In line with the study aim, parents' perception towards health behaviour promotion in parenting are presented first by describing the top three parenting goals and second to identify the importance of health behaviour in parenting. Finally, parents' perception of environmental determinants at school which influences a healthy lifestyle of children are presented.
Top three self-mentioned parenting goals
When parents were asked to report their top three priorities in parenting, most often mentioned goals were feeling happy, being healthy, being respectful to others, being proud of himself, and I think it is important for my child to participate in the society. In 8 of the 63 interviews (13%) healthy behaviour was mentioned in the top three self-formulated goals. In these 8 cases, parents reported that health has an important role in their family, varied from physically to mental health, having a steady day and night rhythm, participating in sports activities and having balanced healthy diet.
‘My child needs to be healthy and fit. Goes to bed on time, participate in sports, doesn't eat too much candies and eats fruits.’(Mother, 103)
‘Happiness’ (n = 16; 25%) and ‘Being respectful to others’ (n = 6; 10%) were mentioned as the most important goals in parenting, respectively. One respondent mentioned that happiness can be identified as a tenet of having a healthy life, which includes everything that a child needs in parenting. Besides that, being respectful to others was mentioned as a key element in parenting as well, since children need to know their position as compared to others in the society.
Happiness: ‘I think it is important that my child is happy, that is the basis for everything. It is a summary of everything if the child is happy.’(Mother, 318)
Respectful: ‘Our child must know that we are the father, mother, teacher and sir. He must be aware of this.’(Both, 201)
The priority of a healthy lifestyle in parenting
Since parents were asked to rank the self-reported goals in combination with the preselected goals in a three column scheme, the goal “I think it is important for my child to learn what a healthy lifestyle is.” was categorized in the column ‘most important’ 15 times (24%), and 4 times in the top of the column (6%). For example, parents who mentioned a healthy lifestyle as most important goal in parenting, which can be seen as a principle foundation, was explained as follows:
‘As a family, we think everything is important. Being able to stand up for yourself is also being proud of yourself. It is all related to each other. Being healthy is really the most important thing, that is the basis, everything is connected with each other.’(Both, 306)
The presence of chronic diseases related to a unhealthy lifestyle in the family is a reason for parents to prioritize and indicate a healthy lifestyle as an important factor in parenting of their children, evidenced by the following explanation of a parent who categorized a healthy lifestyle in the column ‘most important’:
‘After becoming a mother, you have noticed how important it is to be healthy, for example healthy food, if you eat healthy you also feel much better. There is diabetes mellitus (DM) in both families, partner already has DM, so healthy living and healthy food are extra important to give to the children.’(Mother, 103)
Parents (n = 2; 3%) who have any experience with chronic diseases in their family, were more likely to identify a healthy lifestyle in parenting as important.
In 32 of the 63 interviews (51%), parents categorized healthy lifestyle as less important in parenting and gave different explanations of these categorization. In general, parents indicated health-related behaviour as a routine in parenting, or as a base of their religion and own beliefs. Additionally, parents mentioned that children are too young to focus on healthy lifestyle.
‘You will learn to live a healthy lifestyle when you get older. I think that a child nowadays has to learn to be independent is more important than focusing on a healthy lifestyle. A healthy lifestyle comes more naturally, more automatically. This is also educated to the children at school.’(Mother, 101)
‘Eating healthy is part of our (Christian) religion. Start your day with a very good breakfast, in the evening we eat less, no alcohol. We do not exaggerate, we search for a good balance.’(Mother, 205)
Parents experienced difficulties in dealing with social pressure and influence with regard to a healthy lifestyle and personal preferences of parents has an influence on parenting. A single parent mentioned the preference of a certain lifestyle which is not dependent on others, but it is his own personal preferences in parenting.
‘Health is important but nowadays there is enormous pressure. You can't give children anything. As a parent, you must be able to decide in your own parenting style.’(Mother, 329)
‘[…] Being loyal to your own system. Our ancestors were completely carnivorous. Parents should immerse themselves there.’(Father, 216)
The role of the school environment in supporting a healthy lifestyle in parenting
Almost all participants indicated the environment as an important factor in supporting a healthy lifestyle of children, i.e. school and parents. In addition, the government and sport canteens are indicated as important stakeholders as well, to create a healthy environment for children. To understand parents' perceptions towards environmental factors related to a healthy lifestyle at school, parents were presented with several statements. These statements consisted of the role of the elementary school teacher, the role of the physical school environment, the role of served fruit at school and the role of the school nurse and the GP, i.e. the healthcare professional.
The elementary school teacher was indicated by parents (n = 42; 67%) as an important role model in developing a healthy lifestyle of their children.
‘The teacher sees my child every day. They take a lot from the teacher, they are role models’(Mother, 311)
Despite these positive quotes, the reverse side indicate that the responsibility of supporting a health behaviour in parenting falls to parents.
‘[…] Of course, the teacher does have a signalling role when children behave unhealthy, but the parents have the first responsible in supporting a healthy lifestyle.’(Mother, 318)
Almost all parents (n = 55; 87%) considered the physical school environment as an important factor in challenging children to exercise.
‘[…] The schoolyard must be sufficiently challenging to be able to play and sufficient playground equipment must be offered, such as bicycles.’(Father, 102)
On the other hand, few parents who disagree with this statement indicated that the time of playing outside is too short and may not have a distinctive capability between children who behave healthily or not.
‘The school environment is not relevant. They can play outside, it's healthy, but they only play for one hour.’(Mother, 318)
‘[…] if you are healthy, you start exercising more. Playground equipment does not have a distinctive character between unhealthy and healthy children.’(Father, 216)
A total of 54 parents (86%) think that fruit served at school contributes positively to the healthy lifestyle of children. Children are introduced to different variations of fruits.
‘That free fruit is served at school is great! It has several reasons: First, unhealthy things are cheaper than fruit. Second, the child is introduced to different kind of fruit, other than home. A third reason is that free fruits at school is an advantage for lower income families. Finally, it works as a group pressure, absolutely: the child in the environment eats fruit, then the rest will also eat fruit. You have a conversation about fruit at school.’(Mother, 305)
Slightly less than 10% of the parents (n = 6) do not agree with this statement, due to the fact that they give fruit themselves in their children's lunchbox.
‘You can better use your subsidy money in a different way. If it is free, the children will not learn from it. Give the responsibility to your child: ‘You can make your own choices, it is your own body. Even when brushing your teeth.’(Mother, 205)
More than half of the parents (n = 33; 52%) who were interviewed disagree with the statement that a healthcare professional, e.g. school nurses and GPs, has an important role in developing a healthy lifestyle of children. For example:
‘We never see them. We don't know what they do. It is childish how they communicate. Patronizing. It does not meet the needs and wishes of the parents.’(Both, 327)
Some parents only think that a nurse should act if there is something problematic with their child or children.
‘Only when something is wrong, you go to the nurse. If you want to encourage healthy behaviour through the nurse, then something must be wrong in the first place.’(Both, 308)
One of the parents was delighted that a nurse was present at school one time, to identify and detect overweight in her own child.
‘[…] the school nurse is able to give advice about physical activity, they are able to identify a child's physical condition. This can be important for especially our children.’(Father, 331)