“Cause it’s family talking to you”: Children acting as change agents for adult food and physical activity behaviors in American Indian households in the Upper Midwestern United States

Abstract

This article presents research findings from the formative phase of OPREVENT, a pilot obesity prevention intervention trial for American Indian households on two reservations in the Upper Midwestern United States. We describe processes by which American Indian children acting as change agents influence adult food and physical activity behaviors on an Ojibwa and a Potawatomi reservation. This study borrows from Bronfenbrenner and Ceci's socio-ecological model and extends Daniel's resiliency theory for practice with vulnerable children. Using purposive sampling, we interviewed 168 community members, including 25 children between 6 and 13 years of age, using adult in-depth and paired-child interviews, household group interviews, focus groups, and community workshops. Results reveal that six American Indian children, 10-13 years old, were acting as change agents. We propose a socio-ecological conceptual framework to guide our understanding and application of a children as change agent approach for adult health behaviors which includes cultural identity (macro-system), institutional and community support (mezzosystem), family support through a secure base (micro-system), and children's sense of belonging, Childhood self-esteem, self-efficacy, knowledge, and actions as change agents (intrapersonal factors). Resiliency and vulnerability are dynamic processes that intersect the multiple systems throughout children's developmental stages to bolster their agency. We conclude with considerations for the OPREVENT pilot project and discuss future directions for developing a child as change agent theoretical framework for adult health behavior change.

Diet and physical activity changes among low-income families: perspectives of mothers and their children

“…The current study findings are consistent with the concept of reciprocal determinism in that family members described influencing each other's knowledge about health, belief about their abilities to create change, and expectations of outcomes related to dietary or activity changes. Consistent with previous literature (Gadhoke et al, 2015;Laroche et al, 2008Laroche et al, , 2009Williams, et al, 2011), we found health approaches used by both adults and children were influenced by other family members, both in regards to diet and physical activity.…”

“…Children also have more direct influences on parents' diet and physical activity. Children can play active roles in being a part of and advocating for, change in diet and physical activity for parents with diabetes (Gadhoke, Christiansen, Swartz, & Gittelsohn, 2015;Laroche et al, 2009). Some parents may be motivated to be more physically active to be good role models for their children, to provide opportunities for their children to be physically active, or to stay healthy and be able to care for their children for the long term (Mailey, Huberty, Dinkel, & McAuley, 2014), possibly impacting their outcome expectations for being more active.…”

“…Only a handful of studies have simultaneously examined adult and children's perspectives, but these have mainly focused on diet, one included physical activity and one focused on sedentary time. For example, these studies have emphasized parents' roles in promoting healthy diet (Williams, Veitch, & Ball, 2011), different dietary practices among low-income families with an adult with diabetes (Laroche, Davis, Forman, Palmisano, & Heisler, 2008), lack of healthy diet information among Latino parents and children (Lilo, Munoz, & Cruz, 2018), why children engage in sedentary behaviours from a parent and child perspective (Hidding, Altenburg, van Ekris, & Chinapaw, 2017), and ways children can act as change agents among six Native American families (Gadhoke et al, 2015). Though these are important additions to the obesity prevention literature, none specifically addressed children's interest in making changes for themselves or other family members and how their desires influenced family behaviour.…”

Social influences on eating and physical activity behaviours of urban, minority youths

“…Importantly, these data will help researchers and programme staff to identify potential ‘change agents’ (31) (i.e. influential individuals who could be engaged in obesity prevention interventions), as well as generate strategies to effectively incorporate social relationships in nutrition interventions.…”

OPREVENT2: Design of a multi-institutional intervention for obesity control and prevention for American Indian adults

“…Children influence adults in their households positively for healthier nutrition and PA related habits on multiple levels [36–41]. School-based curricula have reported improved adult household members’ food getting habits, reduced fat intake and consumption, increased fruit and vegetable consumption, and lower BMI.…”