Consumption of foods from the WIC food packages of Chinese prenatal patients on the US west coast

A realist review to explore how low-income pregnant women use food vouchers from the UK's Healthy Start programme

OBJECTIVES

To explore how low-income pregnant women use Healthy Start food vouchers, the potential impacts of the programme, and which women might experience these impacts and why.

DESIGN

A realist review.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Primary or empirical studies (of any design) were included if they contributed relevant evidence or insights about how low-income women use food vouchers from the Healthy Start (UK) or the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) programmes. The assessment of 'relevance' was deliberately broad to ensure that reviewers remained open to new ideas from a variety of sources of evidence.

ANALYSIS

A combination of evidence synthesis and realist analysis techniques was used to modify, refine and substantiate programme theories, which were constructed as explanatory 'context-mechanism-outcome'-configurations.

RESULTS

38 primary studies were included in this review: four studies on Healthy Start and 34 studies on WIC. Two main outcome strands were identified: dietary improvements (intended) and financial assistance (unintended). Three evidence-informed programme theories were proposed to explain how aspects of context (and mechanisms) may generate these outcomes: the 'relative value' of healthy eating (prioritisation of resources); retailer discretion (pressure to 'bend the rules'); the influence of other family members (disempowerment).

CONCLUSIONS

This realist review suggests that some low-income pregnant women may use Healthy Start vouchers to increase their consumption of fruits and vegetables and plain cow's milk, whereas others may use them to reduce food expenditure and save money for other things.

Family and Cultural Issues in a School Swallowing and Feeding Program

Purpose

This article presents a rationale for speech-language pathologists (SLPs) to provide culturally competent evaluation, diagnostic, and intervention services for children with oral motor, swallowing, and feeding disorders in school settings. There is also a discussion of how changing American public school demographics necessitate the consideration of cultural issues and family-focused approaches to dysphagia services.

Method

This article provides an overview of cultural, religious, and health beliefs of several ethnic groups, as well as information on the dynamics and requirements of cultural competence and family-focused intervention. Ethnographic interviewing is presented as a culturally sensitive diagnostic method. Information on structuring a culturally relevant individualized educational program process is provided. Guidance in the use of interpreters and translators is also offered.

Conclusion

Attention to cultural and family issues in the diagnosis and treatment of dysphagia in a school setting optimizes the opportunities for successful outcomes and better meets the needs of children and families from culturally/linguistically diverse backgrounds.