Search Results (742)

Background/Objectives: Qualitative child-centered research on pediatric obesity treatment and body image remains limited. This study aimed to explore children’s and adolescents’ experiences with hospital-based obesity treatment and how these experiences relate to body image. Methods: A full-day workshop including three main participatory tasks was conducted in two groups of children (9–13 years) and adolescents (14–18 years), focusing on their experiences with obesity treatment and body image. Data were audiotaped, transcribed verbatim, and analyzed using reflexive thematic analysis. Results: Four main themes emerged, reflecting different aspects of participants’ experiences. The first theme, Talk with me and not my parents, encompassed participants’ desire for greater agency, as children described lacking information and feeling excluded from consultations. The second theme, Experiences of communication with healthcare professionals (HCPs) about obesity, concerned participants’ perceptions of trust, support, and non-judgmental communication, with some adolescents expressing a need for additional psychological support. The third theme, Internalization of lifestyle advice, indicated that healthy diet was viewed as the primary focus of obesity treatment, while physical activity received less attention. The final theme, Perceptions of the body, conveyed mixed experiences with weighing and most participants perceived weight loss as success in treatment and weight gain as failure. The participants shared experiences of weight-based bullying, perceived stigma, and challenges with maintaining a positive body image in a society with stereotypical thin and muscular body ideals. Conclusions: Body image was influenced by HCPs’ emphasis on health and body size, and by their own internalized perceptions, influenced by societal ideals and experiences of stigma. Full article

In Hong Kong, the interaction between traditional values and modern influences creates a unique cultural landscape that influences family dynamics, intergenerational communication, and adolescent mental health. This study aimed to fill critical research gaps by exploring the relationship between authoritative and authoritarian parenting styles within this hybrid cultural context. Parenting style scores were based on the PSDQ-26 questionnaires completed by both parents of 2325 students. These students also provided demographic data used in the analysis (1013 girls, M_age = 13.35, SD = 1.22). The data analysis examined the correlations between parenting styles and variations across gender and age groups. Contrary to patterns observed in Western contexts, the results indicated no significant correlation between authoritative and authoritarian parenting styles (r = 0.02, p > 0.05), suggesting a complex coexistence influenced by Hong Kong’s hybrid sociocultural context. Notably, the study revealed gender-based differences: boys’ parents reported higher levels of democratic participation and reasoning, reflecting authoritative parenting, while also showing greater use of physical coercion and punitive discipline, indicative of authoritarian parenting. Authoritative parenting, but not authoritarian parenting, showed a decline as children matured. By investigating these dynamics, the study not only addresses a significant gap in the literature but also enhances the understanding of how cultural and developmental factors shape parenting practices. These insights are crucial for developing culturally adapted parenting education materials and informing interventions that support child development in diverse cultural settings. Full article

Caregiver self-regulation may be a critical component of caregivers’ effective delivery of caregiver-mediated interventions (CMIs). CMIs are a highly evidence-based group of interventions that target a broad range of challenges, including social communication, emotion regulation, and externalizing behaviors, for autistic and neurotypical children. CMIs teach caregivers to be “coaches” to help their children learn and practice skills in daily life. However, being a good “coach” likely requires caregivers to optimally self-regulate their emotions, thoughts, and behaviors when working with their children in moments that are often emotionally heightened. Caregiver self-regulation is a set of skills that promote parenting autonomy and confidence: self-sufficiency, self-efficacy, self-management, personal agency, and problem solving. This conceptual paper will briefly discuss the literature on the role of caregiver self-regulation in CMIs and argue that future implementation research on CMIs should measure caregiver self-regulation because, in line with recent expansion of the theory of planned behavior, caregiver self-regulation may predict more effective implementation of CMIs. We also argue, in line with CFIR 2.0, that supporting caregiver self-regulation could ultimately improve the implementation of CMIs with regard to each implementation outcome in the Implementation Outcomes Framework. For example, enhancing caregiver self-regulation may improve CMI appropriateness (by increasing alignment with each caregiver’s values and culture), adoption (by increasing engagement to finish the full CMI protocol), and even CMI sustainability (by increasing caregivers’ ability to problem-solve and generalize to new child challenges independently, freeing up provider time to work with new caregivers and allowing the agency to provide the CMI for a reduced relative cost). Should future research demonstrate that caregiver self-regulation is an implementation determinant, future implementation strategies may need to include support for caregiver self-regulation, because it may explain or enhance the implementation of CMIs across early intervention and community mental health systems. Full article

Background: Healthcare systems globally face complex challenges including rising costs, increasing chronic disease burden, and fragmentation of care. Systems-based models represent promising approaches to healthcare transformation, yet their implementation remains incompletely understood. Objective: To critically analyze the Saudi model of Care (MoC) as a case study of systems-based healthcare transformation, examining its conceptual framework, implementation strategies, and projected health outcomes. Methods: We conducted a narrative review synthesizing publicly available official documents on the Saudi MoC, primarily the 2017 overview and 2025 revision, identified through targeted searches of Ministry of Health websites and grey literature portals (no date restrictions); formal quality appraisal was not applied as sources were official policy documents, with bias mitigated through cross-verification and critical analysis. Results: The Saudi MoC exemplifies systems-based transformation through its multi-layered framework organized around six patient-centered systems of care spanning the lifecycle. Key innovations include: (1) an architectural approach integrating activated individuals, healthy communities, virtual care, and traditional clinical settings; (2) a comprehensive intervention taxonomy with 42 specific initiatives; (3) explicit contextual adaptations for diverse settings; and (4) a phased implementation approach with detailed performance metrics. National indicators improved during the reform period, including life expectancy and maternal and child health. These are national trends observed during the period of health reforms. Causal attribution to the Model of Care requires a counterfactual evaluation. Conclusions: This analysis of the Saudi MoC contributes to the literature on systems-based healthcare transformation by illuminating how theoretical principles can be operationalized at national scale. The model’s patient-centered design, comprehensive intervention taxonomy, and attention to implementation factors offer valuable insights for other healthcare systems pursuing transformation. Further research should examine actual implementation outcomes as the model matures. Full article

This study examined social and physical environmental exposures, health, and healthcare utilization among children aged 0–12 in urban areas. A population-based cross-sectional design was used, incorporating general practitioners’ data (2018–2019, n = 14,547), and societal and environmental data. Latent class analysis identified three distinct classes based on child and family demographics: ‘Dutch-origin two-parent household’ (n = 7267), ‘households with diverse countries of origin’ (n = 4313), and ‘single-parent household’ (n = 2967). Binary and multinomial logistic regression examined associations with environmental factors and child health outcomes. Children from the Dutch-origin class most often had favorable family demographics, neighborhood conditions, and health outcomes. Children from the diverse countries of origin class most often faced adverse neighborhood conditions, had higher rates of physical or somatic health conditions, and higher healthcare costs. Children from the single-parent class more often had less favorable family demographics, a higher likelihood of mental health problems, more frequent general practitioner visits, and were often in contact with youth care. This study highlights how child and family demographics and social and neighborhood conditions impact child health and healthcare utilization. Future approaches should focus on strategies to build and strengthen family and community resilience and adopt family-centered, context-sensitive interventions. Full article

Background: Early preventive dental visits are critical to reducing oral diseases in children and establishing lifelong oral hygiene behaviors. The American Academy of Pediatric Dentistry (AAPD) recommends that a child’s first dental visit occur by age one. However, in Saudi Arabia, limited evidence exists on parental awareness, attitudes, and barriers toward this recommendation. Objective: This study aimed to evaluate the timing of the first dental visit among Saudi children and to identify parental knowledge, barriers, and sociodemographic factors associated with compliance with AAPD guidelines. Materials and Methods: A cross-sectional survey was conducted between April and July 2025 at the Pediatric Dental Clinic, King Saud University, Riyadh. A validated, self-administered Arabic questionnaire was distributed both online and in-clinic to Saudi parents of children under 12 years. A total of 465 completed responses were analyzed using descriptive statistics, chi-square tests, logistic regression, and Spearman correlation to assess associations between parental awareness, socioeconomic variables, and compliance. Results: Of the 465 respondents, 39.6% were aware of AAPD guidelines, yet only 30.5% reported compliance with the recommendation of a dental visit by age one. The most cited barriers were lack of time (42%), difficulty accessing clinics (22%), shortage of pediatric dentists (20%), and lack of awareness (16%). Higher parental education (p = 0.003) and income (p < 0.001) were significantly associated with compliance. A moderate positive correlation was observed between early dental visits and regular annual check-ups (ρ = 0.319). Conclusions: Compliance with AAPD guidelines among Saudi parents remains low, largely due to limited awareness and access barriers. Strengthening parental education, community-based programs, and affordable pediatric dental services is essential to promote preventive care and improve oral health outcomes in children. Full article

Background/Objectives: Vaccination uptake in Ethiopia is deeply shaped by gender norms, with women serving as primary caregivers but often limited by low autonomy, while men typically control household decisions but remain less engaged in child health. This study examines gendered influences on vaccine hesitancy and acceptance to inform future strategies. Methods: A community-based cross-sectional mixed-methods study was conducted in four regions of Ethiopia (Amhara, Oromia, Afar, and Tigray). Quantitative data were collected from 992 caregivers through multistage stratified sampling procedure, whereas qualitative data were collected from 26 in-depth interviews, 24 exit interviews and 11 key informant interviews and were analyzed thematically guided by the WHO Behavioural and Social Drivers framework. Multivariable logistic regression was conducted to determine the associations. Results: The result highlighted that the proportion of caregivers who reported willingness to vaccinate their child with all recommended vaccines was high (93.5%) and more likely among those with higher education, family support, religious support, and frequency of health worker contact. However, 51.1% of caregivers displayed some degree of vaccine hesitancy, with higher prevalence among males. Hesitancy was linked to traditional beliefs and norms that assign vaccination responsibility to mothers, urban residence, and being employed, while secondary education, family support, and religious support were protective. While acceptance is high, hesitancy persists. Gender roles, education, social support, and health worker engagement influence immunization outcomes. Conclusions: The study highlighted that expanding immunization across all age groups and reducing persistent hesitancy requires a shift toward gender-responsive strategies including integrating a gender perspective into the immunization programs that address traditional norms and misinformation. Full article

Background/Objectives: Based on years of work from high-income countries, the Parenting for Lifelong Health programme for parents of Young Children (PLH-YC) was developed by the first and last authors, as a freely available low-cost programme for low-income families in low- and middle-income countries (LMICs). The initial group-based 12-session programme has since been delivered, adapted, and evaluated across many LMICs and now has a significant body of evidence. Over the last 10 years, early intervention services in the UK have been considerably reduced whilst, exacerbated by the impact of COVID-19, service demands have grown. This paper describes a feasibility trial of the 12-session PLH-YC programme in Wales to explore whether it could recruit and retain parents, and demonstrate improvements in parenting skills and reductions in child behaviour problems. Methods: Two small pre–post trials were conducted in socially disadvantaged communities in Wales, and they were delivered by local parenting practitioners. Of the 20 parents recruited across 3 groups, 17 provided pre- and post-course data and 10 completed qualitative interviews. Results: Retention was good (85%) with mean attendance of 8.7 sessions, and parental and facilitator feedback reported high levels of satisfaction with the programme, with the only recommendation being to make the programme longer and for facilitators to be given more time. Results showed significant benefits to parent-reported parenting practices, child behaviour, and parental mental wellbeing. Conclusions: These preliminary results justify work to develop a rigorous evaluation to establish whether PLH-YC could have a place among parenting-support programmes in the UK. Full article

This study reviews the role of Child-Friendly Green Spaces (CFGS) in supporting children’s psychological, physical, and educational recovery following natural disasters. The main research question guiding this review is the following: how do CFGS contribute to holistic child well-being and resilience in disaster-affected contexts, and what barriers and strategies influence their effective integration into recovery frameworks? Employing a rigorous literature review methodology, we synthesized interdisciplinary evidence from environmental psychology, urban planning, public health, and education, encompassing studies published between 2000 and 2024. Findings demonstrate that CFGS significantly reduce trauma-related symptoms such as anxiety, depression, and post-traumatic stress, promotes physical health through active play, and foster educational engagement by improving concentration, attendance, and informal learning opportunities. Furthermore, CFGS contribute directly to multiple Sustainable Development Goals, particularly SDG 3 (Good Health and Well-being), SDG 4 (Quality Education), and SDG 11 (Sustainable Cities and Communities). Despite these advantages, CFGS are often overlooked in formal disaster recovery planning due to prioritization of immediate relief, financial and logistical challenges, and socio-cultural factors. To address these challenges, this study proposes a participatory, culturally sensitive framework for CFGS implementation, which integrates inclusive design, multi-sector collaboration, and ongoing monitoring and evaluation. Grounded in theoretical perspectives such as the Biophilia Hypothesis, Bronfenbrenner’s Ecological Systems Theory, and restorative environments, CFGS are reframed as critical infrastructures for children’s holistic recovery and resilience. The findings underscore the urgent need to embed CFGS within disaster recovery and urban planning policies to promote child-centered, sustainable community development. Full article

Background/Objectives: Dental neglect represents a preventable form of child maltreatment that may lead to significant oral and systemic health complications. This study primarily aimed to investigate the main oral manifestations and determinants of dental neglect in a pediatric population from Bihor County, Romania. Additionally, it assessed the association between systemic factors, such as nutritional status and psychological conditions, and the severity of oro-dental lesions, with the goal of informing future preventive strategies and public health interventions. Methods: A retrospective analysis was conducted on 333 pediatric patients diagnosed with dental neglect. Clinical data were collected from two centers between 2020 and 2024. Oral health status, socio-demographic characteristics, and psychological conditions were evaluated. Statistical analyses included Fisher’s Exact Test, Mann–Whitney U Test, and Bonferroni-adjusted Z-tests, with significance set at p ≤ 0.05. Results: Among the 333 participants, 52.9% were male, with a mean age of 8.75 ± 3.29 years. Most children (81.7%) resided in rural areas, and 55.6% were first-born. Carious lesions were identified in 100% of cases, with 54.7% showing complications such as endodontic pathology. Poor oral hygiene was reported in 99.1% of children, while 58.6% presented signs of periodontal disease and 37.2% reported spontaneous gingival bleeding. Acute pain was experienced by 40.2% of participants. Nutritional issues were prevalent, with 24.3% classified as obese and 21.6% as malnourished. Significant associations were found between lesion severity and both psychological disorders (p < 0.001) and malnutrition (p < 0.001). Conclusions: This study identifies untreated carious lesions, poor oral hygiene, acute dental pain, and oro-dental trauma as key clinical indicators of pediatric dental neglect, with rural residency and limited education as significant socio-demographic risk factors. The findings highlight the urgent need for integrated, community-based strategies, including school-based screenings, parental education, and referral pathways, to improve early detection and prevention in Romania. Full article

Background/Objectives: Children’s social–emotional difficulties and unhealthy lifestyle behaviors co-occur but are rarely addressed concurrently in parent-based interventions. These problems are exacerbated by family stressors (e.g., parental trauma, mental health, substance misuse, illness, financial strain, racism), which further compound existing health and healthcare inequities for families experiencing marginalization who are more likely to face major stressors. Yet, most parent-based interventions do not sufficiently address parents’ own stress and self-regulation. To inform prevention efforts to address these gaps, this mixed methods formative needs assessment explored strengths, challenges, and intervention preferences of parents dealing with major stressors, informing parent-based prevention to improve child social–emotional and physical health. Method: A sociodemographically diverse sample of parents/caregivers (N = 46) who had a child aged 3–9 years and ≥ two major stressors completed surveys assessing child well-being, parenting, parental stress, self-regulation, and intervention preferences. A subsample (n = 24) completed qualitative interviews further exploring these areas. Results: Parents expressed high interest in programming on emotion regulation, mindfulness, dealing with trauma, and reducing stress while strengthening children’s social–emotional and physical health. Conclusions: Results underscore the need to address caregivers’ own emotion-related skills to promote children’s well-being. Findings inform implementation and evaluation of a preventive program to improve child health, promote positive parenting, and address parental stress through self-regulation and coping. By aligning with community needs and preferences, parenting interventions that simultaneously address parental well-being and stress may be a promising avenue for improving equitable access to and quality of healthcare for families experiencing marginalization and stress. Full article

Introduction: The implementation of pedagogical tactics with ethnic-cultural approaches represents essential mechanisms for promoting breastfeeding, ensuring greater effectiveness in knowledge dissemination. These are supported by cultural ideologies that integrate didactic processes tailored to the beliefs and practices of each ethnic group, thus facilitating greater acceptance and adherence to health recommendations. Objective: The study aims to analyze the effectiveness of culturally sensitive educational strategies from the prenatal stage at the Quiroga Health Center, Ecuador, exploring how indigenous cultural dynamics influence the receptivity of education. Methodology: The research is quantitative, quasi-experimental, and employs a descriptive, documentary, bibliographic, and analytical cross-sectional cohort design to thoroughly analyze collected data and identify cause-and-effect factors influencing breastfeeding knowledge and practice. Results: The effectiveness of the educational intervention in promoting cognitive awareness of breastfeeding was confirmed using the McNemar statistic applied to related samples. Conclusions: Breastfeeding knowledge levels are closely tied to reproductive history, a constantly evolving process affected by various social factors. Health education is implemented and strengthened through teaching programs as these strategies can significantly contribute to maternal and child health promotion, adapting to the specific needs and contexts of each community. Full article

Background/Objectives: Parental weight stigma and bias can shape how parents talk about weight and health with their children, yet their interplay in Romania is unexplored. We examined how parents’ experienced stigma, internalized bias, and explicit antifat attitudes relate to weight- and health-focused conversations with 5–17-year-olds, and whether these links vary by child weight status. Methods: In a cross-sectional survey of 414 Romanian parents, we assessed stigma (teasing/unfair treatment), internalized bias (WBIS-M), antifat attitudes (AFA, UMBFAT), and frequency of health (healthy eating/PA) versus weight-focused talks and comments. BMI-derived child weight status was classified via WHO percentiles. Multivariate regressions and mediation analyses tested predictors and indirect effects. Results: Nearly 80% of parents discussed weight at least sometimes; higher child BMI percentile and parental internalized bias independently predicted more weight conversations (β = 0.44 and β = 0.25, both p < 0.001). Internalized bias mediated the effect of experienced stigma on weight talk (indirect effect = 0.105, 95% CI [0.047, 0.172]). Explicit antifat attitudes drove comments about others’ weight (β = 0.17, p = 0.002). Health-focused talks were unrelated to stigma or bias but were more frequent among parents with higher education, better self-rated health, and lower BMI. Conclusions: Parents’ internalized weight bias—shaped by stigma—fuels weight-focused conversations, especially when children have higher BMI, while antifat attitudes underlie negative comments about others. Interventions should reduce parental internalized bias and train supportive, health-centered communication to curb weight stigma transmission. Full article

Background: Stunting remains a major public health issue globally and in Indonesia, often linked to inadequate complementary feeding, cultural practices, and limited family empowerment. Objective: This study aimed to develop and evaluate a family empowerment model based on transcultural care theory to improve quality and prevent stunting among children aged 6–24 months. Methods: A cross-sectional explanatory survey was conducted among 324 mother–child pairs from 11 primary healthcare centers in Kediri, East Java. Data were collected using a validated questionnaire covering demographic, educational, technological, economic, and cultural factors, as well as family empowerment and quality. Structural Equation Modeling with Partial Least Squares (SEM-PLS) was applied for hypothesis testing and model development. Results: The model showed moderate explanatory power (R² = 0.223 for family empowerment; R² = 0.115 for complementary feeding quality). Demographic, educational, technological, economic, and cultural factors significantly influenced family empowerment (p < 0.05), which in turn had a strong positive effect on quality (β = 0.340, p < 0.001). Family empowerment mediated the relationship between these factors and quality. Key contributors included knowledge, technology access, income level, and cultural practices. Conclusions: The proposed transcultural care-based family empowerment model effectively improves quality. Strengthening health education, supporting community health volunteers, and integrating culturally sensitive practices, such as encouraging paternal involvement and shared meals, should be prioritized in stunting prevention programs. The model may be adapted for use in similar community settings to enhance program effectiveness. Full article

Adverse childhood experiences (ACEs) are associated with profound long-term health and developmental consequences. However, current identification strategies are largely reactive, often missing opportunities for early intervention. Therefore, the potential of machine learning to proactively identify children at risk of ACE exposure needs to be explored. Using nationally representative data from 63,239 children in the 2018–2020 National Survey of Children’s Health (NSCH) after listwise deletion, we trained and validated multiple machine learning models to predict ACE exposure categorized as none, one, or two or more ACEs. Model performance was assessed using accuracy, precision, recall, F1 scores, and area under the curve (AUC) metrics with 5-fold cross-validation. The Random Forest model achieved the highest predictive accuracy (82%) and demonstrated strong performance across ACE categories. Key predictive features included child sex (female), food insufficiency, school absenteeism, quality of parent–child communication, and experiences of bullying. The model yielded high performance in identifying children with no ACEs (F1 = 0.89) and moderate performance for those with multiple ACEs (F1 = 0.64). However, performance for the single ACE category was notably lower (F1 = 0.55), indicating challenges in predicting this intermediate group. These findings suggest that family environment factors can be leveraged to predict ACE exposure with clinically meaningful accuracy, offering a foundation for proactive screening protocols. However, implementation must carefully address systematic selection bias, clinical utility limitations, and ethical considerations regarding predictive modeling of vulnerable children. Full article