Factors Associated with Health-Related Behaviours in Adolescents: The stories of Rarotongan adolescents and their parents

Abstract

Noncommunicable diseases (NCDs) including diabetes, cancers, and cardiovascular diseases represent a global crisis that is disproportionately affecting low and middle income countries such as the Cook Islands. Establishing health-promoting behaviours during adolescence may reduce the onset of NCD risk and incidence in adulthood for the individual and their future offspring. This phenomenological case study aimed to investigate factors associated with health-related decision-making and behaviours among 14-15 year-olds in Rarotonga whose self-reported dietary behaviours were associated with increased long-term risk of developing NCDs. A Pacific framework, Talanoa, was used to guide a mixed-methods investigation involving thirteen students and eleven of their parents/caregivers. Case study participants were selected from students in the 2016 Year 9 cohort of the Pacific Science for Health Literacy Project who reported at-risk behaviours for health-promoting and risk-promoting foods at baseline. Selfreported change in dietary behaviours was assessed using 12-week and 12-month postintervention surveys. Student participants completed a three-day food and activity diary 14- months post-intervention, and an interview. Their parents/caregivers were also interviewed at this time. Interview evidence was analysed using an inductive approach. Full pre- to 12-month post-intervention data assessing nine dietary behaviours was available for eleven of the thirteen students. At baseline, 88% of these self-reported behaviours were categorised as being at-risk. Positive shifts in 46% of these behaviours were reported at 12- months post-intervention. Key factors perceived as enabling healthy food decision-making and behavioural change included regulated access to spending money, authoritative parenting, access to filtered water, positive role models, motivation for sports scholarships, and having an active role in cooking in the home. Perceived barriers to healthy eating included a preference for unhealthy foods, time constraints, access to unregulated spending money, accessibility of junk foods in school, limited availability to healthy produce, and inadequate parental presence at home. The reported small positive shifts in the thinking and behaviours of these students are encouraging. Findings highlight the complexity of the interrelated personal, social and economic influences on health-related behaviours. This study offers the participating school evidence that could facilitate further exploration of these reported enablers and barriers within the staff, student and parent communities that may contribute to policy and practice.