Health behaviour, self-efficacy and perceived control in school-age children : foundations for obesity prevention

Abstract

Understanding children’s health, as it influences their present and future lives is essential for many reasons. With the recent rapid increase in overweight and obesity among children and adolescents worldwide, the need to study the factors that may be contributing to this health-compromising condition has also escalated. This pilot study undertook to establish a baseline health profile for 9-11 year olds in a south central Canadian community, with a focus on healthy eating and physical activity determinants of health, and to investigate the relationship between health behaviours (healthy eating and physical activity) and the psychosocial correlates of self-efficacy (SE) and multidimensional health locus of control (MHLC). Contextual understanding was added through qualitative input from teachers and parents. The study found that, overall, this was a predominantly healthy, economically well-off group of children who lived in stable family environments that were health promoting. The majority reported healthy eating habits and were very physically active. However, there were small but significant groups of children who reported poor health, lived with smokers, did not get regular dental care, irregularly ate healthfully, or were not physically active. Further, rates of sedentary activity, in particular TV watching, were fairly high. Based on physical measurements, rates of overweight and obesity were similarly high to those found in national surveys. Due to sample size limitations, overall health status was used as a proxy measure for overweight and obesity. Gender differences related to health status confirmed the research consensus that girls report poor health significantly more frequently than boys. However, no other gender differences were evident. Trends were identified suggesting that living in rural locations and living with both parents may influence health status. Though socioeconomic status indicators used in this study were not significantly associated with overall health, these trends suggest that related factors such as family structure and geographic location may be important. Investigation of the associations among the psychosocial variables found that physical activity SB was significantly associated with health status, but nutrition SB was not. However, children who were high in either nutrition SB or physical activity SB were also significantly more likely to eat healthfully and be more physically active. These findings suggest that self-efficacy may be an important psychosocial correlate of health status and its related determinants. Multidimensional health locus of control for nutrition was also found to be significantly associated with healthy eating and physical activity. Though the other associations found for health locus of control variables were different from the SB variables, they were, nonetheless, important. Healthy children were more likely to report being in control of their health. Physical activity and physical activity SB were the only strong predictors of health status identified by regression analysis. This finding supports the importance of physical activity to health, and hence to reduction of overweight and obesity, but additionally adds to the uncertainty of the contribution of nutrition. It may be that children, at this age, are more likely to see themselves as capable in the realm of physical activity than nutrition. Teachers’ comments suggested that this might be the case, and also emphasized a lack of good health practices among their students and the importance of positive parental influences. Similarly, parents reinforced the view that children need boundaries, while being given opportunities to be involved in decision making related to eating healthfully and being physically active.