Health professionals' counselling on the use of infant formula: A scoping review.

OBJECTIVE: Many parents experience lack of support and access to resources on how to prepare, handle, and provide formula milk to their infants. The purpose of this scoping review was to map and describe key information in existing research about how healthcare professionals receive information and how they inform and counsel parents about formula milk. DESIGN: A scoping review fulfilling the PRISMA-ScR checklist criteria used systematic searches targeting the study objective in the databases Embase, MEDLINE, and CINAHL on February 8th and 9th, 2022. RESULTS: Six studies with 959 participants in total were included. The research designs were focus group studies with and without combining individual interviews, an individual interview study, a study consisting of individual interviews and ethnographic observations, a survey, and a two-phase study consisting of a qualitative interview and a quantitative survey. Findings indicate lack of evidence-based information provided about infant formula by health care professionals when they counsel parents on formula feeding. CONCLUSIONS: Few studies focus on how healthcare professionals inform and counsel parents about formula milk. Health authorities should provide more evidence-based information to make formula feeding more feasible. Due to conflicting and omitted information, mothers often receive poor counselling on formula feeding.

First-Time Parents' Support Needs and Perceived Support From a Child Health Service With the Integrated New Families Home Visiting Programme.

The transition to parenthood is complex and influenced by interacting factors related to society, the parents and the child. Professional support is considered to be one of the societal factors affecting this transition by facilitating parents' sense of confidence and their competence as parents. In this study, we aimed to explore first-time parents' support needs and experiences of support from a child health service with the integrated New Families home visiting programme, in the context of their transition to parenthood in the first year postnatally. Interpretive description guided this qualitative study. Six couples and one mother, all well-educated and employed, were interviewed individually (N = 13). The parents were recruited from the research project 'New Families - Innovation and Development of the Child Health Service in Oslo'. We found that being a first-time parent is perceived as overwhelming and that defining support needs may be challenging, particularly in the first period postnatally. In addition, the support needs are constantly changing due to the complexity of interacting factors and the ongoing development of confidence in the parental role. Retrospectively, the parents were satisfied overall with the support from the child health service. The home visit during pregnancy facilitated management and relational and informational continuity. However, we identified a need for even more proactive information provision and communication to optimise the service's availability and efficiency postnatally. In addition, the importance of peers and of approaching both mothers and fathers must be acknowledged in facilitating parental confidence.

Public health nurse reflections on implementing the New Families home visiting programme: A qualitative study.

AIM: To investigate reflections of public health nurses (PHNs) on implementing the New Families programme, a supplement to the usual Norwegian child health centre programme. It involves user-led decisions on the content and number of home visits offered by the family's PHN from pregnancy week 28 until the child is 2 years. DESIGN: An interpretive description approach. METHODS: Altogether 206 anonymized, undated reflection notes by PHNs becoming familiar with the programme were collected in 2017-2020. NVivo 12 and inductive content analysis were used to convert the data into manageable segments. RESULTS: Focusing on childhood experiences and parental role expectations among prospective parents during home visits was seen as a major shift in the nurses' counselling strategy. Providing relevant information to the parents-to-be ahead of a meeting was important. Given sufficient staff and guidance, the programme was considered a good basis for building a relationship with the family.

Reflections on a complex intervention targeting healthy eating in young children.

In this article, the author offers her experiences of conducting a public health nursing intervention based on the use of the Medical Research Council framework for complex interventions. This article provides examples aimed at helping and inspiring others who might be interested in conducting a complex intervention study. The intervention focused on counseling about food and feeding practices provided by public health nurses in a sample of child health centers in Norway 2015-2018. Aspects of food and nutrition are central to public health nurses' counseling at the child health center, and they experience challenges when counseling on these themes. This article offers an approach to handling the complexity of public health nursing interventions on counseling among families. The topics presented on planning and performing an intervention and the related challenges might have relevance for public health nursing in several countries.

The use of a communication tool about diet at the child health centre: A cluster randomized controlled trial.

Aim: To investigate the effect of a communication tool about diet used in public health nurse consultations with parents compared with standard consultations concerning the 2-year-old child's diet. Design: A cluster randomized controlled trial. Methods: Ten municipalities were selected randomly and matched in pairs. In each pair, the control or intervention group was randomly allocated. Parents were recruited to participate from January 2015 to January 2017. In intervention clusters, a communication tool about diet was used to help the parents (N = 140) to focus on a healthy diet for their child. In the control clusters, parents (N = 110) attended standard consultations. The participants completed semi-quantitative food frequency questionnaires at baseline and end point. Results: No effect of the intervention was seen on the child's daily intake of vegetables or saturated fat, or body mass index. Significantly fewer parents desired more information about food for toddlers in the intervention than in the control group.

Parental experience of counselling about food and feeding practices at the child health centre: A qualitative study.

AIMS AND OBJECTIVES: To investigate how parents experience counselling about food and feeding practices and the use of a communication tool about diet at the child health centre. BACKGROUND: Food-related counselling is a key element in parents' consultations with public health nurses at child health centres. Public health nurses possess limited strategies and tools for addressing nutritional issues, especially in the context of client diversity. DESIGN: An interpretive description approach, fulfilling the COREQ checklist criteria. METHODS: Individual interviews performed between January 2017-May 2017 among parents (n = 12) of children (mean age 28 months) who had been exposed to a communication tool about diet, in regular child health centre consultations with their child. These consultations were included in clinical trial (ClinicalTrials.gov.: Identifier: NCT02266953). RESULTS: Counselling using the communication tool about diet was primarily based on the public health nurse presenting images of healthy food choices. After infancy, consultations sometimes became more time-pressured, inhibiting parents from asking questions related to the child's diet. The parents who had questions related to food allergy or breastfeeding of their child sometimes experienced limited support. Some parents felt overwhelmed with information about healthy food choices if their child's diet differed from the recommendations presented. CONCLUSIONS: The parents' existing expectations and needs had an impact on their satisfaction in relation to their perceptions of nutritional counselling. The use of the communication tool about diet to promote a two-way dialogue instead of providing one-way dietary information might be particularly useful in consultations for parents who do not follow customary recommendations. RELEVANCE TO CLINICAL PRACTICE: If the diet of the family differs from what is recommended, parents often experience limited support at the child health centre. Promoting a two-way dialogue in consultations using a communication tool about diet could help parents in their concerns related to feeding their child.

Parental concerns of allergy or hypersensitivity and the infant's diet.

AIM: To investigate a possible association between children's current diet and parents' reported avoidance of appropriate foods in the child's diet at the age of 10 months, due to fears of allergic or hypersensitivity reactions. DESIGN: A cross-sectional study. METHODS: In 10 randomly selected municipalities willing to participate, 686 children represented by their parents visiting the child health centre were enrolled in the study. From January 2015-January 2017, 440 (64%) parents completed a semi-quantitative food frequency questionnaire concerning their child. RESULTS: Thirty-four percent of parents reported that they avoided introducing some food items due to fears of allergy or hypersensitivity in their child. A statistically significant relationship emerged between this reporting and parents wanting more information about food for infants and toddlers. However, the reported fear was not associated with dietary restrictions regarding actual feeding of the child.

Counselling parents on young children's healthy diet: A modified scoping review.

AIMS AND OBJECTIVES: To map and describe key information in existing research about counselling of parents of children aged 0-2 years on the child's healthy diet in preventive healthcare settings, particularly in public health nursing. BACKGROUND: Many parents are likely to be concerned with their infant's food-related happiness "here and now," disregarding the child's long-term health and development related to feeding practices. Hence, a focus on counselling parents in considering young children's healthy diet is important. DESIGN: A modified scoping review with an inductive qualitative content analysis of selected empirical studies. METHODS: Systematic searches in EMBASE (1996-2015 Week 46), Ovid Nursing Database (1946-2015 November Week 1), Ovid MEDLINE and Ovid OLDMEDLINE (2000-18 November 2015) and CINAHL (2000-22 December 2015), using search terms based on aims. RESULTS: Eight included studies, with participants per sample ranging from 19->500. Research designs were focus group discussions and/or interview study (n = 2), cluster-randomised trials (n = 2), randomised controlled trials (n = 2), a follow-up interview study (n = 1) to a previous randomised controlled trial and a cross-sectional electronic questionnaire study (n = 1). The studies included a total sample of 2,025 participants, 42 of them in interview studies. Findings indicate parents' perceptions of inconsistency, misconceptions and uncertainty related to the recommendations on child feeding from the authorities. Thus, adapted advice could impact healthier child diet. Maternal knowledge on child feeding and reduced use of food as a reward are mediators for improved diet quality in children. CONCLUSIONS: Counselling on young children's healthy diet should be anticipatory, consistent and adapted to the family. RELEVANCE TO CLINICAL PRACTICE: Due to inconsistent recommendations and omitted focus on anticipatory counselling on child feeding, parents might perceive pressure and uncertainty related to the child's diet.

Implementing guidelines for preventing, identifying and treating adolescent overweight and obesity-School nurses' perceptions of the challenges involved.

AIMS AND OBJECTIVES: To gain a better understanding of school nurses' perceptions of the challenges involved in implementing national guidelines on managing overweight and obesity in adolescents. BACKGROUND: National guidelines for the management of childhood overweight and obesity are developed in many countries to translate scientific knowledge into practice. However, several challenges are involved in their implementation. DESIGN AND METHODS: A qualitative design with focus group interviews was chosen for data collection. Six focus group interviews with 21 school nurses were conducted. Data were analysed by qualitative content analyses. RESULTS: National guidelines provided new directions for managing overweight and obesity in school health services. School nurses were assigned new tasks and responsibilities, which they felt they were not sufficiently prepared for, nor were they supported by extra resources. Challenges in implementation of the guidelines were identified at various levels: system level (implementation strategy, available resources, training and support, professional collaboration, referral options); individual school nurse level (perceived competence, burden of responsibility, attitudes and emotions); subject level (sensitivity of weight-related issues); and professional level (scepticism to a body mass index cut-off of 25 kg/m2 as the starting point for intervention). CONCLUSIONS: School nurses felt overwhelmed in terms of implementing the guidelines. This indicates barriers not being sufficiently identified or acted upon during implementation. Further, the nurses' scepticism about the body mass index cut-off for intervention, and their experience that measuring and follow-up of adolescents' weight development was their responsibility alone, indicates that important discussions are needed on this as an adequate measure as well as on the professional division of responsibilities. RELEVANCE TO CLINICAL PRACTICE: Having a proper strategy for implementation, and ensuring that necessary clinical structures and resources are available, is crucial. Including school nurses in developing and implementing such strategies is vital for success in implementing national guidelines.

Counseling Immigrant Parents about Food and Feeding Practices: Public Health Nurses' Experiences.

OBJECTIVES: To describe the experiences of public health nurses (PHNs) in counseling immigrant parents on food and feeding practices at child health centers (CHCs). DESIGN AND SAMPLE: In this study employing a qualitative description (QD) approach, the participants (n = 26) were PHNs from five CHCs in the greater Oslo region of Norway. MEASURES: Data were collected through five focus group interviews and examined using qualitative content analysis. RESULTS: Counseling on food and feeding practices was an important topic in most consultations with immigrant parents. The PHNs were concerned that the child should eat ordinary, healthy food regularly. Immigrant families were often experienced as a "generic group" and the PHNs disclosed that they rarely adjusted their counseling strategy based on enquiries about families' food culture or parents' level of education or knowledge. Time constraints and language and cultural barriers were common challenges. The PHNs suggested that culturally adapted information materials and visual aids from health authorities could improve communication. CONCLUSIONS: Counseling immigrant parents on food and feeding at CHCs is often challenging for PHNs. The study findings could be used in the development of guidelines to assist PHNs in delivering culturally competent counseling about food and feeding practices.