Three themes and seven sub-themes emerged in the structural analysis (Fig. 1). The themes were “A sense of belonging”, “Awareness of one’s role as a parent” and “Inspiration towards new and healthier behaviours”.
A sense of belonging
A free zone for the family
Being together as a family during the programme activities was described as important for the participants’ family relations. Days with programme activities were the families’ own free zone, where they had the opportunity to try new activities and have fun together as a family.
For participating children, being together with their family during activities were emphasised in a joyful tone and described as fun. One child said: “It was fun with the family and friends, and to try new activities” (child 1). Some parents emphasised the impacts of their participation in the programme from a social perspective.
One parent said: “We are now closer as a family, it happened when we did the activities together” (parent 6). Other parents highlighted more practical aspects, such as the meals served on weekdays and the near-by location of activities that were perceived as facilitating factors for the families to attend. Without these meals, many parents experienced that they would not have been able to attend. They talked about how difficult it could be to have time for everything, and especially to prioritise physical activities. Participants, especially those with younger siblings, emphasised how the whole family were able to participate. To be able to have a free zone with the family, without having to rush home to do all their everyday chores:
“It is much easier for the whole family to do something together, we'll go and everyone (in the family) is going, so that no-one has to make sure that the food is cooked.” (parent 9)
Being together in the programme
Being together as a group in the programme, with other families created a sense of belonging for the participants. They had the ability to attend activities twice a week during a whole school year. At first, even though the children went to the same school, their parents described how they barely knew the other children’s parents. The continuity and the fact that whole families were able to attend the programme activities were addressed in different ways. A participant described the importance of being together in the group in relation to the programme by saying:
“Every time we were there, we met two times each week, I felt like I was part of a group, that is why I talk about belonging, we were always together, I never felt excluded” (Parent 4)
The duration and frequency of the programme facilitated the sense of belonging and some participants made new friendships that lasted after the programme. A child described:
“I made a friend during A Healthy Generation, I did not have any friends in her class, but now I have become friends with her, and with one of her friends, so now I know a lot of people” (child 4)
All participants did not make new friends after the programme, some participants described how they focused more on being with their family during the activities. However, to know more people in the neighbourhood, to say “hi” to each other at the supermarket was described as something positive and good enough for these participants.
From isolation to social participation
For some participants, especially those that had been feeling isolated before their participation in A Healthy Generation, expressed with emphasis how the participation helped them to break out from isolation. To participate in the activities increased social participation for them. One parent described a lonely life, where they were mostly at home. The children watched TV and the parents felt that it was difficult to get out. A Healthy Generation was described as an extra family:
"I don't have any relatives in Sweden, but when you come here (to A Healthy Generation), it's like coming to my relatives. You eat food, you do something together". (Parent 1)
Other participants also acknowledged the importance of the programme for social integration, especially for migrants:
“There are many families who are trapped inside, they could come and meet each other, it is very nice with A Healthy Generation. It's a very nice start into the society, people get started.” (Parent 13)
Social participation also included how new contacts in the neighbourhood contributed to a feeling of security. Although many parents felt that the neighbourhood was not safe for their children to play alone, the fact that more people knew their child was reassuring:
“I know now that if he goes out by himself, there is someone who knows him. If he does something strange, someone will tell me or help him, because they know who he is. So, it feels safe that way.” (Parent 4)
Awareness of one’s role as parents
New insights on how to act as a parent
Parents described how they got new insights on how to act as parents in relation to their children’s health-related behaviours. The programme, including the parental support sessions, were important to help parents reflect about their family relations and how they acted towards their child/ children: “We discussed how we are within the family and in relations and how to improve…
It was interesting, I thought differently before, the most important is how you talk with children. It is difficult sometimes, when they (the children) don’t want to do anything. I got good examples during this time, so to say” (parent 3)
The parents also learned from each other, from other parents, children, health coordinators and local sport leaders during the programme. This way they became aware of new ways of thinking and acting towards their children. One such situation was when their children learned to eat more vegetables during the meals in the programme, as they gave each other advice.
Negotiating differences between parents
To participate in a health-promoting programme together with other families was also challenging, mostly due to perceived differences between the participating parents. Parents negotiated differences in relation to active participation, cultural aspects and how parents acted towards their own children. In term of active participation, parents were supposed to participate actively in the activity sessions. Even though most parents participated, some parents sat down on a bench or arrived late to the activities. Such occurrences were described as disturbing for those who participated actively. By contrast, some parents experienced that other parents participated too actively, for example when they played a sport and competed against each other. Cultural differences between parents were also brought up by a few participants, both as difficult and enriching. Difficulties mostly related to differences in parenting:
“How one is as a parent differs from nation to nation and from person to person. It has to do with upbringing, and how you are as a person.… How should I say it, some parents don’t care about how their children behave. I had to step in as a parent, I had to tell the children, it was these things that I reacted to… it is like being a parent”. (parent 2)
To facilitate active participation and order in the group, the health coordinator played an important role. The participants emphasised the importance of having continuity with the same health coordinator. When the coordinators knew the group, and especially the children that needed extra attention, they could take a firmer role as a leader.
Inspiration towards new and healthier behaviours
Participants described how their experiences in the programme contributed to experience-based insights, how they had the opportunity to explore their own interests and how the experiences in the programme helped them to become more secure in relation to different sport activities. Even though the participants had various experience of physical activity, ranging from being very active and “sporty” as a child to very limited previous experience, to try many different sport activities within the programme was enriching. To participate together as a family in a joyful, friendly and familiar environment was important and described as a secure platform. A child that previously had been afraid to participate in physical education lessons at school described how the experiences of the programme helped her to overcome the fear and experienced more self-confidence:
Child: All sports that I recognise, (I think that) I have done this before, that's right, I remember it from A Healthy Generation! So, when I am in school (physical education in school), I recognise it.
Interviewer: how does it feel then?
Child: Good, I feel that I recognise it. Before, I did not like physical education, because I was afraid of balls, but I love it now! (child 5)
For the parents, it could be extra joyful to try a sport that they had participated in as a child or a new sport they had never tied:
“I tried different sport activities that I had never tried in my life, and the children liked it too!” (parent 7)
Skiing and ice-skating were activities that few participants, especially those born in other countries than Sweden, had previously tried. These activities were mentioned as particularly fun and exciting to learn in the programme, although difficult to begin with.
Healthy life-style changes
Participating in A Healthy Generation often led to healthy lifestyle changes. Some parents initially decided to participate in the programme to change their own lifestyle and others were interested because of the opportunity for their children to try different activities. Lifestyle changes included for example: to exercise more, eat healthy food and do activities together as a family. The participants were extremely grateful to the whole programme and keen to explain what it meant for them to participate. One parent commented:
“I think it meant a lot! It helped us to think about our children’s health. Not to be unhealthy, it awoke a feeling to think about food, to think about exercise, to think healthily and to sustain this. I am very satisfied and it meant a lot to us.” (parent 10)
Overall the experiences within the programme helped the participants to appreciate regular and more intense PA as well as healthy food habits. The participants received advice and information related to food habits from the health coordinators and they had discussions with each other, which were important reminders of how to choose healthier food patterns at home. In terms of PA, one participant described how she started to appreciate to exercise intensively during the programme:
“You get sweaty and breathe loudly, you want to rest and sit down. They say: (the health coordinators), you need to run. You know that you need to keep running, and you want to do it, so you run.” (parent 1)
Life-style changes also included changes in other areas in life. One parent changed job and working hours after the programme, which affected their family’s lifestyle habits starting with spending more time together, he said: “Now, I can go home and be a father to my child”. (parent 2).