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Table 3 Search details and key findings of reviews #4–6

From: Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth

 

Timeline

Databases Used

Search Terms

Number of reviewers

Number of articles included

Review #4 – Family systems approaches applied to understand 24-h movement behaviours among children and youth

Sept. –

Nov. 2019

Academic search premier, CINAHL Complete, Cochrane Central Register of Controlled Trials, Health Source: Nursing/Academic edition, Humanities and Social Sciences Index (H.W. Wilson), MEDLINE with Full text, PsychARTICLES, and PsycINFO

Family systems theory; family-based interventions; childhood obesity; 24-h movement behaviors; family behaviour change; child behaviour change; family and child physical activity, sedentary and sleep behaviours; Family Ecological Model; family characteristics; family relations; parent-child relations; father-child relations; mother-child relations; parenting; parenting styles; parental behaviour; parents; fathers; mothers; siblings; sibling relations; bother; sister; attitudes; perception; attitude to health; health behaviours.

2

20

 

Origin and development of family systems theory:

• Family systems theory is the primary theoretical approach to understanding and intervening upon family behaviour [206]. The approach has considerable overlap with Attachment Theory from developmental psychology [207] and highlights that the family is in a constant cycle of interactions with inherent evolution and change. Recurring challenges, reorganization, and changes are inevitable parts of the family life cycle that must be considered [62, 63]. Interventions should likely target the family unit rather than the child in isolation.

• Barnhill [208] advanced the Family Systems Theory by specifying eight dimensions: individuation vs. enmeshment, mutuality vs. isolation, flexibility vs. rigidity, stability vs. disorganization, clear vs. unclear/distorted perception, clear vs. unclear/distorted communication, role reciprocity vs. unclear roles of role conflict and clear vs. diffuse or breached generational boundaries. These eight dimensions of healthy family functioning can be grouped into four mutually causal constructs that include identity processes, change, information processing, and role structuring.

• Bronfenbrenner [209] aextended family systems to a larger environment and proposed three systems that impact child development: mesosystems, exosystems, and chronosystems. Mesosystems incorporate the developmental processes that occur outside of the family home, such as experiences at school. Exosystems include parents’ social networks, the workplace, and friend circles. The chronosystem describes life transitions. Bronfenbrenner highlights that these contexts do not operate independently of one another and instead interact with each other.

Family systems theory adapted for health behaviour changes:

• Davison and colleagues [210] presented the revised family systems ecological model, which incorporates factors that affect parenting cognitions and behaviours such as intra-familial (educational and cultural) backgrounds in addition to community factors (social connectedness to neighbours and friends). The model suggests that parenting for child health behaviour includes: i) knowledge and beliefs about health behaviour; ii) modelling of health behaviours; iii) shaping of child behaviour through rewards and punishments; and, iv) provisions for the child to engage in the health behaviour.

• Myoungock and Whittemore [211] proposed the family management style framework for childhood obesity interventions. It focuses on family functioning and parental perspectives associated with the management of children’s health behaviours.

• Kitzman-Ulrich and colleagues [212] proposed a Family Systems Theory framework for evaluating family-level variables and positive (authoritative) parenting styles that lead to improvements in youth health behaviours (physical activity, dietary and weight-loss behaviours).

• Nowicka and Flodmark [213] presented a family therapy model for treating childhood obesity known as Standardized Obesity Family Therapy (SOFT). The SOFT model integrates Family Systems Theory and elements used in focused solution development such as creating expectations for change, establishing goals for therapy and defining potential solutions.

• The Levels of Interacting Family Environmental Subsystems (LIFES) framework incorporates theoretical concepts from ecological systems and Family Systems Theory [214], highlighting that child health behaviours are influenced by both child factors and factors existing within the family (i.e., parents’ behaviours, parenting practices and family functioning).

Studies that have tested family systems approaches with interventions (n = 2):

• Both studies applied the SOFT model [213] to examine integrating Family Systems Theory and solution-focused theory (i.e., focusing on solutions, preferred future and goals as opposed to the problem and its cause) into family therapy sessions for adolescents and their families.

• This treatment model focused n engaging the whole family in the obesity treatment process with an emphasis on encouraging physical activity (60 min per day) and reducing sedentary screen-time (less than 2 h per day). Both interventions were effective in decreasing child body mass index in comparison to control conditions; unfortunately, no behavioural outcomes were assessed in these trials so the complete understanding of the effectiveness of the intervention is limited [215, 216].

 

Timeline

Databases Used

Search Terms

Number of reviewers

Number of articles included

Review #5 – Correlates of parental support of child and youth 24-h movement behavioursa

Sept. –

Nov. 2019

Academic search premier, CINAHL Complete, Cochrane Central Register of Controlled Trials, Health Source: Nursing/Academic edition, Humanities and Social Sciences Index (H.W. Wilson), MEDLINE with Full text, PsychARTICLES, PsycINFO, SPORTDiscuss, and ScienceDirect

Parent; caregiver; mother; father; parental support; parenting practices; parenting strategies; parenting behaviours; parental correlates; child; adolescent; physical activity; exercise; sport; physical exertion; aerobic; active transportation; active commute; park; outdoor; outdoor play; active lifestyle; active neighbourhood. Prospero# CRD42020154439

3

25 (22 unique datasets)

Key Findings

Composition of studies and characteristics

• Sixteen studies focused on physical activity support (76%), with two studies focused on sleep support [54, 217] and four on sedentary behaviour or screen-time restriction [14, 218,219,220]. The majority of the studies used a cross-sectional design, and the targets of the support focused on both children and youth; only 27% focused on a single age group (i.e., children or adolescents).

• Overall, parental support measurement was extremely varied, with most studies employing different instruments. However, the assessment of frequency of encouragement, logistical support, and co-participation activity were common elements across most of the measures and all measures reported generally sound indicators of reliability.

Correlates of parental support of child and youth physical activity

• Among potential demographic correlates of physical activity, only child age showed a reliable negative association (median r = −.13) [59, 218, 221,222,223,224,225,226,227,228], suggesting that older children and youth received less support than younger children and youth.

• All social-cognitive factors assessed (attitudes, perceived control) were significant correlates of parental support in the medium effect size range [229]. Intention and planning to support were correlated with support behaviours in the large effect size range [229].

• Parenting style, in the form of authoritative parenting, had mixed results as a correlate of support for child/youth physical activity [225, 230].

• Neighbourhood safety [225] was a correlate of parental support in the small effect size range (median r = .16) [229].

Correlates of parental restriction of child and youth sedentary behaviour

• Sedentary behaviour restriction studies included only two correlates. Child body mass index and parent gender had no association with sedentary behaviour measured as screen-time) restriction [219, 220].

Correlates of parental support of child and youth sleep

• Studies on parental support of child and youth sleep found child age had a negative relationship with sleep support [54, 219]. Planning was the only cognitive and behavioural construct present in current studies and it showed a medium sized association (r = 0.24–0.50) with sleep support [54, 217, 218].

 

Timeline

Databases Used

Search Terms

Number of reviewers

Number of articles included

Review #6 Family-based interventions on children and youth 24-h movement behaviours

Sept. –

Nov. 2019

Academic search premier, CINAHL Complete, Cochrane Central Register of Controlled Trials, Health Source: Nursing/Academic edition, Humanities and Social Sciences Index (H.W. Wilson), MEDLINE with Full text, PsychARTICLES, PsycINFO, SPORTDiscuss, and ScienceDirect

Family-based; family mediators; family interventions; family moderators; behavior change strategies; children; youth; sleep; bedtime; sports; exercise; physical activity; sedentary lifestyle; sedentary behaviour; inactivity; physical inactivity; sitting; laying; TV; TV viewing; video games; Internet; computer; screen; smartphone; iPad; apps; mobile applications; social media; Facebook; YouTube; Twitter; Snapchat; Instagram; Pinterest; screen viewing; screen-time.

3

10

Key Findings

Composition of studies and characteristics

• Eleven review articles met the inclusion criteria [49,50,51, 231,232,233,234,235,236,237,238]. Two-hundred and fifty studies (not independent) from the 11 review articles targeted child and adolescent physical activity behaviour. Four review articles incorporated 83 studies (not independent) that targeted screen-time and/or sedentary behaviours in addition to physical activity [49, 51, 234, 235]. Only one review that included 24 studies addressed child sleep behaviours [49], but this did not include the efficacy of these interventions.

• The majority of reviews included studies published between 1980 and 2015. All reviews targeted families with school-aged children (5–12 years old) and eight of these also included adolescents (12–18 years old). Overall, the reviews targeted diverse samples whereby four reviews included families of low socioeconomic status [49, 231, 234, 235], and six reviews targeted ethnic minority populations [49, 50, 231, 232, 235, 238]. Four reviews included randomized controlled or quasi-experimental trials only [49,50,51, 231] and the other reviews also incorporated non-controlled trials, pilot or feasibility studies, and prospective cohort studies [232,233,234,235, 237, 238].

Family-based physical activity intervention effectiveness

• Overall, nine reviews provided evidence of intervention effectiveness in physical activity [50, 51, 231,232,233,234,235,236, 238]. Two of these reviews provided a point estimate of intervention effectiveness using meta-analysis [50, 233]. There was considerable heterogeneity between the reviews (d = .29 with an average confidence interval between 0.17 and 0.42). This heterogeneity was further highlighted in the seven narrative reviews, where four concluded outcomes were inconclusive for family interventions [51, 231, 232, 238], one considered the evidence for behaviour change to be convincing [234], and the other two concluded that family interventions have been ineffective at changing child/youth physical activity [235, 237].

Moderators of physical activity effectiveness

• Whether certain demographic profiles have been more responsive to intervention is currently mixed. The exception to this finding appears to be low socioeconomic groups, who have been successfully targeted in such interventions with positive physical activity outcomes [231, 234]. There is mixed evidence on whether following a formal theoretical framework has improved outcomes. Similarly, behaviour change strategies based on family-level support sessions to promote physical activity, and coordinated parent-child physical activity behaviour, have yielded mixed effects across reviews [235, 237, 238]. By contrast, there is consistent evidence that mere information-based education on the benefits of physical activity administered to children and their parents is an ineffective strategy to produce changes in physical activity. The largest and most recent review [233] found that behavioural strategies (goal setting, reinforcement) have been successful in invoking positive changes in physical activity. The best setting in which to promote family-based physical activity was inconclusive, but one review [233] found very limited evidence that primary care settings were a useful context in which to intervene. Similarly, delivery modes for the intervention were appraised as both successful and with mixed findings across face-to-face, distance-based (e.g., telephone), and larger group-based settings.

Family-based screen-time intervention effectiveness

• Two of the reviews found the current evidence inconclusive [51, 235] and the third concluded that family-based interventions have been ineffective [236]. The current data set is too limited to address moderators of intervention effectiveness with any certainty. There is preliminary evidence that families of low socioeconomic status may be responsive to intervention [231], and that merely providing information on the harms of sedentary behaviour may be ineffective [231, 235]. There appears to be equally mixed findings on how best to deliver these interventions with heterogeneity across face-to-face, distance, and group interventions.

Family-based sleep intervention effectiveness

• No reviews overviewed the effectiveness of sleep interventions for children and youth.

  1. aFull details on the physical activity portion of this review can be found in Rhodes, R.E., Perdew, M. & Malli, S. (in press). Correlates of Parental Support of Child and Youth Physical Activity: A Systematic Review. International Journal of Behavioral Medicine