Health, health-related quality of life and behavior among children from low-income families

Abstract

The Family Stress Model posits that financial hardship increases parental stress which impairs parenting, thereby increasing children’s health and behavioral problems and worsening their HRQOL. High level of physical activity (PA) may reduce the negative impact of stress on health. This PhD research study aimed to investigate how parental stress and negative emotions influenced health, HRQOL and behavior of children in Chinese low-income families. It explored the efficacy of a smartphone app-based exercise intervention in improving HRQOL and behavior of Chinese children.

This research comprised of four parts. Part one was a cross-sectional study on 205 parent-child dyads from Chinese low-income families to examine the associations of parental stress, negative emotions or HRQOL and child PA with health, HRQOL or behavior of children. Part two was a longitudinal study on 157 parent-child dyads from low-income families to determine the bidirectional relationship between parental stress, negative emotions or HRQOL and child HRQOL or behavioral problems. It explored whether these parent-child associations were mediated through non-authoritative parenting, child physical maltreatment and neglect and family disharmony and whether a high level of child PA moderated the association between parental stress or negative emotions and child HRQOL or behavior. Part three was the development of a smartphone app “Family Move” on parent-child exercises. Part four was an evaluation of the efficacy of the Family Move in improving HRQOL, behavior and PA level of 67 Chinese children.

I found a bidirectional relationship between child physical HRQOL and parental physical HRQOL (standardized regression coefficient (β) parent → child: 0.19; βchild → parent: 0.18) and anxiety symptoms (βparent → child: -0.14; βchild → parental: -0.19), between child psychosocial HRQOL and parental mental HRQOL (βparent → child: 0.15; βchild → parent: 0.20), and between child behavioral problems and parental stress (βparent → child: 0.21; βchild → parent: 0.14). Children who spent 1 hour more in moderate PA per week had a significant 0.91-point increase in CHQ-PF50 General Health score (p=0.041) and those who spent 1 hour more in vigorous PA per week had a 0.38-point decrease in SDQ Total Difficulties score (p=0.006). The association of parental stress or depression symptoms with child behavioral problems was completely mediated through non-authoritative parenting, child physical maltreatment and neglect and family disharmony. Children of families who had used the Family Move app showed a significant increase of 1216.08 MET-minutes/week in total PA level at 6-month follow-up. Higher app usage points were associated with fewer behavioral problems in children at 1 month post intervention (β: -0.15, p=0.018).

Parental stress and negative emotions and poor HRQOL had adverse effects on child HRQOL and behavior. Children’s poor HRQOL and behavioral problems also increased parental stress and negative emotions and reduced parental HRQOL, leading to a vicious cycle. The findings of this study support the promotion of authoritative and non-abusive parenting, family harmony and PA to improve HRQOL and behavior of Chinese children in low-income families.