Doing Best for Children: An emerging grounded theory of parents’ policing strategies to regulate between-meal snacking

By Ruth Freeman, Ph.D.; Richard Ekins, Ph.D. & Michele Oliver,
M.Med.Sc
.

Abstract

Changes in children’s lifestyle from structured family meals to
unstructured between meal sugar snacking has been recognised
as a risk factor in childhood obesity. Parental insights into children’s
between meal snacking and their experiences of regulation are
important if an understanding of sugar snacking is to be gained in the
field of childhood obesity. The aim of this study was to use grounded
theory techniques to analyze the qualitative data obtained from
participants and to generate an emerging theory of snack regulation. A
series of focus groups with parents and their children were conducted.
Data were analysed using grounded theory techniques. The core
category that emerged from the data was ‘doing best’. Parents used
the behavioural strategy of policing as a consequence of doing best.
Parents had to balance time availability, disposable income, energy
levels, parental working patterns and family life with the child’s food
wishes and social needs. Balancing such contextual constraints
influenced the style of policing.

Introduction

The World Health Organization (WHO, 2002) has stated that added
and refined sugars should contribute to no more than 10 percent
of an individual’s total calorific intake. Recent research has shown
that the average teenager obtains 20 percent of their calories from
added sugars and consumes on average 50kg of sugar/person/year
(Sibbald 2003). The increased sugar consumption has been linked
to the steep rise in childhood obesity and particularly in children living
in deprivation and poverty (Strauss, 2002; Lobstein and Frelut, 2003;
Lobstein et al., 2003).

Childhood obesity is associated with increased health risks in
childhood, reduced self-esteem (Sarlio-Lahteenkorva et al., 2003,
Sahota et al 2001), and quality of life (Friedlander et al., 2003).
Childhood obesity acts as an independent risk factor for adult obesity
(Tingay et al., 2003) and is linked with adult cardiovascular disease,
adult onset diabetes, osteoarthritis and cerebral vascular accident
(Parsons et al., 1999) as well as low-income work and poverty (Tingay
et al., 2003). Childhood obesity, with its many health, social and
life-course consequences, is perceived as a harbinger of adult ills
(National Institute for Clinical Excellence [NICE], 2004).

Various suggestions have been proposed to explain the increasing
prevalence of childhood obesity. These include the food industry
flooding the marketplace with cheap high-sugar and high-fat foods
(Sibbald, 2003), the absence of readily available low-cost healthy
foods (Alderson and Ogden, 1999; Bunting and Freeman, 1999)
and shifts in structured family mealtimes to childhood between meal
snacking (Feunekes et al., 1999; Strauss, 2002). Reasons given by
families for changing from structured to unstructured eating patterns
are important in the childhood obesity story (Alderson and Ogden,
1999; Feunekes et al., 1999). Therefore, this research team embarked
upon an investigation to increase understanding of this unstructured
pattern of sugar intake in children.

Qualitative data was collected as part of a larger controlled trial (Oliver
et al., 2002), which evaluated the role of school-based snacking
policies upon the consumption of snack foods in 9 and 11-year-old
children. As it was important to discover if school-based policies
affected the children’s out-of-school snacking, parents and children
were approached to canvass their views and opinions on regulating
snacking between meals. The aim of this study was to use grounded
theory techniques to analyze the qualitative data obtained from
participants and to generate an emerging theory on snack regulation.

The Research Context

Participants in this study came from the Southern Health and Social
Services Board (SHSSB), located in Northern Ireland (NI). In this
area, the majority of schools tend to be in small towns or villages.
All SHSSB primary schools were classified by socio-economic status
(SES) in accordance with the NI Department of Education’s use of
free school meal entitlement (FSMs). This is an aggregate-level
measure of poverty, low-income and social deprivation. Currently,
25 percent of all NI primary school children are entitled to FSMs
(Department of Education, Northern Ireland [DENI], 2001) which
reflects the proportion of children living on or below the poverty line
(Northern Ireland Statistics and Research Agency [NISRA], 2003).
Schools were classified as middle SES schools if up to 15% of the
children were in receipt FSMs and classified as low SES schools if
40% or more children were provided with FSMs.

Participants

Sixteen primary schools were selected from 54 primary schools in
the SHSSB region. Eight schools were classified as middle SES
schools and 8 schools were classified as low SES schools. Three
hundred and sixty-four children attended the selected schools. A
twenty-five percent random sample of children (n=91) was selected
by researchers using computer generated random numbers. Ninetyone
invitations to participate, together with parental and child
information leaflets, written consents, were distributed by Year 5 and
Year 7 teachers. Ethical approval was obtained from the local ethical
research committee.

Sixty-four Caucasian children (forty 9-year-old children and twentyfour
11-year-old children) and their parents agreed to take part. Fiftyone
percent (n=33) of the children were girls. Twenty-eight children
attended low SES schools and 36 children attended middle SES
schools, which reflected the SES and ethnic profile of the SHSSB
region (NISRA, 2003; DENI, 2001).

The focus group discussions

Parents and children were interviewed separately using a focus group
format. Two sets of 8 focus group discussions took place with parents
and children over an eight-week period. As the interviews continued,
the researchers deliberately chose fathers in order to develop new
concepts and ideas that emerged from the data. For instance, fathers
acted more erratically than mothers, for example using the child’s
weight on one occasion to refuse money for sweets but on another
occasion giving the same child money for snacks.

The interviews took place in a variety of agreed settings. The children
and parents were asked to focus upon their attitudes towards a range
of issues associated with healthy eating. The children and parents
were invited to talk about any subject they wished to, to refuse to
pursue any topics they found disagreeable and to close the interview
at their request. Refreshments for the participants were provided. All
groups were audio-taped for transcription.

Qualitative data analysis

The qualitative data in this study were analysed using grounded
theory techniques. Grounded theory is a general method of data
analysis leading to conceptualization. The methodology entails (1)
the generation of substantive categories, (2) creating definitions of
and linkages between categories at different levels of abstraction
and (3) making constant comparisons between cases, instances and
categories in order to explore fully the complexities of a data corpus.
While grounded theory uses a systematically applied set of methods
to generate an inductive theory about a substantive or formal area, it
is also useful as a set of techniques to analyze data in a qualitative
study. The latter approach was applied to this study. The focus of
this qualitative exploration was how parents regulated their children’s
between meal snacking.

In any grounded theory study, whether the aim is to generate theory
or simply analyze data, the research purpose is to clarify the main
concern and find out how participants resolve that concern. The
resolution of the main concern forms the core category. The core
category accounts for most of the variations in a pattern of behaviour
(Glaser, 1992).

The procedures and techniques of grounded theory followed in
this study were that of open and selective coding. As mentioned
previously, the data analysis was conducted as part of a controlled
trial and this constrained the researchers’ ability to conduct theoretical
sampling. The controlled trial allowed for a longitudinal and in-depth
quantitative analysis of child reported and actual snacking behaviours
in the school environment (Oliver et al., 2002). It did not provide an
insight into what happened at home. It was decided to collect parents’
views and opinions on the regulation of their children’s between
meal snacking. The rigor of the ethical committee together with the
constraints of time meant that it was impossible to conduct theoretical
sampling. Nevertheless, this study describes an emerging grounded
theory as a core category gradually appeared during the analysis of
the data.

The Research Findings

Doing Best – The Core Category

The core category that emerged from the data was ‘doing best’. The
desire to do best was consistent across all parents irrespective of
socio-economic status or household budget; however, for some
parents doing best was hard to achieve. Constraints such as time
availability, energy levels and parental working patterns all influenced
the parents’ resolve to enforce the family’s regimes that ensured their
children were getting the best.

This was apparent when mothers and fathers tried to do their best
to provide a healthy diet for their children. Parents did not wish their
children to snack between meals and in some families sugar snacks
were only eaten at week-ends. In other families, children were allowed
the snack of their choice if they ‘ask permission first’, ‘ate good food
first’ and ‘only if they shared [with others]’. Other parents provided
a limited supply of snacks for all the family. The children could help
themselves, however, once the snacks were eaten no more would be
provided. A final group of parents provided a constant supply of sugar
snacks and allowed children to snack at anytime as they believed this
was ‘doing the best for [their] child’.

The concern with doing their best for their children was also affected
by parental ability to be consistent. The degree of consistency with
which parents enforced their family snacking regimes varied between
parents, families and households. Fears about greediness or a child’s
lack of food intake, for example, gave rise to compromises. Children
who nagged, children who were sick or who had poor appetites were
allowed to consume large amounts of snack foods. It seemed that
the consistency of the enforcement of the family snacking regime was
dependent upon a power tussle between the parents’ resolve to do best
for their children and the child’s persistence to get snacks. Because
variation in parental determination to enforce family snacking regimes
existed, it became possible to conceptualize the strategy employed to
do best as policing. Two policing styles emerged – these were hard
policing and soft policing.

Hard policing

Hard policing was a consequence of doing best. Hard policing was
a dictatorial and strict mode of enforcement. Mothers spoke of being
resolute and consistent in their control of the family food regimes.

The cultivation of healthy (good) eating habits was of central
importance to parents. Being initiated into the compulsory elements of
the families’ between meal sugar snacking policies meant that young
children were acquainted with the household’s food directives:

If you don’t eat your food, like, you just eat a little bit of your
dinner and go out and then come back in looking for sweets or
biscuits – you won’t get any. If I don’t eat all my dinner I don’t
get any chocolate bars. Mummy says, ‘If you don’t have room
for good food you don’t have room for rubbish’. (Child 32)

I wouldn’t ask – she [mother] just gives me what I am allowed
– just on Friday – that’s only when I’m allowed sweets,
biscuits and cola. (Child 9)

The consistency and rigor of the deployment of the household food
rules suggested that doing best and providing healthy foods had
acquired a moral flavor. Mothers and fathers had the conviction
that it was their moral responsibility to ensure that their children
developed ‘correct’ and ‘healthy’ dietary habits. Eating sugar at the
permitted times was ‘good’, however, eating sugar snacks at any other
time was ‘bad’. The requirement for parents to instill ‘good’ dietary
choices appeared to be linked to morality and to perceptions of good
parenting:

Parents should know they shouldn’t give children sweets – it’s
bad for them. Like when you go to the movies and you see
them coming in with bags and bags of sweets and you know
what, the parents are wrong for doing it. (Mother 3)

The power inequity, which existed between parents and children,
within the hard policing style, suggested that parents held the power.
Any changes or shifts in power from parent to child resulted in parental
actions to readdress the power balance. In some situations, parents
were unable to hold onto their power and saw their authority slip away
as children continually nagged for sweets and grandparents accused
mothers of depriving their children. With ever-greater numbers of
children in the family, the parents’ attempts of ‘keeping an eye’ on the
children’s activities became increasingly difficult. Mothers complained
of ‘a lack of energy’ and a ‘reduced resolve’ to keep their children ‘on
the straight and narrow’. These observations allowed two styles of
hard policing to emerge – consistent hard policing and inconsistent
hard policing.

Consistent hard policing

Consistent hard policing was characterised by parents who
consistently and resolutely enforced the household food regimes.
Parents appeared all powerful with the ability to reward for compliance
and punish their children for defiance:

After tea, as long as Jane’s made a good attempt at eating her
food then – only then can she have a biscuit or what ever she
wants. (Mother 10)

I sneaked the chocolate bars Mummy had for the visitors for
me and my friends. There was none left and when Mummy
found out she slapped me, so she did, she slapped me hard
and I didn’t get sweets or biscuits for ages. (Child 21)

Despite the parents’ belief that they relaxed the household food rules
and became more flexible as children approached adolescence, this
was not supported by the data. Many older children admitted to
openly flaunting their parents’ wishes and to practising a deception
upon their parents:

Sometimes I get carried away [laugh], like the odd time when
Mum works night duties – so when I come in from school,
she’s in bed. I just help myself to her chocolate biscuits and
she never knows. (Child 35)

On discovering their children’s disobedience and deceptions, the
parents’ rage was palpable:

I was so cross, so ashamed not to mention embarrassed. I
took him to the doctor. He threw his blazer at me and all
these chocolate and sweet papers fell out of his pockets. He
knows he’s not allowed to eat sweets during the week, only
at weekends. Then I discover he’s eating them behind my
back. (Mother 2)

She’s just disgusting. She knows I don’t allow sweets during
the week and never in their bedrooms! Then what do I find
– under her bed – empty chocolate and sweet wrappers – and
it gets worse – a tin of drinking chocolate – half empty – with
a teaspoon in it. I could have swung for her. I was so cross
what with the mess not to mention that she had lied to her
father and me. (Mother 15)

The children’s resolve to circumvent and to break the rules suggested
that sugar had become immoral and had acquired the status of the
forbidden – something pleasurable to be done behind parents’ backs.

Physiological pleasures and sugar highs

Evidence from the physiological literature demonstrates that high
levels of sugar-induced opioids exist after eating sugars – in other
words, sugar can induce a euphoric state – a ‘sugar high’ (Grigson,
2002; Kelley et al., 2002). In this guise, sugar snacking could be
conceptualized in terms of illicit dependency, an obsessive desire for
a ‘sugar high’ and the children’s deceptive behaviour as a means of
satisfying their ‘junkie-sugar’ cravings.

In this climate of deception and enforcement, sugar became the
first battleground from which other more serious disagreements
developed:

My sister’s older boy and his sister wanted to come to
the garage with me and I was really pleased to have their
company. They bought sweets! I knew their mother would be
furious – the daughter swore me to secrecy – it was all quite
unpleasant. I thought this isn’t a battle worth waging and then
what did I hear that the older boy – he’s about 16 had been
out with his mates – he’d got drunk and was too frightened
to go home – the mother disapproves of alcohol too. The
children just deceive her all the time – she hasn’t attempted to
give them any means of managing – it’s like living in a police
state she dictates and the children deceive her. (Mother 4)

Inconsistent hard policing

Under a continual verbal onslaught by children, mothers and fathers
often gave in and practiced an erratic or inconsistent form of hard
policing. Despite parents threatening either punishment or ‘never
to bring those damn biscuits into the house again’, when children
continued to ‘torture’, ‘moan and groan for long enough’, their mothers
gave in. Mothers stated that they wanted ‘an easy life’, ‘to keep things
calm’, ‘to keep them occupied’ and ‘just to pacify them’ as reasons for
capitulation to the children’s demands:

If I want money for the shop to get sweets I just keep going on
and on about getting money and my Mum gets real cross. First
she says, ‘No’. If I nag enough then she just grabs her purse,
hands me out the money and says, ‘Do what you want with it!’
– that’s ‘cause she’s in a bad mood cause I have nagged and
won’t leave until I get money for sweets. (Child 20)

Friends, fathers, grandparents and family visitors were lured into
the children’s schemes to obtain sugar snacks. All these individuals
were used as conspirators in a form of blackmail to break maternal
resolve:

I’ve bought ‘Sunny Delight’ so they could try it. It didn’t mean
to say they were going to like it – but when they nagged and
said their friends all had it and they’re the only ones who didn’t
– then I worried they felt different– I mean, like they were
losing out – so I bought it. Yeah, it was – what do they call it?
– Ah, yes a peer pressure thing. (Mother 22)

Similarly, parents recognised that visiting family provided children
with an opportunity to extort sugar snacks and family visitors were
greeted with delight. The reason being that children recognised that
snacks would not only be on offer but, with visitors present, requests
for snacks would not be refused:

Suppose I’d have to admit I’ve been guilty myself, ‘cause I
know my sisters don’t buy sweets [laugh] for their children
either – so when it comes to visiting them I would usually bring
something, a ‘treat’ [laugh] you know those fun packs, those
bars, I mean I would treat them, I would do that but not for my
own children. (Mother 42)

As soon as I hear Auntie Jane in the house – I run to the
kitchen ‘cause I know she’ll have brought sweets for Mum and
her to eat. Even if she hasn’t Mum will get the biscuits out and
Mum says, ‘Just take one and get out’ -then I take one and
sneak two biscuits or even [laugh] more! (Child 14)

Hard policing: doing best for children?

Hard policing is a consequence of parents doing best for their
children. But are hard policing strategies best for children? Hard
policing styles initiate children into a family’s food regimes and reenforce
the household rules regarding between meal sugar snacking.
The difficulty, however, for parents relying upon hard policing styles
is that, while younger children readily comply with parental rules, as
they become older and enter adolescence they reject parental values.
Parents are forced to adopt an inconsistent style of hard policing and
because of the dictatorial nature of earlier consistent hard policing
strategies children are left with no repertoire to control their sugar
cravings. Recent research, by Hill (2003) provides support for this
proposition. He questions the appropriateness of using restrictive
dietary practices with children and is of the opinion that parents who
rigidly and dictatorially control their children’s food consumption bring
up children who are unable to develop their own internal or ‘selfregulatory
dietary abilities’. Hill (2003) has called for the need to
re-consider parental influences upon children’s food choices, to help
parents develop appropriate dietary skills and to provide children with
the internal means of managing their dietary cravings.

Soft policing

Soft policing was characterised by what seems an apparent lack of
parent-power as parents yielded to their children’s demands and
wishes. The provision of sugary snacks, demanded by children,
ensured that children ate ‘at least something’, had the same foods as
their peers and parents had a ‘quiet life’. Parents, therefore, appeared
subservient to their children; however, this camouflaged the parental
wish to do best for their children.

Central to soft policing and paramount in the parents’ strategies,
therefore, was the need to do best for their children. Balancing such
contextual constraints as family life and disposable income with the
child’s food cravings and social needs influenced the style of policing.
Consequently, lower socio-economic group families appeared less
restrictive when regulating their children’s between meal sugar
snacking. Rarely, but on occasion, parents would be inconsistent
and would not permit their children to eat snacks whenever they liked.
This suggested that two styles of soft policing existed – consistent soft
policing and inconsistent soft policing.

Consistent soft policing

Consistent soft policing was characterised by children snacking
between meals and choosing what, when and where to eat:

Well everybody’s different really; maybe other parents would
say that they give them sweets to pacify them or to keep them
happy. Well I’m inclined to buy her a packet of biscuits or
sweets because she likes them. I try my best for her and the
best thing is for her to have what she likes to eat’. (Mother
39)

If there’s a packet of chocolate biscuits sitting in our house
and I said, ‘Don’t eat them!’ they would eat them anyway. I
would always buy them sweets whenever I go to the shop,
I don’t think it does them any harm and they like them so
much. (Mother 56)

This apparent abnegation of control by parents was perceived as a
‘coping mechanism’ to ensure that parents had a ‘quiet life’ and that
their children ate at least something:

My Jim, just won’t eat meals, full stop. I set him down to
different meals and he picks at them, he won’t eat them at
all. He eats packets of crisps or sweets and he is skinny,
he is desperate I can’t get him to eat anything good. I will
give him something sweet because my attitude is as long as
he’s getting something. I have to make sure he is getting
something you know. (Mother 19)

At first sight, it seemed that the children had considerable power over
their parents. This suggestion, however, ignored the fact that parents
recognized the power of sugar and used it to do the best for their
children. Sugary snacks were used as a protection from being bullied
or ridiculed at school. The inclusion of a chocolate bar, in a lunch-box,
for instance, ensured that children were the same as everyone else
and included in their peer group:

I mean you’re not going to send them to school with a lunchbox
that’s different from everybody else. (Mother 62)

I heard of a couple of cases of kids like who weren’t allowed to
have chocolate biscuits or anything like that well – they’re sort
of laughed at and teased by other children. (Mother 59)

Parents believed that their children needed calories and the source
of the calories was unimportant – ‘whatever foods – doesn’t matter
as long as its calories’ and ‘my attitude is it doesn’t matter what the
calories are as long as he’s eating something’. Wasted foods not only
resulted in lower calorific intakes but also money being effectively
lost from the household budget – money [food] literally being ‘thrown
to the dogs’. In these situations, parents feared that a reduction in
disposable income would result in their children having less than the
best. Therefore, when children demanded particular foods these were
provided irrespective of their costs or nutritional value. In the following
examples, mothers consistently provided foods that they knew their
children would eat and are illustrative of consistent soft policing:

My daughter will say, ‘Oh I would love Chinese [food]’, so then
they all want a Chinese [meal] and I say, ‘That’s a good idea’,
you know, maybe not thinking. Yes, its expensive but it’ll be
eaten when it’s bought – not be wasted like all the other food
that’s thrown out and that’s money down the drain.
(Mother 19)

When I get home from my shift say at half five or six o’clock
I’m exhausted. I get out the chip pan and put on the chips and
I think that’ll do them – it’s gets the children filled. (Mother
28)

Inconsistent soft policing

Inconsistent soft policing was a rare occurrence. It was most notable
in fathers’ interactions with their children and was observed when
fathers feared their children were becoming obese. Fathers often
gave their children money for sweets:

My Daddy gives money to me – my Daddy’s awful soft – the
shops only across the road for sweets. (Child 55)

Daddy would give me money, so he would, to go up to the
shop to get sweets and then when I come back down Daddy
says, ‘Where’s my share?’. (Child 57)

The behaviour of fathers changed when they noticed their children
had gained weight. Fathers refused to provide money for sweets and
discouraged their children to eat biscuits:

My Daddy just says I’m not allowed them. He says, ‘You’re
getting too much weight on and you have to lose some of it’.
(Child 61)

Children complained of their fathers’ inconsistencies – sometimes
they were told they were ‘too fat and given sweets’ and at other times
they were ‘too fat for sweets’:

Last week my daddy called me fat, like I know I am and that’s
annoying but what I find really annoying is when I ask him for
money for something to eat he calls me fat. (Child 59)

Mothers also acted inconsistently when they noted their children were
heavier. The inconsistent nature of their dietary interventions was
such that it often resulted in the children eating more of everything:

My wee fellow would be a bit overweight. I have stopped
buying all that sweet stuff. It’s a banana – he gets if he’s
hungry. I say, ‘Have your banana’ but then he eats crisps,
then he has a drink, then a wheaten bread sandwich, then he
has to have something on top of them and he’ll still eat a big
dinner. (Mother 60)

Soft policing: balancing constraints to do best

Soft policing was a balancing act that parents performed to do best for
their children. Parents juggled such contextual constraints as family
life, disposable income, children’s social needs and food wishes to do
best for them. Parents, nevertheless, recognised the power of sugar
and, within the guise of soft policing, used it to do the best for family
life. The need for a ‘quiet life’ was essential when mothers worked
night shifts. In other family situations, ‘sugar as pacifier’, was used
when parents wanted their children to be quiet:

Say with wee ones – now you know what if you were taking
them somewhere – now say if I was bringing my wee one here
today – well I’d have been inclined to buy her a packet of
biscuits or sweets to keep her occupied, to keep her quiet. So
you’d like mm you try your best to buy the best thing for the
children – sure the best thing – to keep them quiet. (Mother
19)

For the most part, but not entirely, parents who practiced soft policing
were living near or on the poverty line. For families balancing doing
best within the constraint of low-income there was an increased
tendency for lower quality diets (Blackburn, 1999). As the cheapest
source of calories came from foods with high fat and high sugar
content (Casey et al., 2001), children whose parents worried about
their children’s food intake or who had financial concerns, were more
likely to provide meals that were inadequate in fruit and vegetables
(Chinn et al., 2001) or to be characterised as ‘unhealthy’ (Sweeting
and West, 2005):

Mary will not eat so I say she might as well have sweets or
chips instead of a dinner with vegetables that will be thrown
out. (Mother 20)

The association between maternal employment, socio-economic
status and diet has been highlighted as central in children’s ‘unhealthy
snacking’ and ‘less health eating’ (Sweeting and West, 2005). Despite
the strength of evidence supporting Sweeting and West’s (2005)
conclusions, their analysis excludes the difficulties encountered by
low socio-economic group parents when they attempt to find solutions
to their families’ problems. The findings presented here, buttress and
extend the work of Sweeting and West (2005). By conceptualizing
soft policing as a consequence of doing best, this work provides the
means to understand parental behaviours. Even in the face of potential
adversity, parents strive to provide the best lives for their children, not
only with regard to diet but also with respect to their children’s quality
of school and family life.

Discussion

The background to this study was a controlled trial to evaluate the
effectiveness of a school-based policy to regulate children’s between
meal snacking. Because of the nature of the experimental design,
it proved difficult to assess the effect of the policy on outside school
snacking. Consequently, a series of interviews was arranged and
conducted with participants to discover their views and opinions on
regulating their children’s sugar snacking. The aim of this study was
to use grounded theory techniques to analyze the qualitative data and
to generate an emerging theory on snack regulation.

An emerging grounded theory of snack regulation

The core category of ‘doing best’ was central to all parental activities
surrounding their children’s sugar snacking. Hence, a consequence
of parents ‘doing best’ was the policing of their children’s snacking
between meals. Two policing styles emerged – these were hard
and soft policing. In the home environment, parents had to balance
time availability, their energy levels, parental shift work, and family
life with the child’s food cravings and social needs. Balancing such
contextual constraints influenced the style of policing and, therefore,
some parents consistently or inconsistently practiced hard and/or soft
policing. Central to all policing was the parental wish to do best for
their children.

To generate a complete grounded theory, it would be necessary to
conduct theoretical sampling; however, due to time limitations and
ethical approval constraints, it was impossible to do this in the present
programme of research. To create a substantive theory, it would be
necessary to theoretically sample parents of children and adolescents
in different situations where parents are doing best. Some parents
in the current study provided glimpses and hints of how adolescence
restricted and shifted their policing styles when doing the best for their
adolescent sons and daughters. As children entered adolescence,
parental policing styles gradually acquired a softer dimension with
shifts from consistently harder to inconsistently softer policing styles.
It may be postulated that parents with adolescent children would
increase their dragnet. Parents would not only police snacking but
also their children’s home-work, out of school activities, friends and
peers, sexual encounters as well as their consumption of alcohol,
tobacco and drugs. In an atmosphere of the adolescent revolt,
parents would be unable to maintain consistent hard policing styles
and parents, in an attempt to do best, would shift from hard to soft
policing with the tendency to adopt inconsistent policing styles.

Limitations

Difficulties abound in health promotion research and evaluation (Watt
et al 2001). The first diffi ulty is that the health promoter perceives a
health problem and imposes their solution upon a target population.
The second difficulty is that the health problem belongs to the health
promoter and not to the individuals. It is this mismatch in perception of
health need, which, we suggest is at the centre of difficulties in health
promotion. In contrast grounded theory supports the emergence of
problems that are identified by people (Glaser 1998). As individuals
start to interact they make sense of their own environment, their
specific difficulties and concerns. Doing so allows them to identify
what is going on in their lives and the social processes they use to
solve their concerns, difficulties and/or problems.

Therefore, at the outset of this programme of research there were
limitations. The researchers had not allowed the problem to emerge –
the health problem of childhood obesity and its solution (the regulation
of between meal snacking) had been imposed upon the parents by
the researchers. When the parents’ concern emerged as doing best
for their children, it allowed the researchers to understand the place
of between meal snacking in the family lives of the participants. What
was primary for parents was to do their best for their children and the
need to regulate (police) was secondary. Another limitation of the
study was the lack of theoretical sampling which restricted the aims
of the study with regard to theory generation. It would not be true to
state, however, that this study represents a qualitative exploration of
parental views rather it represents an emerging theory since the core
category ‘doing best’ emerged from the data.

Conclusions: grounded theory in health promotion

Since the Ottawa Charter (WHO, 1986), health promotion has become
conscious of the need to work in partnership with communities to
strengthen community actions for health. Partnerships to strengthen
community action have been defined within the construct of community
capacity, being defined by Labonte and Laverack (2001) as the
“increase in community groups’ abilities to define, assess, analyze and
act on health (or any other) concerns of importance to its members”
(p.114). Community capacity is, therefore, not an inherent property of
a locality nor of the groups of individuals within it. Community capacity
is about the social interacting that binds people together (Laverack,
2004). With greater social interacting and increasing capacity, the
community becomes empowered to identify its own health problems
and solutions to them (Laverack 2004). To have effective partnership
working the health promoter must ‘tune in’ (Freire, 1970) and gain an
insight into the community’s concerns and worries. The importance
of grounded theory techniques for partnership working, community
capacity and health promotion, therefore, cannot be overstated.

Despite the limitations of this present study, the use of grounded
theory techniques to analyze the qualitative data provided the
researchers with an insight into the family lives of parents and
children. The awareness that parents wanted to do their best for their
children allowed the researchers to re-assess their current methods of
health promotion with children and parents and to adopt partnership
working with children and parents. The health promoter who uses
grounded theory techniques will gain an insight into people’s concerns
and the behaviours they use to solve those concerns. The adoption
of a grounded theory approach is essential if health promotion is to be
informed, assisted and empowered to strengthen community actions
for health.

Acknowledgements

This research project was funded by the NHS R&D Programme
Primary Dental Care; grant number RDO/90/07. The views and
opinions expressed in this paper do not necessarily reflect those of
the DoH.UK.

We would like to thank Grace Bunting for her assistance with data
collection and transcription of the data.

Authors

Ruth Freeman Ph.D.
Dental Public Health and Behavioural Sciences
Queen’s University Belfast

Richard Ekins Ph.D.
School of Media and Performing Arts, University of Ulster

Michele Oliver M.Med.Sc.
Community Dental Service, Armagh and Dungannon HSS Trust

Address for correspondence

Ruth Freeman
Dental Public Health and Behavioural Sciences
School of Medicine and Dentistry
Queen’s University Belfast,
RGH, Belfast BT12 6BP
Tel+44 (0) 28 9063 3827
Fax+44 (0) 28 9043 8861
Email: r.freeman@qub.ac.uk

References

Alderson, T. StT., & Ogden, J. (1999) What do mother feed their
children and why? Health Education Research; 14 (6): 717-
727.

Blackburn, C. (1999) Poverty and health: working with families.
Milton Keynes Open University Press.

Bunting, G., & Freeman, R. (1999) The influence of sociodemographic
factors upon children’s break-time snacks in
north and west Belfast. Health Education Journal; 58 (4):
401-409.

Casey, P.H., Szeto, K., Lensing, S., Bogle, M., & Weber, J. (2001)
Children in food-insufficient, low-income families. Archive of
Pediatric and Adolescent Medicine; 155 (4): 508-514.

Chinn S., & Rona R.J. (2001) Prevalence and trends in overweight
and obesity in three cross-sectional studies of British
children. British Medical Journal; 322 (7277): 24-26.

Department of Education, Northern Ireland. (2001) New Targeting
Social Need (NTSN). Analysis of existing information on
education, participation, achievement and outcomes for
disadvantaged individuals and groups. Belfast. DENI.

Feunekes, G.I.J., de Graff, C., Meyboom, S., & Staveren, W.A.
(1998) Food choice and fat intake in adolescents and adults:
associations of intakes within social networks. Preventive
Medicine; 27 (5):645-656.

Freire, P. (1970) Pedagogy of the oppressed. Continuum Publishing
Press. New York.

Friedlander, S.L., Larkin, E.K., Rosen, C.L., Palermo, T.M., &
Redline, S. (2003) Decreased quality of life associated
with obesity in school-aged children. Archives of Pediatric
Adolescent Medicine. 2003; (12) 157:1206-11.

Glaser, B.G. (1992) Emergence vs. Forcing: Basics of grounded
theory analysis. Mill Valley, CA. Sociological Press.

Glaser, B.G. (1998) Doing Grounded Theory: Issues and discussions.
Mill Valley, CA. Sociological Press.

Grigson, P.S. (2002) Like drugs for chocolate: separate rewards
modulated by common mechanisms? Physiological
Behaviour; 76 (3): 389-395.

Hill, A.J. (2003) Developmental Issues in Attitudes to Food and Diet.
Proceedings of the Nutrition Society; 62 (2): 259-266.

Kelley, A.E., Bakshi, V.P., Haber, S.N., Steininger, T.L., Will M.J., &
Zhang M. (2002) Opiod Modulation of Taste Hedonics within
the Ventral Striatum. Physiological Behaviour; 76 (3): 365-
377.

Labonte, R., & Laverack, G. (2001) Capacity building in health
promotion. Part 1: for whom and for what purpose? Critical
Public Health, 11(2): 111-127.

Laverack, G. (2004) Health promotion practice: power and
empowerment. London. SAGE.

Lobstein, T., & Frelut, M-L. (2003) Prevalence of overweight among
children in Europe. Obesity Reviews; 4 (4): 195-200.

Lobstein, T., Baur, L., & Uauy, R. IASO International Obesity Task
Force. (2004) Obesity in children and young people: A crisis
in public health. Obesity Review; 5 Suppl 1:4-104.

National Institute for Clinical Excellence. (2004) Obesity: the
prevention, identification, assessment and management of
overweight and obesity in adults and children. Final scope
June 2004. London. NHS. NICE.

Northern Ireland Statistics and Research Agency. (2003) Northern
Ireland Census Area Statistics. Belfast. NISRA.

Oliver, M., & Freeman, R. (2002) Boosting better breaks: an
evaluation of the effectiveness of a healthy break-time policy
in improving the dental health status of school children in
primary education. Armagh: Armagh and Dungannon HSST.

Parsons, T.J., Power, C., Logan, S., & Summerbell, C.D. Childhood
predictors of adult obesity: a systematic review. International
Journal of Obesity 1999; 23 (Suppl 8):S1-S107.

Sahota, P., Rudolf, M.C.J, Dixey, R., Hill, A.J, Barth, J., & Cade, J.
(2001) Randomised controlled trial of primary school based
intervention to reduce risk factors for obesity. British Medical
Journal: 323 (7354); 1-5.

Sarlio-Lahteenkorva, S., Parna, K., Palosuo, H., Zhuraveleva, I., &
Mussalo-Raihamaa, H. (2003) Weight satisfaction and selfesteem
among teenagers in Helsinki, Moscow and Tallin.
Eating & Weight Disorders; 8 (4): 289-295.

Sibbald, B. (2003) Sugar industry sour of WHO report. Canadian
Medical Association Journal. 168 (12): 1585.

Strauss, R. (2002) Perspectives on childhood obesity. Current
Gastroenterology Reports; 4 (3): 244-250.

Sweeting, H., & West, P. (2005) Dietary habits and children’s lives.
Journal Human Nutrition & Diet; 18: 93-97.

Tingay, M., Tan, C.J., Tan, N. C-W., Tang, S., Teoh, P.F., Wong, R., &
Gulliford, M.C. (2003) Food insecurity and low income in an
English inner city. Journal of Public Health Medicine; 25 (2):
156-159.

Watt, R.G., Fuller, S.S., Harnett, R., Treasure, E.T., & Stillman-
Lowe, C. (2001). Oral health promotion evaluation – time for
development. Community Dentistry and Oral Epidemiology
29, 161-166.

World Health Organization, Health and Welfare Canada, Canadian
Public health Association. (1986). Ottawa Charter for health
promotion. Copenhagen. WHO.

World Health Organization. (2002). Globalization, diets and
noncommunicable diseases. Geneva. WHO.

Facebooktwittergoogle_plusredditpinterestlinkedinmail