Abstract
Introduction
Childhood obesity and sedentary lifestyles are growing public health concerns, with familial practices playing a critical role in shaping children’s physical activity attitudes. The influence of family attitudes and behaviours regarding nutrition and exercise has been highlighted as a pivotal determinant in promoting healthier choices among children. This study aims to explore the relationship between family nutrition and physical activity practices and children’s attitudes toward physical activity.
Methods
A descriptive cross-sectional study was conducted with 633 children and their parents from a tertiary hospital in eastern Turkey. Data were collected using three tools: (1) a sociodemographic form, (2) the Family Nutrition and Physical Activity Screening Scale (FNPASS), and (3) the Youth Physical Activity Attitude Scale in Children and Young People. Data were analysed using SPSS software and statistical analyses included Pearson correlation, linear regression, and ANOVA to explore associations and group differences.
Results
Family nutrition and physical activity practices significantly predicted children’s physical activity attitudes. Physical activity positive attitudes (mean score: 3.74 ± 0.88) correlated strongly with healthier family practices (FNPASS mean: 52.44 ± 7.65; r = 0.648, p < 0.01), while physical activity negative attitudes (mean: 2.46 ± 0.92) showed inverse relationships (r = -0.596, p < 0.01). Higher parental education, urban residency, and income levels were associated with more physical activity positive attitudes (p < 0.001). Underweight children had higher positive attitude scores than overweight/obese peers (p < 0.001).
Conclusion
Family environments significantly influence children’s physical activity attitudes, with socioeconomic factors acting as key modifiers. This study demonstrates that family nutrition and physical activity practices significantly influence children’s attitudes toward physical activity. Healthier family habits correlated with more positive attitudes in children, particularly among families with higher parental education and urban residency. Public health initiatives should focus on educating parents about healthy practices while ensuring equitable access to physical activity opportunities for children.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-025-24230-w.
Keywords: Family, Children, Nutrition, Activity, Family nutrition, Physical activity, Health behaviours
Introduction
Childhood is a critical developmental stage in which individuals form healthy lifestyle habits. Especially the 7–12 age range is of great importance in terms of acquiring these habits due to the rapid changes in physical, cognitive, and social development. In children, physical activity promotes bone health, encourages healthy growth and development of muscle, and improves motor and cognitive development [1]. Sedentary lifestyle and unhealthy diet significantly increase the risk of childhood obesity and related chronic diseases [2].
The existing literature shows that families have a significant impact on children’s physical activity attitudes and behaviours [3]. Families’ attitudes, beliefs, and behaviours towards physical activity can directly affect children’s choices and habits in this regard. Having healthy eating habits, keeping healthy foods at home, having regular family meals, and encouraging children to engage in physical activity help children develop similar habits. In this context, a comprehensive examination of the effect of familial factors on children’s physical activity attitudes is essential in terms of public health. However, factors such as the sedentary lifestyle brought about by modern life, the increase in fast food consumption, the prolonged use of screens, and the decrease in the time allocated for physical activity make it difficult for children to gain healthy eating and physical activity habits. Therefore, it is crucial for families to develop practices that support the healthy lifestyle choices of children between the ages of 7–12 and to scientifically examine the effect of these practices on children’s physical activity attitudes.
Moreover, parental lifestyle factors, such as Body Mass Index (BMI) and dietary patterns, significantly reflect in children’s nutritional intake and physical activity levels [4]. Notably, children from families with healthier nutritional and activity patterns exhibit improved health metrics, which may be leveraged in interventions aimed at curbing obesity [5]. Existing studies emphasize that the socio-economic context, including parental education and family income, shapes children’s engagement in healthy eating and active lifestyles [6]. In addition, demographic factors such as parental education, family income, socioeconomic status, and parental BMI have a clear impact on family nutrition and physical activity practices, as well as children’s attitudes and behaviours toward physical activity [6]. Children from families with higher socioeconomic status, higher parental education, and healthier parental behaviours tend to have better nutrition and physical activity habits [6–9]. This systemic perspective underscores the importance of addressing both familial and societal factors in devising comprehensive health promotion strategies targeted at children [10].
The growing prevalence of childhood obesity and related health issues has prompted a critical need to examine factors contributing to children’s nutritional and physical activity behaviours. Various studies have indicated that a favourable attitude towards physical activity significantly correlates with enhanced participation in physical activities among children, underscoring the role of family in shaping these attitudes through nutritional habits and lifestyle practices [11]. Specifically, the influence of family attitudes and behaviours regarding nutrition and exercise has been highlighted as a pivotal determinant in promoting healthier choices among children [6]. Although previous studies have explored the impact of family practices on children’s health behaviours, few have simultaneously examined how family nutrition and physical activity patterns directly relate to children’s attitudes toward physical activity. Moreover, there is limited evidence on how sociodemographic variables such as parental education, employment, and income intersect with these patterns in middle-income countries. This study addresses this gap by exploring these complex associations in a large, diverse sample from eastern Turkey. This study aims to explore the relationship between family nutrition and physical activity practices and children’s attitudes toward physical activity.
Research hypotheses
H1: There is a significant positive relationship between family nutrition and physical activity practices and children’s positive attitudes toward physical activity.
H2: There is a significant negative relationship between family nutrition and physical activity practices and children’s negative attitudes toward physical activity.
H3: Family nutrition and physical activity practices significantly predict children’s physical activity attitudes.
H4: Children’s physical activity attitudes and family practices differ significantly by sociodemographic characteristics (e.g., parental education, employment status, income level, place of residence, BMI, and gender).
H5: There are significant correlations between children’s physical activity attitudes and continuous variables such as age, height, weight, and BMI.
Methods
Study design
This study was a descriptive cross-sectional study.
Settings, participants, and sampling
The study population consisted of children aged 7 to 12 years and their parents who were admitted to a tertiary public hospital in eastern Turkey during the data collection period. The inclusion criteria were: (1) children aged between 7 and 12 years, (2) both child and parent willing to participate, (3) parents able to read and complete the questionnaire in Turkish. Exclusion criteria included: (1) children with diagnosed cognitive or physical impairments that could affect their ability to engage in physical activity or understand instructions, (2) incomplete data. It is important to note that the children included in this study were not derived from a clinical population. Instead, participants were selected from those attending the paediatric outpatient department for routine health check-ups and minor non-urgent issues (e.g., seasonal allergies, growth monitoring). No children undergoing treatment for chronic or acute serious medical conditions were included.
A convenience sampling method was used, and a total of 633 parents and their children were included. While convenience sampling method allowed for efficient recruitment of a relatively large and diverse sample, it may introduce selection bias and limit the generalizability of the results.
Sample size was determined based on power analysis using G*Power, assuming a medium effect size (f² = 0.15), α = 0.05, power = 0.95, and up to 10 predictors. The required minimum sample size was calculated to be 172. The final sample of 633 exceeded this threshold, enhancing the robustness and generalizability of the results.
Data collection
Data were collected between January 20, 2025 and February 16, 2025, using questionnaire technique with printed hard-copy questionnaires consisting of 3 parts. The aim of the study was explained to the participants. The time to fill out the questionnaire took about 15 min.
Data collections forms
Socio-demographic information form
This socio-demographic information form was filled in by the parents. It included 14 questions regarding sociodemographic variables such as the age of the child and the parent, gender, the education level of the parents, family income, and the occupation of the parent (Supplementary file). In addition to demographic details, parents were asked whether their child had any known health conditions diagnosed or reported by professionals (e.g., anxiety, asthma, learning disabilities). These items were collected to provide descriptive context and support the general health characterization of the sample. However, this information was not included in the main statistical analyses, as the study’s focus was on the influence of family practices and sociodemographic variables on physical activity attitudes. Children with serious medical conditions or cognitive impairments affecting their ability to engage in physical activity were excluded from the sample at the recruitment stage.
Family Nutrition and Physical Activity Screening Scale (FNPASS)
FNPASS is a screening tool developed by Ihmels et al. [12]. This scale evaluates family environments and children’s nutrition and physical activity habits. The Turkish validity and reliability of the scale were conducted by Ekıcı et al. [13]. The Turkish form of the scale consists of 20 items and each item is rated on a four-point Likert type scale with options 1 = never/hardly ever, 2 = sometimes, 3 = often, 4 = usually/always. The scale includes 10 subdimensions and two questions for each sub-dimension. Seven of the items (3, 4, 5, 7, 10, 13) were inversely coded. The sub-dimensions are made of “meals in the family”, “family eating habits”, “food choices”, “beverage choices”, “limitation/rewarding”, “screen time”, “healthy environment”, “family activity”, “child activity”, and “family planning/sleep pattern”. The total score is calculated by summing the scores obtained from each sub-dimension. The total score is then used to interpret the physical activity and nutritional status of the family. Since there is no cutoff value when comparing total scores, The total score ranges from 20 to 80, with high scores indicating healthy family practices and behaviours, while low scores indicate less healthy family practices related to physical activity and nutrition.
Reliability analysis was performed by medium to high reliability (0.422–0.925) and good internal consistency (Cronbach’s alpha = 0.724) were achieved. In this study, Cronbach’s alpha value of the Family Nutrition and Physical Activity Screening Scale was found to be 0.912. This scale was filled in by the parents who participated in the study.
Youth physical activity attitude scale in children and young people
The Youth Physical Activity Attitude Scale in Children and Adolescents was developed by Simonton et al. [14] to measure the attitudes of primary and secondary school students towards physical activity. This scale was prepared in 5-point Likert type and consisted of 12 items. The internal consistency coefficients of the scale, which has two sub-dimensions, positive and negative attitude, are 0.78 and 0.75, respectively. The scale consists of 2 sub-dimensions and 12 items in its original form. The positive attitude sub-dimension consists of 7 items and the negative attitude sub-dimension consists of 5 items. In this study, Cronbach’s alpha value of the physical activity positive attitude sub-dimension was found to be 0.896, and the physical activity negative attitude sub-dimension was found to be 0.886. The Turkish validity and reliability of the scale were conducted by Uyhan et al. [15]. This scale was filled in by the children who participated in the study.
Data analysis
The data were analysed through SPSS 22.0 statistical program. Frequency and percentage analyses were used to determine the descriptive characteristics of the children participating in the study, and mean and standard deviation statistics were used to examine the scales. Kurtosis and skewness values were examined to determine whether the research variables showed normal distribution (Table 2). In the relevant literature, it is accepted as a normal distribution that the results of the kurtosis skewness values of the variables are between + 1.5 and − 1.5 [16] and + 2.0 and − 2.0 [17]. It was determined that the variables showed normal distribution. Parametric methods were used in the analysis of the data.
Table 2.
Mean scores and standard deviations for children’s physical activity attitude subscales and family nutrition/physical activity screening scale
| n | Mean | SD | Min. | Max. | Kurtosis | Skewness | Alpha | |
|---|---|---|---|---|---|---|---|---|
| Physical activity positive attitude | 633 | 3.74 | 0.88 | 1.00 | 5.00 | −0.55 | −0.14 | 0.89 |
| Physical activity negative attitude | 633 | 2.46 | 0.92 | 1.00 | 5.00 | −0.82 | −0.13 | 0.88 |
| Family Nutrition and Physical Activity Screening Scale | 633 | 52.44 | 7.65 | 34.00 | 72.00 | −0.31 | 0.41 | 0.91 |
Physical activity attitude subscale scores represent item means (range 1–5). FNPASS scores represent sums (range 20–80).
Pearson correlation and linear regression analyses were conducted to examine the relationships between the scores of the Family Nutrition and Physical Activity Screening Scale and the sub-dimensions of the Youth Physical Activity Attitude Scale (positive and negative attitude scores). Independent samples t-test and one-way analysis of variance (ANOVA) were used to compare the mean scores of the scales based on the children’s sociodemographic characteristics. When a significant difference was found in ANOVA, post hoc tests (Tukey and LSD) were applied to identify the specific group differences.
Ethical consideration
Ethical approval was obtained from the Mardin Artuklu University Non-Invasive Clinical Research Ethics Committee (Date: January 7, 2025; Reference number: 2025/1–2). Institutional permission was granted by the Mardin Provincial Directorate of Health (Date: January 15, 2025; Reference number: E-68051626-949-265610386). Written informed consents were obtained from all individual participants and the parents or legal guardians of any participant under the age of 16. The present study was conducted according to the principles of the Declaration of Helsinki.
Results
Descriptive characteristics of participants were provided in Table 1. When the descriptive characteristics of the children participating in the study were examined, 50.6% of the participants were female (n = 320). When examining parental status, 472 participants (74.5%) were mothers and 161 participants (25.5%) were fathers. When the places of residence of the participants were evaluated, it was determined that 50.7% of them resided in the city centre (n = 321), 39.3% in the district (n = 249), and 10.0% in the village (n = 63). When the distribution of the education level of the mothers was examined, it was seen that 28.1% had primary school (n = 178), 27.2% had secondary school (n = 172), 19.7% had high school (n = 125) and 25.0% had bachelor’s degree level or higher (n = 158). Among participating parents, 28.1% of mothers (n = 178) and 92.7% of fathers (n = 587) reported being employed. Family income was categorized based on self-reported household financial status and 12.8% of the families had lower income than expenditure (n = 81), 63.7% had balanced income and expenditure (n = 403), and 23.5% had higher income than expenditure (n = 149).
Table 1.
Descriptive characteristics of participants
| Variables | n | % |
|---|---|---|
| Child’s gender | ||
| Male | 313 | 49.4 |
| Female | 320 | 50.6 |
| Parents participating in this study | ||
| Mother | 472 | 74.5 |
| Father | 161 | 25.5 |
| Place of residence | ||
| City centre | 321 | 50.7 |
| District | 249 | 39.3 |
| Village | 63 | 10.0 |
| Mother’s education level | ||
| Primary school | 178 | 28.1 |
| Secondary school | 172 | 27.2 |
| High school | 125 | 19.7 |
| Bachelor’s degree and higher | 158 | 25.0 |
| Father’s education level | ||
| Primary school | 87 | 13.7 |
| Secondary school | 163 | 25.8 |
| High school | 179 | 28.3 |
| Bachelor’s degree and higher | 204 | 32.2 |
| Employment status of mother | ||
| Employed | 178 | 28.1 |
| Not employed | 455 | 71.9 |
| Employment status of father | ||
| Employed | 587 | 92.7 |
| Not employed | 46 | 7.3 |
| Income | ||
| Income is lower than expenditure | 81 | 12.8 |
| Income equal to expenditure | 403 | 63.7 |
| Income is higher than expenditure | 149 | 23.5 |
| BMI | ||
| Underweight | 342 | 54.0 |
| Healthy weight | 252 | 39.8 |
| Overweight | 39 | 6.2 |
| Mean | SD | |
| Age of the child | 9.81 | 1.87 |
| Height | 130.06 | 12.19 |
| Weight | 32.79 | 10.88 |
| BMI | 19.51 | 6.65 |
| Age of the mother | 38.19 | 7.41 |
| Age of the father | 41.79 | 8.17 |
| Number of children in the family | 3.19 | 1.60 |
According to the BMI classification, 54.0% (n = 342) of the children were underweight, 39.8% (n = 252) were healthy weight and 6.2% (n = 39) were overweight or obese. The mean age of the children was 9.81 ± 1.87 years (min = 7; max = 34), mean height 130.06 ± 12.19 cm (min = 86; max = 160), mean weight 32.79 ± 10.88 kg (min = 20; max = 139) and the BMI was 19.51 ± 6.65 (min = 11.83; max = 77.41). The mean age of the mothers was 38.19 ± 7.41 years (min = 22; max = 60), and the mean age of the fathers was 41.79 ± 8.17 years (min = 26; max = 70). The mean number of children per family was 3.2 ± 1.6 (min = 1; max = 11).
Table 2 showed the mean scores and standard deviations for children’s physical activity attitude subscales and family nutrition/physical activity screening scale. According to the results obtained in the study, the mean of physical activity positive attitude scores was 3.74 ± 0.88 (min = 1.000; max = 5.000). The mean of physical activity negative attitude scores was 2.46 ± 0.92 (min = 1.000; max = 5.000). The mean score of the family nutrition and physical activity screening scale was 52.44 ± 7.65 (min = 34.000; max = 72.000).
Correlation analysis results are depicted in Table 3 and showed a negative and highly significant relationship between physical activity positive attitude and physical activity negative attitude (r=−0.733, p < 0.01), a positive and significant relationship between physical activity positive attitude and family nutrition and physical activity attitude (r = 0.648, p < 0.01), and a negative and significant relationship between physical activity negative attitude and family nutrition and physical activity attitude (r=−0.596, p < 0.01).
Table 3.
Correlation analysis between scale scores
| Physical activity positive attitude | Physical activity negative attitude | Family nutrition and physical activity screening scale | ||
|---|---|---|---|---|
| Physical activity positive attitude | r | 1.000 | ||
| p | 0.000 | |||
| Physical activity negative attitude | r | −0.733a | 1.000 | |
| p | 0.000 | 0.000 | ||
| Family nutrition and physical activity screening scale | r | 0.648a | −0.596a | 1.000 |
| p | 0.000 | 0.000 | 0.000 |
a0.01<; Pearson correlation analysis
*<0.05
Table 4 showed the effect of family nutrition and physical activity screening on physical activity in children. Regression analysis results showed that the Family Nutrition and Physical Activity Screening Scale score was a significant predictor of both positive and negative attitudes toward physical activity in children. Specifically, higher family nutrition and activity scores significantly predicted higher positive physical activity attitude scores (β = 0.648, t = 21.389, p < 0.001), and the model accounted for approximately 42% of the variance (F = 457.501, p < 0.001, R² = 0.419). Conversely, the same predictor variable was negatively associated with children’s negative attitudes toward physical activity (β = −0.596, t = −18.622, p < 0.001), explaining 35.4% of the variance (F = 346.787, p < 0.001, R² = 0.354).
Table 4.
The effect of family nutrition and physical activity screening on physical activity in children
| Dependent variable | Independent variable | ß | t | p | F | Model (p) | R 2 |
|---|---|---|---|---|---|---|---|
| Physical activity positive attitude | Constant | −0.180 | −0.970 | 0.332 | 457.501 | 0.000 | 0.419 |
| Family nutrition and physical activity screening scale | 0.648 | 21.389 | 0.000 | ||||
| Physical activity negative attitude | Constant | 6.241 | 30.459 | 0.000 | 346.787 | 0.000 | 0.354 |
| Family nutrition and physical activity screening scale | −0.596 | −18.622 | 0.000 |
Linear regression analysis
When Table 5 was examined, it was determined that physical activity positive attitude, physical activity negative attitude, and family nutrition and physical activity screening scores did not differ significantly according to the gender of the children (p > 0.05). In the analyses conducted according to the variable of place of residence, it was seen that all scale scores differed significantly and children living in the province had higher positive attitude and family nutrition and physical activity screening scores, while those living in the district had higher negative attitude scores (p < 0.001).
Table 5.
Differentiation of scale scores according to demographic characteristics
| Demographic characteristics | n | Physical activity positive attitude | Physical activity negative attitude | Family Nutrition and Physical Activity Screening Scale |
|---|---|---|---|---|
| Child’s gender | Mean ± SD | Mean ± SD | Mean ± SD | |
| Male | 313 | 3.71 ± 0.86 | 2.51 ± 0.90 | 51.89 ± 7.78 |
| Female | 320 | 3.79 ± 0.91 | 2.42 ± 0.95 | 52.99 ± 7.50 |
| t= | −1.101 | 1.171 | −1.799 | |
| p= | 0.272 | 0.242 | 0.072 | |
| Place of residence | Mean ± SD | Mean ± SD | Mean ± SD | |
| City centre | 321 | 4.07 ± 0.88 | 2.18 ± 0.91 | 54.64 ± 8.43 |
| District | 249 | 3.37 ± 0.68 | 2.83 ± 0.76 | 50.05 ± 6.21 |
| Village | 63 | 3.64 ± 1.03 | 2.47 ± 1.09 | 50.76 ± 5.07 |
| F= | 51.751 | 38.988 | 29.228 | |
| p= | 0.000 | 0.000 | 0.000 | |
| PostHoc= | 1 > 2, 3 > 2, 1 > 3 (p < 0.05) | 2 > 1, 3 > 1, 2 > 3 (p < 0.05) | 1 > 2, 1 > 3 (p < 0.05) | |
| Mother’s education level | Mean ± SD | Mean ± SD | Mean ± SD | |
| Primary school | 178 | 3.84 ± 0.92 | 2.32 ± 1.03 | 52.23 ± 8.00 |
| Secondary school | 172 | 3.56 ± 0.75 | 2.66 ± 0.74 | 50.41 ± 6.74 |
| High school | 125 | 3.48 ± 0.80 | 2.77 ± 0.87 | 51.63 ± 6.92 |
| Bachelor’s degree and higher | 158 | 4.06 ± 0.93 | 2.18 ± 0.91 | 55.55 ± 7.85 |
| F= | 14.627 | 14.411 | 14.046 | |
| p= | 0.000 | 0.000 | 0.000 | |
| PostHoc= | 4 > 1, 1 > 2, 4 > 2, 1 > 3, 4 > 3 (p < 0.05) | 2 > 1, 3 > 1, 2 > 4, 3 > 4 (p < 0.05) | 4 > 1, 1 > 2, 4 > 2, 4 > 3 (p < 0.05) | |
| Father’s education level | Mean ± SD | Mean ± SD | Mean ± SD | |
| Primary school | 87 | 4.02 ± 1.04 | 2.28 ± 1.15 | 55.13 ± 8.28 |
| Secondary school | 163 | 3.64 ± 0.76 | 2.45 ± 0.85 | 49.85 ± 6.87 |
| High school | 179 | 3.52 ± 0.77 | 2.79 ± 0.76 | 51.15 ± 6.65 |
| Bachelor’s degree and higher | 204 | 3.92 ± 0.93 | 2.28 ± 0.94 | 54.51 ± 7.91 |
| F= | 10.596 | 11.838 | 17.777 | |
| p= | 0.000 | 0.000 | 0.000 | |
| PostHoc= | 1 > 2, 4 > 2, 1 > 3, 4 > 3 (p < 0.05) | 3 > 1, 3 > 2, 3 > 4 (p < 0.05) | 1 > 2, 4 > 2, 1 > 3, 4 > 3 (p < 0.05) | |
| Employment status of mother | Mean ± SD | Mean ± SD | Mean ± SD | |
| Employed | 178 | 4.03 ± 0.99 | 2.15 ± 0.92 | 55.92 ± 8.49 |
| Not employed | 455 | 3.64 ± 0.82 | 2.59 ± 0.90 | 51.09 ± 6.85 |
| t= | 5.083 | −5.552 | 7.430 | |
| p= | 0.000 | 0.000 | 0.000 | |
| Employment status of father | Mean ± SD | Mean ± SD | Mean ± SD | |
| Employed | 587 | 3.77 ± 0.90 | 2.44 ± 0.92 | 52.78 ± 7.68 |
| Not employed | 46 | 3.41 ± 0.65 | 2.80 ± 0.88 | 48.22 ± 5.85 |
| t= | 2.680 | −2.594 | 3.936 | |
| p= | 0.001 | 0.009 | 0.000 | |
| Income | Mean ± SD | Mean ± SD | Mean ± SD | |
| Income is lower than expense | 81 | 3.55 ± 0.99 | 2.61 ± 1.05 | 49.77 ± 7.50 |
| Income equal to expenditure | 403 | 3.58 ± 0.80 | 2.63 ± 0.84 | 50.80 ± 6.58 |
| Income is higher than expense | 149 | 4.31 ± 0.82 | 1.92 ± 0.87 | 58.36 ± 7.46 |
| F= | 44.653 | 37.022 | 72.013 | |
| p= | 0.000 | 0.000 | 0.000 | |
| PostHoc= | 3 > 1, 3 > 2 (p < 0.05) | 1 > 3, 2 > 3 (p < 0.05) | 3 > 1, 3 > 2 (p < 0.05) | |
| BMI | Mean ± SD | Mean ± SD | Mean ± SD | |
| Underweight | 342 | 3.94 ± 0.87 | 2.24 ± 0.91 | 53.65 ± 7.99 |
| Healthy weight | 252 | 3.56 ± 0.85 | 2.73 ± 0.92 | 51.25 ± 7.07 |
| Overweight | 39 | 3.23 ± 0.84 | 2.73 ± 0.57 | 49.62 ± 6.41 |
| F= | 21.957 | 23.638 | 10.280 | |
| p= | 0.000 | 0.000 | 0.000 | |
| PostHoc= | 1 > 2, 1 > 3, 2 > 3 (p < 0.05) | 2 > 1, 3 > 1 (p < 0.05) | 1 > 2, 1 > 3 (p < 0.05) | |
| r/p | r/p | r/p | ||
| Age of the child | −0.097/0.014 | 0.034/0.397 | −0.120/0.003 | |
| Height | −0.014/0.718 | −0.033/0.404 | −0.173/0.000 | |
| Weight | −0.119/0.003 | 0.084/0.034 | −0.222/0.000 | |
| BMI | −0.113/0.004 | 0.106/0.008 | −0.109/0.006 | |
| Age of the mother | 0.054/0.178 | −0.075/0.060 | −0.079/0.046 | |
| Age of the father | 0.020/0.695 | −0.001/0.987 | −0.084/0.049 |
F Anova test, T Independent groups T-Test, PostHoc Tukey, LSD Pearson correlation analysis
In the analysis conducted using one-way ANOVA, it was determined that physical activity attitudes and family nutrition and activity scores significantly differed based on mothers’ education level (p < 0.001). It was determined that the positive attitude and family attitude scores of the children of mothers with bachelor’s degree and higher education level were higher, and the negative attitude scores were lower. Significant differences were found in all scales in terms of father’s education level (p < 0.001) and it was found that the positive attitude and family attitude scores were higher in the children of fathers with bachelor’s degree and higher education level.
In the comparison made according to the mother’s employment status, it was determined that the positive attitude and family attitude scores of the children of working mothers were higher and the negative attitude scores were lower (p < 0.001). Similarly, in terms of father’s employment status, it was determined that the positive attitude and family attitude scores of the children of working fathers were higher and the negative attitude scores were lower (p < 0.05).
In the analyses conducted according to the income status variable, it was found that the positive attitude and family attitude scores were higher and the negative attitude scores were lower in the children of families whose income was higher than the expenditure (p < 0.001).
In the analysis made according to BMI groups, it was determined that the positive attitude and family attitude scores of the underweight children were higher than those with normal weight and overweight, while the negative attitude scores were lower (p < 0.001).
In the comparison made using Pearson correlation analysis, significant negative relationships were found between child age and both positive physical activity attitude scores (r = −0.097, p = 0.014) and family nutrition and physical activity scores (r = −0.120, p = 0.003). Significant negative correlations were found between child height and family attitude (r=−0.173, p < 0.001), child weight and positive attitude (r=−0.119, p = 0.003) and family attitude (r=−0.222, p < 0.001). Significant negative correlations were found between BMI and positive attitude (r=−0.113, p = 0.004) and family attitude (r=−0.109, p = 0.006). In the variables of mother’s and parent’s age, a significant negative relationship was found only between their age and family attitude (r=−0.084, p = 0.049).
Discussion
This study aimed to examine the relationship between family nutrition and physical activity practices and children’s attitudes toward physical activity among 7–12-year-olds in eastern Turkey. Specifically, this study investigated how familial behaviours and socioeconomic factors influence children’s positive and negative attitudes about physical activity, while accounting for key demographic variables.
This study revealed a significant positive relationship between family nutrition and physical activity practices and children’s positive attitudes toward physical activity (H1), and a significant negative relationship with children’s negative attitudes (H2). The results supported both hypotheses. The results that families’ attitudes towards nutrition and physical activity affect children’s attitudes towards physical activity are supported by many different studies. Consistent with the results of this study, prior research confirms that family nutrition and physical activity habits correlate with children’s attitudes toward physical activity.
Regression analysis further validated the predictive role of family behaviours on children’s attitudes (H3). Family nutrition and physical activity scores significantly predicted both positive attitudes (β = 0.648, p < 0.001; R² = 0.419) and negative attitudes (β = −0.596, p < 0.001; R² = 0.354). These results are consistent with previous research indicating that parental behaviours and routines exert a long-term influence on children’s health-related attitudes and behaviours [11, 18]. Notably, the strength of these associations highlights the potential for using family-based assessments such as the FNPASS to identify children at risk of negative lifestyle patterns and guide early interventions.
This study found that the positive attitudes of children aged 8–10 years towards physical activity were associated with normal healthy weight. Several studies have indicated that positive attitudes toward physical activity correlate with higher engagement in physical activities among children. Özer et al. noted that a positive attitude can be a robust predictor of physical activity engagement and that it helps children overcome barriers to being active, which may influence their weight management outcomes [11]. In addition, the physical activity and nutritional attitudes of families during the pandemic was associated with the risk of obesity of children and significant decreases in physical activity levels [18]. This situation shows that family behaviours have a direct effect on children’s behaviours [18].
Socio-demographic factors such as parental education level, employment status, and income were significantly associated with children’s physical activity attitudes. For example, children of parents with higher education exhibited more positive attitudes. These results largely coincide with the existing literature and provide important insights about how families’ living conditions shape children’s health behaviours. Higher parental education levels are correlatively linked to healthier dietary practices and increased physical activity in children [8, 9]. Families with higher education levels and incomes may have greater access to resources supporting physical activity (e.g., sports programs) and nutrition (e.g., affordable fresh produce). Structural barriers may limit opportunities for lower-income families, as participation in organised sports frequently requires financial investments. This underscores the importance of acknowledging familial educational backgrounds when investigating children’s nutrition and activity levels. The effect of parental education level on children’s physical activity attitudes has been shown in many studies. For example, Muñoz-Galiano et al. [19] found that children of parents with a high level of education participated in more physical activity and exhibited less sedentary behaviours. It has been emphasized that parental education, especially at the primary and high school level, is strongly associated with children’s exercise patterns [19]. These results are in line with the fact that children of mothers and fathers with a bachelor’s degree or higher education level have higher positive attitude scores.
In addition, high family income levels show that children support both positive physical activity attitudes and healthy living habits of families. Research indicates that children from families with higher income levels are more likely to participate in organized physical activities and generally exhibit better fitness outcomes compared to their peers from lower-income families. For example, a study found a significant association between family income and children’s physical fitness, where children from higher-income families tended to have better fitness levels, suggesting that higher economic status facilitates access to resources and opportunities for physical activity [20]. This is consistent with the fact that high-income children have higher positive attitude scores.
This study revealed that children of working mothers develop more positive attitudes and have higher family attitude scores. This was supported by existing literature which found that working parents, especially mothers, can transfer positive work values and life skills to their children [21]. In addition, the study of Alharbi et al. [22] found that education, income, and parental employment status had significant effects on children’s perceptions and participation in physical activity. This study emphasizes the importance that parents attach to physical activity translates into long-term behaviours in children [22].
This study revealed that children living in the province have more positive attitudes. This result indicated that the influence of environment, family engagement, and socioeconomic factors on children’s attitudes toward physical activity and overall well-being. In line with this result, existing literature indicates that students’ attitudes toward physical activity significantly shape their participation and intention levels in organized physical activities, suggesting a potential link between geographic location and attitude formation [23]. In contrast to this result, Cottrell et al. [24] found that children in rural settings may exhibit better physical activity habits, as these environments facilitate outdoor play and activities. The combination of supportive familial structures and environmental factors in provincial settings fosters positive attitudes among children.
Implications and recommendations
Factors such as parental education, income level and employment status indirectly shape children’s attitudes, and this plays a critical role in the establishment of healthy living habits in childhood. The results of this study on the relationship between family nutrition, physical activity practices, and children’s attitudes toward physical activity carry significant implications for public health, education, and family engagement strategies. Given that familial influence is a paramount factor in shaping children’s nutritional and physical activity behaviours, interventions should prioritize the involvement of families in health promotion programs. Creating an environment where healthy eating and active lifestyles are modelled and encouraged, parents can create a supportive framework for their children’s health behaviours.
Developing comprehensive educational programs that target both parents and children is needed for maximizing the effectiveness of health interventions. Such programs could navigate the challenges presented by the increasing independence of children, who often make nutritional choices without parental guidance. Educational workshops that enhance nutrition knowledge among parents are needed, as this knowledge is strongly related to better dietary practices adopted by children.
In light of these results, it is recommended that stakeholders adopt a multi-faceted approach towards enhancing children’s wellness. This involves encouraging family-based interventions that actively engage parents in health education, promoting school policies that facilitate physical activity and nutrition education, and advocating for community programs that reinforce these messages outside of the school environment. Such actions not only hold the potential to improve individual health outcomes but also contribute to broader public health goals aimed at reducing childhood obesity and fostering lifelong healthy behaviours.
Strengths and limitations
This study has several notable strengths. First, the use of validated and reliable scales, such as the Family Nutrition and Physical Activity Screening Scale (FNPASS) and the Youth Physical Activity Attitude Scale, ensures the robustness of the data collected. The high Cronbach’s alpha values for these scales (ranging from 0.886 to 0.912) further confirm their internal consistency and reliability in the study context. Second, the study included a relatively large sample size (n = 633) of children aged 7–12 and their parents, which enhances the generalizability of the results. The inclusion of participants from diverse socioeconomic and cultural backgrounds, as well as varying residential settings (urban, district, and rural), adds to the representativeness of the sample.
Despite its strengths, this study has some limitations. First, the cross-sectional design limits the ability to establish causal relationships between family practices and children’s attitudes. Longitudinal studies would be needed to determine the long-term effects of familial influences on children’s physical activity behaviours. Second, the study was conducted in a single region of eastern Turkey, which may limit the generalizability of the results to other cultural or geographic contexts. Replicating the study in different regions or countries would help validate the results. Lastly, since a convenience sampling method was used, the results may not be generalizable to all children and families, particularly those not accessing hospital-based services or from different cultural or geographic contexts.
Conclusion
Family environments significantly influence children’s physical activity attitudes, with socioeconomic factors acting as key modifiers. This study demonstrates that family nutrition and physical activity practices significantly influence children’s attitudes toward physical activity. Healthier family habits correlated with more positive attitudes in children, particularly among families with higher parental education and urban residency. Public health initiatives should focus on educating parents about healthy practices while ensuring equitable access to physical activity opportunities for children. These results underscore the importance of family-centered health promotion programs that: (1) educate parents about modelling healthy behaviours, and (2) advocate for equitable access to physical activity resources in underserved communities. Future research should examine longitudinal and culturally diverse populations to validate these associations.
Supplementary Information
Acknowledgements
The author would like to acknowledge the participants for attending to this study. The author would also like to thank Bahar Hamidi, Öznur Sarohan, Eda Yardım, Abdulmelik Elhilal, Mehmet Ahyan, Muhammed Elhalid, Selva Elmuhammed, Hibetullah Elagul, Hilal Akgül, and Kübra Geçici for their help with data collection.
Abbreviations
- BMI
Body Mass Index
- PA
Physical Activity
- FNPASS
Family Nutrition and Physical Activity Screening Scale
Authors’ contributions
Ahmet Butun: Conceptualization, Resources, Data curation, Sofware, Visualization, Methodology, Project administration, Formal analysis, Writing – original draft, Writing – review & editing.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
Ethical approval was obtained from the Mardin Artuklu University Non-Invasive Clinical Research Ethics Committee (Date: January 7, 2025; Reference number: 2025/1–2). Institutional permission was granted by the Mardin Provincial Directorate of Health (Date: January 15, 2025; Reference number: E-68051626-949-265610386). Written informed consents were obtained from all individual participants and the parents or legal guardians of any participant under the age of 16. The present study was conducted according to the principles of the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.