This study examined the use of parenting practices in raising healthy primary schoolchildren in specific situations around healthy diet, PA and SB. The findings provide new insights into which practices parents use and whether they perceive them as effective or ineffective. Furthermore, these perceived effective and ineffective parenting practices are situated within one or both theories (SDT or SCT). To start with, general findings across all three energy-related behaviors will be discussed. Secondly, specific findings concerning the three energy-related behaviors will be considered separately and finally, some limitations of the study will be recognized.
General parenting practices
Across all focus groups, a strong consensus was found concerning the positive effect of explaining to a child why it is important to engage in healthy behavior. According to SDT, giving the child a reasonable explanation for behaving healthily, will make the child understand why he/she has to act that way. This autonomy-supportive practice enhances the chance that the child will obey.
In the group discussions using time-out appeared to be an effective and commonly used parenting practice. This practice, which is in accordance with the principles of SCT, was also studied by Kaminski et al. . Teaching parents to use time-out was an effective parent training component associated with larger effects on enhancing behavior in children aged 0–7 . According to our knowledge, time-out has not yet been studied as a parenting practice in the scope of SDT. But, bearing in mind the principles of SDT, time-out could yield benefits in particular circumstances for which mainly the way of using time-out is important. If negative emotions gain the upper hand and the child is impervious to reason, then time-out can be predicted as an effective parenting practice when explaining the reason for the use of time-out and restarting the interaction with the child afterwards.
Furthermore, parents reported the counterproductive practice ‘anger’ of which the ineffectiveness is in line with SDT because it frustrates the fundamental basic human need to feel related, competent, and autonomous [42, 47].
Reacting empathetically, motivating your child to be active and increasing the intrinsic value of an activity are all mentioned in the group discussions as effective parenting practices. Their perceived effectiveness is consistent with both the principles of SDT and SCT as these practices are autonomy supportive and encourage pro-social behavior. This effectiveness was also confirmed in several studies on parenting practices for healthy lifestyles. The review of Kaminski et al.  about parent training effectiveness demonstrated that increasing positive parent–child interactions and parental emotional communication skills are consistently associated with larger effects on enhancing behavior in children aged 0–7. Moreover, a growing body of research shows that children are more likely to be physically active when their parents encourage and support them to be active [20, 58] and participate together in sport or physical activities with them [59, 60].
Other parenting practices considered effective, were applying clear rules and agreements, being consistent and parental monitoring. Parents give their children as much freedom as possible (which is autonomy supporting), but simultaneously they impose the necessary limits by making clear agreements, monitoring the behavior of their child and being consistent when the child does not listen. These parenting practices provide structure to a child which fulfills both the principles of SCT and the fundamental need of feeling competent according to SDT [44, 61].
Less consensus existed on the effectiveness of obligations. Some parents stated that they give their child the freedom to choose him/herself to go to the sports club or youth movement, whereas others oblige their child to go. In the latter, parents tend to control their child’s behavior (i.e., pressurize them to behave, think or feel in a certain way) rather than support their child’s autonomy as in the first example. Results of a varied number of studies have affirmed that controlling contexts undermine children’s intrinsic motivation , which is incompatible with the concepts of SDT to actively support the child’s capacity to be self-initiating and autonomous .
Finally, being rewarded at the end of a task or behavior, was reported by parents as a stimulus for the child to persist. Also in the study of Borra et al.  parents mentioned that children need instant gratification. If children have to sustain, they need incentives along the way. This practice of rewarding fits with the principles of SCT, of which the fundamental tenet is that moment-to-moment exchanges are crucial: if a child receives an immediate reward for its behavior, then he/she is more likely to repeat this behavior . In the qualitative study of Sebire et al. , children believed that rewards for screen viewing reductions would lead to behavior change. However, some reported that removal of rewards was frustrating. This is in accordance with SDT which believes that rewards undermine children’s natural interest in activities and the need for autonomy [65, 66]. Rewards induce children to engage in the activity not for their own enjoyment but to earn the rewards. As a result, children feel pressured, disinterested, or disaffected . Furthermore, for activities that children find inherently interesting, receiving expected rewards leads to a decrement in intrinsic motivation. When reward contingencies are absent, spontaneous engagement in the activity decreases .
This work nevertheless found that rewards are a popular and frequently used practice by parents. Therefore, the challenge is to teach parents how this practice can be used without controlling behavior with negative results. Introducing praise, helping parents to recognize feelings surrounding praise and the impact upon behavior, minimizing the predictability of rewards and not using promised rewards but only presenting them after the performance of the behavior, are examples used in the Teamplay intervention in which rewards are used in a positive way .
Since the prevention of overweight and obesity by limiting the amount of SB is a relatively new concept in literature and in public health messages, it was expected that most parents would not yet apply restrictions for SB. Indeed, in the current study some parents did not apply TV viewing rules because formal rules were not perceived as necessary (“my child is physically active enough”) or would cause the opposite effect (greater desire to watch TV).
Nevertheless, some parents do apply clear rules about TV time to limit the SB of their children. Rules provide structure to a child which meets the principles of SCT and the need of feeling competent according to SDT . In other studies, setting rules to limit TV time in general or during meals, has been associated with less screen time, less TV viewing or computer use, and less SB in general . Finally, offering children alternative activities with as much choice as possible, can prevent them from watching TV or other screen-time in an autonomy-supporting (SDT) and problem solving way (SCT) [42, 43]. But, although some parents reported they involve their children in household chores as an alternative for screen-time, this seems to be challenging for other parents. Especially in times of stress, parents take the view that they can do household chores better and faster if they do them themselves without in involving their child . How parents can truly engage their children in realistic home-based alternatives to screen time will be an interesting challenge for future interventions.
Within the use of rules in eating practices, one has to distinguish rules about snacking and soft drinks from rules about the amount of food to be eaten. About the effectiveness of applying these types of rules, inconclusive results were found in the group discussions. Some parents apply strict rules about how much and when to consume soft drinks whilst others do not apply rules because they are more concerned about their child not drinking sufficiently than about the type of drinks that is consumed. The study of Haerens et al. , showed that a lack of family rules related to unhealthy food products was associated with higher fat intake in boys. In girls, lack of food rules was further related to lower levels of fruit intake. Additionally, in the study of Pearson et al. , family rules were positively associated with children’s fruit and vegetable consumption. Finally, the use of clear rules to limit a child’s consumption of unhealthy food products, provides structure to a child (SCT) and the need of feeling competent (SDT) .
Concerning rules about the amount of food that has to be eaten, some parents ensure that their child eats enough healthy food by obliging him/her to eat a certain amount of every served nutritional product. Other parents stated they never oblige their child to eat a certain amount of food, since their own consumption also depends on a varying appetite. According to literature, rules on the amount of food that has to be eaten, teach children to obey and respect rules rather than learning self-control in their eating habits . Studies proved that such coercive or controlling feeding practices in which the parent, rather than the child, makes decisions about how much the child should eat, are ineffective. When parents control their child’s eating, it undermines the child’s natural ability to respond to its own internal hunger and satiety cues, thus establishing maladaptive patterns of eating [44, 74]. Consequently, the concepts of SDT to actively support the child’s capacity to be self-initiating and autonomous are not fulfilled .
On the other hand, when parents apply a ‘tasting rule’ which means that the child just tries the food but then has the choice whether or not to finish what is on his/her plate, this can also be seen as providing structure to a child (which fits to both SCT and SDT [44, 61]). Furthermore, just tasting will not take away a child’s feeling of hunger and therefore does not undermine the child’s natural ability to respond to its satiety feeling and does not subvert the human need to feel autonomous.
The importance of parental food intake and parental modeling on children’s healthy food consumption was both supported in the group discussions and in other qualitative work [72, 75, 76]. According to SCT , individuals learn behaviors by observing others. This observational learning is most prevailing when the person being observed is powerful, respected, or considered to be alike the observer. Furthermore, parental modeling fulfills the fundamental need of feeling related according to SDT .
In the focus groups, many parents stated they use dessert as a reward for their child finishing his/her plate or for good behavior. In theory, SCT claims that moment-to-moment exchanges are crucial. Receiving an immediate reward for a behavior, enhances the chance that a child repeats the behavior . However, this concept cannot be applied to parenting practices for healthy eating because many results reported in literature show that rewarding with food is associated with more problematic eating behavior. Using food (usually sweets) as a reward is theorized to make that food more desirable and the food for which the child is rewarded when eating it less desirable . Also, the use of food for non-nutritive purposes, has been linked with a reduced ability to internally regulate one’s own feelings of hunger and satiety . This matches perfectly with the principles of SDT which proposes that rewarding people undermines intrinsic motivation and creates conditions for a net decline in motivation when rewards are subsequently withdrawn.
All the above makes clear that parents do not raise their children in a way that fits only one theory. Parents use a mix of parenting practices, which can be traced back to SDT ánd SCT. The information arising from this study will be used to inform the content of a randomized controlled trial consisting of a parenting intervention aimed at promoting a healthy diet, PA, and less SB in primary schoolchildren. Such an intervention should not push forward or SDT or SCT as the best theory to teach parents appropriate parenting practices. Better is to select the most feasible effective practices for parents from SDT and SCT and combine both theories. Therefore, the results of this study are an important source of information to integrate parents’ concerns, motivations and current habits, since they determine the success of a parenting program .
This study was subject to some limitations. Due to recruitment difficulties, focus groups were mostly conducted with less than the conventional group size of six to ten participants. Although the data demonstrated considerable convergence, other important information may be missed. Secondly, because of voluntary participation, only those parents who are most open to talk about the subject may have been recruited. Thirdly, our focus group research used self-reporting practices, which may have led to inconsistency with actual experiences or social desirability bias. Furthermore, responses to hypothetical situations may not fully represent the reality of parent–child communications. A last limitation is that SES was not used as a stratification/recruitment factor. By recruiting participants via their workplace, unemployed parents were not involved in the group discussions. That way, over-representation of parents with medium-high SES is possible. Furthermore, in this study differences between low and medium-high SES parents were not investigated, which is an important issue that can be included in future research. Taken the above mentioned limitations into account, as with most qualitative research, prudence is in order in generalizing our findings to all parents of primary schoolchildren.