Self-determination theory provides a framework for how maternal food parenting practices lead to eating behaviors associated with overweight and obesity in
children.54,55 However, it lacks a goal-orientated approach for modifying maternal food parenting practices. As a collaborative, goal-oriented style of communication, MI may enhance motivation and help establish goals for modifying maternal food
parenting practices.58
An Overview of Motivational Interviewing
Clinical psychologist William Miller originally developed MI to treat substance abuse disorders.59 Motivational interviewing was further developed by William Miller and Steven Rollnick, and in 1991 their original book, “Motivational Interviewing: Preparing People to Change Addictive Behavior” was published.60 Since then, MI has been adapted for numerous health-related behaviors including childhood obesity prevention and treatment.61,62 Broadly, MI is a collaborative, goal-oriented style of communication with particular attention to the language of change or “change talk”.58
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It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion.”58 This collaborative, goal-oriented style of
communication actively engages a person in an exploration of the desires, motivation, and goals for behavior change.58 Moreover, the spirit, guiding principles, and
techniques of MI have been used in both clinical and research settings to enhance motivation for behavior change.
Motivational Interviewing – The Spirit, Guiding Principles, and Techniques The spirit or essence of MI is a “way of being” with a person that creates a partnership between the provider and person seeking support for behavior change.58 The underlying spirit of MI includes four qualities: collaboration, acceptance, compassion, and evocation.58 Collaboration creates a partnership that honors the person’s expertise and unique perspectives, which builds rapport and facilitates trust.58 The use of acceptance honors a person’s inherent worth and autonomy as well as acknowledges strengths and efforts made towards behavior change.58 In addition, compassion is a “deliberate commitment to pursue the welfare and best interest of others.”58 Lastly, evocation is the acknowledgement that the skills and motivation for change reside within the person seeking support for behavior change.58 The
convergence of these four qualities is the underlying spirit of MI, which sets the tone for the behavior change partnership.
Building on the underlying spirit of MI, four guiding principles are used by providers to support behavior change: expressing empathy, developing discrepancy, supporting self-efficacy, and “rolling with resistance”.60 Expressing empathy through
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reflective listening, allows providers to communicate acceptance and respect for a person’s point of view fostering collaboration.60 Providers develop discrepancy by exploring how a person’s values and goals align with current behaviors.60 By developing discrepancy, providers enhance a person’s desire or need for behavior change. Self-efficacy or a person’s belief in their ability to change is an important component of behavior change.63 By supporting and enhancing a person’s self-
efficacy the belief in their ability to change and accomplish goals increases.60,63 Lastly, “rolling with resistance” or responding to resistance in a nonjudgmental, empathic manner reduces counterproductive arguments, and supports a person’s autonomy.60 These four principles serve as guide for the specific techniques used during an MI session to support behavior change.
The specific techniques a provider uses during an MI session are often referred to by the acronym OARS: open-ended questions, affirmations, reflections and
summaries.58 The use of open-ended questions (i.e., questions that cannot be answered with a simple yes or no) provides more information on a person’s thoughts, feelings, and beliefs. Affirmations are statements used to support, encourage and bolster a person’s self-efficacy.58 In addition, reflections are statements used by the provider to check understanding (i.e., ensuring the provider understood what a person has said by repeating it back to them with or without added meaning).58 Lastly, summaries are often longer reflections used to tie together components of what the person has said during the MI session.58 Furthermore, providers use OARS to support behavior change
by eliciting reasons for change and a person’s belief in their ability to change or “change talk”.58
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Motivational Interviewing – Individualized Feedback
Although not a specific MI technique, previous research suggests that providing individualized feedback in conjunction with MI may further enhance a person’s motivation for behavior change.58,64 Individualized feedback typically includes key information from a previous session or assessment.64 Using of individualized feedback offers a glimpse of current behaviors, and provides an opportunity to explore whether current behaviors are congruent with goals, values, and beliefs.
The current study used a mother-child meal recording, filmed during the baseline session, to provide individualized feedback to the mother. The Family Mealtime Coding System (FMCS) was used to code the mother’s use of controlling food parenting practices, and selected segments of the meal recording were shown to the mother during the MI-based feedback session. Although our study was the first to use the mother-child meal recording to provide feedback on food parenting practices, one previous study used a mother-child interaction recording to improve parenting
practices.65 The study showed significant improvements in parenting practices (e.g., increased reaction to the infants verbal and non-verbal cues) after the mother was shown a recording of her interaction with her child.65 Although the study targeted general parenting practices, not food parenting practices, this study provides support for the use of a mother-child meal recording to provide feedback.
Motivational Interviewing and Childhood Obesity Interventions
A review by Borrello et al. examined the effects of six MI interventions targeting the parents of overweight and obese children between the ages of 2 to 11-years.61 Of the six interventions included in the review, three demonstrated statistically significant
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reductions in child BMI or improvements in obesity-related behaviors (e.g., reductions in calorie consumption or television viewing).61 These findings suggest that MI
interventions targeting parents may be an effective strategy for modifying behaviors associated with childhood overweight and obesity.
A randomized controlled trial by Resnicow et al. targeting the parents of overweight children between the ages of 2 to 8-years examined the effects of three distinct treatment groups on child weight status from baseline to 2-years.66 Participants were randomized into one of three treatment groups: 1) standard care (i.e., height and weight measurements), 2) standard care plus two MI sessions, or 3) standard care plus six MI session.66 This study showed statistically significant reductions in child BMI percentile in the two groups receiving MI when compared to the group receiving standard care only.66 These findings support the use of MI interventions with parents of overweight to reduce child BMI.66 However, since this study was conducted in primary care provider offices, it is unknown whether similar effects may be seen in home-based interventions.
Although existing research supports the use of parent-targeted MI sessions, little is known about the effects of MI on maternal food parenting practices. Therefore,
research is needed to determine the effects of MI on maternal food parenting practices. Conclusion
Although childhood overweight and obesity prevalence has declined or stabilized in some populations, childhood overweight and obesity prevalence continues to be disproportionately high in low-income8,9 and some minority populations.1,2 The high overweight and obesity prevalence in these populations underscores the importance of
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developing effective obesity prevention interventions. The etiology of childhood obesity is complex, resulting from both genetic and environmental factors.10,11 However, environmental factors (e.g., the family food environment) are modifiable making these factors important targets for childhood obesity prevention efforts.12-15 In most households, mothers maintain the family food environment including the responsibility for child feeding via food parenting practices.14 Maternal food parenting
practices play an important role in the development of a child’s eating behaviors, and subsequent weight status early in life, therefore learning how to modify these practices is essential.12-15 Although some studies have incorporated education on “best feeding practices” within multi-component obesity prevention interventions,47,48 few studies have directly attempted to modify maternal food parenting practices.49,50 Moreover,
few studies have used a theoretical framework to understand how food parenting practices lead to food preferences and eating behaviors in preschool-aged children.54,55 Self-determination theory provides a framework for how maternal child feeding practices may lead to eating behaviors associated with obesity in children. As a goal- oriented approach to behavior change, MI may be an effective strategy for modifying maternal food parenting practices.58
Given the evidence that food parenting practices influence a child’s eating
behaviors, and subsequent weight status early in life, the purpose of this study was to examine the feasibility and acceptability of a novel home-based intervention to modify and improve maternal food parenting practices.
48 References
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54 APPENDIX B EXTENDED METHODS Study Design
This study examined the feasibility, acceptability, and preliminary outcomes of a novel home-based early childhood obesity prevention intervention designed to modify and improve the food parenting practices of low-income mothers with preschool-aged children. The study included three home-based sessions, and used pretest/posttest measurements to assess changes in maternal food parenting practices. The University of Rhode Island Institutional Review Board approved all study procedures.
Recruitment Venue (May 2015 – July 2015)
The student researcher contacted the Program Coordinator for a Special
Supplemental Nutrition Program for Women, Infants and Children (WIC) office at Wood River Health Services (WRHS) in Westerly, Rhode Island. The WIC office provides supplemental foods, nutrition education, and health care referrals for low- income families at risk for nutritional deficiencies,1 making this office an ideal venue for participant recruitment. After conducting meetings with the Program Coordinator and the Director of Quality Improvement to discuss research and recruitment goals, the student researcher received permission to recruit participants from the WIC office at WRHS.
Participant Recruitment (August 2015 – January 2016)
Participant recruitment began in August 2015, and concluded in January 2016. During the recruitment period, WIC office staff provided interested mother-child dyads with an informational flyer (Appendix F) that included a brief description of the study and the student researcher’s contact information. In addition, the student
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researcher was introduced to interested mother-child dyads in the office waiting area immediately following WIC appointments. As time allowed, interested mother-child dyads were screened for eligibility in the office waiting area. Mother-child dyads that expressed interest though lacked time to complete the screening process were
contacted by the student researcher, and screened over the phone. In addition, informational flyers that included a brief description of the study and the student researcher’s contact information were posted in the office area.
Participants
A total of 25 mother-child dyads expressed interest in participating in the study. However, the student researcher was unable to contact 10 mother-child dyads to complete the screening process. A convenience sample of 15 mother-child dyads completed the screening process, and were recruited to participate in the study. Eligibility criteria included mothers (≥18 years of age) with a biological, adopted or