In this study of more than 250 parents participating in a MI-based childhood obesity intervention, parents were generally very satisfied and perceived MI-based visits as helpful. We did observe differences in parental perceptions according to sociodemographic characteristics. Parents born outside the United States, with lower household income and with higher BMI were more likely to perceive MI-based visits as more helpful in improving their pre-school children’s obesity-related behaviors. Furthermore, the MI-based approach used in High Five for Kids increased satisfaction with pediatric primary care among parents who were foreign born, obese, had an obese child, and had lower household income. However, black and Latino parents were less satisfied with the intervention after adjusting for socioeconomic factors.
Previous work has shown provider use of MI communication techniques during routine health care visits in adults to be associated with positive patient perceptions of their care.19,20
Our findings extend this research by demonstrating that parents of overweight and obese children have positive perceptions of and high satisfaction with a MI-based intervention. In a study of adolescent girls who participated in a multi-ethnic obesity prevention study that used MI communication techniques, self-reported rates of satisfaction were similar to those in our study, with 41% being satisfied and 54% very satisfied (compared with 41% of our parents being somewhat satisfied and 56% of parents being very satisfied).21
To our knowledge, our study is one of the first to describe perceptions of an obesity intervention consisting of MI among a diverse group of parents with young children.
We found that foreign-born parents were more likely than US-born parents to perceive greater helpfulness of MI-based visits and experience increased satisfaction with their child’s primary care as a result of intervention participation. The majority of foreign-born parents spoke English and had been living in the United States for an average of almost 19 years, likely representing an acculturated population. The reasons for our findings of generally positive intervention perceptions by immigrant parents are likely multifactorial. First, unmeasured cultural beliefs regarding medical care, such as respect and hierarchy,22
could have translated into greater perceived helpfulness and satisfaction. Second, immigrant Latina mothers have described social isolation and less social support in the United States compared with their countries of birth23
; thus, the human contact and supportive environment provided by nonjudgmental MI communication techniques may have contributed to foreign-born parents’ positive perceptions. Finally, the inclusion of intervention materials in both English and Spanish languages may have influenced immigrant parents’ acceptance of the intervention.
Parents of black and Latino children experienced less satisfaction with the intervention than parents of white children. Lower satisfaction with counseling in primary care settings has previously been described for parents of minority children.11
Although our intervention included bilingual materials and providers, the intervention population was heterogeneous, with a variety of countries and likely several native languages represented. Potential explanations for lower report of satisfaction by parents of black and Latino children include the existence of communication gaps, differences in communication between providers and patients of different racial/ethnic groups, or differences in communication preferences among racial/ethnic groups.24–27
Additionally, concordance of provider and patient race/ethnicity has been associated with patient perceptions of heath care provision; thus, discordance of sociodemographic factors may have played a role in lower participant satisfaction among racial/ethnic minorities.28,29
In our study, parent obesity, child obesity, and lower household income were associated with higher likelihood of the intervention increasing satisfaction with children’s primary care. Parent obesity has repeatedly been shown to be a strong predictor of childhood obesity risk.30,31
In contrast to the findings of our study, parental overweight has been associated with reports of low frequency and poor ratings of dietary and physical activity counseling provided by physicians during routine health care visits of overweight and obese children in a primary care setting.11
Correlations between parent behavior and child behavior change have been previously described.32,33
In the High Five for Kids study, child success in meeting behavior goals was directly related to maternal success in achieving goals.34
Thus, the positive perceptions of obese parents in our intervention may have resulted from improvement in their own, personal unhealthful behaviors. Lower household income has been related to increased obesity risk.35
As previously reported, children from families with an annual household income ≤$50 000 had a significant decrease in BMI at 1 year follow-up of our intervention, making success of the intervention in this subgroup a likely explanation for the increased satisfaction in lower-income households in our current study.11
Our findings that parent and child obesity and lower household income are related to increased satisfaction with children’s primary care after participation in High Five for Kids suggest that individual attention by providers trained in MI is well received by these groups that are at high risk for obesity.
Several limitations of our study should be considered. First, although sampled from 5 pediatric offices with racial/ethnically diverse patient populations, our participants on average had higher income and education levels than the general US population. This may limit the ability to generalize our findings. Second, social desirability may have contributed to inflated reporting of helpfulness and satisfaction. Finally, we have limited information available regarding family language use and immigration status because only 1 parent per child was interviewed. This prevents our ability to more comprehensively explore the role of acculturation in our outcomes. However, our study did include a diverse population with a considerable number of foreign-born black and Latino participants. Because the number of immigrants in the United States is growing36
and the highest risk for childhood obesity exists among black and second-generation Latino children,37
identifying how immigration and race/ethnicity affect suitability of counseling and communication techniques used in early childhood obesity interventions is imperative.
This study supports the important role of family sociodemographic characteristics in the acceptance of a MI-based intervention for pediatric obesity prevention. Parents born outside the United States, with lower household income, and with higher BMI perceived that MI-based visits in a primary care setting were helpful in improving their preschool children’s obesity-related behaviors. Our findings that parents of black and Latino children had lower satisfaction with this MI-based intervention suggest the need for alternative approaches to MI to effect behavior change among racial/ethnic minorities. Taken together, these results emphasize the need to consider immigration status, social contextual factors, and communication preferences when implementing and evaluating obesity interventions in young children.