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Childrens physical activity and screen time: qualitative comparison of views of parents of infants and preschool children

Kylie D Hesketh*, Trina Hinkley and Karen J Campbell

Author Affiliations

School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Burwood Victoria, 3125, Australia

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International Journal of Behavioral Nutrition and Physical Activity 2012, 9:152  doi:10.1186/1479-5868-9-152

The electronic version of this article is the complete one and can be found online at: http://www.ijbnpa.org/content/9/1/152


Received:23 April 2012
Accepted:19 December 2012
Published:28 December 2012

© 2012 Hesketh et al.; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

While parents are central to the development of behaviours in their young children, little is known about how parents view their role in shaping physical activity and screen time behaviours.

Methods

Using an unstructured focus group design, parental views and practices around childrens physical activity and screen time (television and computer use) were explored with eight groups of new parents (n=61; child age <12 months) and eight groups of parents with preschool-aged (3–5 year old) children (n=36) in Melbourne, Australia.

Results

Parents generally believed children are naturally active, which may preclude their engagement in strategies designed to increase physical activity. While parents across both age groups shared many overarching views concerning parenting for childrens physical activity and screen time behaviours, some strategies and barriers differed depending on the age of the child. While most new parents were optimistic about their ability to positively influence their childs behaviours, many parents of preschool-aged children seemed more resigned to strategies that worked for them, even when aware such strategies may not be ideal.

Conclusions

Interventions aiming to increase childrens physical activity and decrease screen time may need to tailor strategies to the age group of the child and address parents misconceptions and barriers to optimum parenting in these domains.

Keywords:
Early childhood; Parenting; Physical activity; Screen time; Qualitative study

Background

Being physically active during childhood is important for health, including the maintenance of healthy body weight, both in childhood and later life [1]. Evidence suggests physical activity and screen time behaviours are established in early childhood [2] and track over time [3,4]. Therefore, it is important that children develop healthy activity patterns early, to set them on a trajectory towards good health and healthy weight throughout life. Governments in Australia, Canada, the United Kingdom and the United States have recognised the importance of these early life behaviours by the release in recent years of national guidelines outlining optimal levels of physical activity and screen time for young children (0–5 years). Yet literature on these early life behaviours remains scarce, particularly for children prior to preschool age. For example, a 2011 review of physical activity and sedentary behaviours in children younger than three years of age identified only two studies reporting physical activity levels and only four reporting any sedentary behaviours [5]. That review called for more research to gain a comprehensive understanding of these behaviours in early life and recognised the important role played by parents.

Parents influence their childrens activity patterns through modelling, and provision of the social (rules and practices) and physical environments (availability of equipment for physical and sedentary pursuits) children are exposed to in the home [6]. The parental role is particularly important during a childs early life, when parents are responsible for the majority of their childs experiences [7]. Parental influences during this time have been shown to be associated with physical activity levels in later childhood [8]. Yet little is known about how parents view childrens physical activity and screen time, and their own role in shaping these behaviours during their childs early life. A recent qualitative study involving parents of 5–7 year olds indicated parents believed their children to be sufficiently active and therefore did not actively promote physical activity [9].

Investigation of views and anticipated practices of parents regarding childrens physical activity and screen time prior to the initiation of these behaviours has not previously been undertaken. Such information would add to a meagre evidence base and provide unique insight into potential strategies to promote optimal levels of these behaviours during the important early childhood period. We hypothesise that new parents may be more receptive to strategies designed to maximise their childs physical activity from its inception and limit screen time. Given this, understanding new parents views is an important first step towards designing interventions that may promote the development of active lifestyles and prevent childhood obesity. Comparing views of these new parents to those of more experienced parents may provide further insight into when and why expectations and practices may form or change, knowledge that could inform optimal times and targets for intervention. The aims of this study were: (1) to understand the views and expectations new parents have about childrens physical activity and screen time, prior to their infants becoming mobile, and (2) to compare these views with those of parents of preschool children, whose children have already begun establishing physical activity and screen time habits.

Methods

Given the purpose of this research was to generate information on a previously unexplored issue, qualitative methodology was considered most appropriate. Use of this methodology allowed a truly exploratory investigation of parental views regarding childrens physical activity and screen time. We chose focus group methodology to enable group dynamics, inherent in the existing social groups utilised for this study, to assist in discussion initiation and development with minimal intervention by the facilitator.

Sample

First-time parents of infants (<12 months old) and parents of preschool-aged (3–5 year old) children were recruited, September-December 2005, from one socio-economically and ethnically diverse local government area[10] in metropolitan Melbourne, Australia. First-time parents were recruited through Maternal & Child Health (MCH) centres which provide a free universal service to children aged under six years [11]. MCH nurses organise new parent groups where first-time parents can attend weekly sessions (usually for 4–6 weeks) providing information relevant to the first year of life and an opportunity to meet other new parents in their neighbourhood. All MCH centres within the local government area with new parents groups running within the time frame of the study were invited to participate (n=8) and all agreed to do so. A researcher visited each new parent group to describe the study and distribute information. Parents were invited to attend a focus group the following week at the MCH centre. Focus groups comprised 4–16 new parents with an average of eight per group.

Parents of preschool-aged children were recruited through preschools randomly selected within the local government area. To be comparable with the first-time parent groups, focus groups were sought from eight preschools. Two preschools (2/8) declined to participate and were replaced with the next preschools on the randomly ordered list. As no parents attended the focus group at one preschool, an additional preschool was recruited. Parents of children at each preschool were invited via letters distributed in their childs locker/pocket/folder to attend a focus group onsite during their childs preschool session. Focus groups comprised 2–9 preschool parents with an average of five per group.

All focus groups ran for 45–60 minutes, with recorded group discussions lasting for an average of 42 minutes (range 30–54 minutes). There was no correlation between group size and length of recorded discussion. This study received approval from the Deakin University Human Ethics Research Committee. All participants provided written informed consent. No incentives were offered.

Procedure

Participants self-reported basic demographic information. All focus groups were conducted by a single facilitator, trained and experienced in qualitative research methods. As the focus groups were designed to be exploratory, no formal questions were used. Instead, participants brainstormed topics that came to mind when they thought of childrens physical activity and television and computer use (screen time). The facilitator recorded all topics suggested by participants and used these as prompts for discussion; she restricted further input to generic prompts and encouragement, allowing natural conversation between participants to dictate the direction of discussions. This method ensured participant- rather than facilitator-initiation of discussion content. All sessions were audio recorded and transcribed verbatim by a commercial company.

Analyses

A grounded theory approach to analyses was used. Two researchers (KH & KC) independently reviewed the same randomly selected transcript and compared codings and themes. Each then reviewed half of the focus group transcripts, coded each quote and grouped those with similar content using the open coding method of thematic analyses [12]. A third researcher (TH) independently coded half the focus group transcripts for validation. Transcript codings were collated and themes representing the main messages conveyed by the data were extracted by two researchers (KH & TH). For validation, themes were discussed and reviewed by the third researcher (KC) and reviewed by the focus group facilitator. Sociodemographic information was summarised.

Results

Descriptive data

Eight focus groups were conducted with a total of 61 new parents, all mothers. The mean age of infants was 4.5 months, with most (89%) aged six months or younger. A further eight focus groups were conducted with a total of 36 parents/carers (including 1 grandparent; henceforth referred to as parents) of preschool children. The mean age of the oldest preschooler in the family (some families had multiple children in the 3–5 age range) was 4.8 years (58 months). The demographics of preschool parents were similar, but slightly more heterogeneous, to those of the new parents (Table 1). Themes from the two cohorts are discussed below. A summary of the main themes relating to physical activity and screen time, with illustrative quotes, are presented in Tables 2 and 3 respectively.

Table 1. Sample characteristics

Table 2. Physical activity: summary of themes from new parent and preschool parent focus groups with illustrative quotes

Table 3. Screen time: summary of themes from new parent and preschool parent focus groups with illustrative quotes

Physical activity

General impressions and expectations

While positive and negative impressions of childrens physical activity were each mentioned by one group of preschool parents, new parents devoted much discussion to these topics. All but one group discussed positive expectations they held about their child becoming physically active. These included that physical activity would assist with the promotion of learning and the development of social skills, that family activities would be shaped by child activity preferences, that physical activity conferred health benefits, it would add structure to family routines, encourage more involvement from fathers, and improve sleep. Most commonly discussed was the expectation that a child becoming physically active would increase family activity levels (discussed in four groups).

″I think it will be a change for the better for us [child being more active]. I love being outdoors but I dont get out as much as I should.″ [New Parent group 6].

Four new parent groups also discussed perceived negative aspects of a physically active child. The displacement of creative and mental pursuits and the likelihood of injuries were discussed, but the predominant topic under this theme was extra parental demands. A variety of parental demands were mentioned including the pressure for parents to involve or expose their child to multiple sports and activities, the physical demands of chasing a toddler around, and the need for increased house cleaning.

″Sometimes I think there is too much pressure now on parents, but mothers in particular, to take their kids everywhere. They have to have something on every day of the week…swimming, piano, netball.″ [New Parent group 1].

One preschool group also discussed the perceived demand on parents to enrol their children in organised activities, and the dilemma of how to keep the balance between exposing them to different activities and not making them do too much.

Influences on childrens physical activity

Across both cohorts, the two influences on childrens physical activity primarily discussed were innate versus family influence. Three new and two preschool parent groups discussed the belief that physical activity is natural in children and will occur spontaneously, without need for direct involvement or encouragement. While not the focus of group discussions, one new parent and one preschool parent also mentioned the belief that innate activity levels and interests are different for different children, with the new parent specifically believing this is gender driven (boys are naturally sporty).

″I think they have got this natural desire to run around and play, I don′t think you have to do too much to encourage them.″ [New Parent group 1].

In addition to the reflection that the drive to be physically active was innate, four and three groups of new and preschool parents, respectively, believed parent or family activity levels would influence their childs activity.

″We do a bit of kayaking or cycling and sometimes they say, ′Oh we don′t want to do this…′ but as soon as we go they love it.″ [Preschool Parent group 9].

Of interest, discussions of the innate or natural nature of childrens physical activity and of the influence of parent or family activity levels were often intertwined within groups. These did not appear to be mutually exclusive ideas.

Strategies for encouraging childrens physical activity

Five of the eight new parent groups and six preschool parent groups discussed various strategies they intended to (new parents) or did (preschool parents) use to encourage their child to be physically active. Providing children with a supportive environment was the most commonly discussed strategy. Three new and five preschool parent groups provided various examples of supportive environments (see Table 2) including the provision of sporting equipment and pets, holidays to places that encourage active pursuits, providing rules and active alternatives to television, active transport and attending nearby schools.

″One of the priorities for me in terms of where we live will be related to school. I really will like to be close to a school so that we don′t have to rely on cars.″ [New Parent group 6].

The idea of providing companionship or playmates for their children as a strategy to encourage physical activity was also discussed in eight groups (two new parent groups and six preschool parent groups). However, unlike the similarity in discussion between the two cohorts on the provision of a supportive environment, the type of companionship discussed was different for the two cohorts. Parents of infants discussed exposing their infants to environments where they can interact with other children to foster socialisation and active play (e.g. play groups, visiting friends and cousins). Preschool parents discussed the importance of adult supervision for childrens physical activity and discussed companionship as often involving mothers as the playmate.

″Mostly I find that I′ve got to be available. He wants to play games with me or he wants me to come out and chase him or play hide and seek. As [younger sister]′s getting older the two of them will run around and chase each other, but they usually they want me involved as well.″ [Preschool Parent group 8].

Other forms of parental facilitation were also discussed as strategies for encouraging childrens physical activity. These included enrolling children in organised physical activity (discussed in three new parent groups), parental modelling and encouragement of physical activity (three new and one preschool parent group), teaching their children skills (three preschool parent groups), and encouraging outdoor play (two new and two preschool parent groups). The three groups of preschool parents that discussed using physical activity to teach their children skills, talked about both fundamental movement skills and sport specific skills like swimming and batting. Discussion centred around how these skills could be drawn on as the child grew older and give them a sense of accomplishment and achievement as well as facilitating their involvement in organised sport. While two new parent groups discussed encouraging outdoor play as a strategy for encouraging physical activity, the two groups of preschool parents that discussed outdoor play focused on their use of outdoor facilities such as parks and beaches. Only one preschool parent group discussed explicitly encouraging outdoor time and this was in the context of an alternative to screen time rather than as a strategy for encouraging physical activity.

″We just get to a point where we have turn it [the television] off and say ″let′s get dressed and go outside for a little while, you can watch it again later on″, and as soon as it′s off they forget about it.″ [Preschool Parent group 6].

Other strategies for encouraging physical activity mentioned in individual new parent groups included making active play fun, getting children involved in play, exposure to different organised physical activities, encouraging self-directed play, fostering imagination, allowing freedom within a safe environment, establishing physical activity habits early, and making physical activity an important part of their life.

Within this theme, some of the individual discussion points reflected multiple strategies. For example, the following quote reflects provision of a supportive environment through active transport, as well as parental modelling and encouragement:

″We walk to school which is a 25 minute walk. The amount of complaining that we got about that initially! But now that′s just what we do. So they never even think to say can we take the car. And we always walk to the local shops and to the hairdressers and things.″ [Preschool Parent group 8].

Barriers to childrens physical activity

In addition to strategies for encouraging childrens physical activity, parents discussed issues they believed limited childrens physical activity. As observed with regard to strategies for promoting physical activity, there was variation in the consistency of views about barriers across the cohorts. Safety was the most commonly raised issue, discussed in five new and two preschool parent groups. However the focus of safety discussions differed between the cohorts. New parents referenced perceived changes since their own childhood: decreased neighbourhood safety, road safety issues such as busy roads limiting child access to parks, stranger danger and limitations they would place on their childs access to neighbourhood facilities because of safety concerns. While preschool parents also referenced perceived changes since their own childhood, their discussions were focussed more generally on the need for supervision due to parents concerns for child safety in public areas.

Other issues related to structural and social environments were discussed in four new and one preschool parent group. Changes in social environments and norms since their own childhood were raised in both cohorts; new parents discussed changes in childrens popular culture from outdoor games to indoor electronic entertainment being the more popular past-time, and a change from walking to school to being driven as the norm. Preschool parents discussed differences over time in social norms related to independent mobility around the neighbourhood. New parents identified yard size as an issue they had not considered prior to having children, but many had small backyards that would limit physical activity options. Also noted by new parents was the difference between rural and city living, with rural environments perceived to be more conducive to physical activity, particularly from a safety aspect.

″I grew up in a country town where you could just go off and play. There were gangs of kids running around the street playing cricket and stuff. Youre not living in the city and your kids are just free.″[New Parent group 7].

Time and planning complexities were discussed as barriers to childrens physical activity in one group of new and four groups of preschool parents. Having two parents working, greater demands on family time and the planning required to engage in activities were seen as barriers to participation in structured physical activity, particularly if the family had multiple children.

″I think it gets to a point of how much can you actually do? You know Ive got three kids, how many places am I supposed to be after school on one night?″ [Preschool Parent group 7].

Other barriers mentioned by both cohorts were the impact of bad weather and their limited knowledge of age appropriate activities. Additionally, new parents mentioned anticipated barriers including reduced parental influence as their child gets older, the child not enjoying physical activity, and finding activities suitable for children at varying developmental stages when there are siblings. Other barriers to engagement in physical activity mentioned by preschool parents included reduced parental energy levels, childrens health issues and childrens skill levels.

Screen time

Expectations and intentions

Parents discussed both positive and negative aspects of screen time (Table 3). Positive aspects were discussed by five groups in each cohort, while negative aspects were discussed in two new and six preschool parent groups.

The most commonly discussed positive aspect of screen time was the ″babysitter″ aspect. Three groups of new parents and five groups of preschool parents discussed screen time (predominantly television time) as a means to allow parents to get things done or to have some time to themselves. Parents were quite open in discussing their practice of using screen time in this way.

″As much as I don′t like the idea of them watching a lot of television I just know I′m so exhausted at the end of the day that I′d just really like it if he would just sit and watch [television show] for half an hour while I do the dishes or whatever.″ [New Parent group 4].

″Best invention ever. I will never begrudge the television. We have a bookshelf full of videos, DVD′s you name it … Love it. It′s the best babysitter.″ [Preschool Parent group 2].

Other positive aspects of screen time discussed were: developing computer skills which will be required in later life; the promotion of physical activity through programs that encourage children to sing and dance along; the use of screen time as a reward for desired behaviour; and the educational value of television and computer use.

″You know the other good thing about that show is they sing the same songs every day so theyre actually learning. I think thats really good.″ [New Parent group 5].

Negative aspects of screen time that were discussed included: detrimental health outcomes parents believed to be associated with screen time, such as obesity and attention deficit disorder; inappropriate content on television, such as violence and news reports; exposure to advertising during television viewing; and parental perception that screen time exposure causes negative emotions and temperament in their child.

″I find, with both girls, [they get] so crabby if you leave them on [computer games] for too long. I′m not sure what′s happening to their brain but it′s physical inactivity combined with mental activity. They go mad if you leave them on for too long, they get really angry.″ [Preschool Parent group 9].

The importance of balancing screen time with other activities, or setting time limits, was discussed in five new parent and six preschool parent groups.

″…hopefully we will be very, very conscious of how much time they spend with those things [electronic media], and limit it and get them outside doing things.″ [New Parent group 6].

Other topics mentioned in individual new parent groups were the difficulty of limiting exposure to electronic media, the need for parents to change their own habits to limit child exposure, diminishing parental influence on child pursuits over time, and a desire not to hinder peer relationships by restricting activities (e.g. viewing popular programs). One parent believed computer games imitating sports encouraged physical activity. Other topics mentioned by individual preschool parent groups included beliefs that: computer use was more beneficial than television; television was better for childrens eyes than computer exposure; morning television viewing distracted children from getting organised for school/kindergarten; television is more attractive during colder weather; and television relaxes children.

Strategies for limiting screen time

While many parents believed there were positive aspects to electronic media use, all but one new parent and two preschool parent groups discussed strategies for limiting their childrens screen time. The most commonly discussed strategy related to rules and limit setting.

″It′s all very limited. I let them watch TV when they get home for maybe half an hour until dinner′s ready. There′s no TV with dinner at all. It goes off.″ [Preschool Parent group 1].

Parental monitoring of childrens screen time was also seen as important by three new parents and two preschool parents groups, particularly with regard to content.

″I think the main thing is keeping an eye on that [computer use]… because there can be some negative influences on the Internet. You just want to make sure you watch what the kids are doing on there and make sure they′re not getting into anything they shouldn′t be.″ [New Parent group 3].

Further to discussions of rule setting and parental monitoring, providing a home environment that helps to limit screen time was discussed in three new parent and six preschool parent groups.

″I don′t think I′d buy my son a Playstation. I′d just avoid it.″ [New Parent group 5].

″For us it′s been not making that an option at all, we don′t have television.″ [Preschool Parent group 8].

One group of new parents and two groups of preschool parents talked about encouraging alternative activities to screen time for their children.

″You can plonk them in front of a pile of books, you can plonk them in front of blocks, you can plonk them in front of a lot of things and they′ll play happily.″ [New Parent group 5].

″We just get to a point where we have to turn it off and say, ″Let′s get dressed and go outside for a little while. You can watch it again later on.″ And as soon as it′s off they forget about it.″ [Preschool Parent group 6].

Other strategies that were mentioned but not discussed in detail were the impact of parental role modelling on childrens screen time (mentioned in two groups of new parents) and strategies utilised to accommodate the needs of younger children, such as not allowing older children to view programs inappropriate for younger siblings or viewing in a separate room (mentioned in one group of preschool parents).

Barriers to limiting screen time

In comparison to discussions relating to strategies for limiting screen time, fewer groups across the two cohorts discussed barriers. Barriers to limiting childrens screen time covered the broad areas of access (physical environment), the influence of other people (social environment), and other demands on parents.

Three new and two preschool parent groups discussed access to electronic media within the broader environment as a potential barrier to limiting childrens screen time. Two of these new parent groups and one preschool group talked about the school environment and the prevalence and importance of computers as a barrier to limiting childrens computer use at home. These groups, and one group of preschool parents, also discussed the ready access to computers and ″electronic gadget culture″, as a further barrier. The other new parent group discussed barriers within the family environment such as readily accessible electronic games.

″From when I was a child, the level of exposure to that type of [electronic] media has just skyrocketed. Like kids are so computer literate and exposed to it at such an early age. And so much of it!″ [New Parent group 5].

Barriers related to the social environment and the influence of other people also received considerable discussion. The influence of other carers, particularly fathers, who like television or electronic games themselves was discussed in two new parent and two preschool parent groups. Similarly the difficulty of restricting screen time when other children, such as peers, siblings or cousins, are engaging in these activities was discussed in two new parent groups.

″I have enough trouble getting my husband to do that [turn the TV off], let alone my child.″ [New Parent group 8].

″Like our nephew who is ten … plays … computer games. So we′ve also got that element in the family. With grandma [saying], ″Oh, but [cousin] always did that. Why can′t your [child play computer games]?″ [New Parent group 8].

Parental factors were discussed by two groups of preschool parents and one group of new parents as further potential barriers to limiting screen time. These parental factors included other commitments, such as work and caring for other children, lack of parental energy, and lack of parental time. Within these discussions the use of television as a babysitter (also discussed above under the theme of positive aspects of screen time) was also infused. Parents discussed the use of television to allow them time to get other things done.

″I′m not a big television fan at all. But I have used it when we had our restaurant and I′d be working twelve hours. I would put him there [in front of the TV], with his breakfast and I′d get another hour [sleep]. I hated myself for doing it but I needed it in order to function for the rest of the day, and then go to work.″ [Preschool Parent group 8].

Discussion

This study sought to describe the views and expectations of new parents of infants regarding their childs future physical activity and screen time, and to compare these to parents of preschool children already engaging in such activities. Increased knowledge of parenting in regard to these behaviours during early childhood is important to understand how best to support parents to promote increased physical activity and reduced screen time in children, with the ultimate aim of preventing childhood obesity and other adverse outcomes.

Overall, regardless of their childs age, parents believed children are naturally physically active and thus there is little need for parent engagement. For example, few parents considered the need to promote outdoor play, despite this being one of the most consistent correlates of physical activity in young children [13]. It is apparent that such ideas do not change as children become older and parents have more first-hand experience of childrens physical activity. This finding corresponds with results of a previous qualitative study where parents reported not actively promoting their 5–7 year olds to be physically active due to the belief they would naturally achieve sufficient levels of physical activity [9]. The belief that children are innately active is at odds with evidence showing even young children spend a very small proportion of their time being physically active [14-16]. The lack of physical activity observed in young children, despite the commonly held belief that children are naturally active, may stem from another issue raised in this study, the fact that constraints are placed on childrens physical activity both by parents (e.g. due to safety concerns) and the environment (e.g. smaller backyards). The social changes parents in this study noted since their own childhood are likely to have increased the level of constraint placed on contemporary childrens physical activity and may contribute to the low levels of physical activity observed. The misconception about children being naturally physically active has important implications for the development of strategies addressing childrens physical activity. If parents do not believe this is an area they need to actively encourage, it seems unlikely that they will engage in strategies to promote physical activity. Thus interventions aiming to increase the activity levels of children may need to first convince parents, not only of the importance of physical activity, but of the fact that children do not naturally achieve enough physical activity for optimal health. Only then is it likely that parents will see this as an important part of their role.

While parents shared their overarching views about child physical activity screen time, the consideration of strategies to promote or limit (respectively) these behaviours differed by cohort, suggesting a change in parental expectations as children age. This may be due to the different experiences and current circumstances of parents across the cohorts. Issues discussed by parents of preschool children may not yet have been encountered by parents of infants, suggesting the importance of understanding later life stages and considering anticipatory guidance approaches in interventions. While most new parents were optimistic regarding their ability to positively influence their childs physical activity and screen time, such optimism was not apparent amongst parents of preschool children. Parents of preschool children generally spoke with some resignation, noting that they used strategies they knew were not ideal (e.g. television as a babysitter) because it was effective for them. Similar findings have been reported in quantitative research on parental self-efficacy to promote obesity protective behaviours amongst 18 month and 5 year olds, published since this study was conducted [17]. In that quantitative study, self-efficacy was higher amongst parents of younger children and was directly associated with child behaviours. For example, parents demonstrating greater self-efficacy for limiting television viewing had children who watched less television [17]. This highlights the importance of parental confidence for shaping desired behaviours and of providing parents with strategies early on, to manage the increasing demands of parenting as children get older and family circumstances change.

Further differences between the cohorts were seen in the consideration of barriers to facilitating physical activity and limiting screen time. Parents of preschool children more frequently identified a range of issues, such as restricted time and the impact of external influences. It is likely that parents of preschool children may be more time poor that those of younger children, being more likely to have returned to work (either at home or outside the home) and more likely to have additional children to care for. However some identified barriers could be overcome by providing parents with strategies and support. For example, inclement weather was identified as a barrier to promoting physical activity and limiting screen time. Providing parents with ideas for active indoor pursuits (e.g. dancing), and access to low-cost local community resources such as playgroups and indoor play centres may be useful strategies to overcome this barrier. Further, activities requiring minimal supervision such as dancing could act as an alternative to the use of television as a babysitter for time poor parents.

Interestingly, parents of infants identified more positive than negative aspects of screen time, with television viewing in particular seen as a pastime with many benefits. This is despite emerging evidence that television may have harmful consequences for children in the short and longer term. Exposure to television has been associated with obesity [18], lipid abnormalities [19], sleep problems [20], attention problems [20], aggressive behaviour [20], externalising behaviours [20], emotional reactivity [20], and poorer reading ability [21], in children, and childhood viewing has being associated with lower educational attainment in adulthood [22]. A longitudinal study spanning 5 to 26 years of age found excessive television viewing during childhood was associated with increased risk of overweight, raised serum cholesterol, poorer cardiorespiratory fitness, and increased risk of smoking [23]. Further, level of television viewing has been shown to track, even from as young as two years of age [24], suggesting a need to limit television from early in life. In addition to limiting television viewing, parents could be supported to understand the importance of circumscribing the content and mode of viewing. Co-viewing (parents watching with the child and discussing content) may confer social benefits and has been shown to improve any positive effect from beneficial content [25].

While this study sought to investigate the views of parents, those who attended the focus groups were predominantly mothers. Only two fathers were included, both in preschool groups. This reflects a limitation of the sampling technique and likely reflects the fact that mothers continue to be the primary caregivers, particularly for infants and young children. Nonetheless the views of fathers with regard to childrens physical activity and screen time may provide alternative insights into these behaviours and warrant further investigation.

Other aspects of the sample also reflect limitations of the study. As the focus groups were conducted during the day, working parents were underrepresented; the sample was also predominantly dual-parent, Australian-born and English-speaking. Despite sampling from a socioeconomically diverse local government area, there was greater heterogeneity in socioeconomic characteristics, such as level of education and low income health care card, in the preschool parent groups than in the infant parent groups. Such sample characteristics may limit the generalisability of the findings but do not impact internal validity.

In considering these findings it should be noted that as discussions were unstructured and topics were initiated by the group, not all topics were covered in all groups. Further, the length and depth of discussion relating to individual topics varied substantially between groups and between topics, there were a large total number of themes discussed, and some topics were touched on only briefly in some groups. As new parents beliefs about physical activity and screen time is a previously unexplored area, there was no evidence with which to inform structured questions for qualitative investigation. Thus an unstructured format was the most appropriate methodology for exploring the views and expectations of new parents. The unstructured approach was a strength of this study, given discussion was parent initiated rather than directed by preconceived notions of the researchers. Further, as physical activity and screen time beliefs of new parents have not previously been explored, they provide unique data with which to inform future research in this area. A further strength of this study was the novelty of comparing views of parents temporally, providing unique insights into ways parents thinking about these behaviours evolves, and when it may be most effective to intervene to support parents to promote physical activity and limit screen time in their children. The information gleaned from this exploratory study raises additional questions that warrant further research, for example, how the attitudes and intentions of parents of preschool aged children have changed and evolved since their children were infants, and how they have changed with the addition of siblings and with changed parental circumstances (e.g. returning to work).

Conclusions

In conclusion, this study provided unique insight into the views of parents of young children on their childs physical activity and screen time and their own involvement in influencing these behaviours. While many views were shared by new parents of infants and parents of preschool-aged children, new parents appeared more excited and optimistic about their role in shaping these behaviours. Interventions to increase young childrens physical activity and reduce their screen time may benefit from addressing the erroneous parental perception that children innately engage in sufficient physical activity for health. Further, such interventions could be enriched by understanding barriers to engaging in physical activity and limiting electronic media use and aiming to provide practical strategies and skills to allow parents them to overcome these barriers. Such skills and strategies may need to be tailored to the stage of parenting. In comparison to new parents of infants, who are optimistic about their abilities to influence their childs behaviours and have not yet encountered the barriers to promoting physical activity and limiting screen time, parents of older children may require additional strategies and motivation to overcome the barriers they have already experienced.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

KH and KC conceived the study and oversaw its conduct. KH and KC reviewed the focus group transcripts and applied thematic codings. TH coded half of the focus group transcripts for validation. KH and TH extracted themes from the data codings and drafted the results section of the manuscript. KH drafted the manuscript. KC and TH reviewed the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Funding for this study was provided by a Deakin University, School of Exercise and Nutrition Sciences Early Career Researcher Grant. KH was supported by a NHMRC/National Heart Foundation of Australia Postdoctoral fellowship when this work was conducted and is now supported by a National Heart Foundation of Australia Career Development Award. KC was supported by a National Heart Foundation Postdoctoral Fellowship when this work was conducted and is now supported by a Victorian Health Promotion Foundation Research Fellowship. We would like to thank Anne Griffiths who facilitated the focus group sessions and Anna Sztendur, the research assistant on the project.

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