Parental food selection questionnaire - Infant version.

PURPOSE: Complementary feeding practices (CFPs) are associated with health outcomes (e.g., obesity and food allergies). Understanding how parents select foods for their infant is limited. This study's purpose was to develop a psychometrically sound measure of parents' food selection motives for their infant during the complementary feeding period. METHODS: Development and testing of the Parental Food Slection Questionnaire-Infant Version (PFSQ-I) occurred in three phases. English-speaking, U.S. mothers of healthy infants, aged 6-19 months old participated in a semi-structured, face-to-face interview (Phase 1) or a web-based survey (Phases 2 & 3). Phase 1 was a qualitative study of maternal beliefs and motives surrounding complementary feeding. Phase 2 involved adaptation and exploratory factor analysis of the original Food Choice Questionnaire (Steptoe et al., 1995). Phase 3 involved validity testing of the relationships among PFSQ-I factors and CFPs (timing/type of complementary food introduction, frequency of feeding method, usual texture intake, and allergenic food introduction) using bivariate analyses, and multiple linear and logistic regression analyses. RESULTS: Mean maternal age was 30.4 years and infant age was 14.1 months (n = 381). The final structure of the PFSQ-I included 30 items and 7 factors: Behavioral Influence, Health Promotion, Ingredients, Affordability, Sensory Appeal, Convenience, and Perceived Threats (Cronbach's α = 0.68-0.83). Associations of factors with CFPs supported construct validity. DISCUSSION: The PFSQ-I demonstrated strong initial psychometric properties in a sample of mothers from the U.S. Mothers who rated Behavioral Influence as more important were more likely to report suboptimal CFPs (e.g., earlier than recommended complementary food introduction, delayed allergenic food introduction, and prolonged use of spoon-feeding). Additional psychometric testing in a larger, more heterogenous sample is needed, along with examination of relationships between PFSQ-I factors and health outcomes.

Choking, allergic reactions, and pickiness: A qualitative study of maternal perceived threats and risk avoidance strategies during complementary feeding.

An infant's early eating experiences influence later growth and health. However, motivators for mothers' complementary feeding decisions for their infants, such as the process of introducing solid foods, remains unclear. This qualitative study identified maternal perceived threats surrounding complementary feeding and strategies mothers use to mitigate perceived threats of adverse feeding-related health outcomes for their infants. Twenty-seven mothers participated in private, semi-structured interviews. Inductive and deductive qualitative content analysis revealed three primary themes of maternal perceived threats: a) choking, b) allergic reaction, and c) pickiness. Within each primary theme were sub-themes that further delineated the perceived threats and outlined specific and focused complementary feeding practices (CFPs) mothers used for each type of perceived threat. Findings suggest mothers have difficulty with estimating the likelihood and severity of risks and rely on elevated threat perception to guide their feeding decisions. CFPs used to prevent perceived threats were disproportionate to risks, and, at times, actually introduced additional, alternative risks.

Evaluation of two academic practice partnerships for chronic disease management in nursing education.

More clinical sites are essential to meeting the learning needs of nursing students who will care for patients with chronic disease after graduation. Partnerships between schools of nursing and academic practices can increase clinical training capacity, allow future nurse practitioners (NPs) to apply knowledge and skills in the context of care delivery, and potentially improve patient outcomes with little associated risk. This article describes the experiences of primary care NP students (n = 37), NP faculty (n = 2), and clinic providers (n = 2) in an academic practice partnership performing home visits with complex pediatric asthma and adult heart failure (HF) patients. A 14-item postexperience survey was used to obtain student feedback. Over 75% (n = 28) of student participants responded. Most respondents, 80% assigned to pediatric asthma patients and 90% assigned to adult HF patients, reported the home visit experience prepared them to care for patients with chronic diseases. Clinic providers indicated the extra attention to both patient groups reduced barriers to care and improved care continuity. This partnership offers a model for developing clinical skills in advanced practice nursing students and enhancing scarce clinical placement resources. Findings were used to refine the program and expand to include all 150 students in the subsequent academic year.

Innovative Work Behavior of Middle School Faculty and Staff Related to Student Mental Health.

School nurses may find increased capacity to respond to student mental health needs by understanding and capitalizing on the innovative work behavior (IWB) of faculty and staff. The purpose of this study was to describe IWB related to student mental health among middle school faculty and staff as well as to determine the influence of selected individual characteristics, school characteristics, and behavioral health indicators on IWB related to student mental health. Multimethods of data collection were used including surveys, interviews, and publicly available school data. Data were described and relationships examined via correlational and multiple linear regression analysis and hierarchical linear modeling. The median IWB score was 41 (range 0-84) for faculty and staff participants. An increase in number of years worked in the K-12 environment was associated with less IWB related to student mental health. School nurses who explore IWB by faculty and staff may find opportunities to collaborate and improve student health outcomes.

Vitamin D deficiency and depressive symptoms in the perinatal period.

Depression affects 1 in 7 women during the perinatal period. Women with vitamin D deficiency may be at an increased risk for depression. This study investigated the relationship between maternal and cord blood 25-hydroxyvitamin D (25OHD) and maternal depressive symptoms over the perinatal period. Study objectives were to examine variations and relationships between maternal and cord blood vitamin D levels and maternal depressive symptoms over the perinatal period. At a large medical center in southern California, pregnant women (N = 126) were recruited for this longitudinal cohort study. Depressive symptoms (Edinburgh Postnatal Depression Screen, EPDS) and vitamin D status (25OHD) were measured at three time points in the perinatal period: time 1 (T1; N = 125) EPDS and 25OHD were collected in early pregnancy; time 2 (T2; N = 96) EPDS was conducted in the third trimester with blood collected at time of delivery; and time 3 (T3; N = 88) was collected postpartum. A significant inverse relationship between vitamin D status and depressive symptoms was observed between 25OHD and EPDS scores at all time points in this sample (T1 = - 0.18, P = 0.024; T2 = - 0.27, P = 0.009; T3 = - 0.22, P = 0.019). This association remained after controlling for confounders. Low cord blood 25OHD levels were inversely associated with higher EPDS scores in the third trimester (r = - 0.22, P = 0.02). Clinicians may want to consider screening women diagnosed with vitamin D deficiency for depression and vice versa. Vitamin D may represent an important biomarker for pregnant and postpartum women diagnosed with depression. Further studies examining underlying mechanisms and supplementation are needed.

Correction to: The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial.

The article "The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial", written by Melanie Lutenbacher, Tonya Elkins, Mary S. Dietrich and Anais Riggs, was originally published electronically on the publisher's internet portal (currently SpringerLink) on 31 May 2018 without open access. With the author(s)' decision to opt for Open Choice the copyright of the article changed on 16 July 2018 to

The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial.

Introduction The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting program, utilizing peer mentors to improve maternal/child health outcomes in underserved communities. Findings are presented from a randomized clinical trial (RCT) testing the efficacy of the MIHOW model in a sample of Hispanic women in Tennessee. We hypothesized maternal and infant outcomes would be better in women assigned to MIHOW than women assigned to the minimal education intervention (MEI) group (receipt of educational materials). Methods Women entered the study during pregnancy (< 26 weeks gestation) and were followed through 6 months postpartum. A total of 188 women were enrolled and randomly assigned (MEI = 94; MIHOW = 94), with 178 women completing the study (MEI = 87; MIHOW = 91). Results Positive and statistically significant (p < 0.01) effects of MIHOW were observed on breastfeeding self-efficacy and exclusivity, levels of depressive symptoms and parenting stress, safe sleep practices, and infant stimulation in the home. No statistically significant differences were noted in number of prenatal visits. Discussion Results expand limited empiric evidence and provide strong support of the effectiveness of MIHOW on improving health outcomes in this sample of Hispanic mothers and their infants. MIHOW is a viable option for providing culturally sensitive services to immigrant and underserved families.

Improving Asthma Management in the Elementary School Setting: An Education and Self-management Pilot Project.

PURPOSE: To increase daily asthma symptom self-assessments of elementary school students using Green Means Go, an asthma education and self-assessment program, via a partnership between an elementary school and a school of nursing. METHODS: Over four months, accelerated MSN nursing students provided small group education sessions to teach students and teachers to identify asthma symptoms by Asthma Action Plan (AAP) zones and actions for each zone. To promote continuity of care between school and home, a teacher-parent communication log during yellow zone days was encouraged. RESULTS: Students with asthma (n = 90), teachers (n = 12) and parents (n = 1) participated. Previously no students performed daily self-assessments and at program end, all students accurately identified symptoms, AAP zones, and action steps. A total of 789 symptom self-assessments were recorded. Teachers reported increased asthma knowledge. One parent attended an education session and one home visit was completed. No communication logs were returned. CONCLUSIONS: Partnerships between elementary and nursing schools may be an effective strategy for delivery of health programs to high-risk children with chronic diseases. Self-assessment of symptoms and taking appropriate actions at school are critical components of early asthma intervention, particularly when a school nurse is not always available. Training teachers to follow a child's AAP within school policies is a critical second step. Home visits showed potential as a strategy for engaging parents. PRACTICE IMPLICATIONS: In the current climate of school nurse shortages, management of asthma-related episodes in school can be improved with similar partnerships and programs that promote health education and self-management.

Enhancing Pediatric Asthma Care and Nursing Education Through an Academic Practice Partnership.

BACKGROUND: Home environmental assessments and interventions delivered via academic practice partnerships (APP) between clinics and schools of nursing may be a low or no cost delivery model of pediatric asthma care and professional education. Patients receive enhanced clinical resources that can improve self-management and healthcare utilization. Additionally, students can practice chronic disease management skills in actual patient encounters. OBJECTIVE: To describe outcomes of the implementation of an APP between a school of nursing and a pediatric asthma specialty clinic (PASC) to deliver a home visit program (HVP). The HVP was designed to reduce emergency department visits and asthma related hospitalizations in PASC patients and provide clinical experiences for nursing students. METHODS: PASC referred patients to the HVP based on their level of asthma control. Students provided an individualized number of home visits to 17 participants over a nine month period. A 12-month pre- and post-HVP comparison of emergency department visits and asthma related hospitalizations was conducted. Additional information was gathered from stakeholders via an online survey, and interviews with APP partners and HVP families. OUTCOMES: Children had fewer asthma related hospitalizations post HVP. Findings suggest a reduction in exposure to environmental triggers, improved patient and family management of asthma, and increased PASC knowledge of asthma triggers in the home and increased student knowledge and skills related to asthma management. CONCLUSIONS: Multiple clinical and educational benefits may be realized through the development of APPs as an infrastructure supporting targeted interventions in home visits to pediatric asthma patients and their families.

Reflections of Black Women Who Choose to Breastfeed: Influences, Challenges and Supports.

OBJECTIVES: Black women continue to have the lowest rates of breastfeeding. Of those who choose to breastfeed up to half cease nursing within the first few days or months postpartum. This study identified factors that influence and challenge Black women who choose to breastfeed, and supportive strategies that facilitate successful breastfeeding experiences. METHODS: Four focus groups were conducted in 2013 with 16 self-identified Black women aged 21-46 (M = 31.35 years), with 11-18 (M = 14.94) years of education, and were either pregnant or had given birth to an infant within the prior 5 years (range of pregnancies 1-7; M = 2.44). A standard set of questions guided discussions. Data saturation occurred after three groups. All discussions were audiotaped and transcribed. Qualitative methods were used to identify categories and subthemes. Reviewers met periodically to resolve ambiguities and coding discrepancies. Member checking was conducted. RESULTS: Four major categories emerged: Balancing the influences: People, myths, and technology; Being in the know; Critical periods; and, Supportive Transitions. Most women experienced little help with breastfeeding from health providers or systems. More influential was the interplay of family members,myths and the internet "as my friend". Role models and personalized support were noted as important but lacking among Black women. Patient profiling, experienced by some of the women, impacted breastfeeding choices. CONCLUSIONS: Black women such as our participants are critical partners as we develop systems of care to decrease disparities and increase Black women's successes in breastfeeding. Findings underscore the importance of having diverse, readily available, user-friendly, culturally sensitive options for Black women who choose to breastfeed.

Does additional prenatal care in the home improve birth outcomes for women with a prior preterm delivery? A randomized clinical trial.

Women with a history of a prior preterm birth (PTB) have a high probability of a recurrent preterm birth. Some risk factors and health behaviors that contribute to PTB may be amenable to intervention. Home visitation is a promising method to deliver evidence based interventions. We evaluated a system of care designed to reduce preterm births and hospital length of stay in a sample of pregnant women with a history of a PTB. Single site randomized clinical trial. Eligibility: >18 years with prior live birth ≥20-<37 weeks gestation; <24 weeks gestation at enrollment; spoke and read English; received care at regional medical center. All participants (N = 211) received standard prenatal care. Intervention participants (N = 109) also received home visits by certified nurse-midwives guided by protocols for specific risk factors (e.g., depressive symptoms, abuse, smoking). Data was collected via multiple methods and sources including intervention fidelity assessments. Average age 27.8 years; mean gestational age at enrollment was 15 weeks. Racial breakdown mirrored local demographics. Most had a partner, high school education, and 62% had Medicaid. No statistically significant group differences were found in gestational age at birth. Intervention participants had a shorter intrapartum length of stay. Enhanced prenatal care by nurse-midwife home visits may limit some risk factors and shorten intrapartum length of stay for women with a prior PTB. This study contributes to knowledge about evidence-based home visit interventions directed at risk factors associated with PTB.

Brooding and reflection as explanatory of depressive symptoms in adolescents experiencing stressful life events.

Delineating etiologic mechanisms of adolescent-onset depressive disorders has implications for advances in depression recognition and prevention. Two cognitive processes, namely brooding and reflection, may be instrumental in the development of depressive symptoms. Study aims were to (1) examine the relationships among brooding, reflection, dysfunctional attitudes, negative inferential style, stressful life events, and depressive symptoms and (2) determine the unique contributions of brooding and reflection to depressive symptoms in adolescents who are experiencing stressful life events. A secondary data analysis was conducted using cross-sectional data gathered via a web-based survey (N = 111) of 12-15 year olds. Descriptive statistics, Pearson's correlations, and hierarchical linear regression modeling were used to evaluate study aims. The final regression model explained approximately 73% of the variance in depressive symptoms (Multiple R = 0.85, p < .001). After controlling for each of the study variables, both brooding (beta = .48, p < .001) and reflection (beta = .33, p < .001) demonstrated unique contributions to the prevalence of depressive symptoms. Our findings suggest that brooding and reflection are significant contributors to depressive symptoms in young adolescents experiencing stressful life events. With this knowledge, nurses are better equipped to identify adolescents at high risk for depressive symptoms and implement appropriate levels of intervention.

Are services to tennessee children with special health care needs comparable with national achievement of MCHB objectives?

OBJECTIVE: We assessed experiences of families with children with special health care needs already engaged with Tennessee Children's Special Services or a family advocacy agency, family voices, and compared their experiences with national data to determine achievement of national maternal-child health objectives. DESIGN AND SAMPLE: Using a descriptive/comparison design, Tennessee families engaged with the state or advocacy agency (n = 816) were compared with the 2005-2006 sample of the National Survey of Children with Special Health Care Needs (n = 40,840) and the Tennessee subsample (n = 794). MEASURES: Primary data were obtained from a survey of families associated with either Tennessee agency. Secondary data analysis used raw data from the national survey. RESULTS: All families reported challenges related to time, finances, and family interactions. Most were satisfied with health care services received. Dental care was an issue for all families, but more so for the agencies' sample. Those families also reported more problems with continuous screenings of their affected child and less coordination of care than the national sample. CONCLUSIONS: Examining the experiences of families with special needs children who receive services from state agencies in the national context contributes to improving family-centered services and achieving Maternal-Child Health Bureau objectives.

Using Community Health Workers to Improve Health Outcomes in a Sample of Hispanic Women and Their Infants: Findings from a Randomized Controlled Trial.

Introduction: The Maternal Infant Health Outreach Worker (MIHOW) program, an early childhood home visiting program, uses community health workers (CHWs) to improve health outcomes in underserved communities. Methods: This randomized clinical trial evaluated the impact of MIHOW's use of CHWs on selected maternal/infant outcomes up to 15 months postpartum. We hypothesized outcomes would be better among Hispanic women receiving MIHOW compared to a similar group of women eligible for MIHOW who received only a minimal education intervention (MEI). The study also expanded earlier research testing MIHOW's efficacy among Hispanic families using criteria set forth by federal guidelines. Women living in middle Tennessee enrolled during pregnancy (≤26 weeks gestation) and continued through 15 months postpartum. Results: Enrolled women (N = 132) were randomly assigned, with 110 women completing the study (MEI = 53; MIHOW = 57). Positive and statistically significant (p < .01) effects of MIHOW were observed on breastfeeding duration, safe sleep practices, stress levels, depressive symptoms, emotional support, referral follow through, parental confidence, and infant stimulation in the home. Conclusions: Findings provided strong evidence of the effectiveness of MIHOW for improving health outcomes in this sample. Using trained CHWs makes programs such as MIHOW a viable option for providing services to immigrant and underserved families.

Bridging Didactic Learning and the Complexity of Practice Through Clinical Immersion: Evaluating the Sexual Assault Nurse Examiner Trainee Experience.

ABSTRACT: In this article, we discuss the development and evaluation of the Vanderbilt Nursing Education Program for Sexual Assault Nurse Examiners (VEP-SANE), a 3-day clinical immersion (CI) program, including the lessons learned and the challenges experienced with the completion of two trainee cohorts. To bridge didactic learning and the complexity of practice, the VEP-SANE team designed an innovative, competency-based CI. Fifteen trainees from Cohort 1 and 19 trainees from Cohort 2 met requirements for CI participation. Trainees in Cohort 1 represented the advanced practice registered nurse specialties of emergency, women's health, and pediatrics. For Cohort 2 recruitment, enrollment was expanded to include family and midwifery advanced practice registered nurse specialties. Trainees were required to complete online training modules before CI participation. Online surveys assessed trainee perceptions about levels of knowledge and confidence related to sexual assault nurse examiner competencies (pre/post CI), each CI session, and the overall CI experience. Separate focused discussions were conducted with trainees and faculty after each CI. Both cohorts rated CI sessions as "excellent" or "very good" over 93% of the time. Perceived levels of knowledge and confidence increased from pre-CI to post-CI for both cohorts. Similar CI strengths were identified across trainees and faculty including speakers, high interactivity, safe environment, reality of cases, and surrogate practice. All trainees indicated readiness for preceptorships and interest in a virtual community of practice. Suggestions included more time for laboratory sessions, documenting photos, and interaction with individuals from the lesbian, gay, bisexual and transgender (LGBT) community and presenters. Future efforts focus on CI conversion to a virtual format because of the impact of COVID-19, increased VEP-SANE community of practice interaction, and expanded engagement with practicing sexual assault nurse examiners.

Negative Correlation Between Health Care Coverage and Postpartum Depression Among Hispanic Women.

Postpartum depression (PPD) affects women across all races with serious health consequences for mothers and infants. Maternal factors may increase PPD risk, but research in exclusive Hispanic populations is limited. This secondary analysis evaluated the associations between maternal sociodemographic characteristics and reliable decrease in depressive symptoms in Hispanic women between prenatal study enrollment and 2 months postpartum. Data from all women (n = 178) who completed a randomized control trial assessing the efficacy of a home-visitation program were included. Most women were from Mexico (66.9%), had incomes <$10,000/year (68.5%), had health insurance (58.4%), and intended to breastfeed (84.2%). Few women had high school education/graduate equivalency degree (19.3%) or a health care provider (2.3%). Using multivariate logistic regression and controlling for baseline Edinburgh Postnatal Depression Score, gestational age at enrollment, and group assignment, health care coverage (OR = 4.04, 95% CI 1.27, 12.76, p = 0.017) increased the likelihood of a decrease in level of depressive symptoms at 2 months postpartum. Acculturation, breastfeeding behaviors, and age were not associated with change in depressive symptoms. Results increase our understanding of variability of depressive symptoms in Hispanic women. Having access to health care coverage is critical. Findings provide guidance for culturally competent interventions and policies.

Clinical strategies for addressing obesity in infants and toddlers.

ABSTRACT: Babies' earliest food experiences have a lifelong impact on eating preferences and dietary habits, laying the foundation for obesity risk. NPs have the opportunity to provide education about healthy infant feeding practices before the growth trajectory becomes abnormal and focus intensive education on at-risk families.

Family-Centered Care: How Close Do We Get When Talking to Parents of Children Undergoing Diagnosis for Autism Spectrum Disorders?

Autism spectrum disorder (ASD) affects 1:59 children, yet little is known about parents' perceptions of family-centered care (FCC) during the diagnostic process leading up to diagnosis. This mixed-methods study explored key elements of FCC from 31 parents of children recently diagnosed with ASD using parallel qualitative and quantitative measures. Parents rated highly their receipt of FCC and discussed ways providers demonstrated FCC. However, the majority of parents indicated that the period when their child was undergoing diagnosis was stressful and reported symptoms of depression and anxiety. The study points to ways in which health care providers can enhance FCC provided to families when a child is undergoing ASD diagnosis.

Infant feeding beliefs and practices: Effects of maternal personal characteristics.

PURPOSE: Information is limited about how mothers make food decisions on behalf of their children. Eating practices are established early in life and are difficult to change, so it is imperative to focus on the caregiver who influences a young child's food preferences and eating behaviors. The purpose of this secondary data analysis was to examine the relationship between maternal characteristics and infant feeding beliefs and practices in a sample of multiparous mothers with a history of a prior preterm infant birth. DESIGN AND METHODS: Secondary analysis of a subset of data (n = 112) collected from women who participated in a randomized clinical trial (RCT) assessing the efficacy of a home-based intervention to improve maternal and child outcomes. Inclusion criteria for the RCT: women ≥18 years of age at enrollment with a prior preterm live birth >20 and <37 weeks gestation, <24 weeks gestation at enrollment, spoke/read English, and received prenatal care at a regional medical center. Criteria for the subset included: completed the Infant Feeding Questionnaire at 5 months postpartum and had reported a prenatal body mass index (BMI). Univariate correlations and multiple linear regression analyses were used to assess the associations between maternal personal characteristics and infant feeding practices. RESULTS: Median age of the mothers was 27 years (interquartile range [IQR]: 23-32) with median education of 12 years (IQR: 12-16). More than two-thirds (68%) of the women breastfed their last baby. These women were less likely to be concerned about their infant's hunger (r = -.20; p = .035). After controlling for education, maternal BMI, breastfed last baby, self-esteem, locus of control, and depressive symptoms, decreased maternal age (ß = -.35; p < .001) and higher levels of stress (ß = .19; p = .042) were associated with greater concern about their infant's hunger. Maternal demographic and psychosocial variables were not found to be statistically significantly associated with either concern about infant overeating and becoming overweight or an awareness of infant's hunger and satiety cues. PRACTICE IMPLICATIONS: Differences in maternal psychosocial variables and attitudes toward infant feeding may contribute to long term eating habits and weight outcomes in children. A better understanding of maternal variables that influence infant feeding attitudes and practices could improve the design of future intervention studies aimed at mothers at risk for having poor infant feeding practices.

Limited access to care and home healthcare.

Access to perinatal healthcare services for women living in poverty is complicated by many barriers and directly affects rates of premature births, low birthweight infants, and maternal and infant deaths. Health and social services delivered in the home can help improve pregnancy outcomes. Home visiting programs need sustainable funding and support from physicians and other healthcare providers. Ongoing research is needed to develop, refine, and evaluate systems of care that integrate home visiting components and different service delivery models that address pregnancies complicated by various psychosocial and medical complications.