CHAPTER 1: INTRODUCTION

1.1 Introduction

The Latin word "adolescere," which means "to grow up," is the root of the English
word "adolescence.1"Adolescence is a time when a person transitions from puberty to
maturity on a psychological, social, and physical level.2 Adolescents make up one in
five of the population.3 Worldwide 1.2 billion people today are in the transitional
stage between childhood and maturity. India has 243 million adolescents out of the
world's 7.5 billion inhabitants.4 It's common knowledge that adolescence is a time of
ideal health. However, statistics for the current situation reveal the exact opposite.5-6

Adolescents have a variety of health issues, including communicable and non-

communicable diseases, both internationally and domestically.6 Children and
teenagers are hit by the global tsunami of non-communicable diseases (NCDs), which
has spread across the age groups. However, the younger age group afflicted by NCDs
is frequently overlooked.7 According to the World health organization (WHO) global
status report on NCDs (2014), globally almost 1.2 million fatalities globally among
people aged under 20 years are attributed to NCDs each year, and India accounts for
about 60% of these deaths.8 NCD risk factors might emerge as a result of an
unhealthy lifestyle.9

The way that adolescents live today varies from person to person and is a significant
social problem.10 Particular way of a person‘s life is referred to as his/her lifestyle.11-14
Adolescents carry over their lifestyle decisions into adulthood.15-18 Unhealthy
behaviour changes, such as a decline in physical activity and an increase in sedentary
behaviour, are frequently observed during the transition from elementary to secondary
school.13,19 According to the WHO, bad eating patterns and physical inactivity result
in 2 million deaths per year.1 Numerous chronic illnesses and NCDs are linked to
lifestyle factors.20-23

Obesity is a leading risk factor for NCDs. It is discovered that cardiovascular risk
factors such as hypertension, dyslipidemias, diabetes, and metabolic syndrome, are
linked to childhood obesity.24-26In addition, one-third of obese children and teenagers
are likely to remain fat throughout adulthood, increasing their risk for osteoarthritis,

1
type 2 diabetes, heart disease, and numerous types of cancer.15,28 In numerous studies
weight increase is linked to the pathogenesis of cancer, cardio-vascular diseases
(CVD), diabetes, and hypertension.29-32 In addition, obesity can result in higher
disability and death rates, as well as growing treatment expenditures in most areas.
Between 300,000 to 587,000 fatalities per year are attributable to obesity
worldwide.17,33

The second-largest global cause of death that may be prevented is obesity.18,34 A

healthy lifestyle is vital for lowering the risk of chronic non-transmissible diseases
such as type 2 diabetes, hypertension, obesity, some malignancies, and metabolic
syndrome. It also involves following an adequate diet, exercising regularly, and
getting enough sleep.35-38 In order to prevent adult obesity and lifestyle diseases, it is
important to address the modifiable risk factors and adopt effective health promotion
measures at a young age.39-42 Curing obesity among adults is a challenge because it
has long-term negative effects, similar to those of childhood obesity.21

The primary setting for teaching students about health and leading healthy lifestyles,
as well as for implementing interventions to support their health is the school.41-44 It is
important to regularly instruct growing adolescents regarding proper nutrition and
physical education at the school level in order to prevent adolescent obesity.45 Parents,
relatives, teachers, and peers are significant drivers of health behaviours among
children. According to the national guidelines for community-based practitioners on
the prevention and management of overweight and obesity (among children).23,45-47

Without parental assistance, adolescent obesity cannot be prevented. Positive

influences include support and encouragement from the family, peers, teachers, and
exercise educators of the child.22,48 The best location to teach growing adolescents
about good lifestyle habits is at school.24,49 The only way to maintain weight is
through making permanent behavioural changes, such as eating healthier and
engaging in physical activity.23,50 The three main factors that influence the likelihood
of a child being overweight are parental involvement, access to junk food, and
declining physical activity.25,51 Therefore, there is a need to increase physical activity
among adolescents and teach parents and children about changing their lifestyles. This
can be achieved through the implementation of parent involved multi-component
intervention programme (PIMCIP).

2
1.2 Background of the study

The prevalence of overweight and obesity among children has steadily increased since
1980.26,52 It is commonly acknowledged that one of the most important health issues
confronting adolescents in the 21st century is obesity.1-3 WHO refers to obesity as a
global epidemic. There is a dramatic rise in overweight and obese people over the
past 20 years.18,53-55 According to the current WHO guidelines and data from 79
developing nations, including a handful of wealthy nations, globally 22 million
children are overweight.19 Around the world, the prevalence of obesity among school-
aged children is 20% in the United Kingdom and Australia, 15% in Saudi Arabia,
15% in Thailand, 10% in Japan, and 7.8% in Iran.19-20 According to the WHO one of
the top ten health dangers in the world, is being overweight.56

Adolescent obesity is emerging as a major health problem in developing countries

such as India, especially in urban populations.20,57 The magnitude of overweight
ranges from 9 to 27.5%, and obesity ranges from 1 to 12.9% among Indian children.7
Reports from Delhi and Chennai have shown a prevalence of overweight and obesity
at 7.4% and 6.2%, respectively.21 Joseph et al., (2015), conducted among adolescent
children in South Karnataka reported that the prevalence of overweight and obesity is
9.9% and 4.8%, respectively, In South Karnataka, the prevalence of obesity is more in
urban areas (30%) as compared to rural areas (10%).22 One of the causes of the shift is
food and lifestyle habits that are causing an increase in the incidence of overweight
and obesity among teenagers in modern times.23 By 2025, more than 70 million
children and adolescents will be overweight if this trend persists.25

Adolescent obesity can profoundly affect their physical, social, and emotional well-
being, and self-esteem. It is also associated with poor academic performance and a
lower quality of life experienced by the child.28,58-60 Childhood obesity has an
association with numerous medical conditions. These conditions include but are not
limited to, fatty liver disease, sleep apnoea, Type 2 diabetes, hypertension, asthma,
CVD, high cholesterol, cholelithiasis, glucose intolerance and insulin resistance, skin
conditions, menstrual abnormalities, impaired balance, orthopedic problems. Until
recently, most of the above health conditions are found mostly in adults; now they are
extremely prevalent in obese children.29,61-63 Even though the majority of the physical
health problems linked to childhood obesity are treatable and can go away once a kid

3
or adolescent reaches a healthy weight, some of them persist into adulthood and cause
harm. Some of these health issues may, in the worst circumstances, even cause
death.30,64-66 Therefore, effective obesity management and prevention must start in
childhood. Weight management among children is impacted by a number of factors.31
It is discovered that changing one's way of life is an effective weight-loss method.32
Children can be encouraged to pick acceptable lifestyle practices as they are still
impressionable.33,67

A crucial element of effective weight control therapies for teenagers identified is

parental participation. Parent-involved interventions, also known as ―parent agent-of-
change‖ interventions, are those that exclusively target parents in the treatment of
adolescent overweight/obesity.34,68-70Direct involvement of the child is highly
important when the child is a teenager, and parent involvement in terms of good
parenting techniques, health awareness, and education, behaviour change,
environmental changes, and the setting is also beneficial. Parental information (such
as how to prepare nutritious meals), attitudes, being active parents, support, and
encouragement, all affect obesity-related behaviours among children.16,71-73

Due to the busy schedules of parents, lack of time available for adolescents to
complete academic tasks, easy access to junk food, excessive screen time, a lack of
motivation, and peer support, conducting this type of intervention in the current
environment is not very simple. In such cases, a school-based family intervention
programme may be the best choice. The family environment and the school
environment are the two most significant environmental settings influencing
adolescents‘ behaviours, and school-based interventions with direct parental
involvement have the potential to improve weight status, physical activity, and
sedentary behaviour among adolescents. Therefore, the goal of the current study is to
determine the efficacy of multi-component intervention programmes involving
parents (PIMCIP) in enhancing lifestyle choices and lowering overweight and obesity
among adolescents.

4
1.3 Need for the study

Worldwide the phenomenon of obesity has increased alarmingly, especially among

adolescents.34,74 The National Health and Mobility Survey (NHMS) 2011 reported
that, among children and adolescents aged <8 years 3.9% (0.3 million) and 18 years
27.2% (4.4 million) were obese (Public Health Institute, 2013).35 While data from the
global school-based student health survey (2012), 19.1% of students aged 13–17 years
were overweight while 7.9% were obese (WHO, 2012).36 From these findings it can
be interpreted that the rate of obesity among children and adolescents is at an
alarming level.37

Obesity is commonly recognized as a consequence of a disparity between energy

consumption and expenditure, with a rise in positive energy balance being closely
associated with the lifestyle adopted and dietary intake preferences.37,76-79 The causes
of overweight and obesity are complex, which includes genetics, behavioural, social,
and environmental factors that result in excess weight.39,80 Obesity is associated with a
wide range of adverse health consequences, including problems and disorders related
to sleeping, respiratory, gastrointestinal, endocrine, nervous system, orthopaedic,, and
psychiatry, as well as cardiovascular risk factors.39,80-83 Childhood overweight and
obesity often persists into adulthood and thus increase the risks of developing NCDs
at an earlier age.25,84 Besides, adolescent overweight or obesity is associated with
psychological comorbidities, such as depression, lower perceived health-related
quality of life (QOL) emotional and behavioural disorders, and low self-esteem.18,87

The prevalence of overweight and obesity in an urban area is more when compared to
a rural area. Lack of physical activity and family factors are important risk factors for
this reason.28,88-90 Adolescents overweight and obese exhibited associations with less
frequent physical activity, and more television and internet use.40,91-92 Hormis and
D‘silva (2013), conducted a school-based study in Mangalore, Karnataka revealed
that the overall prevalence of overweight among adolescents is growing high and
action needs to be taken to curb the problem of obesity among adolescents.41

In order to encourage sustainable healthy behaviour changes, especially among

growing youth, it is important to implement lifestyle interventions that address a wide
variety of risk factors.26,93Although efforts local, national, and international are

5
implemented to reduce overweight and obesity their prevalence among children and
adolescents is still increasing and high.27,94 In 2013, 23.8% boys and 22.6% girls in
developed countries were overweight or obese.16 Unhealthy eating behaviours, low
levels of physical activity and sedentary lifestyle are important causes of overweight
and obesity. It is an imbalance in the energy of these individuals ‗which is
influenced by multiple factors, such as the environment to which the child is
exposed.30,95-97

Many school-based interventions are developed with the aim to promote healthy
behaviour of teens.31,98-101 Considering the important influence of parents on children
the WHO school health promotion framework advocates parental involvement in
these school-based interventions.25 As a result, multiple school-based interventions
with parental involvement are being implemented.26,95-97 A systematic review
conducted by Abarca et al., (2017),included both school-based interventions with
direct or indirect parental involvement. The study reported that school-based physical
activity and nutrition interventions with direct parental involvement were more likely
to be effective than school-based interventions.34 A semi-experimental research has
revealed that cognitive behavioural therapy is more effective than exercise therapy in
reducing body weight, when combined it is more effective than any other methods of
weight loss.42

Therefore, there is a need to encourage and support the development of healthy

behaviours within the family unit, and to provide parents with resources and
knowledge to promote these healthy habits. Interventions designed to prevent and
reduce obesity among adults and children should engage both parents and adolescents
in order to develop healthy behaviours within the family unit overall. Thus, the
researchers of the current study sought to determine the effectiveness of parent-
involved multi-component intervention programme (PIMCIP) in terms of training for
physical activity, health education to adolescents with regular reinforcement with
parental supervision for regular physical activity, and online education for parents of
overweight and obese adolescents on prevention and control of overweight/obesity.

6
1.4 Significance to nursing

Prevention is better than cure. It is prominent to primordial prevention. Intervention

needs to be initiated from a young age itself. Health promotion can be achieved only
through health education. The role of community health nurses is to spread health
propaganda in every interaction with the public. A family is a basic unit of health. So,
health promotion activities need to begin from the family itself. Literature supports
that even though people are aware of the consequences of being overweight and obese
still the prevalence is growing high. Though many pieces of evidence are available
still there is a lack of real implementation in this issue. A true parent-involved
programme or family and school-focused interventions need to be started because
addressing today‘s youth as a family is particularly difficult. With the assistance of
the school, this can be done. Therefore, as trained professional nurses, with the
support of various stake holders, they may use this data to lower the worldwide
burden of non-communicable diseases and advance the health of future generations by
consistently promoting healthy lifestyle choices.

1.5 Aim of the study

The aim of the study is to evaluate the effectiveness of the parent-involved multi-
component intervention program in improving lifestyle practices and reduction of
body mass index of overweight and obese adolescents.

1.6 Statement of the problem

Effectiveness of parent-involved multi-component intervention programme on

lifestyle practices and Body mass index of overweight and obese adolescents of urban
schools under Mangaluru Taluk, Karnataka, India.

1.7 Objectives of the study

Phase 1

1.To identify overweight and obese adolescents as measured by body mass index
calculation.

7
Phase 2

1. To assess the pre-test BMI status of overweight and obese adolescents in the study
groups
2. To determine the pre-test knowledge on prevention and control of overweight and
obesity among overweight and obese adolescents in the study groups
3. To find the pre-test lifestyle practices of overweight and obese adolescents in the
study groups
4. To determine the pre-test knowledge on prevention and control of overweight and
obesity among parents of overweight and obese adolescents in the study groups
5. To find the effectiveness of parent-involved multi-component intervention
program in terms of:
a) Change in post-test BMI status of overweight and obese adolescents in
intervention group I
b) Change in the post-test knowledge on prevention and control of
overweight and obesity among overweight and obese adolescents in
intervention group I
c) Change in post-test lifestyle practices of overweight and obese
adolescents in intervention group I
d) Change in post-test knowledge on prevention and control of
overweight and obesity among parents of overweight and obese
adolescents in intervention group I
6. To compare the mean post-test1) BMI status of overweight and obese adolescents
2) knowledge on prevention and control of overweight and obesity, and 3)
lifestyle practices of overweight and obese adolescents in group I, group II, and
group III
7. To compare the mean post-test knowledge on prevention and control of
overweight and obesity among parents of overweight and obese adolescents in
groups I, group II, and group III.
8. To find out the association between pre-test 1) BMI status, 2) knowledge on
prevention and control of overweight and obesity, and 3) lifestyle practice of
overweight and obese adolescents with selected demographic variables in the
study groups

8
9. To find out the association between pre-test knowledge on prevention and control
of overweight and obesity among parents of overweight and obese adolescents
with selected demographic variables in the study groups

1.8 Operational definitions

1.8.1 Effectiveness, In the present study, it refers to the extent to which the parent
involved multi-component intervention program has attained the desired goal in terms
of, a) reduction of BMI status among overweight and obese adolescents measured
based on WHO revised consensus guidelines for BMI classification for the Asian
population. b) gain in knowledge on prevention and control of overweight and obesity
among overweight and obese adolescents; measured by using a structured knowledge
questionnaire on the prevention and control of overweight and obesity among
adolescents which is graded as excellent, good, average, and poor knowledge. c)
enhancement in lifestyle practices among overweight and obese adolescents;
measured by a self-reported lifestyle practice rating scale and, d) gain in knowledge
on prevention and control of overweight and obesity among respondent parents of
overweight and obese adolescents. measured by using a structured knowledge
questionnaire on the prevention and control of overweight and obesity among
adolescents which is graded as excellent, good, average, and poor knowledge

1.8.2 Lifestyle practices, In the study, refers to individual practices and personal
behavioral choices that are related to dietary practices, physical activity, and sleep
patterns as measured by a self-reported lifestyle practice rating scale. A higher mean
score indicates good lifestyle practices.7,1

1.8.3 Body Mass Index (BMI), In the study, refers to the BMI of adolescents and is
calculated by using the formula BMI=weight (Kg)/height (m2). The categorization of
the adolescents is done based on the WHO revised consensus guidelines for BMI
classification for the Asian population, and adolescents are classified as underweight,
normal weight, overweight and obese.2

1.8.4 Parent-involved multi-component intervention program (PIMCIP), In

the present study, refers to an action plan prepared by the investigator to promote
healthy lifestyle practices and reduce BMI through modification of lifestyle among
overweight and obese adolescents who are participating in the intervention Group I.

9
This includes structured physical activity workout training sessions, group health
education for overweight and obese adolescents, supervision of physical activity by
respondent parents, and online group health education training program for parents of
overweight and obese adolescents including reinforcement of health education about
prevention and control of overweight and obesity.

a) Structured physical activity workout training session, In the present study,

refers to a structured video-assisted physical activity workout session prepared by the
investigator for overweight and obese adolescents (once a day, 6 days per week for 40
minutes and minimum 3 days a week to attend to include in the study). All physical
activity sessions included warm-up, aerobic activities, and a cool-down exercise,
which is communicated and handed over to the physical educator for implementation
accordingly. Physical activity training sessions are carried out and supervised by the
physical educator of the school for a duration of one month. Physical educator (PE) is
the one who is appointed by the concerned school with the minimum qualification
required to be appointed as PE based on school policy (i.e., B. P. Ed.). After one-
month physical activity training the overweight and obese adolescents were asked to
continue physical activity under the supervision of their respondent parent up to 24th
weeks at their home settings.

b) Group health education to overweight and obese adolescents, In the present

study, refers to the provision of group health education on the prevention and control
of overweight and obesity for 40 minutes with using of powerpoint presentation to all
the overweight and obese adolescents once who participated in the intervention Group
I Thereafter, additional reinforcement was done once at the end of 3 months using
different audio-visual aids such as information pamphlets, and animated videos
prepared by the investigator. The effectiveness was measured by using a structured
knowledge questionnaire on the prevention and control of overweight and obesity
among adolescents which is graded as excellent, good, average, and poor knowledge.

c) Group health education to respondent parents of overweight and obese

adolescents, In the study, refers to an online-based group health education training
program for respondent parents of overweight and obese adolescents who participated
in intervention group I regarding the prevention and control of overweight and obesity
among adolescents one time for 40 minutes by using power point presentation.

10
Thereafter, additional reinforcement was done by distributing an information booklet
prepared by the investigator at the end of 3 months. The effectiveness was measured
by using a structured knowledge questionnaire on the prevention and control of
overweight and obesity among adolescents which is graded as Excellent, Good,
Average and poor knowledge

d) Supervision of physical activity by parents, In the study, refers to the supervision

of physical activity by the parents of overweight and obese adolescents who
participate in the intervention group I from 5th weeks to 24th weeks at their home
settings for a minimum of 40 minutes per day either before or after the school hours.
The physical activity of the adolescent was ensured through a proficiency checklist
maintained by the parents. A video with a workout plan was handed over to the
parents of overweight and obese adolescents who participated in intervention group I.
All physical activity sessions included warm-up, aerobic activities, and a cool-down
exercise.

1.8.5 multi-component intervention programme (MCIP): In the present study,

refers to an action plan prepared by the investigator to promote healthy lifestyle
practices and reduce BMI through modification of lifestyle among overweight and
obese adolescents who is participating in the intervention Group II. This includes
structured physical activity workout training sessions and group health education on
prevention and control of overweight and obesity among adolescents.

a) Structured physical activity workout session, In the present study, refers to a

structured video-assisted physical activity workout session prepared by the
investigator for overweight and obese adolescents (once a day, 6 days per week for 40
minutes and minimum 3 days a week to attend to include in the study). All physical
activity sessions included warm-up, aerobic activities, and a cool-down exercise,
which is communicated and handed over to the physical educator for implementation
accordingly. Physical activity training sessions are carried out and supervised by the
physical educator of the school for a duration of one month. Physical educator (PE) is
the one who is appointed by the concerned school with the minimum qualification
required to be appointed as PE based on school policy (i.e., B. P. Ed.). After one-
month physical activity training the overweight and obese adolescents were asked to

11
continue the physical activity on their own for up to six months without any
supervision.

b) Group health education to overweight and obese adolescents, In the present

study, refers to the provision of group health education on the prevention and control
of overweight and obesity for 40 minutes with using of power point presentation to all
the overweight and obese adolescents once who participated in the intervention Group
II. The effectiveness health education program was measured by using a structured
knowledge questionnaire on the prevention and control of overweight and obesity
among adolescents which is graded as Excellent, Good, Average and poor knowledge

1.8.6 Adolescents Phase I: In the present study, it refers to adolescent‘s boys and
girls aged 13 to 15 y.

1.8.7 Adolescents Phase II: In the present study, the adolescent boys and girls aged
13 to 15 y. and whose BMI ≥ 23.0–24.9 kg/m2, according to WHO revised consensus
guidelines for BMI classification for the Asian population.2

1.8.8 Parents of overweight and obese adolescents Phase II : In the present

study, refers to parents with an adolescent child aged 13 to 15 y. and whose BMI ≥
23.0–24.9 kg/m2.

1.8.9 Overweight and obese adolescents: In the study, it refers to adolescents who
are overweight or obese and whose BMI ≥ 23.0 –24.9 kg/m2, based on WHO revised
consensus guidelines for BMI classification for the Asian population.2

1.8.10 Schools at Mangalore Taluk, In the study, refers to English medium high
schools that come under Mangalore City Corporation Limits. (i.e., North, and South
zone).

1.9 Assumptions

The study assumes that,

 Lifestyle practices of growing adolescents can be changed through continuous

motivation.

12
 Multiple interventions for reducing overweight among adolescents may give
better results.

 Schools have a vital role in inculcating healthy lifestyles among adolescents.

1.10 Hypotheses

The following hypotheses were considered in this study:

H1: There will be a significant difference between the mean pre-test and post-test
BMI status among overweight and obese adolescents in intervention group I

H2: There will be a significant difference between the mean pre-test and post-tests
knowledge scores among overweight and obese adolescents in intervention
group I

H3: There will be a significant difference between the mean pre-test and post-test
lifestyle practices among overweight and obese adolescents in intervention
group I

H4: There will be a significant difference between the mean pre-test and post-test
knowledge scores on the prevention and control of overweight and obesity
among parents of overweight and obese adolescents in intervention group I

H5: There will be a significant difference between the mean post-test BMI scores of
overweight and obese adolescents in the study groups

H6: There will be a significant difference between the mean post-test knowledge
scores of overweight and obese adolescents in the study groups

H7: There will be a significant difference between the mean post-test lifestyle
practice scores of overweight and obese adolescents in study groups

H8: There will be a significant difference between the mean post-test knowledge
scores on prevention and control of overweight and obesity among parents of
overweight and obese adolescents in study groups.

H9: There will be a significant association between the pre-test BMI status of
overweight and obese adolescents with selected demographic variables

H10: There will be a significant association between pre-test knowledge scores of

overweight and obese adolescents with selected demographic variables

13
H11: There will be a significant association between the pre-test lifestyle practices
score of overweight and obese adolescents with selected demographic variables

H12: There will be a significant association between pre-test knowledge scores of

parents of overweight and obese adolescents on prevention and control of
overweight and obesity with selected demographic variables

1.11 Delimitation of the study

The study is delimited to:

 adolescents aged between 13-15 years

 only English medium urban high schools

 schools under Mangalore municipal city corporation limit.

 overweight and obese adolescents and their parents.

1.12 Theoretical framework

A conceptual framework is a theoretical approach to study problems that are

scientifically based, which emphasizes the selection, arrangement, and clarification of
its concepts.

The present study aims to evaluate the effectiveness of the parent involved multi-
component intervention programme in improving lifestyle practices and reduction of
BMI among overweight and obese adolescents.

The Health Promotion Model notes that each person has unique personal
characteristics and experiences that affect subsequent actions. A set of variables for
behavioural-specific knowledge and effect has important motivational significance.
These variables can be modified through nursing actions. Health-promoting behaviour
is the desired behavioural outcome and is the endpoint in the Health Promotion
Model. Health-promoting behaviours should result in improved health, enhanced
functional ability, and better quality of life at all stages of development. The final
behavioural demand is also influenced by the immediate competing demand and
preferences, which can derail intended health-promoting actions.

14
The conceptual framework facilitates communication and provides a systematic
approach to nursing research, education, administration, and practice. The conceptual
framework for the present study is based on Pender‘s Health Promotion Model (1982,
revised 1996) (Figure 1.1).

Pender‘s Health Promotion Model aims to increase individual health promotion

activity. This model describes the multi-dimensional nature of persons as they interact
within their environment to pursue health. This model notes that each person has
unique personal characteristics and experiences that affect subsequent actions. Health-
promoting behaviours should result in improved health, enhanced functional ability,
and better quality of life at all stages of development. Health-promoting behaviour is
the desired behavioural outcome and is the endpoint in the health promotion Model.

In the present study, the concepts from Pender‘s Health Promotion Model are utilized
where the adolescent with their knowledge and favourable lifestyle practices, act as
agents for improving health and nutritional status and ultimately bringing up social
development.43

The focus of the model is to explain factors that influence the knowledge and practice
among adolescents on improving lifestyle practices and reduction of overweight and
obesity through a parent-involved multi-component intervention programme.

The model focuses on the following 3 areas of health-promoting behaviour:

 Individual characteristics and experience

 Cognitive perceptual factors

 Behavioural outcomes

1.12.1 Individual characteristics and experience

It consists of prior related behaviour and personal factors of an individual

1.12.1.1 Prior related behaviour:

This is the frequency of similar behaviour in the past.In this study, prior related
behaviour includes poor, adequate, good, and excellent knowledge on prevention and
control of overweight and obesity assessed by a structured knowledge questionnaire
and unfavourable lifestyle behaviours such as inadequate physical activity, poor

15
dietary practices, altered sleep habits leading to overweight and obesity which is
measured by self-reported lifestyle practice rating scale.

1.12.1.2 Personal factors:

These factors are predictive of a given behaviour and shaped by the nature of the
target behaviour being considered.

a) Personal biological factors:

Include variables such as age, gender, BMI, pubertal status, aerobic capacity, strength,
agility, or balance. In the present study, Personal biological factors are age, sex, BMI,
pubertal status, family history of overweight and obesity, aerobic capacity, strength,
agility, and balance.

b) Personal psychological factors:

Include variables such as self-esteem, self-motivation, personal competence,

perceived health status, and definition of health. In the present study, personal
psychological factors are variables such as self-esteem, self-motivation, personal
competence, perceived health status, and definition of health.

c) Personal socio-cultural factors:

Include variables such as race, ethnicity, acculturation, education, and socioeconomic

status. In the present study, personal sociocultural factors include variables such as
education, and socioeconomic status. type of family, number of siblings, education
status of parents, occupation status of parents, and annual family income (INR).

1.12.2 Behaviour-specific cognitions and affect:

This set of variables includes:
 Perceived benefits of action

 Perceived barriers to action

 Perceived self-efficacy

 Activity-related affect

 Interpersonal influences

 Situational influences

16
1.12.2.1 Perceived benefits of action:

Anticipated positive outcomes that will occur from health behaviour. In the present
study, improving lifestyle practices through increasing knowledge and reduction of
overweight and obesity.

1.12.2.2 Perceived barriers to action:

Anticipated, imagined, or real blocks and personal costs of understanding a given

behaviour. In the present study, the perceived barriers to action include lack of time,
inconvenience, lack of interest, inadequate family support, culture and belief, non-
availability of resources, and academic requirements.

1.12.2.3 Perceived self-efficacy:

The judgment of personal capability to organize and execute a health-promoting

behaviour. Perceived self-efficacy influences perceived barriers to action, so higher
efficacy results in lowered perceptions of barriers to the behaviour‘s performance. In
the present study, good knowledge regarding the prevention and control overweight
and obesity and prior experience is considered perceived self-efficacy.

1.12.2.4 Activity-related affect:

Subjective positive or negative feeling occurs before, during, and following

behaviour based on the stimulus properties of the behaviour itself. Activity-related
effect influences perceived self-efficacy, which means the more positive the
subjective feeling, the greater its efficacy. In turn, increased feelings of efficacy can
generate a further positive effect. The present study relates to the enthusiasm or
indifference about parent involvement in the multi-component intervention
programme.

1.12.2.5 Interpersonal influences:

Cognition concerning behaviours, beliefs, or attitudes of others. Interpersonal

influences include norms (expectations of significant others), social support
(instrumental and emotional encouragement), and modelling (vicarious learning
through observing others engaged in a particular behaviour). Primary sources of

17
interpersonal influences are families, peers, and healthcare providers. In the present
study parental involvement, motivation from teacher‘s peer support, and
encouragement from community health nurses on health promotional activities are
considered Interpersonal influences.

1.12.2.6 Situational influences:

Personal perceptions and cognitions of any given situation or context can facilitate or
impede behaviour. Situational influences include perceptions of options available,
demand characteristics, and aesthetic features of the environment in which given
health-promotion is proposed to take place. In the present study, physical activity
training is provided on school premises with assistance from physical educators and
parents, which is safe and convenient.

1.12.3 Behavioural outcomes

It includes commitment to a plan of action, immediate competing demands and

preferences, and health-promoting behaviour of an individual

1.12.3.1 Commitment to the plan of action:

According to this model, a plan of action is the concept of intention and the
identification of a planned strategy that which leads to the implementation of health
behaviour. The commitment to a plan of action involves two processes: commitment
and identifying specific strategies for carrying out and reinforcing the behaviour. In
the present study, specific strategies for carrying out parent-involved multi-
component intervention programmes, regular reinforcement of the importance of
healthy lifestyle practices, and the plan of action, is accepted as health-promoting
services and utilization of the facilities.

1.12.3.2 Immediate competing demands:

Competing demands are that alternative behaviour over which an individual has a low
level and high level of control. For e.g., an unexpected work or family responsibility
may compete with a planned visit to the health club, and not responding to this
responsibility may cause a more negative outcome than missing the exercise routine38.
In the present study, low control demands are academic commitments, exams,

18
vacations, and the role of adolescents in family and society. High level of control,
e.g., a lack of time, interest, inconvenience, or high-fat food over a low-fat food
because it tastes better has ‗given in‘ an urge based on competing performances. In
the present study, high levels of demands are controlled demands to enrich knowledge
regarding the prevention and control of overweight and obesity.

1.12.3.3 Health promotion behaviour:

According to the present study, health-promoting behaviour is the endpoint or action

outcome directed towards attaining positive health outcomes such as optimal well-
being, personal fulfilment, and productive living. In the present study, health is
promoted through practicing preventive measures and developing healthy lifestyle
practices, and reducing the body mass of overweight and obese adolescents.

Summary

This chapter has discussed the problem, background, need the significance of the
present study in nursing. Discussed the significance of this study in nursing. It also
discusses the objectives, hypotheses, and conceptual framework of the study.

19
 Individual characteristics Behaviour-specific Behavioural
and experiences cognitions and affect outcomes

Perceived benefits of action: Improving lifestyle

Personal factors practices and reduction of overweight and obesity
Immediate competing demand
Biological: Age, sex, body mass Low control: Academic commitments, exams,
index, pubertal status, family history Perceived barriers to action: Lack of time, vacation, the role of adolescents in family and
of overweight and obesity, aerobic inconvenience, lack of interest, poor knowledge, society
capacity, strength. inadequate family support, culture and belief, non- High control: Enrich knowledge regarding
availability of resources, academic requirements, and prevention and control of overweight and obesity.
Psychological: Personal availability of junk foods.
competence, perceived health status,
and definition of health Perceived self-efficacy: Adequate knowledge
Socio-cultural: Education, and regarding prevention and control of overweight and
socioeconomic status. type of obesity and prior experience.
family, number of siblings, Commitment to plan Health-promoting
education status of parents, Activity-related affect: Enthusiastic or indifferent of action: Carrying behaviour: Health
occupation status of parents, and about parent involvement multi-component out parent involved is promoted through
annual family income intervention programme. multi component adopting healthy
intervention lifestyle practices
program. Accepting and reducing body
Prior related behaviour: health promotional mass of overweight
Unfavourable lifestyle behaviours Interpersonal influences: Parental involvement,
activities and obese
such as inadequate physical activity, teachers ‗motivation, peer support and encouragement
from community health nurse on the importance of
adolescents.
poor dietary practices, and altered
sleep habits leading to overweight health promotional activities.
and obesity
Inadequate knowledge on prevention Situational influences: Physical activity training
and control of overweight and provided in school premises which is safe and
obesity convenient; assistance from physical educators and
parents.

Figure 1.1 Conceptual framework based on Pender’s Health Promotion Model

20