• Are the sample characteristics representative of the target population?
• Was the sample size adequate?
• How would you rate the quality of the sampling procedures and your confidence in drawing inferences to the target population?

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 23

C
hildhood obesity has become
a serious health issue in the
United States. According to
the Centers for Disease Con –

trol and Prevention (CDC) (2019),
roughly 18.5% of children are obese.
The CDC (2019) also reports that
obese children may begin to present
signs of obesity and develop comor-
bidities as early as preschool age.
Studies have found that obese chil-
dren are more likely to advance to
chronic diseases, such as hyperten-
sion, diabetes, depression, and joint
problems, earlier in life than children
who are not obese. Identifying deter-
minants that contribute to obesity in
children may guide health care
providers in the prevention and con-
trol of obesity (Alexander et al., 2015;
Rune et al., 2015).

A significant association between
parental influence and childhood
obesity has been identified in the lit-
erature (Hansen et al., 2014; Moore et
al., 2012; Rune et al., 2015). In many
circumstances, a child’s diet and
physical activity were dependent on
the discretion of the parent.
Identifying parental perceptions and
attitudes of childhood obesity can
provide guidance in formulating evi-
dence-based interventions to prevent
and control childhood obesity (Abela
et al., 2014).

Continuing Nursing Education

Assessing Parental Perceptions on
Childhood Obesity: An Educational

Intervention
Felicia Renales, Kelli Whitted, and Noreen Lennen

Felicia Renales, DNP, FNP-BC, is an Assistant Professor, Troy University, Phenix City, AL.

Kelli Whitted, DNP, FNP-BC, APRN-BC, is an Associate Professor, Troy University, Phenix City,
AL.

Noreen Lennen, PhD, RN, is an Assistant Professor, Troy University, Phenix City, AL.

The correlation between a child’s
weight and the parents’ perception of
their child’s weight affected a child’s
risk of becoming obese (White et al.,
2016). Parents who displayed concern
about their child’s weight were more
likely to control environmental fac-
tors, such as screen time and physical
activity. Children were more success-
ful and compliant with weight control
when their parents were supportive
and proactive in the practice of adopt-
ing healthy habits (Alexander et al.,

2015; Black et al., 2015; Moore et al.,
2012; Rune et al., 2015).

Evidence suggests that assessments
related to parental knowledge and per-
ception of their child’s weight status
could decrease the risk of obesity by
allowing the opportunity for providers
to discuss weight concerns and ideas
with parents. Assessment of parents’
perception of their child’s weight and
education from a health care provider
has been successful in preventing obe-
sity in children and identifying those

Renales, F., Whitted, K., & Lennen, N. (2021). Assessing parental perceptions on
childhood obesity: An educational intervention. Pediatric Nursing, 47(1), 23-
29, 51.

Background: Parental influence on children’s health behaviors has been recog-
nized as significantly impacting childhood obesity.

Objective: The objective of the study was to examine the impact of an education
intervention on the perceptions and attitudes that parents of school-aged chil-
dren displayed on childhood obesity.

Method: A random sample of 30 parents was recruited to complete a survey
before and after reviewing an educational pamphlet on childhood obesity. The
survey assessed parental perceptions, knowledge, and importance of obesity
risk factors and obesity prevention strategies. The survey also addressed
parental perceptions of their children’s weight status and their children’s environ-
ment.

Results: The education intervention brought awareness that parental percep-
tions and attitudes can influence children’s obesity risk factors. This measurable
finding indicates that an educational pamphlet can serve as a valuable tool to
assist parents with choosing healthier lifestyles for their children.

Conclusion: Health care providers and parents play vital roles in the wellness
and health promotion of children. Informing parents by means of an educational
pamphlet can improve parents’ awareness about childhood obesity and positive-
ly impact the health of their children.

Key Words: Pediatric obesity, parental perception, parents’ knowledge, risk
factors, body mass index, parental concern.

Instructions for CNE
Contact Hours

PNJ 2104
Continuing nursing education (CNE)

contact hours can be earned for
completing the learning activity

associated with this article. Instructions
are available at pediatricnursing.net

Deadline for submission:
February 28, 2023
1.3 contact hour(s)

24 PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1

at risk (Rune et al., 2015). Brief educa-
tional interventions about the child’s
weight can increase parental knowl-
edge (Rune et al., 2015).

Purpose
The purpose of this study was to

examine the effectiveness of an edu-
cational intervention on the percep-
tions and attitudes of childhood obe-
sity among parents of school-aged
children. The expected outcome was
that implementation of a written edu-
cational program would promote
healthier attitudes.

Methods

Study Design
A pretest-posttest research design

was used for the study. Following
Institutional Review Board approval,
participants were recruited from an
after-school day care facility that serv-
ices children ages 6 weeks to 12 years.

Sample
A convenience sample of 30 indi-

vidual parents were recruited for the
study. Parents 18 years of age or
greater whose child attended the
after-school day care facility and who
could read and write in English were
included in the study. Data were col-
lected over a four-month timeframe
during the Fall of 2017.

Procedures
After participants signed the con-

sent form, a pre-intervention survey
was administered to parents. Upon
completion of the pre-intervention
survey, parents were given an educa-
tional pamphlet on childhood obesity
and a post-intervention survey to com-
plete at their convenience. Parents
were instructed to return the post-
intervention survey within one week
to the after-school day care facility.

Instruments
A modified version of a question-

naire developed by Alexander and
colleagues (2015) was used for the
study. Guided by the social ecological
model and the social cognitive theo-
ry, the survey was used to assess
parental perceptions of risk factors,
child’s weight status, and importance
of prevention strategies relating to
childhood obesity. Reliability and
validity of the survey was previously
established through interrater reliabil-

Parental Perception of Risk
Factors Associated with
Childhood Obesity

In both the pre-intervention and
post-intervention groups, parents
agreed that lack of physical activity,
food advertising, watching television,
eating foods, and parental eating and
exercise habits were risk factors associ-
ated with childhood obesity (see
Table 2). Following the educational
intervention, parental perception that
food advertising, watching television,
and parental eating habits was
reduced. Perceptions that eating foods
or food choices increased, indicating
appropriate inference from the educa-
tional pamphlet; however, the differ-
ences were not statistically signifi-
cant.

Complications Associated
with Childhood Obesity

Parents were asked to identify spe-
cific complications associated with
childhood obesity (see Table 3). Post-
intervention scores increased for
identifying physiologic complications
associated with childhood obesity.
However, more than 30% of the par-

ity, internal consistency reliability
(0.71 to 0.82), face validity, and con-
tent validity.

For this study, five primary sub-
scales were used to examine changes
in parental perception following the
educational intervention. Pre-inter-
vention and post-intervention analy-
sis examined parental perception of
risk factors associated with childhood
obesity, complications of childhood
obesity, their child’s weight, the play
environment, prevention strategies,
and importance of prevention strate-
gies. Cronbach’s alpha for this study
was 0.86.

Results
The sample consisted of 30 partici-

pants aged 19 to 44 years. There was a
100% return of post-test surveys with
all 30 participants completing the pre-
test and post-test surveys. Demo –
graphic information is presented in
Table 1. A majority of the respondents
were female (76.7%), White (56.7%),
held a high school degree or equiva-
lent (30%), and were currently married
or in a domestic partnership (70%).

Table 1.
Description of the Sample

Characteristics n %

Gender

Female 23 76.7
Male 7 23.3

Race

White 17 56.7
Hispanic or Latino 1 3.3
Black or African American 9 30.0
More than one race 3 10.0

Highest degree

High school or equivalent 9 30.0
Some college, no degree 5 16.7
Trade 3 10.0
Associate 4 13.3
Bachelor 6 20.0
Master 3 10.0

Marital status

Single 5 16.7
Married or domestic partnership 21 70.0
Widowed 1 3.3
Divorced 3 10.0

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 25

Table 2.
Frequencies of Pre-Intervention and Post-Intervention Risk Factors for Childhood Obesity

Variable

Pre-Intervention Post-Intervention

n % n %

Do you disagree, neither, or agree that the following are risk factors of childhood obesity?
Lack of physical activity

Disagree 4 13.3 3 10.0
Neither 0 0.0 1 3.3
Agree 26 86.7 26 86.7

Food advertising
Disagree 1 3.3 3 10/0
Neither 6 20.0 8 26.7
Agree 23 76.7 19 63.3

Watching TV
Disagree 1 3.3 2 6.7
Neither 7 23.3 7 23.3
Agree 22 73.3 21 70.0

Eating foods
Disagree 1 3.3 2 6.7
Neither 5 16.7 3 10.0
Agree 24 80.0 25 83.3

Parent’s eating habits
Disagree 1 3.3 3 10.0
Neither 2 6.7 1 3.3
Agree 27 90.0 26 86.7

Parent’s exercise habits
Disagree 0 0.0 0 0.0
Neither 3 10.0 3 10.0
Agree 27 90.0 27 90.0

Table 3.
Frequencies of Pre-Intervention and Post-Intervention Complications of Childhood Obesity

Variable
Pre-Intervention Post-Intervention
n % n %

Do you disagree, neither, or agree that the following are complications of childhood obesity?
Asthma

Disagree 8 26.7 6 20.0
Neither 6 20.0 4 13.3
Agree 16 53.3 20 66.7

Diabetes
Disagree 2 6.7 2 6.7
Neither 3 10.0 1 3.3
Agree 25 83.3 27 90.0

Bone and joint problems
Disagree 4 13.3 1 3.3
Neither 6 20.0 5 16.7
Agree 20 66.7 24 80.0

Irregular menstrual cycle
Disagree 2 6.7 2 6.7
Neither 13 43.3 8 26.7
Agree 15 50.0 20 66.7

26 PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1

Table 4.
Frequencies of Pre-Intervention and Post-Intervention Parental Perception of Child’s Weight Status

Variable
Pre-Intervention Post-Intervention
n % n %

Do you disagree, neither, or agree that the following regarding your child’s weight?
Concern about weight

Disagree 14 46.7 13 43.3
Neither 4 13.3 4 13.3
Agree 12 40.0 13 43.3

Appropriate weight
Disagree 4 13.3 3 10.0
Neither 7 23.3 4 13.3
Agree 19 63.3 23 76.7

My child is overweight
Disagree 21 70.0 20 66.7
Neither 4 13.3 6 20.0
Agree 5 16.7 4 13.3

My child is underweight
Disagree 21 70.0 18 60.0
Neither 7 23.3 10 33.3
Agree 2 6.7 2 6.7

Doctor discusses weight
Disagree 13 43.3 12 50.0
Neither 3 10.0 5 16.7
Agree 14 46.7 13 43.3

Parental influence
Disagree 3 10.0 1 3.3
Neither 5 16.7 3 10.0
Agree 22 73.3 26 86.7

ents either disagreed or neither agreed
nor disagreed post-intervention that
asthma and an irregular menstrual
cycle were potential complications of
childhood obesity. Additionally, post-
intervention scores indicated that
20% of the parents disagreed or nei-
ther agreed nor disagreed that bone
and joint problems were a potential
complication of childhood obesity,
and 10% disagreed or neither agreed
nor disagreed that diabetes was a
potential complication.

Parental Perception of Their
Child’s Weight Status

Parents were surveyed for percep-
tion of their child’s weight status (see
Table 4). There was a noted difference
in parental perception of whether
their child’s weight was appropriate.
In the pre-intervention sample, 63%
felt their child was of an appropriate
weight. Post-intervention, 76.7% of
the parents felt their child was of an
appropriate; however, data did not

indicate whether the parent felt their
child was underweight or overweight
pre-intervention. Surprisingly, more
than 50% of the sample indicated the
health care provider did not discuss
their child’s weight with the parent.

Parental Perception of Their
Child’s Play Environment

Following the intervention, pa –
rental perception of the child’s envi-
ronment indicated the environment
was less safe than in the pre-interven-
tion scoring (see Table 5). This is evi-
denced by an increase in scores for the
presence of stray dogs, not enough
play areas, and lack of programs.
Parents who agreed that stray dogs
affected their child’s environment
increased from the pre-intervention
group (26.7 %) to the post-interven-
tion group (50%). Parental perception
of not enough play areas increased
from 43.3% pre-intervention to 56.7%
post-intervention, and parents who
agreed that lack of programs affected

their child’s environment increased
from the pre-intervention (26.7%) to
the post-intervention (46.7%). Paired
sample t tests were also used to exam-
ine differences in the child’s play envi-
ronment. There was a significant dif-
ference in pre-intervention and post-
intervention parental perception for
the application of stray dogs (t

(29)
= –

02.23, p < 0.05, 95% CI = -0.42 to 0.16) and lack of programs (t

(29)
= -2.16, p <

0.05, 95% C. I. -0.65 to -0.02) associat-
ed with the child’s environment. A
statistically significant difference was
also identified in parental perception
of environmental traffic (t

(29)
= -2.36, p

< 0.05, 95% CI = -0.68 to -0.05). Among the pre-intervention sample, 50% of participants felt traffic impact- ed their child’s ability to play. Post- intervention, this decreased to 23.3%.

Parental Perception of
Prevention Strategies

There was an increase in the num-
ber of participants who agreed schools

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 27

Table 5.
Frequencies of Pre-Intervention and Post-Intervention Parental Perception of Child’s Play Environment

Variable
Pre-Intervention Post-Intervention
n % n %

Do you disagree, neither, agree that the following apply to the environment for your child to play?
Safe in community

Disagree 2 6.7 4 13.3
Neither 0 0.0 0 0.0
Agree 28 93.3 26 86.7

Stray dogs
Disagree 7 23.3 6 20.0
Neither 15 50.0 9 30.0
Agree 8 26.7 15 50.0

Not enough areas
Disagree 9 30.0 9 30.0
Neither 8 26.7 4 13.3
Agree 13 43.3 17 56.7

Traffic
Disagree 10 33.3 6 20.0
Neither 5 16.7 2 6.7
Agree 15 50.0 22 23.3

Lack of programs
Disagree 14 46.7 10 33.3
Neither 8 26.7 6 20.0
Agree 8 26.7 14 46.7

Present health programs
Disagree 5 16.7 8 26.7
Neither 12 40.0 9 30.0
Agree 13 43.3 13 43.3

Motivate
Disagree 5 16.7 4 13.3
Neither 4 13.3 4 13.3
Agree 21 70.0 22 73.3

and the child’s doctor were useful in
preventing childhood obesity. Parents
who agreed that schools played a role
in childhood obesity increased from
pre-intervention (60%) to post-inter-
vention (70%). Parents who agreed
their child’s doctor positively impact-
ed the prevention of obesity in their
child also increased from pre-interven-
tion (63.3%) to post-intervention
(76.7%) (see Table 6).

Importance of Prevention
Strategies

There was an increase in parental
perception on the importance of lim-
iting portion size and reading nutri-
tion labels. The number of parents
who felt that limiting portion size was
not at all important in preventing

childhood obesity decreased from five
to one, and the number of parents
who felt reading nutrition labels was
not at all important decreased from
three to zero. Additionally, the num-
ber of parents who felt that limiting
portion sizes was extremely important
increased from 40% in the pre-inter-
vention sample to 56.7% in the post-
intervention sample. There were sig-
nificant changes in pre-intervention
and post-intervention parental per-
ception on the importance in the pre-
vention strategies of limiting portion
sizes (t

(29)
= -2.13, p < 0.05, 95% CI = -

1.24 to -0.03) and pre-intervention
and post-intervention limiting high
calorie foods (t

(29)
= -2.09, p < 0.05,

95% CI = -0.86 to -0.01) (see Table 7).

Discussion
Exploring and understanding the

sources of obesity in children are ini-
tial steps to reducing the prevalence of
childhood obesity. Influences related
to parents’ perceptions and attitudes
on their child’s diet, concern about
child’s weight, limits on a child’s eat-
ing, and the amount of physical activ-
ity were factors ob served in this study.
Researchers have used qualitative sur-
veys and questionnaires to evaluate
parents’ perception and knowledge on
obesity. By im plementing an educa –
tional inter vention, such as a pam –
phlet on child hood obesity, health
care providers can improve parental
perception and attitudes on childhood
obesity. Pa rents globally can be
encouraged to promote healthier

28 PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1

Table 6.
Frequencies of Pre-Intervention and Post-Intervention Parental Perception of Prevention Strategies

Variable
Pre-Intervention Post-Intervention
n % n %

Do you disagree, neither, or agree that the following are strategies of childhood obesity prevention?
Schools

Disagree 4 13.3 6 20.0
Neither 8 26.7 3 10.0
Agree 18 60.0 21 70.0

My child’s doctor
Disagree 3 10.0 3 10.0
Neither 8 26.7 4 13.3
Agree 19 63.3 23 76.7

My community
Disagree 4 13.3 3 10.0
Neither 11 36.7 12 40.0
Agree 15 50.0 15 50.0

Drink water
Disagree 0 0.0 1 3.3
Neither 0 0.0 0 0.0
Agree 30 100.00 29 96.7

Provide education
Disagree 0 0.0 0 0.0
Neither 0 0.0 2 6.7
Agree 30 100.0 28 93.3

Provide low-fat meals
Disagree 1 3.3 2 6.7
Neither 4 13.3 4 13.3
Agree 25 83.3 24 80.0

Income
Disagree 3 10.0 3 10.0
Neither 5 16.7 7 23.3
Agree 22 73.3 20 66.7

lifestyle habits for their children by
increasing their awareness of child-
hood obesity.

Despite successful results, there
were limitations to the research.
Project findings could have been lim-
ited due to the small sample size of 30
participants from one geographic loca-
tion. Furthermore, the tool was origi-
nally developed for African American
families in Georgia; however, in this
study a multiethnic population was
used, which did not seem to have
affected the implementation of this
study.

Recommendations/
Implications for Practice

Sustaining the best choices to pro-
vide an opportunity for every child to
live the healthiest life possible has

been a central incentive in the preven-
tion of childhood obesity in pediatric
nursing. By detecting influential risk
factors and causes of obesity in chil-
dren, health care providers can play a
role in reducing rates of childhood
obesity. Employing an effective plan
of care that targets perceptions and
attitudes of parents may help increase
children’s compliance and adoption
of healthier lifestyle habits. Com –
prehending misperceptions that par-
ents have on childhood obesity can
guide health care providers in formu-
lating appropriate resources to admin-
ister to parents of patients who are
obese or at risk. Health care providers
must remain current with recent rec-
ommendations and guidelines to
accurately inform parents. With the
assistance of health care providers uti-

lizing educational interventions, the
goal is to alter negative parental per-
ceptions and attitudes on childhood
obesity into positive outcomes.

References
Abela, S., Bagnasco, A., Arpsella, M.,

Vandoni, M., & Sasso, L. (2014).
Childhood obesity: An observational
study. Journal of Clinical Nursing, 23,
2990-2992. https://doi.org/10.1111/
jocn.12357

Alexander, D.S., Alfonso, M.L, & Hansen, A.R.
(2015). Childhood obesity perceptions
among African American caregivers in a
rural Georgia community: A mixed
methods approach. Journal of Com –
munity Health, 40, 367-378. https://doi.
org/10.1007/s10900-014-9945-4

continued on next page

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 29

Table 7.
Frequencies of Pre-Intervention and Post-Intervention Parental Perception on

Importance of Prevention Strategies

Variable
Pre-Intervention Post-Intervention

n % n %
How important do you feel the following factors are for your child?
Limit screen time

Not at all important 0 0.0 0 0.0
Slightly important 3 10.0 2 6.7
Somewhat important 5 16.7 5 16.7
Moderately important 6 20.0 5 16.7
Extremely important 16 53.3 18 60.0

Limit portion size
Not at all important 5 16.7 1 3.3
Slightly important 4 23.3 2 6.7
Somewhat important 2 6.7 4 13.3
Moderately important 7 23.3 6 20.0
Extremely important 12 40.0 17 56.7

Provide healthy snacks
Not at all important 0 0.0 0 0.0
Slightly important 0 0.0 0 0.0
Somewhat important 3 10.0 3 10.0
Moderately important 7 23.3 7 23.3
Extremely important 20 66.7 20 66.7

Exercise with my child
Not at all important 0 0.0 0 0.0
Slightly important 0 0.0 1 3.3
Somewhat important 5 16.7 3 10.0
Moderately important 4 13.3 5 20.0
Extremely important 21 70.0 20 66.7

Read nutrition labels
Not at all important 3 10.0 0 0.0
Slightly important 3 10.0 3 10.0
Somewhat important 6 20.0 6 20.0
Moderately important 8 26.7 5 16.7
Extremely important 10 33.3 16 53.3

Limit high-calorie foods
Not at all important 0 0.0 1 3.3
Slightly important 2 6.7 1 3.3
Somewhat important 10 33.3 3 10.0
Moderately important 8 26.7 8 26.7
Extremely important 10 33.3 17 56.7

Health professional
Not at all important 2 6.7 0 0.0
Slightly important 1 3.3 4 13.3
Somewhat important 4 13.3 5 16.7
Moderately important 8 26.7 6 20.0
Extremely important 15 50.0 15 50.0

continued on page 51

PEDIATRIC NURSING/January-February 2021/Vol. 47/No. 1 51

Assessing Parental Perceptions
continued from page 29

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