Qualitative Analysis of Factors Influencing

Healthy Eating and Dental Practices Among

Caregivers of Young Children

Project Practicum
Courtney LeDuc
Acknowledgements
Major Advisor: Valerie Duffy

Research Committee: Tina Dugdale, Ellen Shanley

Research Mentors: Kate Killion & Amy Corcoran

Dental/Nutrition Project Team: Kate Killion, Amy Corcoran, Daniela Avelino, Valerie Duffy, Sam
Conroy, Grace Xiong, Isabella Rubio, Swetha Kalapatapu, and more…

Funding: Academy of Nutrition and Dietetics Foundation (Killion) & SNAP-Ed (Duffy)
Problem
● Childhood Obesity and Dental Health Prevalence
○ 18.7% of U.S. children aged 2-19 are affected by obesity (CDC, 2022)
○ 40% of children suffer from dental caries (ADA, 2023)
● Importance of Early Intervention
○ Establishing healthy eating and dental care habits in early childhood
○ Prevent long-term health issues
● Need for Tailored Approaches
○ Diverse factors influencing children’s health behaviors, need for personalized interventions
● Study Rationale
○ Effective interventions targeting diet and dental health behaviors are needed to lessen
health risks among at-risk young children
○ Less understood are current and relevant influences to healthy eating and oral health in
young children
Aim #1
Perform a qualitative analysis of motivational interviews
with caregivers engaged in a behavior change research study
to identify the key factors influencing the healthy eating and
dental health practices of their young children.
Methods
 Nutrition and Dental Project

Data Collection: In-depth motivational interview/goal setting sessions with caregivers

Participants: Caregivers of children aged 2-6 years old, living in Connecticut

Qualitative Analysis Procedures
Data Collection → MI sessions

Transcription

Thematic Analysis → Development of Codebook → Themes

Validation and Reliability

Phases of Thematic Analysis
Braun & Clarke, 2008

1. Familiarizing yourself with your data

2. Generating initial codes

3. Searching for themes

4. Reviewing themes

5. Defining and naming themes

6. Producing the report

Codebook Disrupters of Healthy Nutrition Behaviors

Interpersonal Modeling
Supporters of Healthy Nutrition Behaviors

Negative Exposure to Healthy Eating/Feeding Behaviors

Interpersonal Modeling

Intrinsic Child Characteristics

Positive Exposure to Healthy Eating/Feeding Behaviors
Lack of Resources
Intrinsic Child Characteristics

Disrupters of Healthy Dental Behaviors

Caregiver Concern for Child Health

Interpersonal Modeling
Resources

Negative Exposure to Healthy Eating/Feeding Behaviors

Supporters of Healthy Dental Behaviors

Intrinsic Child Characteristics

Interpersonal Modeling
Lack of Resources
Positive Exposure to Healthy Dental Behaviors
Routine/Habit
Intrinsic Child Characteristics

Caregiver Concern for Child Health Caregiver Motivation

Resources Change Talk

Routine/Habit Sustain Talk

Results
 N = 25 %

Caregiver Gender

Demographics Female
Caregiver Age
18-29
21

5
84%

20%
30-39 18 72%
40-49 1 4%
Caregiver Race/Ethnicity
White, Non-Hispanic 9 36%
Hispanic/Latino 4 16%
Black/African American 6 24%
Asian 0 -
American Indian or Alaskan Native 6 24%
Other 1 4%
Child Gender
Female 13 52%
Child Age
2 1 4%
3 9 36%
4 10 40%
5 5 20%
6 0 -
Child Race/Ethnicity
White, Non-Hispanic 10 40%
Hispanic/Latino 4 16%
Black/African American 6 24%
Asian 1 4%
American Indian or Alaskan Native 5 20%
Other 1 4%
Child Insurance
Themes Identified
Nutrition:
1. Intrinsic child characteristics support or hinder healthy eating and feeding behaviors
2. Interpersonal modeling shapes children’s food preferences
3. Concern for child health drives caregivers motivation for behavior change
4. Caregivers engage in recommended and non-recommended practices to encourage
healthy eating and feeding behaviors
5. Caregivers face external factors that influence their children’s healthy eating and feeding
practices

Dental:
6. Intrinsic child characteristics support or hinder oral health behaviors
7. Interpersonal modeling shapes children’s engagement in dental care
8. Resources facilitate oral health practices
9. Concern for child health drives caregiver motivation for behavior change
10. Caregivers implement engaging practices to encourage oral health practices
11. Caregivers frame dental care as routine or habitual
 Child-Related
Nutrition:
“She is an adventurous eater, which I appreciate about
her. She wants to try anything that we have, which is
great.”
Intrinsic child characteristics support or hinder
healthy eating and feeding behaviors
“Very picky. He is very set in his ways, but he also if he
doesn't know something like a food if he hasn't seen it
hasn't tried it. He doesn't want it. He doesn't like it.”

Dental:
“They both love to brush and floss, and they love the
dentist.”
Intrinsic child characteristics support or hinder
oral health practices
“She doesn't want to brush her teeth because she doesn't
like the way that [toothpaste] tastes.”
 Nutrition: Caregiver Related
“I have a lot of obesity in my family, and I don't
Concern for child health drives
want my daughter to go down that path. So, we're
caregiver motivation for behavior
trying to make sure that she eats healthy, and she
change
has enough of everything.”

“We will never force her to eat if she's not hungry. I

Caregivers engage in recommended
don't believe in that.
and non-recommended practices to
encourage healthy eating and feeding
behaviors “Sometimes we have to bribe her, like, ‘Okay, you
eat this and then you can have some ice cream.’"

Caregivers face external factors that “Sometimes it's easier to hand them that pack of
influence their children’s healthy snacks or that pack of chips or whatever that they
eating and feeding practices want because it's just easier.”
 Dental: Caregiver Related
Concern for child health drives “It's really important to me because I felt I had a lot of
caregiver motivation for behavior cavities growing up. I’m trying to avoid that for her.”
change

“She likes to play dentist. She'll lay down and we'll brush
Caregivers implement engaging
her and floss her, then we'll give her a pretend goody bag
practices to encourage oral health
and she's like, ‘Yay, thank you dentist’ and on her way
practices
with her imaginary stickers. She's happy doing that.”

“They know it's a no wiggle room. Your teeth have to get

brushed.”
Caregivers frame dental care as
routine or habitual
“The whole family, we don't have the habit of brushing at
night, so maybe we should bring that habit back.”
 Child/Caregiver Related
Nutrition:
“She wants to try it if I’m eating it.”
Interpersonal modeling shapes children’s
food preferences “Sometimes when we are drinking cola or
soda, he asks us to give soda to him also.”

Dental:
“I brush, and, like, she's watching me brush so we
Interpersonal modeling shapes
brush up the same time and I show her ‘You got to
children’s engagement in dental care
go up here and down here’ and she mirrors it."

Resources facilitate oral health “At daycare, she's told that she cannot [suck on
practices her fingers]...so that has been successful.”
Discussion
Key Findings Recap
Child-Related Themes:
● Intrinsic Characteristics - Children’s natural preferences can impact eating and dental habits

Caregiver-Related Themes:
● Health Motivation: Caregiver’s concern drives proactive health behaviors
● Engagement in Practices: Variety of strategies used, challenged by external pressures

Child/Caregiver Related Themes:

● Interpersonal Modeling: Children mirror eating and dental hygiene habits observed in family
or peers
● Resource Availability: Access to educational and health resources facilitate better health
practices
Aim #2
Use insights from qualitative analysis to develop and pilot
test responsive feeding and dental health messages,
tailored according to influential factors identified.
Methods
Message Development
Interpersonal Modeling

● Parent Role Modeling

○ “Lead the way! Your little ones learn from watching you. Eat fruit and vegetables and your
kids will too.”
○ “Celebrate your role! You’re not just a caregiver; you’re a teacher and a role model. You’re
helping shape your child’s future habits.
○ “Show your kids the way to a healthy smile! When you make brushing and flossing a
positive routine, you’re teaching them essential habits for a lifetime of healthy teeth.”
Negative Exposure to Eating/Feeding and Dental Behaviors
● Irregular Dental Care Routines
○ Daily care, happy teeth! Make brushing and floss a regular part of your child’s day. Small efforts now lead to
healthy smiles later!
● Cooking Together
○ Cook together, eat together, talk together! Simple and safe activities like mashing fruits or veggies can still be
fun and educational. These easy kitchen moments teach lessons that stick with them for life.
● Family Meals
○ Help your kids become independent! Let them serve themselves at dinner. Show them to take a little bit first,
and they if they’re still hungry, they can get more. It’s an easy way to learn about responsibility and help
them listen to their own bodies (tummies?) are telling them.
● Avoiding Punishments
○ Encourage good dental habits without using treats as a reward. Keep routines positive by focusing on
teaching instead of pushing. Being supportive and positive helps build healthy habits that last a lifetime.
● Responsive Feeding
○ Practice patience, not pressure. Introduce your child to new foods, and then let them decide how much to
eat. When kids have the freedom to choose, they’re more likely to become independent eaters.

○ Children’s appetites vary daily – some days they eat a lot, other days a little. Focus on the big picture and
offer a variety of nutritious options every day. Let their changing appetites guide the way to a healthy eating
routine.
Intrinsic Child Characteristics

● Picky, fussy, distracted, sensory, and liking preferences

○ Learning to like new foods can take time, it’s okay if your child doesn’t like them
immediately. Introduce new foods several times and celebrate small wins, like taking a
tiny bite, smelling, or playing with the food. It’s like planting a seed – sometimes it needs
time and care to grow.

Lack of Resources
● Time Constraints
○ Busy schedule? Quick dinners can still be nutritious! Experiment with speedy recipes
featuring your child’s ‘known favorites’. Adding something familiar to the plate can make
trying new foods a more comfortable and enjoyable experience.

○ Save time, enjoy variety! Introduce new foods gradually. It’s about building a taste for
many different options over time.

○ Keep those teeth happy with daily care. Make brushing and flossing a regular part of your
child’s day. Little steps now can save a lot of time (and money) at the dentist later!
Message Testing
Recruitment
2/8 - East Hartford Family Resource Center
Playgroup (N=4)
2/10 - Manchester Early Childhood Fair (N=9)
2/14 - East Hartford Public Library (N=0)
Results
Respondents Preference for Messages Related to
Responsive Feeding and Dental Health (N=11)
 Message
Feedback Liked or Found
Interesting
Disliked or Didn’t
Understand
Comments

Celebrate your role! You’re not just a caregiver; you’re a "Help shape your child's future
teacher and a role model. Help shape your child’s – habits by modeling healthy Very encouraging.
future habits by modeling healthy eating. eating."

Encourage good dental habits without using treats as a

reward. Focus on teaching instead of pushing. Being "...without using treats as a
supportive and positive helps your child build lifelong
– reward."
Felt judgy.
healthy habits.

Keep those teeth happy with daily care. Make brushing

and flossing a regular part of your child’s day. Little Felt like a list of
steps now can save a lot of time (and money) at the
– –
things to do.
dentist later!
 Disliked or Didn’t
Liked or Found Interesting Comments
Understand

"Practice patience, not

Practice patience, not pressure. New foods take time.
pressure." "Practice patience, not
When kids have the freedom to choose, they’re more Felt judgy.
“Children's appetites change pressure."
likely to become independent eaters.
daily"

Children’s appetites change daily – some days they

"Focus on the big picture
eat a lot, other days a little. Focus on the big picture A different nutritionist
and offer a variety of
and offer a variety of nutritious options every day. Let – said this too and it was
nutritious options every
their changing appetites guide the way to a healthy helpful.
eating routine.
day."

Learning to like new foods takes time, it’s okay if your

child doesn’t like them immediately. Introduce new
foods several times and celebrate small wins, like
– – Felt positive.
taking a tiny bite, smelling, or playing with the food.
It’s like planting a seed – sometimes it needs time and
care to grow.
Discussion
Summary of Feedback
Objective:
Gather insights from caregivers on the effectiveness and appeal of health messages
designed to promote children’s habits.
● Participants: Engaged with 11 participants to evaluate messaging
● Process: Ranked 6 health messages from most to least convincing and provided
annotations (circling likes, crossing out dislikes)

Understanding parental perspectives helps refine our approach to tailoring

messages that resonate and motivate positive changes in children’s health
behaviors.
Detailed Analysis of Each Message
Message #1 - Celebration of Role
○ Highly ranked: Empowering
parental role
○ Resistance to specific phrases
Message #2 - Encouraging Good
Dental Habits
○ Mixed Reception: Not using
treats perceived as judgmental
Message #3 - Daily Dental Care
○ Least convincing: Viewed as a
checklist rather than engaging
advice
○ Lacks emotional connection
Message #4 - Patience Over Pressure
○ Generally positive
○ Some felt it was judgemental despite
positive ranking
Message #5 - Children’s Changing
Appetites
○ Positive reception: Acknowledged as
conforming, realistic advice
○ Some redundancy in nutrition advice
Message #6 - Learning to Like New
Foods
○ Highly positive: Encouraging tone,
clear, and effective
Key Insights
General Trends:
● Messages that empower and acknowledge the complexity of parenting are favored
● Positive reinforcement is more effective and preferred over messages that could
be perceived as criticism
● Messages that come across as too directive or judgemental are less effective

Common Themes:
● Positive Tone - Positive messages are more engaging and convincing
● Parental Role - Affirmations of caregiver’s role as a teacher enhances message
receptivity
● Realistic and Supportive - Caregivers appreciate messages that realistically reflect
daily parenting challenges and offer supportive guidance
Next Steps for Research
 Professional Development
Team Research 2022-2024 CT Academy of Nutrition
● Weekly meetings & Dietetics Spring
● Recruitment Meeting - 2024
● MI Sessions ● Poster Presenter
● Message Refinement
● Data Analysis
● Facebook Posts
References
Questions?