Infant Overfeeding in Immigrant Families

描述(由申请人提供)：背景：我们公共部门的初步数据表明，婴儿过度喂养导致超重，特别是在索马里婴儿中。开发和评估培训初级保健提供者使用强调自我管理的咨询策略的课程可能有助于解决婴儿喂养过多的问题。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以有效解决婴儿喂养问题的课程。这些新知识将与涵盖当前婴儿营养支持最佳实践的内容联系起来。该培训项目名为“婴儿喂养文化支持”课程，旨在培训初级保健提供者在第一年就诊时如何使用协作性自我管理支持和解决问题的技巧。具体地说，这项研究的目的是：1)使用定性技术开发一个了解文化的IFCS课程，2)在IFCS课程中培训儿科初级保健提供者，3)评估IFCS课程中培训提供者在a)改变提供者行为，b)增加照顾者知识，c)改变所报告的婴儿喂养做法方面的影响的可行性。 研究对象/背景：这项研究将招募哈博维尤医疗中心(HMC)儿科诊所的照顾者和他们的初级保健提供者。HMC是一家大型市中心医院，服务于华盛顿州西雅图-金县的低收入人口，有大量来自索马里和其他国家的移民家庭。哥伦比亚卫生中心(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课程将通过对录音、Well儿童相遇和焦点小组进行人种学分析来了解。将通过以下方式向初级保健提供者提供课程：直接观察健康儿童检查，事后提供即时反馈；参加以案例情景和角色扮演为特色的小组会议；以及直接观察/反馈另外3次访问。评估设计：评估将采用准实验设计，对HMC的ICFS干预进行前/后评估，并与对照诊所CHC进行比较。结果指标：这项研究将探索在接受IFCS培训后，提供者在多大程度上解决婴儿喂养做法问题。将对健康儿童访问的测试前和测试后的录音带进行分析，以评估与IFCS课程的一致性。此外，还将评估婴儿照顾者对婴儿喂养做法的了解的变化以及报告的喂养做法的变化。综上所述，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.