1. Using Health Belief Model To Predict Childhood Obesity Prevention Behaviors Among Elementary School Aged Children In India
Nataraja Sarma Vaitinadin (1,2), Brittany L. Rosen (2), Jun Ying (2), Bradley R. A. Wilson (2) & Manoj Sharma (3)
1 Department of Environmental Health, Division of Public Health Sciences, College of Medicine; 2 Health Promotion & Education Program - School of Human Services, College of Education, Criminal Justice and Human Services, 1 & 2 - University of Cincinnati, Cincinnati, OH 3. School of Public Health, Jackson State University, MS.
METHODS
The purpose of this study was to determine if the health belief model predicted childhood obesity prevention behaviors among upper elementary school children in a sample drawn from the Chennai region of southern India. Here we report data about water consumption behavior: drinking 6 to 8 cups of water. The health belief model has offered a practical framework for designing primary prevention interventions to reduce other health problems and continues to do so in the West. This study was designed to examine the extent to which selected health belief model constructs could predict the chosen behaviors among upper elementary school children in India. Institutional Review Board approval was obtained from the University of Cincinnati. Data were collected using a 47-item valid and reliable scale administered to the sample population. From among the participants, in grades 6 and 5 across 6 schools, 737 questionnaires were determined to be valid for data analysis.
Regression analyses, using IBM SPSS v22, by the stepwise method, were run to test for variance in behaviors attributable to each of the independent variables. This was further extended to determine a path model , which in turn evolved the presented structural equation model.
The final regression and structural equation models, using AMOS, revealed that the health belief model predictors were weak in the current context of study, probably due to cultural differences in India compared to the USA where this model originated. Recommendations have been offered to evolve interventions aimed at predicting obesity associated behaviors in children.
IMPLICATIONS FOR PRACTICE
The study illustrates some important findings, especially the need to evolve health behavior theories that would be more consistent with the social and cultural differences seen in India.
For example, unlike the west, children in India are more under the influence of parents and other elders at their homes. This means that even though they might express their perceptions, the behaviors might be different and more in line with adult demands. As such, the ability of constructs like self-efficacy might be limited in predicting chosen behaviors.
Extraneous aspects, like socio-economic factors, are not studied directly under the health belief model. More studies, involving existing health behavior theories need to be done to enhance our understanding of obesity prevention behaviors among children in India.
CONCLUSIONS
As, this and other previous, studies have shown, existing health behavior theories do not capture the gamut of determinants needed to study and predict health behaviors in a non-western culture like India.
This necessitates the contextual enhancement of existing, and the development of new, health behavior theories for countries like India. More awareness needs to be created about health behavior, obesity and the need to evolve prevention strategies, including health behavior theories effective for the Indian context and these need to be done in time to prevent an obesity epidemic in the sub-continent, bearing in mind the detrimental socio-economic impacts of such a catastrophe would far outweigh the effort and cost involved in preventing the same.
References
1 Barlow S. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. [Internet]. Pediatrics p. S164–92. Available from:
2 Kumar S, Mahabalaraju D, Anuroopa M. Prevalence of obesity and its influencing factor among affluent school children of Davangere city. Indian Journal of Community Medicine
3 Andrews K, Silk K, Eneli I. Parents as health promoters: a theory of planned behavior perspective on the prevention of childhood obesity. [Internet]. Journal of health communication p. 95–107. Available from:
ACKNOWLEDGEMENTS We would like to thank the College of Education, Criminal Justice and Human services, University of Cincinnati for the Faculty Mentoring Grant, and the MPH program, in the College of Medicine for helping print the poster.
INTRODUCTION
Obesity is a serious impediment to comfortable living at any age. The onset of obesity heralds a future fraught with diseases and expenses, making it extremely painful in more ways than we can imagine. That being the case, obesity in childhood means a potentially shortened life of pain and suffering. The 2000 CDC Growth Charts for the United States and expert committee definitions put childhood obesity as a BMI at or above the 95th percentile for children of the same age and sex. Not just obesity, even over-weight children face serious issues. The increase in the prevalence of over-weight children is alarming, the prevalence of childhood obesity in India has been shown to be anywhere between 12% and 25%, depending on the study. It is now recognized that being over-weight itself is an etiological and risk factor association for the entire spectrum of metabolic syndrome pathologies including, but not limited to, obesity, type 2 diabetes, cancer, stroke and heart disease and even mental health issues like. depression, and social discrimination.
HEALTH BELIEF MODEL & CHILDHOOD OBESITY
This study examines the relationship between the health belief model and childhood obesity prevention behaviors, and their ability to serve as predictors in preventing childhood obesity.
The chosen behaviors, are
daily 1 hr physical activity,
consuming 5 servings of fruits and vegetables,
drinking 6 to 8 cups of water (data presented here) and
watching not more than 2 hours of television per day,
Health-Belief model constructs being studied are
Perceived susceptibility
Perceived severity
Perceived benefits
Perceived barriers
Cues to action &
Self- efficacy
RESULTS
Parameter Estimates for the Structural Equation Model