Women and children enrolled in federally funded home visitation services are at an increased risk for unhealthy diet and physical activity patterns. Home visitors have a privileged relationship with their clients and hold a unique perspective of the multilevel influences surrounding these behaviors. This study explored the question: “What are the home visitors’ perspectives and experiences with their families’ diet and physical activity behaviors?”. Home visitors enrolled in a larger trial were invited to participate in focus group sessions (n=13). Topics covered their clients’ constraints and capacity building opportunities for healthful diet and activity practices. Reflexive thematic analysis was used to analyze the data. The home visitors discussed key influences of diet and activity, and three overarching themes were identified: (1) Acute periods of crises and mental health issues; (2) The role of the mother within the family; and (3) Support and barriers within mothers’ broader social network. The themes identified in this study highlight the complex, multidimensional influences on the dietary and physical activity patterns of these families, and pinpoint key areas of opportunity for intervention.
Abrams, L. S. & Curran, L. (2009). “And You’re Telling Me Not to Stress?” a Grounded Theory Study of Postpartum Depression Symptoms among Low-Income Mothers. Psychology of Women Quarterly, 33(3):351-362.
Ammerman, R. T., Putnam, F. W., Bosse, N. R., Teeters, A. R., & Van Ginkel, J. B. (2010). Maternal depression in home visitation: A systematic review. Aggressive and Violent Behavior, 15(3):191-200.
Andrews, J. O., Felton, G., Wewers, M. E., & Heath, J. (2004). Use of community health workers in research with ethnic minority women. Journal of Nursing Scholarship, 36(4):358-365. doi:https://doi.org/10.1111/j.1547-5069.2004.04064.x
Bianchi, S. M., Milkie, M. A., Sayer, L. C., & Robinson, J. P. (2000). Is anyone doing the housework? Trends in the gender division of household labor. Soc Forces, 79(1):191-228.
Bird, C. E. & Rieker, P. P. (2008). Gender and Health: The Effects of Constrained Choices and Social Policies. Cambridge University Press. doi:10.1017/CBO9780511807305
Blaine, B. (2008). Does depression cause obesity? A meta-analysis of longitudinal studies of depression and weight control. Journal of Health Psychology, 13(8):1190-1197.
Blake-Lamb, T. L., Locks, L. M., Perkins, M. E., Baidal, J. A. W., Cheng, E. R., & Taveras, E. (2016). M. Interventions for childhood obesity in the first 1,000 days a systematic review. The American Journal of Preventive Medicine, 50(6):780-789.
Bove, C. F., Sobal, J., & Rauschenbach, B. S. (2003). Food choices among newly married couples: convergence, conflict, individualism, and projects. Appetite, 40(1):25-41.
Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2):77-101.
Bull, E. R., McCleary, N., Li, X., Dombrowski, S. U., Dusseldorp, E., & Johnston, M. (2018). Interventions to promote healthy eating, physical activity and smoking in low-income groups: a systematic review with meta-analysis of behavior change techniques and delivery/context. International Journal of Behavioral Medicine, 25(6):605-616.
Center for Disease Control and Prevention. (2019). Lack of Physical Activity. Published 2020. Accessed February 12, 2021. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/physical-activity.htm
Centers for Disease Control and Prevention. (2019). Strategies to Prevent Obesity | Overweight & Obesity. Published October 23, 2019. Accessed October 26, 2020. https://www.cdc.gov/obesity/strategies/index.html
Centers for Disease Control and Prevention. (2020). Social Determinants of Health. Published October 29, 2020. Accessed February 12, 2021. https://www.cdc.gov/chronicdisease/programs-impact/sdoh.htm
Centers for Disease Control and Prevention. (2020). Why It Matters | Nutrition. Published September 1, 2020. Accessed November 6, 2020. https://www.cdc.gov/nutrition/about-nutrition/why-it-matters.html
Chaudron, L. H., Kitzman, H. J., Peifer, K. L., Morrow, S., Perez, L. M., & Newman, M. C. (2005). Prevalence of maternal depressive symptoms in low-income Hispanic women. Journal of Clinical Psychiatry, 66(4):418-23.
D’Alonzo, K. T. (2012). The Influence of Marianismo Beliefs on Physical Activity of Immigrant Latinas. Journal of Transcultural Nursing, 23(2):124-133. doi:10.1177/1043659611433872
de la Haye, K., Bell, B. M., & Salvy, S. J. (2019). The role of maternal social networks on the outcomes of a home-based childhood obesity prevention pilot intervention. Journal of Social Structure, 20(3).
Fergusson, D. M., Grant, H., Horwood, L. J., & Ridder, E. M. (2006). Randomized trial of the Early Start program of home visitation: parent and family outcomes. Pediatrics, 117(3):781-786.
Gillen, M. M., Markey, C. N., & Markey, P. M. (2012). An examination of dieting behaviors among adults: Links with depression. Eating Behaviors, 13(2):88-93.
Harding, K., Galano, J., Martin, J., Huntington, L., & Schellenbach, C. J. (2007). Healthy Families America® Effectiveness: A comprehensive review of outcomes. Journal of Prevention & Intervention in the Community, 34(1-2):149-179.
Hawes, A. M., Smith, G. S., McGinty, E., Bell, C., Bower, K., LaVeist, T. A., Gaskin, D. J., & Thorpe, R. J., Jr. (2019). Disentangling race, poverty, and place in disparities in physical activity. International Journal of Environmental Research and Public Health. 16(7):1193.
Homish, G. G. & Leonard, K. E. (2008). Spousal influence on general health behaviors in a community sample. American Journal Health Behavior, 32(6):754-763.
Jain, A., Sherman, S. N., Chamberlin, L. A., Carter, Y., Powers, S. W., & Whitaker, R. C. (2001). Why don’t low-income mothers worry about their preschoolers being overweight? Pediatrics, 107(5):1138-1146.
Klohe-Lehman, D. M., Freeland-Graves, J., Jordan, K., Cai, G., Voruganti, V. S., Milani, T. J., Nuss, H. J., Proffitt, J. M., & Bohman, T. M. (2007). Low-income, overweight and obese mothers as agents of change to improve food choices, fat habits, and physical activity in their 1-to-3-year-old children. Journal of the American College of Nutrition, 26(3):196-208.
Kumanyika, S. K. (2018). Supplement overview: what the Healthy Communities Study is telling us about childhood obesity prevention in U.S. communities. Pediatric Obesity, 13(S1):3-6. doi:https://doi.org/10.1111/ijpo.12478
Kumanyika, S. K. (2019). A framework for increasing equity impact in obesity prevention. Am J Public Health, 109(10):1350-1357.
MacMillan Uribe, A. L. & Olson, B. H. (2019). Exploring healthy eating and exercise behaviors among low-income breastfeeding mothers. Journal of Human Lactation, 35(1):59-70.
Martinez, S. M., Rhee, K. E., Blanco, E., & Boutelle, K. (2017). Latino mothers’ beliefs about child weight and family health. Public Health Nutrition, 20(6):1099-1106. doi:10.1017/S1368980016002962
McLoyd, V. C., Cauce, A. M., Takeuchi, D., & Wilson, L. (2000). Marital processes and parental socialization in families of color: A decade review of research. Journal of Marriage and Family, 62(4):1070-1093.
Mills, S., White, M., Brown, H., Wrieden, W., Kwasnicka, D., Halligan, J., Robalino, S., & Adams, J. (2017). Health and social determinants and outcomes of home cooking: a systematic review of observational studies. Appetite, 111:116-134.
Morales, K. H., Kumanyika, S. K., Fassbender, J. E., Good, J., Localio, A. R., & Wadden, T. A. (2014). Patterns of Weight Change in Black Americans: Pooled Analysis from Three Behavioral Weight Loss Trials. Obesity (Silver Spring, Md.), 22(12):2632-2640. doi:10.1002/oby.20904
NVivo 12. (n.d.). QSR International https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home
Poucher, Z. A., Tamminen, K. A., Caron, J. G., & Sweet, S. N. (2020). Thinking through and designing qualitative research studies: A focused mapping review of 30 years of qualitative research in sport psychology. International Review of Sport and Exercise Psychology, 13(1):163-186.
Raposa, E., Hammen, C., Brennan, P., & Najman, J. (2014). The long-term effects of maternal depression: early childhood physical health as a pathway to offspring depression. Journal of Adolescent Health, 54(1):88-93.
Ritchie, N. D., Sauder, K. A., Phimphasone-Brady, P., & Amura, C. R. (2018). Rethinking the National Diabetes Prevention Program for Low-Income Whites. Diabetes Care, 41(4):e56-e57. doi:10.2337/dc17-2230
Salvy, S. J., de la Haye, K., Galama, T., & Goran, M. I. (2017). Home visitation programs: an untapped opportunity for the delivery of early childhood obesity prevention. Obesity Reviews, 18(2):149-163.
Salvy, S. J., Dutton, G. R., Borgatti, A., & Kim, Y. I. (2018). Habit formation intervention to prevent obesity in low-income preschoolers and their mothers: A randomized controlled trial protocol. Contemporary Clinical Trials, 70:88-98.
Satia, J. A. (2009). Diet-related disparities: understanding the problem and accelerating solutions. Journal of the American Dietetic Association, 109(4):610-615. doi:10.1016/j.jada.2008.12.019
Savage, J. S., Fisher, J. O., & Birch, L. L. (2007). Parental influence on eating behavior: conception to adolescence. Journal of Law, Medicine, & Ethics, 35(1):22-34.
Schiller, J. S., Lucas, J. W., & Peregoy, J. A. (2012). Summary health statistics for US adults: national health interview survey, 2011. Vital Health and Statistics Series 10, (256):1-218.
Scott, K., Beckham, S., Gross, M., Pariyo, G., Rao, K., & Perry, H. (2018). What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Human Resources for Health, 16. doi:10.1186/s12960-018-0304-x
Shanti, C. (2017). Engaging parents in early head start home-based programs: how do home visitors do this? Journal of Evidence-Informed Social Work, 14(5):311-328.
Sparkes, A. C. & Smith, B. (2014). Qualitative Research Methods in Sport, Exercise and Health: From Process to Product. Routledge/Taylor & Francis Group.
Story, M., Kaphingst, K. M., Robinson-O’Brien, R., & Glanz, K. (2008). Creating healthy food and eating environments: policy and environmental approaches. Annual Review of Public Health, 29:253-272.
Strine, T. W., Chapman, D. P., Balluz, L., & Mokdad, A. H. (2008). Health-related quality of life and health behaviors by social and emotional support. Social Psychiatry and Psychiatric Epidemiology, 43(2):151-159.
Thompson, S. M., Jiang, L., Hammen, C., & Whaley, S. E. (2018). Association of Maternal Depressive Symptoms and Offspring Physical Health in Low-Income Families. Maternal and Child Health Journal, 22(6):874-882.
Tracy, S. J. (2010). Qualitative quality: Eight “big-tent” criteria for excellent qualitative research. Qualitative Inquiry, 16(10):837-851.
Wang, Y. & Chen, X. (2011). How much of racial/ethnic disparities in dietary intakes, exercise, and weight status can be explained by nutrition-and health-related psychosocial factors and socioeconomic status among US adults? Journal of the American Dietetic Association, 111(12):1904-1911.
Witmer, A., Seifer, S. D., Finocchio, L., Leslie, J., & O’Neil, E. H. (1995). Community health workers: integral members of the health care work force. American Journal of Public Health, 85(8_Pt_1):1055-1058.
Zhang, S., de la Haye, K., Ji, M., & An, R. (2018). Applications of social network analysis to obesity: a systematic review. Obesity Reviews, 19(7):976-988.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright (c) 2022 Sydney Miller, Celina Shirazipour, Aimee Fata Holmes, Sarah-Jeanne Salvy, Kayla de la Haye