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Infant Overfeeding in Immigrant Families

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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.

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