Feeding-Related Knowledge, Attitudes, and Practices among Grandparents in Singapore

Childhood obesity is a growing concern worldwide. Though multifactorial, the family environment exerts significant influence on children's eating habits. Grandparents are increasingly involved as caregivers and they can significantly influence their grandchildren's eating habits. Yet, literature on this topic is lacking. This exploratory sequential mixed methods study (qualitative interview and interviewer-administered questionnaire) aims to understand grandparents' knowledge, attitudes, and practices on the feeding of their grandchildren in Singapore. A total of 11 interview participants and 396 questionnaire respondents with at least one grandchild, aged 12 years and below were included. Qualitative interviews informed the questionnaire development. Responses to interview questions about knowledge, attitudes, and practices revealed sub-themes such as knowledge on the impact of feeding, attitude toward feeding role, and challenges to feeding. Of the 396 participants, 35% were primary caregivers (defined as the person who spends the most time with the grandchild and performs most of the caregiving tasks). Nutritional knowledge was fair (median score 5/8), with misconceptions centered around healthy feeding practices. Grandparents who were primary caregivers, female, Malay, and younger than 70 years old believed that they played an important role in feeding their grandchild (p < 0.05). Overall, 47.2% of the grandparents rarely or never set a maximum limit on the amount of unhealthy food eaten, of which 77.1% are non-primary caregivers. In comparison, primary caregivers tend to set a maximum limit to the amount of unhealthy food their grandchildren eat and choose a wide variety of food (p < 0.05). These findings support the need for further improvement of grandparents' feeding knowledge and practices as part of tackling childhood obesity.