A qualitative investigation of family perceptions, experiences and management of childhood fussy eating behaviours
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Background: Fussy eating refers to the consumption of an inadequate variety or quantity of food. Childhood fussy eating can impact nutritional intake and has been associated with family stress and conflict at mealtimes. A range of child, parent, family, social and cultural factors contribute to the development and management of fussy eating behaviours. Much research has focused on the role of parents. However, this research has focused on parent feeding practices and less is known about other factors that are important to consider in relation to behaviour change intervention (such as beliefs, emotions and goals). In addition, the majority of research on fussy eating to date is quantitative, relies on parent-report and is focused on pre-school children. Aims: Using a qualitative research design, this thesis aims to: 1) explore family perceptions (descriptions and beliefs), experiences (impact and emotions) and management (goals and practices) of fussy eating behaviours, 2) explore these constructs in families of school-aged children, 3) account for both parent and child perspectives and 4) explore how family perceptions, experiences and management strategies relate to each other. Method: This thesis presents a systematic review and synthesis of ten published qualitative studies on family perceptions, experiences and management of fussy eating using the meta-ethnography qualitative synthesis method (Study 1). In addition it presents a qualitative interview study with 20 parents of school-aged children (Study 2A and 2B) and a qualitative interview study with 16 school children between the age of seven and ten years (Study 3). Interviews were analysed using thematic analysis. Findings: The synthesis (Study 1) provides a comprehensive description and definition of fussy eating behaviours as well as a conceptual model which illustrates the relationships between five key constructs in the qualitative fussy eating literature: fussy eating, parent feeding practices, parent feeding beliefs, emotional climate, and parent awareness of food preference development. Thematic analysis of parent interviews (Study 2A) generated three themes that explain how parents experience and manage fussy eating behaviours (Dynamic and Evolving Feeding Goals, Managing Negative Emotions and Parenting Practices: Figuring out what Works) and three distinct response patterns in relation to how parent responses change over time (Resistance-to-Acceptance Response, Fluctuating Response and Consistent Response). In Study 2B, thematic analysis of parent interviews generated four themes explaining parent feeding beliefs and how they relate to feeding practices: 1) Beliefs about the Development of Fussy Eating and the Perceived Role of Parents, 2) Perceived Relational-Efficacy Beliefs: Parents’ Confidence that they can Positively Influence their Child’s Fussy Eating Behaviours, 3) A Hopeful or Worrying Future, and 4) Beliefs put into Practice. Finally, thematic analysis of child interviews (Study 3) produced three themes in relation to children’s perceptions of fussy eating behaviours and their experiences of family processes in the context of fussy eating: 1) Typical Individual Differences or Bad Behaviour? 2) Different Motivations, Goals and Mealtime Emotions and 3) Dealing with Dislikes. Conclusions: Family perceptions, experiences and management of fussy eating behaviours are complex, dynamic and contextual. Parents and children are both active agents with their own conceptualisations of fussy eating, constructed beliefs, mealtime motivations, emotions and strategies. Contradicting goals of parents and children can create conflict in relation to fussy eating. Future research and intervention for fussy eating should consider both the parent’s and child’s point of view, should take the broader context into account, and should target family goals, beliefs and emotions alongside feeding practices.
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