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Ikemi A, Horiuchi S. Mother's perception of early introduction of complementary feeding affecting stunting in Ghana: A qualitative research. Jpn J Nurs Sci 2024:e12611. [PMID: 38923823 DOI: 10.1111/jjns.12611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/12/2024] [Accepted: 05/27/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES The study aimed to explore mothers' perceptions for timely introduction of complementary feeding through interviews with 2-12-month-old infants' mothers in Ghana. METHODS Qualitative descriptive research with 16 semi-structured interviews with mothers attending the Child Welfare Clinic at Ejisu Hospital was conducted from June 2022 to May 2023. The study was guided by the Declaration of Helsinki, and all participants were instructed about informed consent for the study. Interviews and analysis were guided by Theory of Planned Behavior. NVivo 1.5 was used throughout the coding procedure. This study was conducted after the approval from St. Luke's International University. RESULTS Four themes were revealed: (1) attitude toward the behavior based on the mothers' experience raising children, (2) attitude toward the behavior influenced by subjective norm (grandmothers' recommendation), (3) attitude toward the behavior influenced by perceived behavioral control (difficulty in continuing breastfeeding), and (4) mothers who are worried about underweight despite timely introduction of complementary feeding. Attitudes toward the behavior were influenced by mothers' experiences raising children and grandmothers' recommendations. Surroundings disruptive of breastfeeding also influenced attitudes toward intentions and behavior. Moreover, some mothers suffered from underweight even if they introduce complementary feeding at an optimal time. CONCLUSION Supporting to continue breastfeeding and conducting re-education for grandmothers is a key recommendation for midwives and pediatric nurses. Moreover, pediatric nurses are required to further enhance not only health education regarding the timing of initiating complementary feeding but also support after the introduction.
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Affiliation(s)
- Ayame Ikemi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
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Clayton PK, Putnick DL, Trees IR, Ghassabian A, Tyris JN, Lin TC, Yeung EH. Early Infant Feeding Practices and Associations with Growth in Childhood. Nutrients 2024; 16:714. [PMID: 38474842 DOI: 10.3390/nu16050714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Early infant growth trajectories have been linked to obesity risk. The aim of this study was to examine early infant feeding practices in association with anthropometric measures and risk of overweight/obesity in childhood. A total of 2492 children from Upstate KIDS, a population-based longitudinal cohort, were included for the analysis. Parents reported breastfeeding and complementary food introduction from 4 to 12 months on questionnaires. Weight and height were reported at 2-3 years of age and during later follow-up at 7-9 years of age. Age and sex z-scores were calculated. Linear mixed models were conducted, adjusting for maternal and child sociodemographic factors. Approximately 54% of infants were formula-fed at <5 months of age. Compared to those formula-fed, BMI- (adjusted B, -0.23; 95% CI: -0.42, -0.05) and weight-for-age z-scores (adjusted B, -0.16; -0.28, -0.03) were lower for those exclusively breastfed. Infants breastfed for ≥12 months had a lower risk of being overweight (aRR, 0.33; 0.18, 0.59) at 2-3 years, relative to formula-fed infants. Compared to introduction at <5 months, the introduction of fruits and vegetables between 5 and 8 months was associated with lower risk of obesity at 7-9 years (aRR, 0.45; 0.22, 0.93). The type and duration of breastfeeding and delayed introduction of certain complementary foods was associated with lower childhood BMI.
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Affiliation(s)
- Priscilla K Clayton
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, Bethesda, MD 20817, USA
| | - Diane L Putnick
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, Bethesda, MD 20817, USA
| | - Ian R Trees
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, Bethesda, MD 20817, USA
| | - Akhgar Ghassabian
- Department of Pediatrics and Population Health, NYU Grossman School of Medicine, 550 First Avenue, New York, NY 10016, USA
| | - Jordan N Tyris
- Division of Hospital Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Tzu-Chun Lin
- Glotech Inc., 1801 Research Blvd Ste 605, Rockville, MD 20850, USA
| | - Edwina H Yeung
- Epidemiology Branch, Division of Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6710B Rockledge Dr, Bethesda, MD 20817, USA
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Thompson KL, Conklin JL, Thoyre S. Parental Decision-Making Around Introducing Complementary Foods: An Integrative Review. JOURNAL OF FAMILY NURSING 2023; 29:348-367. [PMID: 36899486 PMCID: PMC10629252 DOI: 10.1177/10748407231156914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
A primary role in infant parenting is feeding, and this role undergoes a significant transition when introducing complementary foods (CF), with important long-term health implications. Understanding the influences on parental decision-making around timing the introduction to CF can help health care providers provide parents with effective support for feeding; however, the factors that influence parental decision-making have not been recently reviewed in the United States. To determine influences and information sources, this integrative review examined the literature from 2012 to 2022. Results indicated that parents are confused and distrustful of inconsistent and changing guidelines around CF introduction. Instead, developmental readiness signs may be a more appropriate way for practitioners and researchers to support parents in appropriate CF introduction. Future work is needed to evaluate interpersonal and societal influences on parental decision-making, as well as to develop culturally sensitive practices to support healthful parental decisions.
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Spurlock K, Deave T, Lucas PJ, Dowling S. Parental engagement with complementary feeding information in the United Kingdom: A qualitative evidence synthesis. MATERNAL & CHILD NUTRITION 2023; 19:e13553. [PMID: 37551916 PMCID: PMC10483955 DOI: 10.1111/mcn.13553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/22/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
Complementary feeding is the process of introducing solid foods to milk-fed infants (also known as weaning). Current UK guidance states that complementary feeding should occur around 6 months but not before 4 months. This systematic review explores how parents in the UK, with an infant under 24 months of age, engage with sources of information and advice about complementary feeding. Engaging with sources of information can influence parents' feeding choices and so a better understanding of parents' information behaviours can improve service provisions. Six databases were searched, identifying 15 relevant qualitative studies with the predefined criteria. Data from each study were coded line by line allowing for a synthesis of higher analytical themes. Using thematic synthesis, four main themes were observed: (1) trust and rapport-parents valued information from a trusted source (2), accessibility-information needs were often time sensitive, and parents showed varying levels of understanding, (3) adapting feeding plans-often influenced by practicalities (4), being a good parent-feeding plans were changed to comply with societal ideas of 'good parenting'. The review concluded that parents receive information and advice about complementary feeding from multiple sources and are highly motivated to seek further information. The scope of this novel review explored the parental experience of finding, receiving and engaging with information sources and how this may or may not have influenced their feeding behaviours. The review has provided a new perspective to add to the growing body of literature that focuses on the experience of feeding an infant.
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Affiliation(s)
- Kelly Spurlock
- School of Health and Social WellbeingUniversity of the West of EnglandBristolUK
| | - Toity Deave
- School of Health and Social WellbeingUniversity of the West of EnglandBristolUK
| | | | - Sally Dowling
- Bristol Medical SchoolUniversity of BristolBristolUK
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Ong YY, Pang WW, Michael N, Aris IM, Sadananthan SA, Tint MT, Liang Choo JT, Ling LH, Karnani N, Velan SS, Fortier MV, Tan KH, Gluckman PD, Yap F, Chong YS, Godfrey KM, Chan SY, Eriksson JG, Chong MFF, Wlodek ME, Lee YS. Timing of introduction of complementary foods, breastfeeding, and child cardiometabolic risk: a prospective multiethnic Asian cohort study. Am J Clin Nutr 2023; 117:83-92. [PMID: 36789947 DOI: 10.1016/j.ajcnut.2022.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/22/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The timing of introduction of complementary foods and the duration of breastfeeding (BF) have been independently associated with child overweight and obesity; however, their combined influence on body fat partitioning and cardiometabolic risk is unclear. OBJECTIVE We investigated the associations of the timing of introduction of complementary foods, the duration of BF, and their interaction with child adiposity and cardiometabolic risk markers. METHODS We analyzed data from 839 children in the prospective Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. Mothers reported the age at which infants were first fed complementary foods and BF duration, classified as early (≤4 mo) versus typical (>4 mo) complementary feeding (CF) and short (≤4 mo) versus long (>4 mo) duration of any BF, respectively. We measured adiposity and cardiometabolic risk markers at the age of 6 y and examined their associations with infant feeding patterns using multiple regression, adjusting for sociodemographics, parents' body mass index (BMI), maternal factors, birth weight for gestational age, and infant weight gain. RESULTS Of 839 children, 18% experienced early CF, whereas 54% experienced short BF. Short (vs. long) BF and early (vs. typical) CF were independently associated with higher z-scores of BMI [β (95% confidence interval), short BF, 0.18 standard deviation score (SDS) (-0.01, 0.38); early CF, 0.34 SDS (0.11, 0.57)] and sum of skinfolds [short BF, 1.83 mm (0.05, 3.61); early CF, 2.73 mm (0.55, 4.91)]. Children who experienced both early CF and short BF (vs. typical CF-long BF) had synergistically higher diastolic blood pressure [1.41 mmHg (-0.15, 2.97), P-interaction = 0.023] and metabolic syndrome score [0.81 (0.16, 1.47), P-interaction = 0.081]. Early CF-long BF (vs. early CF-short BF) was associated with a lower systolic blood pressure [-3.74 mmHg (-7.01, -0.48)], diastolic blood pressure [-2.29 mmHg (-4.47, -0.11)], and metabolic syndrome score [-0.90 (-1.80, 0.00)]. CONCLUSIONS A combination of early CF and short BF was associated with elevated child adiposity and cardiometabolic markers. Longer BF duration may protect against cardiometabolic risk associated with early CF. This trial was registered at clinicaltrials.gov as NCT01174875.
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Affiliation(s)
- Yi Ying Ong
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Wei Wei Pang
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore
| | - Navin Michael
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Izzuddin M Aris
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Suresh Anand Sadananthan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Mya-Thway Tint
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | | | - Lieng Hsi Ling
- Department of Cardiology, National University Heart Centre, National University Hospital, Singapore, Republic of Singapore
| | - Neerja Karnani
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - S Sendhil Velan
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Marielle V Fortier
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Republic of Singapore; Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore, Republic of Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fabian Yap
- KK Women's and Children's Hospital, Singapore, Republic of Singapore; Duke-NUS Medical School, Singapore, Republic of Singapore
| | - Yap-Seng Chong
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shiao-Yng Chan
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore
| | - Johan G Eriksson
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Mary F-F Chong
- Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
| | - Mary E Wlodek
- Department of Obstetrics and Gynaecology and Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia
| | - Yung Seng Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Republic of Singapore; Singapore Institute for Clinical Science, Agency for Science, Technology, and Research, Singapore, Republic of Singapore; Division of Paediatric Endocrinology, Department of Paediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Republic of Singapore.
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Acheampong AK, Ganga-Limando M, Aziato L. Qualitative exploration of perceived barriers of exclusive breastfeeding among pregnant teenagers in the Greater Accra Region of Ghana. BMC Public Health 2022; 22:1885. [PMID: 36217132 PMCID: PMC9552491 DOI: 10.1186/s12889-022-14277-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/02/2022] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background The World Health Organization endorses exclusive breastfeeding for the first six months of every child’s life since exclusive breastfeeding has the potential of saving thousands of infants’ lives. The global exclusive breastfeeding rate among mothers is sub-optimal. This predisposes infants born to teenage mothers to all types of ailments. Therefore, this study explored the factors that inhibit the practice of exclusive breastfeeding as perceived by pregnant teenagers in the Greater Accra Region of Ghana which is an urban area. Methods The study used techniques in qualitative descriptive exploration to collect data from 30 pregnant teenagers through focus group discussions. Six focus group discussions were conducted and each group was made up of five participants. Informed consent was obtained from participants who were 18 years and above as well as parents of participants below 18 years while informed assent was obtained from participants below 18 years after purposive sampling. Interviews were audiotaped, transcribed and data were analysed through content analysis. Results Two major themes and eight sub themes emerged from the data after analysis. Personal related barriers (negative emotional feelings, irrational thinking, perceived health risks to the baby and perceived self-inefficacy) and social related barriers (provider-client interaction, disapproval of exclusive breastfeeding by close relatives, unfriendly workplace policies and social myths) were the perceived factors that discouraged exclusive breastfeeding among teenage mothers. Conclusion Health professionals should be trained to provide culturally sensitive care to teenage mothers in order to promote exclusive breastfeeding. The media, religious leaders and politicians should help debunk misconceptions about breastfeeding expressed by participants in the study.
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Affiliation(s)
| | | | - Lydia Aziato
- University of Health and Allied Sciences, Ho, Ghana
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Sanjeevi N, Lipsky LM, Siega-Riz AM, Nansel TR. Associations of infant appetitive traits during milk feeding stage with age at introduction to solids and sweet food/beverage intake. Appetite 2022; 168:105669. [PMID: 34481014 PMCID: PMC8671262 DOI: 10.1016/j.appet.2021.105669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Suboptimal feeding behaviors during infancy, such as introducing solids prior to 4 months and providing foods containing added sugars, are associated with increased risk of later obesity. Although focus group studies suggest that infant appetitive traits during milk feeding stage may influence complementary feeding practices, quantitative evidence on this relationship is lacking. METHODS This study included women who were followed from first trimester to 1-year postpartum. At 6-months postpartum, mothers (n = 217) completed the Baby Eating Behavior Questionnaire which assesses infant appetitive traits during exclusive milk-feeding (food responsiveness, satiety responsiveness, slowness in eating, enjoyment of food and general appetite). Mothers reported infant dietary intake via a food frequency questionnaire (FFQ) administered at 6, 9 and 12 months, from which age at introduction to solids and sweet foods/beverages, and 6- and 12-month sweet food/beverage intake frequency, were calculated. Linear regression analyses examined the relationship of appetitive traits with age at introduction to solids and sweet foods/beverages, and frequency of sweet food/beverage intake, whereas logistic regression examined associations of appetitive traits with odds of introduction to solids prior to 4 months. RESULTS Greater infant enjoyment of food was associated (B±SE = 0.45 ± 0.18, p = 0.01) with higher age at introduction to solids. Slowness in eating was inversely associated with 12-month sweet food/beverage intake frequency (B±SE = -0.25 ± 0.10, p = 0.01). Other associations of appetitive traits with age at introduction to solids and sweet food/beverage exposure were not statistically significant. CONCLUSIONS Findings imply that lower infant enjoyment of food and greater speed of eating during the period of exclusive milk-feeding could be associated with suboptimal complementary feeding practices. Understanding how parents respond to infant appetitive traits may be important considerations in efforts to promote appropriate complementary feeding practices during infancy.
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Affiliation(s)
- Namrata Sanjeevi
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20817, USA.
| | - Leah M Lipsky
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20817, USA.
| | - Anna Maria Siega-Riz
- Departments of Nutrition and Biostatistics & Epidemiology, University of Massachusetts Amherst, Arnold House, Amherst, MA, 01003-9304, USA.
| | - Tonja R Nansel
- Social and Behavioral Sciences Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, 20817, USA.
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Ball R, Duncanson K, Ashton L, Bailey A, Burrows TL, Whiteford G, Henström M, Gerathy R, Walton A, Wehlow J, Collins CE. Engaging New Parents in the Development of a Peer Nutrition Education Model Using Participatory Action Research. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:102. [PMID: 35010363 PMCID: PMC8750105 DOI: 10.3390/ijerph19010102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
This study investigated the implementation model and research methods of a peer education program for new parents focused on infant feeding and nutrition. Two hundred and sixty-nine parents with an infant aged birth to two years old were invited to become co-researchers in a Participatory Action Research (PAR) study over three years. Data included focus group and online participant meeting transcripts, social media data, correspondence between the implementation team and peer educators, and field notes. All data were consolidated regularly and discussed by project participants and the research team. After each PAR cycle, structured content analysis was conducted, informing the next iteration of the implementation model and research methods. Participating parents were highly engaged in child feeding peer-to-peer education, but felt more effective and comfortable being considered as a child-feeding information resource sharer or 'champion' rather than a formal peer educator. Similarly, quantitative data collection was only effective when it was integrated seamlessly into the implementation model. PAR methodology suited the diversity and dynamic real-life study setting, facilitating substantial improvements to the peer nutrition intervention model and data collection methods. Our study demonstrated that a genuine collaboration between health professionals and participants to implement research in practice can achieve both intervention outcomes and research aims.
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Affiliation(s)
- Richard Ball
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
| | - Kerith Duncanson
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
- Health Education and Training Institute (HETI), 1 Reserve Road, St. Leonards, NSW 2065, Australia
| | - Lee Ashton
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
- Priority Research Centre for Physical Activity and Nutrition, School of Education, College of Human and Social Futures, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Andrew Bailey
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
| | - Tracy L. Burrows
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
| | - Gail Whiteford
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
- School of Community Health, Charles Sturt University, Port Macquarie, NSW 2444, Australia
| | - Maria Henström
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
- Department of Biosciences and Nutrition, Karolinska Institutet, 14183 Huddinge, Sweden
| | - Rachel Gerathy
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
| | - Alison Walton
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
| | - Jennifer Wehlow
- Mid North Coast Local Health District, Port Macquarie, NSW 2444, Australia; (A.B.); (G.W.); (R.G.); (A.W.); (J.W.)
| | - Clare E. Collins
- Priority Research Centre for Physical Activity and Nutrition, School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW 2308, Australia; (K.D.); (L.A.); (T.L.B.); (M.H.); (C.E.C.)
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Dearlove T, Begley A, Scott JA, Devenish-Coleman G. Digital Marketing of Commercial Complementary Foods in Australia: An Analysis of Brand Messaging. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157934. [PMID: 34360227 PMCID: PMC8345376 DOI: 10.3390/ijerph18157934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/10/2021] [Accepted: 07/19/2021] [Indexed: 12/28/2022]
Abstract
The digital marketing of commercial complementary foods (CCF) is an emerging area of concern in Australia. Although research into traditional methods has identified a range of problems, the marketing and messaging strategies employed within digital spaces have gone largely unscrutinized. This study sought to examine the methods used by CCF manufacturers to promote Australian baby foods and brands in a digital space. A multiple step approach was used to assess the CCF brands available in major Australian retailers, the social media platforms they used, and to thematically analyze the text and visual messages contained in posts published over a three-month period. Of the 15 brands identified, 12 had a digital presence, and all of these used Facebook. Four themes emerged from an analysis of 216 Facebook posts; (1) general product attributes, (2) socially desirable attributes (which included messaging related to taste (41%), self-feeding (29%) and fun (19%)), (3) concern-based attributes (including organic status (40%), age targets (39%) and additive-/allergen-free status (18%)) and (4) health-focused attributes (which included messaging related to healthy/nutritious ingredients (45%), and child development/growth (15%). Messages contained in Facebook posts were mostly positive brand/product aspects (Themes 1 and 2) or parental concern-based aspects (Theme 3 and 4). These themes match previous analyses of marketing content in traditional media and should be closely monitored due to the personalized nature of consumer social media interactions.
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Parental considerations during complementary feeding in higher income countries: a systematic review of qualitative evidence. Public Health Nutr 2021; 24:2834-2847. [PMID: 33877043 PMCID: PMC9884778 DOI: 10.1017/s1368980021001749] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Worldwide data suggest a clash between parental complementary feeding practices and recommendations. Understanding the circumstances under which parents form their feeding practices is a crucial step to improve such practices. This paper aimed to systematically review the existing qualitative literature and synthesise the factors that parents take into consideration in relation to complementary feeding. DESIGN A systematic review was undertaken. Four electronic databases were searched for qualitative studies published after 2001 exploring parental experiences during complementary feeding. A framework that included authors' outcomes of interest was used to extract and synthesise study findings. The Standards for Reporting Qualitative Research were used to critically assess the included studies. SETTING Upper-middle- and high-income countries. PARTICIPANTS Parents with a child below the age of 3 years. RESULTS A total of forty-seven studies met the eligibility criteria and were included in this systematic review. The themes were organised into three main categories: (1) factors related to introduction of complementary foods; (2) factors related to the type of complementary foods and (3) factors related to both timing and type. The selected literature highlights: prevalent baby cues that prompt parents to introduce solid foods; parents' views on the recommended timing of complementary feeding; factors that drive the choice of complementary foods and perceived value in advice received from health professionals and grandmothers. CONCLUSIONS This systematic review indicates factors that can be barriers to complying with the complementary feeding guidelines, and therefore, its findings are pertinent to improving parental feeding practices through intervention studies and through infant feeding education in a primary care setting.
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Supthanasup A, Banwell C, Kelly M, Yiengprugsawan VS. Recipe Components and Parents' Infant and Young Child Feeding Concerns: A Mixed-Methods Study of Recipe Posts Shared in Thai Facebook Groups for Parents. Nutrients 2021; 13:nu13041186. [PMID: 33916663 PMCID: PMC8065637 DOI: 10.3390/nu13041186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 11/16/2022] Open
Abstract
Social media is increasingly becoming a significant source of information for parents, including about feeding young children. However, little attention has been given to the characteristics of recipes for infants and young children and how they interact with parental perceptions regarding food decisions shared by users on social media. Building on findings related to shared recipe components and parental food choices, between December 2019 and July 2020, this study retrospectively collected 80 shared recipes each from five Thai Facebook groups. This extraction created 379 shared recipes with 1751 peers’ commentaries on the shared recipes’ posts. The shared recipes were classified and components quantified across child age groups, then the textual contents around the reasons behind the food choices were described qualitatively. The results showed that there were differences in meal types, food ingredients, and seasoning used across child age groups. Further analysis found that food allergy awareness was one driving concern behind parental perceptions on food choices in children’s diets. These concerns resulted in delays in the introduction of animal-source foods. Moreover, peers’ commentaries on shared recipes offered a venue for exchanging experiences with food products. Because of the potential influence on parental beliefs and perceptions, further studies are required to understand the impact of existing online communities on actual feeding practices.
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Affiliation(s)
- Abhirat Supthanasup
- Research School of Population Health, Australian National University, Acton, Canberra 2601, Australia; (C.B.); (M.K.); (V.S.Y.)
- School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi 11120, Thailand
- Correspondence: ; Tel.: +61-4-5261-2501
| | - Cathy Banwell
- Research School of Population Health, Australian National University, Acton, Canberra 2601, Australia; (C.B.); (M.K.); (V.S.Y.)
| | - Matthew Kelly
- Research School of Population Health, Australian National University, Acton, Canberra 2601, Australia; (C.B.); (M.K.); (V.S.Y.)
| | - Vasoontara Sbirakos Yiengprugsawan
- Research School of Population Health, Australian National University, Acton, Canberra 2601, Australia; (C.B.); (M.K.); (V.S.Y.)
- Australian Research Council Centre of Excellence in Population Ageing Research, University of New South Wales, Kensington, Sydney 2033, Australia
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Theodorah DZ, Mc'Deline RN. "The kind of support that matters to exclusive breastfeeding" a qualitative study. BMC Pregnancy Childbirth 2021; 21:119. [PMID: 33563230 PMCID: PMC7874650 DOI: 10.1186/s12884-021-03590-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 01/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Worldwide, only 41 % of infants are exclusively breastfed for the first six months while South Africa has an alarming figure of only 12 %. First-time mothers are inexperienced in the initiation and maintenance of exclusive breastfeeding, hence a need for support. Data on forms and quality of exclusive breastfeeding support as experienced by first-time mothers is minimal. The study explored the exclusive breastfeeding support available to first-time mothers in the Buffalo City Metro, South Africa. METHODS A qualitative explorative, descriptive and contextual study, and a non-probability, purposive sampling was used with 10 first-time mothers within the first six months postpartum. The in-depth face-to-face semi-structured individual interviews for data collection and Creswell's steps of thematic analysis were used. RESULTS Two themes emerged; challenges, empowerment, support and resilience during initiation of exclusive breastfeeding, and diverse support and resilience during maintenance of exclusive breastfeeding. First-time mothers received practical support majorly from nurses and other mothers during the initiation; social support was from family members, friends, and community members for the maintenance of exclusive breastfeeding. Sometimes there was a disjuncture between practical support from nurses and that from family members and the community. There were instances where the support was needed but not given or not supportive of exclusive breastfeeding. CONCLUSIONS These findings illustrate that professional, practical and social support for first-time mothers is crucial in the initiation and maintenance of exclusive breastfeeding for the first six months. Timing and the kind of support given to these mothers is crucial for successful exclusive breastfeeding.
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Affiliation(s)
- Dasheka Zukiswa Theodorah
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, 50 Church Street, Eastern Cape, East London, South Africa.
| | - Rala Ntombana Mc'Deline
- Department of Nursing Science, Faculty of Health Sciences, University of Fort Hare, 50 Church Street, Eastern Cape, East London, South Africa
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Sutter C, Pham GV, Yun JT, Narang K, Sundaram H, Fiese BH. Food parenting topics in social media posts: Development of a coding system, examination of frequency of food parenting concepts, and comparison across Reddit and Facebook. Appetite 2021; 161:105137. [PMID: 33493607 DOI: 10.1016/j.appet.2021.105137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 01/13/2021] [Accepted: 01/16/2021] [Indexed: 11/18/2022]
Abstract
This study presents development of a coding system to examine food parenting topics presented in posts on social media, and compared topics between two social media platforms (Facebook, Reddit). Publicly available social media posts were gathered from Facebook (2 groups) and Reddit (3 subreddits) and a coding system was developed based on the concept map of food parenting proposed by Vaughn et al. (2016). Based on the developed coding system, we coded posts into overarching food parenting practice constructs (coercive control: attempts to dominate, pressure or impose parents' will on child, structure: organization of child's environment to facilitate competence, autonomy support: supporting child's ability to self-regulate through allowing food choices, conversations about food, and a positive emotional climate) and recipes. We also coded posts dichotomously as including a question or advice-seeking. Differences in frequencies of food parenting constructs presented in posts on Facebook and Reddit were considered using chi-square tests of independence. Of the 2459 posts coded, 900 were related to food parenting (37%). In the subsample of 900, posts related to structure (43%) and recipes (40%) were the most frequent. Close to half of the posts (44%) included questions about food parenting. Frequency of food parenting topics in posts was related to social media platform, with coercive control and structure more frequently discussed on Reddit and recipes more commonly posted on Facebook. Results suggest that food parenting topics discuss on social media differ by platform, which can aid researchers and practitioners in targeting social media-based outreach to the topics of most interest for users. Findings give insight into the everyday food parenting topics and questions that parents and caregivers may be exposed to on social media. TAXONOMY: Development of Feeding; Parenting; Online Information Services.
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Affiliation(s)
- Carolyn Sutter
- Outlier Research & Evaluation, UChicago STEM Education, University of Chicago, 1427 E. 60th Street, Chicago, IL, 60637, USA; Family Resiliency Center, University of Illinois, Urbana-Champaign, USA.
| | - Giang V Pham
- Charles H. Sandage Department of Advertising, University of Illinois, Urbana-Champaign, USA
| | - Joseph T Yun
- Charles H. Sandage Department of Advertising, University of Illinois, Urbana-Champaign, USA; Accountancy, Gies College of Business, University of Illinois, Urbana-Champaign, USA; National Center for Supercomputing Applications, University of Illinois, Urbana-Champaign, USA
| | - Kanika Narang
- Department of Computer Science, University of Illinois, Urbana-Champaign, USA
| | - Hari Sundaram
- Charles H. Sandage Department of Advertising, University of Illinois, Urbana-Champaign, USA; Department of Computer Science, University of Illinois, Urbana-Champaign, USA
| | - Barbara H Fiese
- Family Resiliency Center, University of Illinois, Urbana-Champaign, USA
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Nsiah-Asamoah C, Doku DT, Agblorti S. Mothers' and Grandmothers' misconceptions and socio-cultural factors as barriers to exclusive breastfeeding: A qualitative study involving Health Workers in two rural districts of Ghana. PLoS One 2020; 15:e0239278. [PMID: 32941500 PMCID: PMC7498105 DOI: 10.1371/journal.pone.0239278] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 09/02/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Education on exclusive breastfeeding (EBF) practices is usually given in the form of health talks by health workers (HWs). The need for HWs to be well-informed about cultural practices and misconceptions that act as barriers to EBF has been documented in literature. This information can guide HWs in developing interventions such as health talks which are culturally sensitive. However, this has not been explored from the perspectives of HWs in Ghana. In this paper, we report mothers' and grandmothers' misconceptions and cultural practices that are barriers to EBF in two rural districts in Ghana from the perspectives of Community Health Workers and Community Health Volunteers. METHODS We used qualitative data collected in the Kwahu Afram Plains South and North Districts of Ghana through nine focus group discussions (FGDs) among HWs and followed the data saturation principle. All FGDs were audio-taped, transcribed verbatim and translated from local dialects to English. The emerging themes were used in writing a narrative account, guided by the principles of the thematic analysis. RESULTS Our main findings included mothers' and grandmothers' perceptions that HWs themselves do not practice EBF. Mothers had the perception that grandmothers did not practice EBF but their children grew well, and gestures of babies suggested their readiness to start eating. Misconceptions revealed included beliefs that breastmilk is watery in nature and does not satisfy infants. Another misconception was that babies gain weight faster when not exclusively breastfed but fed on infant formulas. A custom of giving corn flour mixed with water or light porridge during the first few days after birth to welcome newborns was also reported. CONCLUSIONS The reports of the HWs revealed that several socio-cultural factors and misconceptions of mothers and grandmothers negatively influence EBF practices of mothers. Findings from this study highlight the need for HWs to provide culturally appropriate counselling services on breastfeeding not only to mothers but also to grandmothers and fathers in order to promote EBF and reap its benefits.
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Affiliation(s)
- Christiana Nsiah-Asamoah
- Department of Clinical Nutrition and Dietetics, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Agblorti
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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Samady W, Campbell E, Aktas ON, Jiang J, Bozen A, Fierstein JL, Joyce AH, Gupta RS. Recommendations on Complementary Food Introduction Among Pediatric Practitioners. JAMA Netw Open 2020; 3:e2013070. [PMID: 32804213 PMCID: PMC7431991 DOI: 10.1001/jamanetworkopen.2020.13070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022] Open
Abstract
Importance The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend waiting 3 to 5 days between the introduction of new complementary foods (solid foods introduced to infants <12 months of age), yet with advances in the understanding of infant food diversity, the guidance that pediatric practitioners are providing to parents is unclear. Objective To characterize pediatric practitioner recommendations regarding complementary food introduction and waiting periods between introducing new foods. Design, Setting, and Participants In this survey study, a 23-item electronic survey on complementary food introduction among infants was administered to pediatric health care professionals from February 1 to April 30, 2019. Responses were described among the total sample and compared among subgroups. Survey invitations were emailed to 2215 members of the Illinois Chapter of the American Academy of Pediatrics and the national American Academy of Pediatrics' Council on Early Childhood. Participants were required to be primary medical practitioners, such as physicians, resident physicians, or nurse practitioners, providing pediatric care to infants 12 months or younger. Main Outcomes and Measures The main outcome measures were recommendations on age of complementary food introduction and waiting periods between the introduction of new foods. Categorical survey items were reported as numbers (percentages) and 95% CIs. Means (SDs) were used to describe continuous survey items. Results The survey was sent to 2215 practitioners and completed by 604 (response rate, 27.3%). Of these respondents, 41 were excluded because they did not provide care for infants or pediatric patients. The final analyses included responses from 563 surveys. Of these, 454 pediatricians (80.6%), 85 resident physicians (15.1%), and 20 nurse practitioners (3.6%) completed the survey. Only 217 practitioners (38.6%; 95% CI, 34.1%-44.6%) recommended waiting 3 days or longer between food introduction; 259 practitioners (66.3%; 95% CI, 61.4%-70.8%) recommended waiting that amount of time for infants at risk for food allergy development (P = .02). A total of 264 practitioners (46.9%; 95% CI, 42.8%-51.0%) recommended infant cereal as the first food, and 226 practitioners (40.1%; 95% CI, 36.1%-44.2%) did not recommend a specific order. A total of 268 practitioners (47.6%; 95% CI, 43.5%-51.7%) recommended food introduction at 6 months for exclusively breastfed (EBF) infants, and 193 (34.3%; 95% CI, 30.5%-38.3%) recommended food introduction at 6 months for non-EBF infants (P < .001); 179 practitioners (31.8%; 95% CI, 28.1%-35.8%) recommended food introduction at 4 months for EBF infants, and 239 practitioners (42.5%; 95% CI, 38.4%-46.6%) recommended food introduction at 4 months for non-EBF infants (P < .001). A need for additional training on complementary food introduction was reported by 310 practitioners (55.1%; 95% CI, 50.9%-59.1%). Conclusions and Relevance In this survey study, most pediatric practitioners did not counsel families to wait 3 days or longer between introducing foods unless infants were at risk for food allergy development. The findings suggest that the current recommendation limits infant food diversity and may delay early peanut introduction. Because the approach to food allergy prevention has changed, a reevaluation of published feeding guidelines may be necessary.
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Affiliation(s)
- Waheeda Samady
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emily Campbell
- Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ozge Nur Aktas
- Department of Pediatrics, University of Illinois College of Medicine at Chicago, Chicago, Illinois
| | - Jialing Jiang
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alexandria Bozen
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jamie L. Fierstein
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Alanna Higgins Joyce
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ruchi S. Gupta
- Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Center for Food Allergy & Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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16
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Waring ME, Libby BA, Moore Simas TA, Bracken ML, Bibeau JL, Herrera V, Wang J, Pagoto SL. Delivering a Post-Partum Weight Loss Intervention via Facebook or In-Person Groups: Protocol for a Randomized Feasibility Pilot Trial. JMIR Res Protoc 2019; 8:e15530. [PMID: 31778116 PMCID: PMC6908979 DOI: 10.2196/15530] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Postpartum weight retention contributes to long-term weight gain and obesity for many women. Lifestyle interventions with numerous visits are logistically challenging for many postpartum women. Delivering a lifestyle intervention via social media may overcome logistic challenges to participation in in-person weight loss programs. OBJECTIVE The objective of this study is to conduct a randomized feasibility pilot trial of a 6-month postpartum weight loss intervention delivered via Facebook or in-person groups with 72 postpartum women with overweight or obesity. METHODS Women with overweight or obesity who are 8 weeks to 12 months postpartum (N=72) will be recruited from the Hartford, Connecticut community. Eligible participants must also own an iPhone or Android smartphone and be an active Facebook user. Participants will receive a 6-month postpartum weight loss intervention based on the Diabetes Prevention Program lifestyle intervention and adapted for postpartum women. Participants will be randomized to receive the intervention via a private Facebook group or in-person group meetings. Assessments will occur at baseline, weekly during the intervention, at 6 months (at the end of the intervention), and at 12 months. Primary feasibility outcomes are recruitment, sustained participation, contamination, retention, and feasibility of assessment procedures including measurement of costs to deliver and receive the intervention. We will describe 6- and 12-month weight loss as an exploratory outcome. RESULTS Recruitment began in September 2018. The first wave of the intervention began in February 2019, and the second wave of the intervention is expected to begin in fall 2019. We anticipate completing follow-up assessments in fall 2020, and results will be analyzed at that time. CONCLUSIONS Results will inform the design of a large randomized controlled trial to assess whether delivering a postpartum weight loss intervention via Facebook is noninferior for weight loss and more cost-effective than delivering the intervention via traditional in-person groups. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15530.
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Affiliation(s)
- Molly E Waring
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
| | - Brooke A Libby
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
- Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
- Department of Psychiatry, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, United States
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Madison L Bracken
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, United States
| | - Jessica L Bibeau
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
| | - Valeria Herrera
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
| | - Justin Wang
- Social Sciences Department, Community College of Rhode Island, Warwick, RI, United States
| | - Sherry L Pagoto
- Department of Allied Health Sciences, UConn Center for mHealth and Social Media, University of Connecticut, Storrs, CT, United States
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Matvienko-Sikar K, Toomey E, Delaney L, Flannery C, McHugh S, McSharry J, Byrne M, Queally M, Heary C, Kearney PM. Behaviour change techniques and theory use in healthcare professional-delivered infant feeding interventions to prevent childhood obesity: a systematic review. Health Psychol Rev 2019; 13:277-294. [DOI: 10.1080/17437199.2019.1605838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Elaine Toomey
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Lisa Delaney
- School of Public Health, University College Cork, Cork, Ireland
| | - Caragh Flannery
- School of Public Health, University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Jenny McSharry
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Molly Byrne
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Michelle Queally
- Discipline of Economics, JE Cairnes School of Business and Economics, National University of Ireland Galway, Galway, Ireland
| | - Caroline Heary
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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18
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Tully L, Allen-Walker V, Spyreli E, McHugh S, Woodside JV, Kearney PM, McKinley MC, Dean M, Kelly C. Solid advice: Complementary feeding experiences among disadvantaged parents in two countries. MATERNAL AND CHILD NUTRITION 2019; 15:e12801. [PMID: 30806025 DOI: 10.1111/mcn.12801] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/23/2019] [Accepted: 02/18/2019] [Indexed: 12/11/2022]
Abstract
The initiation of complementary feeding (CF; introducing infants to food/drink other than milk) is recommended close to 6 months and not before 4 months of age. Low socio-economic status (SES) is a determinant of nonadherence to CF recommendations, but there is an evidence gap around reasons for nonadherence among these parents. This study investigated knowledge, attitudes, and practices of disadvantaged families (in terms of SES and social support) and use of guidance for CF, in the Republic of Ireland and Northern Ireland. Parents of infants aged 3-14 months were recruited via community groups. Semistructured focus groups aided by vignettes were used. Data were analysed using an inductive thematic approach. Nineteen focus groups took place with parents (n = 83). A range of factors influence parents when introducing solids. Sources of guidance extend to family, friends, the internet, and commercial resources. Parents experience uncertainty and anxiety during this time, driven by lack of knowledge and conflicting advice. Five major themes were identified: (a) more guidance that is accessible, timely, and respectfully needed; (b) the challenge of choosing safe, nutritious food; (c) "everybody has an opinion"; (d) feelings of inadequacy, embarrassment, and guilt; and (e) decisions are ultimately based on individual circumstances. CF advice should be culturally appropriate, practical, and empowering, emphasising the rationale behind updates to recommendations and consequences of nonadherence. Future training of health professionals for delivery of CF advice and guidance should consider these findings. Compliance with CF recommendations is influenced by health professionals, the wider family, and the commercial baby-food sector.
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Affiliation(s)
- Louise Tully
- Health Promotion Research Centre, National University of Ireland, Galway, Ireland
| | - Virginia Allen-Walker
- Nutrition Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Eleni Spyreli
- School of Biological Sciences, Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Jayne V Woodside
- Nutrition Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | | | - Michelle C McKinley
- Nutrition Group, Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Moira Dean
- School of Biological Sciences, Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - Colette Kelly
- Health Promotion Research Centre, National University of Ireland, Galway, Ireland
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Begley A, Ringrose K, Giglia R, Scott J. Mothers' Understanding of Infant Feeding Guidelines and Their Associated Practices: A Qualitative Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071141. [PMID: 30934967 PMCID: PMC6479610 DOI: 10.3390/ijerph16071141] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 01/12/2023]
Abstract
There is limited evidence to describe Australian mothers’ understanding of the Australian Infant Feeding Guidelines (AIFG). A qualitative inductive methodological approach was used in this study to explore experiences with the introduction of solid food. Seven focus groups with 42 mothers of children aged 4–18 months were conducted in disadvantaged areas in Perth, Australia. The mean age of infants was 9.6 months and mean age of introduction of solid food was 4.3 months (range 1.2 to 7.5 months). Almost half of the mothers in this study were aware of the AIFG however, only half again could correctly identify the recommended age for introducing solid food. Four themes and nine subthemes emerged from the analysis. Themes were (1) Every child is different (judging signs of readiness); (2) Everyone gives you advice (juggling conflicting advice); (3) Go with your gut—(being a “good” mother); and (4) It’s not a sin to start them too early or too late (—guidelines are advice and not requirements). The findings indicated that in spite of continued promotion of the AIFG over the past ten years achieving the around six months guideline is challenging. Professionals must address barriers and support enablers to achieving infant feeding recommendations in the design education materials and programs.
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Affiliation(s)
- Andrea Begley
- School of Public Health, Curtin University, Perth 6102, Australia.
| | - Kyla Ringrose
- School of Public Health, Curtin University, Perth 6102, Australia.
| | | | - Jane Scott
- School of Public Health, Curtin University, Perth 6102, Australia.
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20
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Gibby CLK, Palacios C, Campos M, Lim E, Banna J. Associations between gestational weight gain and rate of infancy weight gain in Hawai'i and Puerto Rico WIC participants. BMC OBESITY 2018; 5:41. [PMID: 30524746 PMCID: PMC6276143 DOI: 10.1186/s40608-018-0219-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/19/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Excessive gestational weight gain and rapid infancy weight gain (RIWG) are associated with increased susceptibility to childhood obesity. Since low-income and minority children are particularly at risk, investigation of the associations between gestational weight gain and rate of infancy weight gain may inform childhood obesity prevention. This study investigated the associations between gestational weight gain and rate of infancy weight gain during the first four to six months postpartum in participants from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Hawai'i and Puerto Rico. METHODS This was a cross-sectional secondary data analysis from a text message-based intervention in WIC participants in Hawai'i and Puerto Rico. The analysis included 80 mother/infant pairs from the control group who completed the follow-up visit when infants were four to six months old. Maternal weight, height, and gestational weight gain were self-reported. Infant weight was measured at baseline and follow-up. A proportional odds model was used to investigate the association between gestational weight gain and infancy weight gain rate (rapid or extremely rapid, on-track, or slow), adjusting for maternal age, pregravid body mass index (BMI) status, parity, and being up-to-date with infant vaccinations. RESULTS In comparison to recommended gestational weight gain, excessive and inadequate (under the recommended amount) gestational weight gain was associated with 77% decreased (adjusted odds ratio [AOR] = 0.23; 95% confidence interval [CI] = 0.08, 0.70; p = 0.01) and 71% decreased (AOR = 0.29; 95% CI = 0.09, 0.94; p = 0.04) odds of RIWG versus on-track or slow infant weight gain, respectively. In comparison to women with one child, women with two children (AOR = 0.31; 95% CI = 0.11, 0.87; p = 0.03) or three or four children (AOR = 0.24; 95% CI = 0.07, 0.88; p = 0.03) had significantly lower odds of RIWG versus on-track or slow infancy weight gain. CONCLUSIONS Women with excessive or inadequate gestational weight gain had lower proportional odds of RIWG and were more likely to have slower infant weight gain than women who gained the recommended amount of weight. TRIAL REGISTRATION ClinicalTrials.gov Identifier; NCT02903186; September 16, 2016.
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Affiliation(s)
- Cheryl L. K. Gibby
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa. Agricultural Sciences 216, 1955 East-West Rd, Honolulu, HI 96822 USA
| | - Cristina Palacios
- Department of Dietetics and Nutrition, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 SW 8th Street, AHC 5–313, Miami, FL 33199 USA
| | - Maribel Campos
- Dental and Craniofacial Genomics Unit, Endowed Health Services Research Center, Medical Sciences Campus, University of Puerto Rico, PO Box 365067, San Juan, PR 00936-5067 USA
| | - Eunjung Lim
- Department of Complementary and Integrative Medicine, Biostatistics Core Facility, John A. Burns School of Medicine, University of Hawai‘i at Mānoa. Medical Education Building 411, 651 Ilalo Street, Honolulu, HI 96813 USA
| | - Jinan Banna
- Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawai‘i at Mānoa. Agricultural Sciences 216, 1955 East-West Rd, Honolulu, HI 96822 USA
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Monteban M, Yucra Velasquez V, Yucra Velasquez B. Comparing Indigenous and public health infant feeding recommendations in Peru: opportunities for optimizing intercultural health policies. JOURNAL OF ETHNOBIOLOGY AND ETHNOMEDICINE 2018; 14:69. [PMID: 30458832 PMCID: PMC6245876 DOI: 10.1186/s13002-018-0271-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 11/02/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND The problem of childhood undernutrition in low-income countries persists despite long-standing efforts by local governmental and international development agencies. In order to address this problem, the Peruvian Ministry of Health has focused on improving access to primary healthcare and providing maternal and child health monitoring and education. Current maternal-child health policies in Peru introduce recommendations that are in some respect distinct from those of Indigenous highland communities. This paper analyses the similarities and differences between public health and mothers' infant feeding recommendations. Furthermore, it analyses persistence and change in those recommendations among women who were mothers before and after the introduction of current public health policies. METHODS Semi-structured interviews were conducted with 18 older mothers, 15 currently breastfeeding mothers, and 15 public health staff in highland rural communities of Peru. During data analysis, thematic codes and text passages were used in an iterative analytic process to document emerging themes. RESULTS The results highlight the existence of a traditional corpus of beliefs surrounding infant feeding and care that is consistent with Andean ethnomedical beliefs. This is illustrated by mother's accounts referring to the importance of maintaining a dietary balance of fluids and semi-fluids and of maintaining harmony with the elements in the natural environment. Mothers also incorporate aspects of public health recommendations that they find useful including initiating breastfeeding immediately after birth and exclusive breastfeeding up until 6 months. There are also tensions between the two systems including differences in the conceptualization of breastfeeding and infant food, the imposition of public health care services by coercive means, and negative stereotyping of rural Andean diets and mothers. CONCLUSIONS Identifying similarities and differences between distinct systems may provide useful input for effective intercultural health policies. Sources of tension should be carefully assessed with the aim of improving public health policies. Such efforts should apply a process of cultural humility engaging health care professionals in exchange and conversations with patients and communities acknowledging the assumptions and beliefs that are embedded in their own understanding. This process should also recognize and value the knowledge and practices of Andean mothers and their role as primary caretakers.
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Affiliation(s)
- Madalena Monteban
- Department of Anthropology, University of Georgia, Athens, USA
- Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- 4600 S.S. de Jujuy, Argentina
| | - Valeria Yucra Velasquez
- Asociación ANDES, Street Ciro Alegria H-13, Urb. Santa Monica–Wanchaq, Postal Nº 567, Cusco, Peru
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Practices of Introduction of Complementary Feeding and Iron Deficiency Prevention in the Middle East and North Africa. J Pediatr Gastroenterol Nutr 2018; 67:538-542. [PMID: 30067543 DOI: 10.1097/mpg.0000000000002059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Iron deficiency (ID) with or without anemia is associated with impaired mental and psychomotor development. Given the paucity of information on physicians' knowledge and practices on iron (Fe) supplementation and impact of ID in the Middle East and North Africa, it was felt important to conduct a survey. METHOD A group of expert physicians developed a questionnaire that was randomly distributed among Middle East and North Africa doctors to assess their knowledge and practices on introduction of complementary feeding, impact of ID, its prevention, and their impression on prevalence of ID. Descriptive statistics were used. RESULTS We received 2444 completed questionnaires. Thirty-nine percent of physicians do not follow the European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines regarding age of introduction of complementary feedings. Approximately 62% estimate the prevalence of ID anemia to be 40% to 70%; however, only 17% always monitor hemoglobin between 9 and 12 months of age, 43% do so "almost" always, whereas 36% do so "rarely" or (4%) "never." For the prevention of ID in infants older than 6 months of age, almost all recommend introducing Fe supplements. Ninety-seven percent agree that untreated ID during infancy may have long-term negative effects on cognitive function, whereas 53.26% consider that Fe-enriched infant cereals result in staining of the baby teeth, constipation, and dark stools. CONCLUSIONS Although there is awareness of the impact of ID, there are some misconceptions regarding age of introduction of complementary feedings, surveillance of Fe status, and side effects of Fe-enriched infant cereals. There is a need for educational initiatives focusing on prevention of Fe deficiency.
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Helle C, Hillesund ER, Øverby NC. Timing of complementary feeding and associations with maternal and infant characteristics: A Norwegian cross-sectional study. PLoS One 2018; 13:e0199455. [PMID: 29949644 PMCID: PMC6021099 DOI: 10.1371/journal.pone.0199455] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022] Open
Abstract
Norwegian Health authorities recommend solid food to be introduced between child age 4-6 months, depending on both the mother´s and infant's needs. The aim of this paper is to describe timing of complementary feeding in a current sample of Norwegian mother/infant-dyads and explore potential associations between timing of introduction to solid foods and a wide range of maternal and infant characteristics known from previous literature to influence early feeding interactions. The paper is based on data from the Norwegian randomized controlled trial Early Food for Future Health. In 2016, a total of 715 mothers completed a web-based questionnaire at child age 5.5 months. We found that 5% of the infants were introduced to solid food before 4 months of age, while 14% were not introduced to solid food at 5.5 months of age. Introduction of solid food before 4 months of age was associated with the infant not being exclusive breastfed the first month, receiving only formula milk at 3 months, the mother being younger, not married/cohabitant, smoking, less educated and having more economic difficulties. Not being introduced to solid food at 5.5 months was associated with the infant being a girl, being exclusive breastfed the first month, receiving only breastmilk at 3 months, the mother being older, married and having 3 or more children. This study shows that there are still clear socioeconomic differences regarding timing of complementary feeding in Norway. Infants of younger, less educated and smoking mothers are at higher risk of not being fed in compliance with the official infant feeding recommendations. Our findings emphasize the importance of targeting socioeconomically disadvantaged mothers for support on healthy feeding practices focusing on the infant`s needs to prevent early onset of social inequalities in health.
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Affiliation(s)
- Christine Helle
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Elisabet R. Hillesund
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Nina C. Øverby
- Department of Public Health, Sport and Nutrition, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Effectiveness of different interventions in public nurseries based on food and nutrition education: promoting breast-feeding and healthy complementary feeding. Public Health Nutr 2018; 21:2454-2461. [PMID: 29745355 DOI: 10.1017/s1368980018001015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Food practices in the early years of life are important to form healthy eating habits; therefore, it is essential for the caregivers of infants to receive appropriate guidance. The present study aimed to investigate the effectiveness of different nutritional interventions on complementary feeding practices in municipal nurseries. DESIGN Non-randomized controlled intervention study with education professionals and parents of infants (<2 years). Participants were divided into: control group (CG), standard food and nutrition education in writing; and intervention group (IG), the same information as the CG and face-to-face meetings (professionals, 8 h; parents, 5 h). Changes in professionals' knowledge on the subject and alterations in parents' beliefs, attitudes and intentions were assessed using questionnaires before and after the educational activities. SETTING Ten public nurseries in Nova Lima, Belo Horizonte, Minas Gerais, Brazil, 2015. SUBJECTS Ninety professionals (fifty in CG; forty in IG) and 169 parents (ninety-seven in CG; seventy-two in IG). RESULTS After the intervention, there was a significant increase in the mean number of correct responses given by professionals in the IG (12·2 v. 10·7; P=0·001). In addition, there were improvements among the parents of the IG in relation to beliefs (soups and broths do not nourish my child: P=0·012), attitudes (offer meat from the sixth month: P=0·032) and intentions (do not offer soups and broths: P=0·003; offer vegetables: P=0·018; offer meat: P<0·001). CONCLUSIONS Face-to-face nutritional intervention had a significantly greater effect on the parameters evaluated, indicating the importance of adequate guidance in childcare services to support the introduction of complementary feeding.
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Matvienko-Sikar K, Kelly C, Sinnott C, McSharry J, Houghton C, Heary C, Toomey E, Byrne M, Kearney PM. Parental experiences and perceptions of infant complementary feeding: a qualitative evidence synthesis. Obes Rev 2018; 19:501-517. [PMID: 29243375 DOI: 10.1111/obr.12653] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/23/2017] [Accepted: 10/31/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Interventions to prevent childhood obesity increasingly focus on infant feeding, but demonstrate inconsistent effects. A comprehensive qualitative evidence synthesis is essential to better understand feeding behaviours and inform intervention development. The aim of this study is to synthesize evidence on perceptions and experiences of infant feeding and complementary feeding recommendations. METHODS Databases CINAHL, EMBASE, MEDLINE, PsycINFO, Academic Search Complete, SocIndex and Maternity and Infant Care were searched from inception to May 2017. Eligible studies examined parents' experiences of complementary feeding of children (<2 years). Data were synthesized using thematic synthesis. RESULTS Twenty-five studies met inclusion criteria for review. Four key themes emerged. 'Guidelines and advice' highlights variety and inconsistencies between sources of complementary feeding information. 'Stage of weaning' describes infant feeding as a process involving different stages. 'Knowing and trying' outlines parents' engagement in feeding approaches based on instinct, prior experience or trial and error. 'Daily life' highlights problematic cost and time constraints for parents. DISCUSSION Parents predominantly understand and want to engage in healthy feeding processes. Consideration of infant feeding as a process that changes over time is necessary to support parents. Provision of clear, consistent information and guidance from trusted sources on when, what and how to feed is also essential.
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Affiliation(s)
| | - C Kelly
- Health Promotion Research Centre, National University of Ireland Galway, Ireland
| | - C Sinnott
- Cambridge Centre for Health Services Research, University of Cambridge, UK
| | - J McSharry
- School of Psychology, National University of Ireland Galway, Ireland
| | - C Houghton
- School of Nursing & Midwifery, National University of Ireland Galway, Ireland
| | - C Heary
- School of Psychology, National University of Ireland Galway, Ireland
| | - E Toomey
- School of Psychology, National University of Ireland Galway, Ireland
| | - M Byrne
- School of Psychology, National University of Ireland Galway, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Ireland
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Suboptimal infant and young child feeding practices among internally displaced persons during conflict in eastern Ukraine. Public Health Nutr 2017; 21:917-926. [PMID: 29268805 PMCID: PMC5848760 DOI: 10.1017/s1368980017003421] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine current status, areas for improvement and effect of conflict on infant and young child feeding (IYCF) practices among internally displaced persons (IDP) in eastern Ukraine. DESIGN Cross-sectional household survey, June 2015. SETTING Kharkiv, Dnipropetrovsk and Zaporizhia oblasts (Ukrainian administrative divisions) bordering conflict area in Ukraine. SUBJECTS Randomly selected IDP households with children aged <2 years registered with local non-governmental organizations. Questions based on the WHO IYCF assessment questionnaire were asked for 477 children. Mid-upper arm circumference was measured in 411 children aged 6-23 months. RESULTS Exclusive breast-feeding prevalence for infants aged <6 months was 25·8 (95 % CI 15·8, 38·0) %. Percentage of mothers continuing breast-feeding when their child was aged 1 and 2 years was 53·5 (95 % CI 43·2, 63·6) % and 20·6 (95 % CI 11·5, 32·7) %, respectively. Bottle-feeding was common for children aged <2 years (68·1 %; 95 % CI 63·7, 72·3 %). Almost all infants aged 6-8 months received solid foods (98·6 %; 95 % CI 88·5, 99·9 %). Mothers who discontinued breast-feeding before their infant was 6 months old more often listed stress related to conflict as their primary reason for discontinuation (45·7 %) compared with mothers who discontinued breast-feeding when their child was aged 6-23 months (14·3 %; P<0·0001). CONCLUSIONS To mitigate the effects of conflict and improve child health, humanitarian action is needed focused on helping mothers cope with stress related to conflict and displacement while supporting women to adhere to recommended IYCF practices if possible and providing appropriate support to women when adherence is not feasible.
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Age at introduction of solid foods and feeding difficulties in childhood: findings from the Southampton Women's Survey. Br J Nutr 2016; 116:743-50. [PMID: 27356464 DOI: 10.1017/s0007114516002531] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This study aimed to determine whether age at introduction of solid foods was associated with feeding difficulties at 3 years of age. The present study was carried out using data from the Southampton Women's Survey (SWS). Women enrolled in the SWS who subsequently became pregnant were followed-up during pregnancy and postpartum, and the offspring have been studied through childhood. Maternal socio-demographic and anthropometric data and child anthropometric and feeding data were collected through interviews and self-administered questionnaires. When the children were 3 years of age, mothers/carers rated six potential child feeding difficulty questions on a four-point Likert scale, including one general question and five specific feeding difficulty questions. Age at introduction of solids as a predictor of feeding difficulties was examined in 2389 mother-child pairs, adjusting for child (age last breast fed, sex, gestation) and maternal characteristics (parity, pre-pregnancy BMI, age, education, employment, parenting difficulties, diet quality). The majority of mothers/carers (61 %) reported some feeding difficulties (general feeding difficulty question) at 3 years of age, specifically with their child eating enough food (61 %), eating the right food (66 %) and being choosy with food (74 %). Children who were introduced to solids ≥6 months had a lower risk of feeding difficulties (RR 0·73; 95 % CI 0·59, 0·91, P=0·004) than children who were introduced to solids between 4 and 6 months. No other significant associations were found. There were few associations between feeding difficulties in relation to age at introduction of solid foods. However, general feeding difficulties were less common among infants introduced to solid foods ≥6 months of age.
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