Fit WIC: attitudes, perceptions and practices of WIC staff toward addressing childhood overweight

Barriers and facilitators to implementing practices for prevention of childhood obesity in primary care: A mixed methods systematic review

Primary care providers (PCPs) have an important role in prevention of excess weight gain in pre-school children. Guidelines exist to support PCPs' practices. This systematic review of PCPs' practice behaviors and their perceptions of barriers to and facilitators of implementation of guidelines was the first step toward the development of an intervention aimed at supporting PCPs. Five databases were searched to identify qualitative, quantitative, and mixed methods studies which examined PCPs' practice patterns and factors influencing implementation of recommended practices. The convergent integrated approach of the Joanna Briggs Institute (JBI) methodology for mixed methods reviews was used for data synthesis. Following analyses, the resultant factors were mapped onto the Capability, Opportunity, and Motivation model of Behaviour (COM-B). Fifty studies met the eligibility criteria. PCPs inconsistently implement recommended practices. Barriers and facilitators were identified at the provider (e.g., lack of knowledge), parent (e.g., lack motivation), and organization level (e.g., inadequate training). Factors were mapped to all three components of the COM-B model: psychological capability (e.g., lack of skills), reflective motivation (e.g., beliefs about guidelines), automatic motivation (e.g., discomfort), physical opportunity (e.g., time constraints), and social opportunity (e.g., stigma). These findings reflect the complexity of implementation of childhood obesity prevention practices.

Health Care Provider's Role in Obesity Prevention and Healthy Development of Young American Indian Children

INTRODUCTION

Health care providers (HCPs) serving American Indian (AI) populations are critical stakeholders in promoting healthy weight-related behaviors of young AI children. The purpose of this study is to develop an understanding of how HCP perceive their role in the healthy development of young AI children, and how they envision working with early care and education teachers and parents to enhance children's health.

METHOD

Twenty HCP that serve young AI children in Oklahoma participated in individual interviews. Thematic analysis was conducted on coded transcripts and three main themes, each with two to four subthemes were identified.

RESULTS

HCP had limited contact with teachers, felt family health was equal or more important than child health, and parental empowerment and gradual change was essential for success.

CONCLUSION

Creating ways to involve HCP, early care and education teachers, and parents together in multilevel and multisector interventions has the potential to improve the health of young AI children.

Psychosocial perspectives and the issue of prevention in childhood obesity

A dramatic increase in childhood overweight/obesity has been recognized globally over the past 50 years. This observed increase may reflect genetic, as well as psychological, environmental, and socio-cultural influences. In the first part of this review, we present an updated summary of the psychosocial factors associated with this change and discuss possible ways in which they operate. Among these factors, lower socio economic status (in both industrialized and non-industrialized countries), being female, belonging to a minority group, and being exposed to adverse life events may all be associated with a greater risk of childhood overweight/obesity. These influences may be mediated via a variety of mechanisms, in particular above-average food intake of low nutritional quality and reduction in physical activity. Other important psychosocial mediators include the influence of the family and peer environment, and exposure to the media. In the second part of the review, we discuss the potential of psychosocial prevention programs to intervene in the processes involved in the rise of childhood overweight/obesity. Two points are emphasized. First, prevention programs should be multidisciplinary, combining the knowledge of experts from different professions, and taking into consideration the important role of the family environment and relevant influential social organizations, particularly school. Second, effective change is unlikely to occur without large-scale programs carried out on a public policy level.

Innovative tools help counselors discuss childhood obesity with parents

BACKGROUND

Childhood overweight and obesity pose potential health risks for many children under the age of 5 years. Women, Infants, and Children (WIC) nutritionists are in a unique position to help reduce this problem because of their frequent counseling contacts with clients during certification visits. Therefore, four new tools to facilitate nutritional counseling of parents of overweight children during certifications were developed and systematically evaluated.

METHODS

The Nutrition and Activity Self-History (NASH) form, Report Card/Action Plan (ReCAP), Talking Tips, and Healthy Weight Poster were evaluated by WIC nutritionists via an online survey. Anchors on the Likert scale were 0 for Strongly Disagree to 6 for Strongly Agree. Four regional focus groups were also conducted. Data were analyzed descriptively.

RESULTS

The response rate on the survey was 83% (n=63). Focus groups were comprised of staff that volunteered to participate (n=34). The NASH form, which replaces a food frequency questionnaire for identifying nutrition risk, had a mean rating of 5.20 as "Helpful when counseling about weight." The ReCAP, Talking Tips, and Healthy Weight Poster achieved mean ratings of 5.70, 4.75, and 5.30, respectively, in this category. Focus group responses were very positive about the usefulness of the ReCAP and Healthy Weight Poster to visually convey the concept of BMI percentile for age using a green, yellow, and red color-coded "traffic light" approach to showing healthy versus unhealthy BMI values.

CONCLUSIONS

WIC programs and other pediatric health care settings may want to consider adopting these innovative tools to better serve their clients and address pediatric overweight in the populations they serve.

Evidence of the adoption and implementation of a statewide childhood obesity prevention initiative in the New York State WIC Program: the NY Fit WIC process evaluation

Process evaluations are critical in determining whether outcome evaluations are warranted. This study assessed the extent to which a childhood obesity prevention initiative, NY Fit WIC, was adopted and implemented by the New York State Supplemental Nutrition Program for Women, Infants and Children (WIC). Process data came from qualitative telephone interviews of 101 WIC local agency directors, following NY Fit WIC trainings. Activities were summarized and cross-tabulated by target level (i.e. participant, staff, agency or community) and by theoretical construct (i.e. knowledge promotion, skill building, self-efficacy or role modeling). Approximately 528 activities were reported across all WIC agencies. When activities were grouped into similar categories, 123 unique activities were identified. Agencies were more likely to implement physical activity-related activities (67%) than nutrition-related activities (33%). The majority of activities targeted WIC participants (47%) and staff (22%) and focused on skill building/self-efficacy (67%) among participants and on role modeling (61%) among staff. The involvement of all agencies shows a high level of adoption of the initiative. The diverse number of activities suggests that WIC local agencies tailored implementation to match their resources and clients' needs as planned. These results suggest that an outcome evaluation is warranted to determine whether meaningful behavioral changes occurred among WIC participants and staff.

Attitudes, concerns, and likelihood for action related to young children's overweight among early childhood program staff

For obesity prevention planning in early childhood programs, attitudes and actions of staff related to communicating with parents about young children's eating and weight need to be assessed. Early childhood program teachers (n = 271) working with children aged 3 to 5 years were surveyed by mail. Factor analysis provided patterns of response for multi-item questions. Respondents reported different levels of agreement and comfort regarding communicating concerns to parents about their child's weight and eating versus observations about the child's daily eating. Feelings about parent communication varied (worried, hesitant, responsible, and willing). Findings suggest opportunities for communication between program staff and parents.

Motivational interviewing skills are positively associated with nutritionist self-efficacy

OBJECTIVE

To examine the relationships between physical and social self-concepts, motivational interviewing (MI), and nutrition assessment skills with dimensions of counseling self-efficacy.

DESIGN

Cross-sectional survey.

SETTING

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics.

PARTICIPANTS

Sixty-five WIC nutritionists.

MAIN OUTCOME MEASURES

Counseling self-efficacy on topics related to physical activity and nutritional behaviors and in the presence of language and cultural differences.

ANALYSIS

Multiple linear regression.

RESULTS

Nutritionists' perception of their own MI skills was positively associated with their self-efficacy for counseling clients of a culture different than their own, when counseling about physical activity, and when counseling about nutrition behavior. Hispanic ethnicity and social self-concept were positively associated with counseling self-efficacy when culture differences were present. Physical self-concept was positively associated with self-efficacy related to physical activity topics. Nutrition assessment skill was negatively associated with self-efficacy for working with non-English-speaking clients.

CONCLUSIONS AND IMPLICATIONS

Development of MI skills and strategies to improve social and physical self-concept may increase WIC nutritionists' counseling self-efficacy, particularly when counseling clients from diverse backgrounds.

Not lost in translation: nutrition education, a critical component of translational research

Translational research is an emerging field of science, embracing disciplines in medicine and public health to create a full-spectrum research agenda. Often described as science "from bench to bedside and back again," translational research may be better described as "from bench to behavior," as it strives to apply laboratory results to clinical settings. Because the demand for translational research has emerged, it is critical for nutrition educators to ensure that translational research includes community and policy areas and to recognize themselves as translation researchers. The purpose of this report is to provide a framework for nutrition educators to better understand translational research and to recognize their role in translational research, using type 2 diabetes as an example.