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Development of an Evidence-Informed Blog to Promote Healthy Eating Among Mothers: Use of the Intervention Mapping Protocol.

Audrée-Anne Dumas, Simone Lemieux, Annie Lapointe, Véronique Provencher, Julie Robitaille, Sophie Desroches

JMIR research protocols [6:e92] (2017)

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Low adherence to dietary guidelines and a concurrent rise of obesity-related chronic diseases emphasize the need for effective interventions to promote healthy eating. There is growing recognition that behavior change interventions should draw on theories of behavior change. Online interventions grounded in theory lead to increased effectiveness for health behavior change; however, few theory-driven social media-based health promotion interventions have been described in the literature. The objective of this study was to describe the application of the Intervention Mapping (IM) protocol to develop an evidence-informed blog to promote healthy eating among French-Canadian mothers of preschool and school-aged children. The following six steps of the IM protocol were performed. In Step 1, a preliminary needs assessment included a literature search on theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults (ie, knowledge, beliefs about capabilities, beliefs about consequences, intention/goals) and a qualitative study including focus groups to identify female Internet users' perceptions of their use of healthy eating blogs. In Step 2, two behavioral outcomes were selected (ie, increase daily intakes of Vegetables and Fruits and Milk and Alternatives of mothers to reach Canadian dietary recommendations) and subsequently divided into six performance objectives inspired by national and international dietary recommendations such as planning for healthy meals. A matrix of change objectives was then created by crossing performance objectives with theoretical domains predicting Vegetables and Fruits intakes and Milk and Alternatives intakes in adults. Step 3 consisted of selecting theory-based intervention methods (eg, modeling and goal setting) and translating them into practical applications for the context of a dietary intervention delivered through a blog. A 6-month intervention was developed in Step 4 in which we aimed to address one performance objective per month in weekly blog publications written by a registered dietitian. For Step 5, we sought to include engagement-promoting methods (eg, peer and counselor support) to promote mothers' use of the blog and adherence to the intervention. Finally in Step 6, a randomized controlled trial has been launched to evaluate the effects of the blog on dietary behaviors of French-Canadian mothers. The intervention study is expected to be completed in March 2018. An intervention mapping protocol allowed for effective decision making in the development of a novel knowledge translation tool to increase adherence to dietary recommendations among mothers of preschool and school-aged children.

 


What motivates maternal and child nutrition peer educators? Experiences of fathers and grandmothers in western Kenya.

Stephanie Martin, Teresia Muhomah, Faith Thuita, Allison Bingham, Altrena Mukuria

Social science & medicine (1982) [143:45-53] (2015)

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Peer-led dialogue groups (i.e., support or self-help groups) are a widely used community-based strategy to improve maternal and child health and nutrition. However, the experiences and motivation of peer educators who facilitate these groups are not well documented. We implemented eight father and ten grandmother peer dialogue groups in western Kenya to promote and support recommended maternal dietary and infant and young child feeding practices and sought to understand factors that influenced peer educator motivation. After four months of implementation, we conducted 17 in-depth interviews with peer educators as part of a process evaluation to understand their experiences as group facilitators as well as their motivation. We analyzed the interview transcripts thematically and then organized them by level: individual, family, peer dialogue group, organization, and community. Father and grandmother peer educators reported being motivated by multiple factors at the individual, family, dialogue group, and community levels, including increased knowledge, improved communication with their wives or daughters-in-law, increased respect and appreciation from their families, group members' positive changes in behavior, and increased recognition within their communities. This analysis also identified several organization-level factors that contributed to peer educator motivation, including clearly articulated responsibilities for peer educators; strong and consistent supportive supervision; opportunities for social support among peer educators; and working within the existing health system structure. Peer educator motivation affects performance and retention, which makes understanding and responding to their motivation essential for the successful implementation, sustainability, and scalability of community-based, peer-led nutrition interventions.

 



Development of a novel motivational interviewing (MI) informed peer-support intervention to support mothers to breastfeed for longer.

Rhiannon Phillips, Lauren Copeland, Aimee Grant, Julia Sanders, Nina Gobat, Sally Tedstone, Helen Stanton, Laura Merrett, Stephen Rollnick, Michael Robling, Amy Brown, Billie Hunter, Deborah Fitzsimmons, Sian Regan, Heather Trickey, Shantini Paranjothy

BMC pregnancy and childbirth [18:90] (2018)

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Many women in the UK stop breastfeeding before they would like to, and earlier than is recommended by the World Health Organization (WHO). Given the potential health benefits for mother and baby, new ways of supporting women to breastfeed for longer are required. The purpose of this study was to develop and characterise a novel Motivational Interviewing (MI) informed breastfeeding peer-support intervention. Qualitative interviews with health professionals and service providers (n = 14), and focus groups with mothers (n = 14), fathers (n = 3), and breastfeeding peer-supporters (n = 15) were carried out to understand experiences of breastfeeding peer-support and identify intervention options. Data were audio-recorded, transcribed, and analysed thematically. Consultation took place with a combined professional and lay Stakeholder Group (n = 23). The Behaviour Change Wheel (BCW) guided intervention development process used the findings of the qualitative research and stakeholder consultation, alongside evidence from existing literature, to identify: the target behaviour to be changed; sources of this behaviour based on the Capability, Opportunity and Motivation (COM-B) model; intervention functions that could alter this behaviour; and; mode of delivery for the intervention. Behaviour change techniques included in the intervention were categorised using the Behaviour Change Technique Taxonomy Version 1 (BCTTv1). Building knowledge, skills, confidence, and providing social support were perceived to be key functions of breastfeeding peer-support interventions that aim to decrease early discontinuation of breastfeeding. These features of breastfeeding peer-support mapped onto the BCW education, training, modelling and environmental restructuring intervention functions. Behaviour change techniques (BCTTv1) included social support, problem solving, and goal setting. The intervention included important inter-personal relational features (e.g. trust, honesty, kindness), and the BCTTv1 needed adaptation to incorporate this. The MI-informed breastfeeding peer-support intervention developed using this systematic and user-informed approach has a clear theoretical basis and well-described behaviour change techniques. The process described could be useful in developing other complex interventions that incorporate peer-support and/or MI.