Control and Chaos: Caregiver’s Basic Psychological Need Frustration is Associated with the Socioemotional Climate when Feeding

Abstract

Objective:

The socioemotional climate when feeding is a focus in childhood obesity prevention efforts. Yet, little is known about why caregivers create non-supportive or supportive climates. This cross-sectional study used a self-determination theory perspective to identify factors associated with the socioemotional climate when feeding in low-income, ethnically diverse families.

Methods:

Caregivers of 2–5-year-old children(n=66) completed the Parent Socioemotional Context of Feeding Questionnaire, the Basic Psychological Need (BPN) Satisfaction and Frustration Scale, and demographic surveys at baseline. Multivariable regressions assessed the association between BPN satisfaction/frustration with autonomy-supportive, structured, controlling, and chaotic feeding climates.

Results:

Participants were predominately Hispanic/Latinx (86.6%), women (92.5%), born outside the US (60%). Their BPN Frustration was positively associated with controlling (β=0.96, SE=0.26, p= 0.001) and chaotic (β=0.79, SE=0.27, p=0.007) feeding.

Conclusions and Implications:

This analysis suggests that BPN frustration is associated with controlling and chaotic feeding and may be important to consider when encouraging responsive feeding.

INTRODUCTION

Poor diet quality in childhood disproportionately affects ethnic and racial minoritized groups, putting them at increased risk for childhood obesity and diet-related diseases.^1-3 Fostering healthy eating behaviors such as willingness to try new foods and learning to self-regulate food intake early in childhood is important for preventing the development of disease because food preferences and eating patterns are established early in life and track into adulthood.^4-6 One factor that is known to play an important role in the development of children’s eating behaviors is the socioemotional climate of feeding which is created by caregivers’ behaviors and emotions when feeding their children.^7-9 Therefore, supporting caregivers in creating a supportive socioemotional climate when feeding their children is a focus of interventions developed to improve diet quality and decrease obesity risk.^10-16 Studies have shown that a supportive socioemotional climate, that provides structure while supporting children’s autonomy is associated with fewer obesogenic eating behaviors.^17,18 Conversely, a non-supportive socioemotional climate that is overly controlling or chaotic is associated with the development of eating behaviors that can contribute to poor diet quality and obesity.^19,20,20,21 However, gaps in the literature remain on what modifiable factors are associated with the socioemotional climate of feeding, particularly for families whose children are at higher risk for obesity e.g. Hispanic/Latinx families and those experiencing poverty.²² A better understanding of modifiable determinants of the socioemotional climate would allow interventions to target more proximal and effective determinants when supporting caregivers in creating a positive climate when feeding their preschool-aged children.

Self-determination theory (SDT), a leading theory of human motivation, has been suggested as a framework to help conceptualize the role of caregivers' influences on child obesity behaviors and may also provide an understanding of the antecedents to the socioemotional climate caregivers create when feeding their children.^23-25 SDT suggests that behavioral regulation depends on the degree to which people satisfy 3 basic psychological needs (BPN).²⁶ These needs, which are deemed universal and essential for psychological growth and well-being are competence (feeling capable), autonomy (feeling of being the origin of one’s behavior), and relatedness (feeling understood and cared for by others).²⁶ SDT proposes that a caregiver’s role is to create a supportive socioemotional climate that supports their child’s BPN.^27,28 Characteristics of a supportive socioemotional climate include autonomy support (allowing choice, perspective taking, and supporting child initiatives and problem-solving attempts) and structure (providing clear guidelines, expectations, and limits).²⁹ Autonomy support and structure have been shown to positively influence children’s overall well-being, and specifically support the development of healthy eating behaviors.^22,30 This is in contrast to a non-supportive socioemotional climate such as one that is psychologically controlling (trying to change a child’s emotions, opinions, or thinking patterns to make them comply with expectations) or chaotic climates (allowing the child to lead while caregivers involvement is inconsistent, erratic, or arbitrary) which are associated with poor outcomes, including the development of problematic eating behaviors and obesity.^22,31,32 Caregivers’ own BPN satisfaction or frustration is an important antecedent to their emotions and parenting behaviors and may be important to understand in the feeding context.^33,34

When caregivers’ BPN are satisfied, they are more likely to express emotions and behave in ways that create a supportive socioemotional climate.^33,34 However, if caregivers’ BPN are frustrated, they are more likely to foster a controlling or chaotic climate.³⁴ While this association has been demonstrated in the general parenting literature, understanding if it is present within the feeding context will be important in designing interventions to best support caregivers in feeding their children in ways that promote healthy eating behaviors.

Therefore, this study examined whether Self-Determination Theory constructs, caregivers’ BPN satisfaction and frustration, are associated with the socioemotional climates created when feeding their children. We hypothesized that high BPN satisfaction would predict a supportive socioemotional climate responsive to children’s BPN (higher autonomy support and structure) and that high BPN frustration would predict a non-supportive socioemotional climate (higher control and chaos).

METHODS

Study Design

We conducted a cross-sectional secondary analysis of the baseline data collected as part of the Strong Families Start at Home study (SFSH study) (n=66).³⁵ The SFSH study was a pilot randomized controlled trial aimed at improving the diet quality of 2-5-year-old children through a home-based intervention. Three bilingual bicultural research assistants, fluent in Spanish, recruited participants using passive and active recruitment at childcare sites and WIC offices in Providence, RI, and surrounding areas. Passive recruitment involved flyers at each recruitment site with contact information, interested caregivers contacted the study team and were screened for eligibility. Active recruitment involved research assistants present in each site, providing printed flyers, explaining the study purpose and structure, and if caregivers were interested screening for eligibility. Eligibility criteria included: Parent or guardian of child 2-5 years old, fluent in English or Spanish, >18 years of age, living with the child, the child was not underweight, the child did not have a diagnosed condition that impacted how the child was fed, guardian owned a phone capable of video recording and was willing to video record a meal or activity with their child. If eligible, research assistants scheduled a baseline assessment visit conducted in the family’s home or preferred location. During the baseline visit caregivers provided written consent for their participation and for the participation of their child. Research assistants then enrolled participants and administered survey measures using RedCap (Research Electronic Data Capture).³⁶ Enrolled participants received $50 for completing baseline measures. All research assistants completed training in social and behavioral human subjects research through the CITI program (The CITI Program, 2018-2019). Research assistants also received a standardized protocol for recruitment, screening, enrollment, and data collection as well as in-person training with the study PI (AT) and project manager (KF) that involved didactic instruction and demonstration through role play for all procedures. The SFSH study underwent a full board review by the Institutional Review Board of the University of Rhode Island. The current secondary data analysis was deemed exempt by the Institutional Review Board of the University of Rhode Island.

Measures

Caregivers completed the Basic Psychological Need Satisfaction and Frustration (BPNSF) Scale.³⁷ The BPNSF has demonstrated construct and predictive validity with BPN satisfaction associated with increased life satisfaction and vitality and BPN frustration associated with decreased life satisfaction and increased depression in samples across North and South America.

It uses a 5-point Likert scale ranging from 1 (completely untrue) and 5 (completely true), with scores averaged for each subscale and higher scores indicating greater endorsement of the construct. We chose to use a 2-factor structure (BPN satisfaction and frustration) to develop a more parsimonious model.³⁸ BPN satisfaction assesses the extent to which an individual feels that their psychological needs are satisfied. For example, the BPNSF asked caregivers to rate how true they felt the following statement was; “I feel that my decisions reflect what I really want” (autonomy satisfaction). BPN frustration measures the extent to which an individual feels that their psychological needs are threatened. For example, the BPNSF asked caregivers to rate how true they felt the following statement was; “I feel pressured to do many things” (autonomy frustration). The BPNSF had good internal consistency in this sample (α=0.8).

Caregivers also completed the Parent Socioemotional Context of Feeding Questionnaire (PSCFQ) a subjective report of caregivers own emotions and behaviors when feeding their children.³⁹ This 24-item measure assesses the extent to which the socioemotional climate caregivers create when feeding their children is positive (autonomy-supportive, structured) or negative (controlling, or chaotic) and has demonstrated good internal consistency and construct validity with mothers of 4-8-year-old children. Caregivers rated each item from 0-4 with a greater score indicating a higher endorsement of the statement and we calculated the mean scores of the items within each subscale. This instrument was forward and back translated by 2 bilingual research assistants and pilot tested to ensure clarity. While not validated with a predominately Hispanic/Latinx population, the PSCFQ had acceptable-good internal consistency (α=0.7-0.8) in this sample.

Caregivers reported their age, gender, race, ethnicity, country of birth, highest education level achieved, income status, and employment as well as their child’s age and gender. Race was self-reported from a list including American Indian/ Alaska Native, Asian, Native Hawaiian or other Pacific Islander, Black or African American, White, more than one race, unknown/not reported, or other (specify). Ethnicity was self-reported as Hispanic or Latino, not Hispanic or Latino, unknow/ not reported. Income was reported as total household income during the past year (<25,000, $25,000-$34,999, $35,000-$49,999, $50,000-$74,999, $75,000-$99,999, $100,000-$149,999, $150,000-$199,999, >$200,000, unknown, do not wish to answer). Caregivers completed a 2-item validated screener to assess for any level of food insecurity.⁴⁰ We categorized the caregivers’ highest level of education achieved as some post-secondary education or no post-secondary education and we defined experiencing poverty as a family income of less than $25,000 per year, corresponding to the federal poverty threshold for a 4-person household in 2019.⁴¹ We also explored the impact of low-income, defined as <$35,000, corresponding to approximately 125-150% of the federal poverty threshold in 2019.

Statistical Analysis

We calculated descriptive statistics with mean (SD) for continuous variables and percentages for categorical variables. BPN satisfaction and BPN frustration were skewed, and regression residuals were non-normally distributed, therefore we conducted analyses using log transformed BPNSF scores. We then used Spearman’s rank correlations to assess the relationship between PSCFQ and BPNSF subscales with demographic variables. We fit separate robust linear regression models using modified generalized maximum likelihood (MM) estimation to calculate coefficients and SE for the associations between independent variables (BPN satisfaction and BPN frustration) with the dependent variables (autonomy, structure, control, and chaos).⁴² We identified a priori covariates that have been associated with food parenting in prior literature (caregivers’ age, gender, ethnicity, education level, household income, and food insecurity as well as child’s age and gender) as candidates to evaluate for inclusion in the models.^8,22 After assessing collinearity and model fit, we removed low-income and college education from the model due to their moderate correlation with food insecurity (r=0.3, r=−0.3, respectively). The fully adjusted model included covariates of caregivers' age, gender, ethnicity, and food insecurity as well as the target child’s age and gender. We then calculated adjusted R² to determine the proportion of variance explained by the unadjusted and fully adjusted models. A post hoc analysis found that the sample size of 66 was sufficient to detect an effect size of 0.1 at alpha 0.05 and power of 0.855 with 7 predictor variables included in the regression.

RESULTS

Demographic characteristics are presented in Table 1. Participants (n=66) were predominantly Hispanic/Latinx (n=57, 86%), women (n= 61, 92%), born outside of the US (n= 40, 61%) with a mean age of 34.2 ± 7.6 years. Approximately half of the participants had some college education (n=32, 49%), were experiencing poverty (n= 36, 55%), and were food insecure (n=30, 45%). The target children averaged 43 months old (3.6 years) and 53% were male (n=35). Table 2 presents the means, internal consistency, and correlation between each of the independent (BPNSF) and dependent (PSCF) variables. Table 3 presents unadjusted correlations between the independent and dependent variables with the sociodemographic variables. BPN satisfaction was correlated positively with age. BPN frustration was correlated positively with food insecurity and negatively with having some college education. With regards to the PSCF, autonomy support was positively correlated with being born in the US and negatively correlated with experiencing poverty. Structure, control, and chaos were not significantly correlated with any sociodemographic variables.

Table 1:

Demographic Characteristics of the Strong Families Start at Home Study (n=66))

	n (%)	Mean ± SD1
Caregiver
Gender
Women	61 (92)
Men	5 (8)
Age		34.2±7.6
Race2
White	24 (36)
Black	11 (17)
Multi-Racial	16 (24)
Other	15 (23)
Ethnicity (Hispanic)	57 (86)
Country of birth
US	26 (39)
Outside of the US3	40 (61)
Highest level of Education
Less than Highschool	9 (14)
Highschool Graduate or GED4	25 (39)
College (including some college)	32 (48)
Experiencing poverty (Household income <25,000/year)	36 (55)
Low-income (Household income <$35,000/ year)	51 (77)
Food Insecure (any level)	30 (45)
Child
Age in months		43.1±10.9
Gender
Girls	31 (47)
Boys	35 (53)

¹Standard deviation

²Self-reported from a list including American Indian/ Alaska Native, Asian, Native Hawaiian or other Pacific Islander, Black or African American, White, more than one race, unknown/not reported, or other

³Included caregivers born in Dominican Republic, Guatemala, Honduras, Puerto Rico, El Salvador, Peru, Mexico, and Ecuador

⁴General Educational Development high school equivalency test

Table 2:

Means, Internal Consistency¹, and Correlations² Between Basic Psychological Needs Satisfaction/Frustration and Parent Socio-emotional Context of Feeding

Variable	Mean± SD3	α	1	2	3	4	5
BPN4-Satisfaction	4.5±0.5	0.8	1
BPN4-Frustration	2.0±0.8	0.8	−0.30 *
Autonomy Support	2.4±1.0	0.8	0.10	−0.15
Structure	3.2±0.7	0.8	0.14	−0.15	0.37 **
Coercive Control	0.9±0.8	0.7	−0.11	0.35**	−0.01	−0.09
Chaos	1.2±0.8	0.7	−0.06	0.39 **	−0.13	−0.39**	0.45***

¹Cronbach’s alpha coefficient

²Spearman’s rank correlation coefficient

³Standard deviation

⁴Basic Psychological Needs

Significant correlations indicated as *p< 0.05

^**p<0.01

^***p<0.001.

Table 3:

Correlation¹ between Sociodemographic Variables with the Basic Psychological Need Satisfaction/Frustration and the Parent Socio-emotional Context of Feeding

	BPN2 Satisfaction	BPN2 Frustration	Autonomy Support	Structure	Coercive Control	Chaos
Caregiver
Gender	−0.11	−0.12	0.05	−0.11	−0.18	−0.10
Age	0.30*	−0.10	0.11	0.12	−0.01	−0.12
Race (Reference white)	−0.09	−0.11	0.10	0.20	−0.05	0.16
Ethnicity (Hispanic)	0.02	−0.18	0.22	0.19	0.08	−0.21*
Country of birth (Reference US)	−0.24	−0.21	0.35 **	0.15	−0.01	−0.14
Education (Reference College)	0.06	−0.33**	0.21	0.16	0.01	−0.16
Experiencing poverty (Household income <25,000/year)	0.07	0.22*	−0.28**	−0.07	−0.06	0.04
Low-income (Household income <$35,000/year)	0.04	0.20	−0.18	−0.17	−0.02	0.07
Food Insecure (any level)	−0.15	0.29*	0.03	0.17	−0.01	0.13
Child
Age in months	0.03	0.09	0.19	0.12	0.07	−0.17
Gender	0.09	0.19	0.08	−0.12	−0.05	0.13

¹Spearman’s rank correlation coefficient

²Basic Psychological Needs

Significant correlations indicated as *p< 0.05

^**p<0.01

^***p< 0.001

As shown in Table 4, BPN satisfaction was not associated with the feeding climates in unadjusted or adjusted models. In unadjusted models, BPN frustration was associated with both controlling and chaotic feeding climates (p = 0.001 and p = 0.001, respectively). Adjusting for covariates, BPN frustration continued to be significantly associated with a controlling climate (p< 0.001) and the model explained 18% of the variance in control (p = 0.001). Similarly, adjusting for covariates, BPN frustration was significantly associated with a chaotic feeding climate (p = .002) and the model explained 23% of the variance in chaos (p = 0.006).

Table 4:

Cross-sectional Association Between Basic Psychological Need Satisfaction and Frustration with Parent Socio-emotional Context of Feeding Questionnaire Subscales (n=66)

	Autonomy		Structure		Control		Chaos
	Estimate (SE)	p	Estimate (SE)	p	Estimate (SE)	p	Estimate (SE)	p
Crude
Satisfaction	1.30(0.85)	0.21	0.96(0.58)	0.05	−0.67(0.72)	0.99	−0.76(0.73)	0.41
Model R2	0.02		0.04		0.00		0.01
Frustration	−0.25(0.30)	0.30	−0.38(0.21)	0.15	0.80(0.24)	0.002	0.81(0.24)	<0.001
Model R2	0.01		0.03		0.13		0.14
Adjusted
Satisfaction	1.18(0.89)	0.26	0.91(0.59)	0.09	−0.70(0.77)	0.83	−0.45(0.75)	0.99
Model R2	0.09		0.17		0.05		0.14
Frustration	−0.33(0.34)	0.21	−0.49(0.23)	0.09	−0.96(0.26)	0.001	0.79(0.27)	0.007
Model R2	0.10		0.16		0.18		0.22

Calculated with linear regression using the modified generalized maximum likelihood (MM) method for robust estimates and standard errors adjusting for caregivers age, gender, ethnicity, and food insecurity as well as child age and gender. P-values for robust linear test comparing the full and reduced model with significance set at p<.05.

DISCUSSION

This secondary data analysis examined the association between caregivers’ BPNSF and the socioemotional context in which they feed their children. We found support for the hypothesis that BPN frustration is associated with controlling and chaotic feeding climates. The association between BPN frustration and controlling and chaotic feeding climates is noteworthy given the role that feeding plays in children’s dietary intake, eating behaviors, and obesity risk. If caregivers’ BPN frustration contributes to controlling and chaotic feeding climates in a causal pathway, it may serve as an important target for interventions seeking to modify how caregivers feed their children.

Individuals with high levels of need frustration have been shown to compensate, by either exerting power over others or disengaging from the context entirely.⁴³ For example, a caregiver who does not feel a sense of autonomy in their own life may compensate by exerting control where they can, such as at mealtimes, or allowing their child complete control. The finding that psychological needs frustration was associated with more controlling and chaotic feeding climates is consistent with the general parenting literature,^33,34 and, within an SDT framework, provides insight into why caregivers may create non-supportive socioemotional climates. This has important implications given the link between controlling and chaotic feeding climates and child diet quality and risk of developing overweight/obesity.^19,21,44 When caregivers express hostile or inconsistent emotions and used controlling or inconsistent behaviors when feeding their children they are less likely to have regular family meals and model healthy eating which are feeding practices that influence the development of children’s food preferences and eating behaviors.^45-47 Preschool-aged children in controlling feeding climates have been shown to consume fewer fruits, vegetables, and whole grains.^18,47,48 They are also more likely to eat in the absence of hunger and have higher weight status.^32,45,49 Preschool-aged children in chaotic feeding climates consume less fruits, vegetables, whole grains, and dairy foods.^44-46 They are also more likely to have a lower satiety response, higher interest in food, and increased weight status at elementary school entry.³² If BPN frustration influences the socioemotional climate caregivers create when feeding their children, it could be an important target for interventions with caregivers to improve child health. However, there has been little research in this area, thus it will be important to consider if variables not considered in this study confound the relationship or if the direction is reversed (a non-supportive socioemotional feeding climate causing BPN frustration).

Potential strategies found in the SDT literature may suggest mechanisms to increase resilience to psychological needs frustration on an individual level such as supporting mindfulness, and awareness.⁴³ Higher levels of awareness and mindfulness have been shown to attenuate the relationship between BPN frustration and maladaptive behaviors across contexts, including psychologically controlling parenting.^26,50 Mindfulness and acceptance-based parenting interventions have been effective in decreasing caregiver emotional reactivity, improving parenting behaviors, and increasing a sense of competence in parenting.^50,51 Preliminary evidence suggests that a mindfulness-based parenting intervention may be effective in slowing weight gain trajectories in preschool-aged children at risk for obesity.⁵²

While ameliorating the effects of psychological BPN frustration is important, researchers must also identify contextual factors that contribute to BPN frustration in populations at risk for childhood obesity so that effective solutions can be designed. Discrimination and acculturation stress may contribute to BPN frustration,⁵³ however research on contextual factors that increase need frustration is limited. Understanding the role of these factors is particularly important in the context of interventions serving historically marginalized families, as both controlling and chaotic feeding have been associated with race/ethnicity, income status, and educational attainment in the literature, although not seen in this study.^54,55 Programs that decrease acculturation stress and discrimination, such as culturally-tailored programs and community-level resources that provide social support and improve neighborhood conditions, may decrease need frustration by offering a potential strategy to strengthen obesity prevention efforts.^56-58

Contrary to our hypothesis, BPN satisfaction was not associated with autonomy-supportive or structured feeding climates. While we found an apparent trend where those with higher levels of BPN satisfaction scoring higher on supportive practices, no significant association between these constructs was found. These results differ from Costa et al.’s findings that did show a significant association between BPN satisfaction and autonomy supportive general parenting.³⁴ While our estimates trended in the hypothesized direction for all PSCFQ subscales, BPN satisfaction was highly skewed and the sample size was small, which may have limited our power to detect a relationship.

Another possible explanation for our null findings may be a difference between general BPNSF and the socioemotional climate caregivers create and BPNSF and the socioemotional climate caregivers create when feeding.⁴⁸ While overall BPN satisfaction may result in a generally more supportive socioemotional climate, the context of feeding presents unique challenges, particularly for caregivers of pre-school-aged children. For example, fussy eating, picky eating, and food neophobia (a normal developmental phase characterized by refusal of novel foods) are common at this age.^59-61 A systematic review of 10 qualitative studies found that caregivers experience preschool aged children’s fussy eating, picky eating, and food neophobia in ways that could influence their BPN satisfaction and/or parenting behaviors.⁶² For example, caregivers experience low parental-self efficacy and feelings of concern, frustration, and guilt when children refuse food at meals.⁶² For some caregivers this socioemotional climate could influence their own BPN for competence or relatedness if they feel unable or disconnected when feeding their children. While the BPNSF scale has been adapted to specific contexts such as work, sport, and romantic and sibling relationships no such scale has been created in the parenting or feeding context.³⁸ Alternatively, caregivers in 7 of the 10 studies reported adapting their feeding practices, often by decreasing structure, to avoid conflict and stress at meals.⁶² Unfortunately, the small sample size of the current analysis limited our ability to examine if child eating behaviors such as food fussiness moderated the relationship between BPN satisfaction and a supportive socioemotional feeding climate.

Some limitations to this study are important to note as we interpret the findings. One such limitation is that interviewer-administered surveys may have introduced social desirability bias. Interviewer-administered surveys are a strength as they increase the response rate, allow for clarification of questions and wording, and do not require participant literacy. However, participants may have wanted to provide more positive responses (reporting more desirable feeding climates or higher levels of needs satisfaction). Also, caregivers completed BPNSF on their overall satisfaction and frustration of their psychological needs and were not specific to the context of feeding their children. Lastly, the study sample of this pilot trial is small and composed predominantly of low-income, Hispanic /Latinx women born outside of the US, and interested in participating in a health promotion intervention. Thus, the findings may not generalize to a larger more diverse population, or caregivers less interested in making changes regarding their child’s health. However, this study has numerous strengths including a research question and measurement selection grounded in SDT. It also provides important information on modifiable factors associated with feeding in families whose children are at increased risk for developing obesity.

IMPLICATIONS FOR RESEARCH AND PRACTICE

Overall, this study provides important insights into the role that caregivers’ basic psychological need frustration plays in how they feed their children. Our results suggest that interventions designed to decrease controlling or chaotic feeding could consider ways in which caregivers’ needs may be frustrated. However, it is not yet clear if this relationship is causal. Future longitudinal research with larger samples could illuminate the nature and direction of this relationship. If BPN frustration causes caregivers to create more controlling and chaotic socioemotional climates, identifying and prioritizing targets that increase resilience to BPN frustration (culturally tailored awareness-based parenting interventions or social support) could strengthen obesity prevention efforts.

Abbreviations:

SDT

Self-Determination Theory

PSCFQ

Parent Socio-emotional Context of Feeding

CEBQ

Childhood Eating Behavior Questionnaire