Impact of a Community-Based Intervention on Latino Grandparents' Knowledge About and Self-Efficacy in Supporting Grandchildren's Physical Activities.
An important way to promote children's physical activity is through family members, with previous research focusing on the roles of parents (e.g., Moore et al., 2019). However, in many Latino-American families, grandparents also are involved in rearing of children [grandchildren] (Carrillo, 2002). Because of the familism culture, Latino grandparents often maintain a close tie with parents and grandchildren and are important socializing agents of grandchildren (Baca Zinn & Wells, 2000). Despite that, the roles of Latino grandparents in promoting children's physical activity have been largely overlooked by prevention scientists. To date, there is a scarcity of childhood obesity prevention efforts that specifically target Latino grandparents. To address this gap, we developed a community-based intervention called Nietos Activos y Saludables (Active and Healthy Grandchildren) with the aim of increasing Latino grandparents' support for grandchildren's (aged 2-12 years) physical activity. This current study reports the results of a pilot testing of the intervention with the assessment focusing on Latino grandparents' knowledge about and self-efficacy in supporting grandchildren's physical activity.
Design of Intervention
Grounded in Ecological Systems Theory (Bronfenbrenner, 1979; Szapocznik & Coatsworth, 1999), Nietos Activos y Saludables intervention addresses the microsystem (i.e., grandparents), mesosystem (grandparents--parents and grandparents--community agencies interactions), and exosystem (support network for grandparents) that are important to grandchildren's physical activity (PA). Informed by a qualitative study (Xie, Caldwell, Loy, & Robledo, 2018), the intervention utilizes a novel strategy, which not only promotes Latino grandparents' direct support for grandchildren's PA but also develops their efficacy and skills on collaborating with and positively influencing parents in grandchildren's PA, which fits the cultural context of Latino-American families and is expected to help form a fully bonded family support for Latino children's PA. The intervention consists of four weekly 90-min sessions: (a) PA for children; (b) opportunities and resources for children's PA; (c) developing grandchildren's interest in PA and overcoming barriers; and (d) collaborating with parents and promoting grandchildren's PA and healthy behaviors. Primary pedagogical approaches include information giving/lecturing, scenario-based problem solving, group discussion, and role-playing games. The intervention was delivered in Spanish, which was the preferred language of most grandparents in the recruitment/sampling area.
Participants and Procedure
The study was approved by the institutional review board of the study-affiliated university. Twelve Latino grandparents participated in pilot testing of the intervention at a Los Angeles County senior center during 4 weeks from October to November 2017. The number of participants in each session was eight, 12, 11, and 11. The majority of the participants were female (n = 9), older than 60 years (n = 11), and were providing care at the time to at least one grandchild (n = 10). The participants were recruited at the senior center and a nearby Catholic church. In the area in which recruitment took place, approximately 20% of the population lives below the poverty level and 88% of the Latinos are of Mexican origin.
A mixed-methods approach was used to assess the intervention impact. First, self-administered pre- and posttest Spanish language questionnaire surveys were conducted immediately before and after each session. Second, two Spanish language focus groups were conducted by the session instructor and an assistant instructor approximately a week after the intervention. Each focus group consisted of six participants and lasted approximately 60 min.
Tables 1 and 2 listed the measures included in each pre- and posttest survey. Grandparents' objective knowledge about PA requirements for children was assessed using seven multiple-choices questions based on guidelines from the National Association for Sport and Physical Education (Goodway, Getchell, & Raynes, 2009), Physical Activity Guidelines for Americans (U.S. Department of Health and Human Services, 2008), and American Academy of Pediatrics, Council on Communications and Media (2013). In addition, participants were asked to indicate (a) perceived knowledge about children's PA (one item) and benefits of PA to children (one item); (b) the number of indoor physical activities (one item) and local parks and recreation centers (one item) they knew; (c) perceived knowledge about different resources/opportunities for children's PA (six items); (d) self-efficacy in motivating children in PA (two items); (e) perceived knowledge about developing children's interest in PA (four items); (f) perceived knowledge about behavioral modification for children (five items); (g) the number of effective strategies/methods they knew to correct grandchildren's bad behaviors or habits (one item); and (h) self-efficacy in collaborating with parents in children's PA (three items). An aggregate score was created for each multiple-item construct by averaging the item scores. In each posttest survey, participants were asked to indicate, on a 5-point scale (1 = strongly disagree, 5 = strongly agree), whether (a) the session provided useful information and (b) whether they enjoyed the discussion with other participants during the session.
Focus Group Questions
Questions in the focus groups addressed the following topics: (a) participants' overall impression of the intervention and their perception of the most and least useful sessions/contents, (b) what participants learned from the sessions, (c) what change(s) participants made or plan to make based on the learning from the sessions, and (d) suggestions for future program improvement. General undirected questions were asked before specific directed questions.
Paired-sample t tests were used to assess participants' change in the self-report knowledge and self-efficacy measures. A Wilcoxon signed-ranks test was used to assess outcomes measured by ordinal items (e.g., number of local parks and recreation centers that participants knew). Focus groups were audio recorded, transcribed verbatim, and translated back to English by bilingual researchers. Two researchers independently coded the data and then compared, discussed, and finalized the codes.
Participants indicated that the intervention provided useful information (Session 1: M = 4.71, SD = 0.488; Session 2: M = 4.50, SD = 0.522; Session 3: M = 4.64, SD = 0.505; Session 4: M = 4.91, SD = 0.302) and that they enjoyed the discussion with other participants (Session 1: M = 5.00, SD = 0.000; Session 2: M = 4.55, SD = 0.522; Session 3: M = 4.64, SD = 0.505; Session 4: M = 4.91, SD = 0.302).
Table 1 reports the results of paired-sample t tests. After intervention sessions, participants achieved a higher score in objective knowledge about PA requirements for children (p < .01). They also reported greater knowledge about children's PA (p < .05); local resources for children's PA (p < .01), and modifying children's behavior (p < .01). In addition, participants reported greater confidence in motivating children in PA (p < .05) and collaborating with parents in promoting children's PA (p < .01). The change in knowledge about benefits of PA to children was not significant, possibly because of the small sample size. Results of the Wilcoxon signed-ranks test (see Table 2) showed that participants knew more indoor physical activities, local parks and recreation centers, and effective strategies/methods on correcting grandchildren's bad behaviors or habits (p < .05) after the intervention sessions.
Four general themes were identified (see Table 3 for sample quotes from participants). The first was satisfaction with the intervention: Participants were satisfied with the intervention and its pedagogical approaches. They indicated that the intervention provided useful and easy-to-apply information and made them better prepared for rearing grandchildren. The second was the perception of learning: Participants indicated that they learned from all four sessions. The examples of learning were mainly related to PA requirement, fun PA options, PA resources/opportunities, negative impact of screen-based media use, recommended time on screen-based media use for children, and supporting/motivating children in PA. The third was behavioral change/planned behavioral change: Participants indicated that they made changes or planned to make changes in different areas related to their grandchildren's PA. Examples mainly included providing more support to grandchildren in PA, monitoring and limiting grandchildren's use of screen-based media, changing the way of interacting with grandchildren, correcting grandchildren's inappropriate behavior, and initiating/increasing communication with parents in grandchildren's PA. And fourth, future program improvement: Many participants suggested that the intervention should consider adding information about nutrition and healthy eating for children. They also confirmed the importance of discussing about children's screen-based media use.
Discussion and Conclusion
Results indicate that Nietos Activos y Saludables intervention provided useful information to Latino grandparents in this study and increased their knowledge about and self-efficacy in supporting grandchildren's physical activity. This study suggests that Latino grandparents may have the motivation and potential to become more competent in promoting grandchildren's physical activity through intervention/education. Future studies should test the intervention's efficacy and long-term outcomes (e.g., Latino grandchildren's physical activity measured by odometer and body mass index) using randomized controlled trials with larger samples. In addition, the intervention may also promote grandparents' engagement in physical activity with grandchildren and improve grandparents' own physical activity and health, which should be assessed in future studies. Finally, future studies may include healthy eating sessions in the intervention to increase its effectiveness in childhood obesity prevention.
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Xie, H., Caldwell, L. L., Loy, S., & Robledo, M. (2018). A qualitative study of Latino grandparents' involvement in and support for grandchildren's leisure time physical activity. Health Education & Behavior, 45, 781-789. http://dx.doi.org/10.1177/1090198117742441
Received April 7, 2019
Revision received June 25, 2019
Accepted August 26, 2019
Hui Xie, PhD
California State University, Northridge
Linda L. Caldwell, PhD
Pennsylvania State University
Steven Loy, PhD, Carolina Aristizabal, MD, MPH, CHES, and Araceli Guzman, MPH, CHES
California State University, Northridge
Hui Xie, PhD, Department of Recreation and Tourism Management, California State University, Northridge; Linda L. Caldwell, PhD, Department of Recreation Park and Tourism Management, Pennsylvania State University; Steven Loy, PhD, Department of Kinesiology, California State University, Northridge; Carolina Aristizabal, MD, MPH, CHES, and Araceli Guzman, MPH, CHES, Department of Health Sciences, California State University, Northridge.
Carolina Aristizabal is now at Community Outreach and Engagement Program, Norris Comprehensive Cancer Center, University of Southern California. Araceli Guzman is now at Perinatal Advisory Council: Leadership, Advocacy, and Consultation, Glendale, California.
The study was supported by the National Institutes of Health (NIH/NIGMS, Building Infrastructure Leading to Diversity: RL5GM118975 and UL1GM118976 awarded to Carrie Saetermoe, Crist Khachikian, Gabriela Chavira, and Margaret Shiffrar).
Correspondence concerning this article should be addressed to Hui Xie, PhD, Department of Recreation and Tourism Management, California State University, Northridge, 18111 Nordhoff Street, Northridge, CA 91330-8269. E-mail: email@example.com
Table 1 Results of Paired-Sample t Tests Constructs and variables [M.sub.Pre] [M.sub.Post] Objective knowledge test on children's physical activity (S1) 1.88 4.50 Knowledge about physical activity for children (S1) Physical activity for children 4.25 6.38 Benefits of physical activity to children. 5.25 7.13 Knowledge about local resources and opportunities for children's physical activity (S2) 2.36 5.83 Children physical activity and sport programs offered by parks and recreation centers 2.58 5.50 Physical activity facilities in parks and recreation centers 2.75 5.83 Children physical activity and sport programs offered by YMCA 2.58 6.58 Financial aid offered by YMCA 1.33 4.75 Children physical activity and sport programs offered by indoor children playgrounds 2.75 5.92 Different organizations/places that offer physical activity and sport programs for children 2.17 6.42 Self-efficacy in motivating children in physical activity (S3) 5.32 7.50 Confidence in motivating children to do more physical activities 5.18 7.73 Confidence in motivating the least physically active grandchild do more physical activities 5.45 7.27 Knowledge about developing children's interest in physical activity (S3) 5.73 7.20 Developing children's interest in physical activity 6.00 7.36 Increasing children's confidence in doing physical activities 5.64 7.45 Providing children a sense of autonomy or control in doing physical activities 5.36 6.73 Making children feel that you are interested in their physical activities 5.50 7.00 Knowledge about behavioral modification for children (S4) 5.24 7.40 Different ways to discipline a child 5.55 6.55 Different ways to reward a child 6.36 8.27 Promoting good habits through rewarding 4.64 7.82 Inappropriate ways to reward a child 4.36 7.18 Negative impact of inappropriate rewarding on a child 5.27 7.18 Self-efficacy in collaborating with parents (S4) 4.85 7.00 Confidence in making a constructive conversation with the parent(s) about the disagreement about grandchild 4.91 7.18 Confidence in persuading parent(s) to provide more support in physical activity (for the least physically active grandchild) 5.09 7.36 Confidence in persuading parent(s) to reduce screen time (for the least physically active grandchild) 4.55 6.45 Constructs and variables t df p Objective knowledge test on children's physical activity (S1) -6.251 7 <.001 Knowledge about physical activity for children (S1) Physical activity for children -2.773 7 .028 Benefits of physical activity to children. -1.894 7 .100 Knowledge about local resources and opportunities for children's physical activity (S2) -4.822 11 .001 Children physical activity and sport programs offered by parks and recreation centers Physical activity facilities in parks and recreation centers Children physical activity and sport programs offered by YMCA Financial aid offered by YMCA Children physical activity and sport programs offered by indoor children playgrounds Different organizations/places that offer physical activity and sport programs for children Self-efficacy in motivating children in physical activity (S3) -2.322 10 .043 Confidence in motivating children to do more physical activities Confidence in motivating the least physically active grandchild do more physical activities Knowledge about developing children's interest in physical activity (S3) -1.925 10 .083 Developing children's interest in physical activity Increasing children's confidence in doing physical activities Providing children a sense of autonomy or control in doing physical activities Making children feel that you are interested in their physical activities Knowledge about behavioral modification for children (S4) -3.733 10 .004 Different ways to discipline a child Different ways to reward a child Promoting good habits through rewarding Inappropriate ways to reward a child Negative impact of inappropriate rewarding on a child Self-efficacy in collaborating with parents (S4) -3.804 10 .003 Confidence in making a constructive conversation with the parent(s) about the disagreement about grandchild Confidence in persuading parent(s) to provide more support in physical activity (for the least physically active grandchild) Confidence in persuading parent(s) to reduce screen time (for the least physically active grandchild) Note. Objective Knowledge Test has a maximum score of 7 and minimum score of 0. Subjective knowledge items were measured on a 10-point scale (1 = not at all knowledgeable; 10 = extremely knowledgeable). Self-efficacy items were measure on a 10-point scale (1 = not at all confident; 10 = extremely confident). S1 (session 1) to S4 (session 4) denotes the session for which an outcome was assessed. Table 2 Results of Wilcoxon Signed Ranks Tests After rank to Mean Variable before rank N rank Number of indoor physical activities (S2) (a) Negative ranks 0 .00 Positive ranks 7 4.00 Ties 3 Number of indoor local parks and recreation Negative ranks 0 .00 centers (S2) (a) Positive ranks 6 3.50 Ties 6 Number of effective behavioral modification Negative ranks 0 .00 strategies/methods (S4) (b) Positive ranks 6 3.50 Ties 4 Sum of Variable ranks Z p Number of indoor physical activities (S2) (a) .00 -2.414 .016 28.00 Number of indoor local parks and recreation .00 -2.271 .023 centers (S2) (a) 21.00 Number of effective behavioral modification .00 -2.271 .023 strategies/methods (S4) (b) 21.00 Note. S1 (session 1) to S4 (session 4) denotes the session for which an outcome was assessed. (a) Scale: 1 = none; 2 = one to two; 3 = three to five; 4 = six to eight; 5 = nine to 12; 6 = more than 12. (b) Scale: 1 = none; 2 = one to two; 3 = three to four; 4 = five to six; 5 = more than 6. Table 3 Sample Quotes From Interviews and Focus Croups Sample quotes Satisfaction with the intervention Grandmother 1: "I liked all the classes. I thank you very much because there are things we did not know. They are very useful things to put into practice with the grandchildren." Perception of learning Grandfather 1: "I learned games like the fun of balloons, bubbles, the game of imitating animals, my grandson is 2 years old. He loves playing with balls." Grandfather 2: "What I liked most was having access to the list of parks and recreation centers to take my grandchildren to exercise." Grandmother 2: "Well, I liked knowing that they (the grandchildren) should not be on their phones all the time, not too much TV time, making sure to limit their time during those activities." Grandmother 3: "I learned how to do exercise with my grandchildren. Also, I learned how to speak well to my grandchildren without frightening them because I am afraid that they will be afraid of me and that they do not want to be with me. I learned to be more affectionate with my grandchildren." Behavioral change/planned behavioral change Grandmother 4: "Yes, that same day of Thanksgiving dinner, I told everyone to turn off their cell phones and put them in a box because at least when we give thanks, we should have quality family time. They all gave me weird looks because they are so used to always having their phones....This was the first year that I took away their cell phones and they all asked why 1 was doing that, and I told them that I had been going to some classes (referring to NAS) where I learned that. I wish I had done this earlier but better late than never." Grandfather 3: "I'm taking my grandchildren to the park. I'm being a better grandparent after attending these classes." Grandfather 1: "I have shared all the information with my son to teach him and his spouse what they should do with my grandchildren." Note. NAS = Nietos Activos y Saludables.
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|Title Annotation:||BRIEF REPORT|
|Author:||Xie, Hui; Caldwell, Linda L.; Loy, Steven; Aristizabal, Carolina; Guzman, Araceli|
|Publication:||Families, Systems & Health|
|Date:||Dec 1, 2019|
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