b) family essential elements: perceptions and concerns about their preschooler’s body shape, nutritional knowledge and skills, participation and consensus. The school component consisted of networking among school organizations, while the public health component involved public health nurses, from the district, who provided school health services and served as co-investigators. Overall, based upon the spiral characteristics of the PAR process, the following procedural steps evolved: 1) preparing the participants; 2) organizing the family management; 3) sharing and promoting knowledge and experiences; and, 4) forming the network.
The model may enhance parents’ knowledge and skills of feeding practices, as well as improve preschoolers’ health behaviors. Fifteen families, through application of the model, were able to maintain their preschoolers’ healthy weight. Use of the model reduced the prevalence of overweight from 16.5% to 13.8 %.
The keys to success were derived from strong family participation in the PAR process and collaborating with school officials to enhance sustainability of the model. Therefore, networking of families, schools and public health nurses are important.