Infant Overfeeding in Immigrant Families

描述（申请人提供）：背景：在我们的公共部门设置的初步数据表明，婴儿过度喂养导致超重，特别是在索马里婴儿。开发和评估课程，培训初级保健提供者使用咨询策略，强调自我管理，可能有助于解决婴儿喂养过度。研究目的：总体目标是更好地了解索马里家庭的婴儿喂养做法，并随后将这一新知识应用于培训初级保健提供者的课程，以有效解决婴儿喂养问题。这些新知识将与涵盖当前婴儿营养支持最佳实践的内容相联系。这一培训方案被称为“婴儿喂养文化支持”课程，旨在培训初级保健提供者在生命第一年的门诊和健康儿童就诊期间使用协作性自我管理支持和解决问题的技巧。具体而言，该研究旨在：1）使用定性技术来制定一个具有文化信息的化安论坛课程，2）对儿科初级保健提供者进行化安论坛课程培训，以及3）根据化安论坛课程对以下方面的影响来评估培训提供者的可行性：a）改变提供者的行为，B）增加护理人员的知识，以及c）改变所报告的婴儿喂养做法。 受试者/设置：该研究将在Harborview医疗中心（HMC）的儿科诊所招募护理人员及其初级保健提供者，该中心是一家大型内城医院，为西澳西雅图国王县的低收入人群提供服务，其中有大量来自索马里和其他国家的移民家庭。哥伦比亚健康中心（CMC）是一家拥有类似患者基础的大型公共部门诊所，将作为对照诊所。方法：ICFS课程将通过对儿童遭遇和焦点小组的录音进行民族志分析来了解。课程将通过以下方式提供给初级保健提供者：直接观察健康儿童检查，并在检查后立即提供反馈;参加以案例情景和角色扮演为特色的小组会议;以及再进行3次访问的直接观察/反馈。评价设计：评价将采用准实验设计，对HMC的ICFS干预进行前/后评估，并与对照诊所CHC进行比较。观察指标：本研究将探讨在接受IFCS培训后，提供者在多大程度上解决了婴儿喂养问题。将对健康儿童访问的测试前和测试后录音带进行分析，以评估其是否与化安论坛课程保持一致。此外，还将评估婴儿看护者对婴儿喂养实践的知识变化和报告的喂养实践变化。总之，这些信息将为一项大型随机临床试验奠定基础，以防止高危索马里婴儿超重。

DESCRIPTION (provided by applicant): BACKGROUND: Preliminary data in our public-sector setting indicate infant overfeeding contributes to overweight, especially among Somali infants. Developing and evaluating a curriculum to train primary care providers to use counseling strategies emphasizing self-management may help address infant overfeeding. STUDY AIMS: The overall aims are to better understand infant feeding practices in Somali families and, subsequently, to apply this new knowledge to a curriculum for training primary care providers to effectively address infant feeding. Thisnew knowledge will be linked with content covering current best practices for infant nutritional support. This training program, termed the "Infant Feeding Cultural Support" curriculum, will be designed to train primary care providers in the use of collaborative self-management support and problem solving techniques during outpatient, well-child visits occurring in the first year of life. Specifically, the study aims: 1) to use qualitative techniques to develop a culturally informed IFCS curriculum, 2) to train pediatric primary care providers in the IFCS curriculum, and 3) to evaluate the feasibility of training providers in the IFCS curriculum in terms of its effect on a) changing provider behavior, b) increasing caregiver knowledge, and c) altering reported infant feeding practices. SUBJECTS/SETTING: The study will enroll caregivers and their primary care providers at the pediatric clinic of Harborview Medical Center (HMC), a large, inner-city hospital serving a low-income population in Seattle-King County, WA with large numbers of immigrant families from Somalia and other countries. Columbia Health Center (CMC), a large public sector clinic with a similar patient base, will serve as the control clinic. METHODOLOGY: The ICFS curriculum will be informed by conducting an ethnographic analysis of audio taped well child encounters and focus groups. The curriculum will be delivered to primary care providers by: direct observation of a well-child check with the provision of immediate feedback afterwards; participation in a group session featuring case scenarios and role plays; and direct observation/feedback of 3 more visits. EVALUATION DESIGN: The evaluation will employ a quasi-experimental design with pre-/post-assessment of the ICFS intervention at HMC and comparison with the control clinic, CHC. OUTCOME MEASURES: This study will explore the extent to which providers address infant feeding practices after receipt of IFCS training. Pre- and post-test audiotapes of well-child visits will be analyzed to assess concordance with the IFCS curriculum. Also, changes in infant caregiver knowledge about infant feeding practices and changes in reported feeding practices will be assessed. Taken together, this information will set the stage for a large randomized, clinical trial to prevent overweight among high-risk Somali infants.