A Mixed-Methods Analysis of a Special Supplemental Nutrition Program for Women, Infants, and Children and Primary Care Partnership to Promote Responsive Feeding for Infants in Group Well-Child Care

Parental experiences of primary health professional support with child health behaviours and growth: a scoping review

OBJECTIVES

This review examined the experiences of parents/carers of 0-5-year-olds engaging with primary health professionals (PHPs) regarding child growth or associated health behaviours (nutrition, physical activity, sedentary behaviour, sleep).

METHODS

Six databases - MEDLINE, CINAHL, Embase, Scopus, Maternity and Infant Care Database, and PsycINFO - were searched. Eligible studies described parent-reported experiences engaging with PHPs, in both clinician- and parent-initiated interactions, regarding child growth or health behaviours in primary healthcare settings, published between 2003 and 2023. Data was synthesised using a convergent integrated approach, with barriers and facilitators to engagement mapped to the Capability, Opportunity, and Motivation model of behaviour.

RESULTS

Eighty-seven papers (85 studies) were included, mostly conducted in the United States of America (n = 17), United Kingdom (n = 15) or Australia (n = 10). Most studies were qualitative (n = 50) and reported experiences of discussing feeding and nutrition (n = 75), with few exploring physical activity (n = 5), sedentary behaviour (n = 4), and sleep (n = 7). Barriers to discussing growth and health behaviours with PHPs included receiving ambiguous or conflicting advice; difficulty accessing services; and insufficient appointment time. Facilitators included personalised, timely, evidence-based advice, supported by appropriate resources, and delivered empathetically and without judgement. Studies reported positive (n = 25), moderate (n = 4), negative (n = 10), and variable (n = 34) levels of satisfaction with PHP support.

CONCLUSIONS

This review highlights that PHPs frequently advise parents regarding child growth and health behaviours, particularly nutrition, in the early years. Improved PHP support may be facilitated using tools and professional development to support a consistent early childhood health promotion approach.

Interventions to mitigate infant food insecurity in high-income countries: an overview of current evidence

Aim

Infant food insecurity (IFI) is a critical and often overlooked issue in high-income countries. This scoping review aims to identify and summarise interventions that reduce food insecurity or improve nutrition amongst families with infants in these regions.

Subject and methods

We searched the major electronic databases and websites of relevant UK and international organisations from 2010 to 2023 to identify reports written in English assessing food insecurity affecting infants (aged 0 to 2 years). The findings were presented in tables and summarised narratively.

Results

Out of 6194 records identified, 104 studies were screened, with only two studies meeting the inclusion criteria. Both studies were conducted in the USA. The KIND (Keeping Infants Nourished and Developing) intervention improved preventive care for food-insecure families, increasing lead level test completion rates and well-infant visits, but it did not affect weight-for-length at 9 months. The GWCC (Group Well-Child Care) intervention aimed at promoting responsive feeding amongst low-income caregivers but showed no significant impact on infant growth in the first year. However, caregiver interviews revealed important feeding-related themes.

Conclusion

Evidence on interventions addressing infant food insecurity is limited, with none found in the UK. The KIND and GWCC interventions showed mixed outcomes, improving some aspects of care but not significantly affecting infant growth metrics. These findings highlight the need for further research to develop more effective strategies to address the nutritional needs of vulnerable infants in high-income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41110-025-00343-5.

Perspectives from parents and clinicians on an ecology-focused approach to a group well-child care

BACKGROUND

Group well-child care (GWCC) is a novel group-based alternative for pediatric primary care visits that may allow for adaptations that better tailor to the needs of underserved populations. This qualitative study investigates clinician and parent perspectives on the acceptability and feasibility of integrating ecology-focused content in GWCC using semi-structured interviews with GWCC parent-graduates and ecology-focused child clinicians.

METHODS

Ecology-focused child clinicians were purposively sampled via email outreach. GWCC parent graduates were recruited via announcement in private Facebook groups. One-on-one interviews were conducted via videoconference, transcribed, and analyzed using an inductive approach. Parent and clinician thematic analyses were independently conducted to construct shared domains.

RESULTS

Nine GWCC parent-graduates and nine ecology-focused child clinicians were recruited into the study. Four overarching themes were constructed across parent and clinician responses: questions about clinical appropriateness, parent and clinician desires for educational support, influences of perceptions of nature on clinicians, and parent desires to develop independence and autonomy.

CONCLUSION

This study identified nuanced considerations from the perspective of parents and clinicians for the implementation of ecology-focused content in the GWCC setting. Understanding the range of preferences parents and clinicians may have over ecology-focused content can help GWCC clinicians in designing ecology-focused preventive counseling materials.

Community-based diet and obesity-related policy, system, and environmental interventions for obesity prevention during the first 1000 days: A scoping review

Community-based policy, systems, and environmental interventions have the potential to reduce modifiable risk factors for obesity early in life. The purpose of this scoping review was to characterize the breadth, generalizability, and methodological quality of community-based diet and obesity-related policy, system, and environmental interventions during the first 1000 days of life, from pregnancy to 24 months of age. Eight databases were searched, and 83 studies (122 references) were included. Data were extracted for breadth (intervention characteristics), generalizability (reach, effectiveness, adoption, implementation, and maintenance), and study quality (Downs and Black Checklist). Systems and environmental approaches were common (> 80%), relative to policy approaches (39%). The majority (60-69%) occurred in the prenatal period and early infancy (0-3 months), assessed breastfeeding or child growth/obesity (53% for both), and included people with lower income (80%) or racial and/or ethnic minority groups (63%). Many interventions reported positive outcomes (i.e., in the expected direction) for child diet, breastfeeding, and feeding practices (> 62%). Few reported intervention maintenance or spanned the full 1000 days. Most studies were classified as good (32%) or fair (56%) methodological quality. The interventions mainly addressed pregnancy and early infancy. Rigorous and representative investigation is needed to improve intervention reach, sustainability, and application in toddlerhood.

WIC staff and healthcare professional perceptions of an EHR intervention to facilitate referrals to and improve communication and coordination with WIC: A qualitative study

Objectives

Participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has numerous benefits, yet many eligible children remain unenrolled. This qualitative study sought to explore perceptions of a novel electronic health record (EHR) intervention to facilitate referrals to WIC and improve communication/coordination between WIC staff and healthcare professionals.

Methods

WIC staff in three counties were provided EHR access and recruited to participate. An automated, EHR-embedded WIC participation screening and referral tool was implemented within 8 healthcare clinics; healthcare professionals within these clinics were eligible to participate. The interview guide was developed using the Consolidated Framework for Implementation Research to elicit perceptions of this novel EHR-based intervention. Semi-structured interviews were conducted via telephone. Interviews were recorded, transcribed, coded, and analyzed using thematic analysis.

Results

Twenty semi-structured interviews were conducted with eight WIC staff, seven pediatricians, four medical assistants, and one registered nurse. Most participants self-identified as female (95%) and White (55%). We identified four primary themes: (1) healthcare professionals had a positive view of WIC but communication and coordination between WIC and healthcare professionals was limited prior to WIC having EHR access; (2) healthcare professionals favored WIC screening using the EHR but workflow challenges existed; (3) EHR connections between WIC and the healthcare system can streamline referrals to and enrollment in WIC; and (4) WIC staff and healthcare professionals recommended that WIC have EHR access.

Conclusions

A novel EHR-based intervention has potential to facilitate healthcare referrals to WIC and improve communication/coordination between WIC and healthcare systems.