Delivery of Nutrition Education to the Mother-Infant Dyad within a Primary-Care Group Approac

BACKGROUND: Mothers and infants suffer from high obesity rates in the United States. Maternal and infant nutrition is intertwined suggesting education focused on mother-infant dyads may effectively reduce obesity risk, but the evidence-base is lacking. Group-care models in family-medicine clinics are promising for nutrition-education delivery to mother-infant dyads, but research on acceptability of the approach is limited. Valid and reliable tools evaluating infant-feeding education effectiveness are needed as they are also lacking.;OBJECTIVE: To determine factors needed for effective nutrition-education interventions for mother-infant dyads by exploring healthy-eating experiences of low-income breastfeeding mothers, determining family-medicine physicians' (FMPs') acceptance of incorporating nutrition-education delivery to maternal-infant dyads into group primary-care models, and to create the Infant Feeding Education Questionnaire (IFEQ) for measuring infant-feeding education effectiveness.;METHODS: Integrated grounded analysis was used to analyze focus groups with low-income breastfeeding mothers investigating diet and exercise experiences. Conventional content analysis guided analysis of interviews with FMPs to explore current practices and acceptability of nutrition-education delivery within group care. The IFEQ was developed and tested for validity and reliability.;RESULTS: Maternal-nutrition education may be more impactful if focused on how maternal nutrition influences infant health. Barriers to healthy diet and exercise and varying preferences for information delivery must be considered when developing maternal-nutrition education.;FMPs felt one-on-one visits, the current nutrition-education delivery method, lacked effectiveness due to time constraints, many topics to cover, and limited FMP training. Group-care was an attractive model; it was viewed as time-efficient, valuable for social support, and an opportunity to utilize other experts. Perceived issues must be addressed for program sustainability in family-medicine settings.;Content-validity assessment resulted in 29 IFEQ questions. Convergent validity was not achieved. Reliability was strong; test-retest analysis showed consistency for IFEQ composite scores and individual IFEQ questions and internal-consistency analysis indicated a strong relationship between IFEQ questions.;CONCLUSIONS: Delivering nutrition-education to mother-infant dyads within group-care models in family-care settings may be successful as it is well-accepted among FMPs. Furthermore, education that connects maternal diet with infant health can be delivered. IFEQ could evaluate group-care infant-feeding education effectiveness among low-income mothers, but more work is needed to obtain validity.