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Impact of a Community-Based Intervention on Latino Grandparents' Knowledge About and Self-Efficacy in Supporting Grandchildren's Physical Activities.

Obesity is a major health issue among Latino American children. Data from 2011-2014 National Health and Nutrition Examination Surveys (Ogden et al., 2016) showed that Latino children had an obesity prevalence rate of 15.6% at ages 2 to 5 (3 times higher than non-Hispanic White children), and 25.0% at ages 6 to 11 (1.8 times higher than non-Hispanic While children). Hence, it is crucial to promote physical activity among Latino children.

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.

Method

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.

Survey Measures

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.

Data Analysis

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.

Results

Quantitative Results

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 &lt; .01). They also reported greater knowledge about children's PA (p &lt; .05); local resources for children's PA (p &lt; .01), and modifying children's behavior (p &lt; .01). In addition, participants reported greater confidence in motivating children in PA (p &lt; .05) and collaborating with parents in promoting children's PA (p &lt; .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.

Qualitative Results

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.

References

American Academy of Pediatrics, Council on Communications and Media. (2013). Policy statement: Children, adolescents, and the media. Pediatrics, 132, 958-961. http://dx.doi.org/10.1542/peds.2013-2656

Baca Zinn, M, & Wells, B. (2000). Diversity within Latino families: New lessons for family social science. In D. H. Demo, K. R. Allen, & M. A. Fine (Eds.), Handbook of family diversity (pp. 252-273). New York, NY: Oxford University Press.

Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press.

Carrillo, C. (2002). Faith and culture in Hispanic families. In K. Johnson-Mondragon (Ed.), Pathways of hope and hope among Hispanic teens (pp. 113-160). Stockton, CA: Instituto Fe y Vida.

Goodway. J., Getchell, N., & Raynes, D. (2009). Active start: A statement of physical activity guidelines for children from birth to age 5 (2nd ed.). Reston, VA: National Association for Sport and Physical Education.

Moore, S. M., Borawski, E. A., Love, T. E., Jones, S., Casey, T., McAleer, S.,... Nevar, A. (2019). Two family interventions to reduce BMI in low-income urban youth: A randomized trial. Pediatrics, 143, e20182185. http://dx.doi.org/10.1542/peds.2018-2185

Ogden, C. L., Carroll, M. D., Lawman, H. G., Fryar, C. D., Kruszon-Moran, D., Kit, B. K.. & Flegal, K. M. (2016). Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. Journal of the American Medical Association, 315, 2292-2299. http://dx.doi.org/10.1001/jama.2016.6361

Szapocznik, J., & Coatsworth. J. D. (1999). An ecodevelopmental framework for organizing the influences on drug abuse: A developmental model of risk and protection. In M. Glantz & C. Hartel (Eds.), Drug abuse: Origins & interventions (pp. 331-366). Washington, DC: American Psychological Association. http://dx.doi.org/10.1037/10341-014

U.S. Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans. Retrieved from https://health.gov/paguidelines/pdf/paguide.pdf

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: jimmy.xie@csun.edu

http://dx.doi.org/10.1037/fsh0000443
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
Words:3381
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