Research BriefAssessing an Infant Feeding Web Site as a Nutrition Education Tool for Child Care Providers
Introduction
The health benefits of breast-feeding to mothers and infants are well documented in the literature.1, 2 However, Colorado's breast-feeding initiation rates of 83% exceed national recommendations, yet they fall short at both 6 months (46%) and 1 year (21%).3, 4 In 2002, the fourth most common reason Colorado mothers cited for ceasing breast-feeding was because they returned to work or school.3
Approximately 12 million of the 19 million children in the United States under the age of 5 are in some form of child care.5 Children who attend child care at 6 months were significantly less likely to have ever been breastfed or remain exclusively breastfed (P < .05).6 With the decline in breast-feeding coinciding with mothers returning to work and more infants attending child care, it is imperative for child care providers to have access to current and correct infant feeding information, including information on offering breast milk to the infants in their care. Child care agencies often support breast-feeding as the preferred infant feeding method. In 1999, the United States Department of Agriculture authorized the reimbursement of child care centers for infant meals that contain only breast milk, thereby allowing for more providers to support the use of breast milk in their centers.7
A literature review and a recently completed needs assessment8 highlight the need to provide accurate educational materials and best practice information about infant feeding, specifically breast-feeding and offering breast milk, to child care providers. According to this needs assessment, 88% of directors and 79% of providers would be interested in a Web site with child-care–specific infant feeding information.8 The apparent interest in educational information distribution on the Internet is further supported by national trends. In 2003, approximately 60 million Americans per year used the Internet to receive health or medical information; this number continues to rise.9
The 2 objectives for this study were: (1) to determine changes in child care providers' knowledge of and attitudes and behaviors toward infant feeding best practices after viewing the InfaNET Nutrition for Child Care Providers Web site; and (2) to determine the effectiveness (eg, content and design) of the Web site as well as the use of the bilingual educational materials.
Section snippets
Development and Evaluation of the Web Site
A Web site was determined to be the most preferred way child care providers wanted to receive infant feeding information (P < .001) compared to conferences, training sessions, and books.8 Group discussions were conducted with providers (n = 5) to determine Web site architectural and format needs. Based on this feedback, the InfaNET Nutrition for Child Care Providers Web site (http://www.infanet.cahs.colostate.edu) was developed and contains printable, child-care–specific handouts in English and
Study Design
Approval was received from the Colorado State University Institutional Review Board. To be confident with the detection of significant differences among respondents,11 14 child care providers in both the intervention and control groups were needed to achieve 80% power. The Colorado Department of Human Services provided a list of 277 licensed child care centers. Recruitment was completed by calling and mailing postcards to the child care centers. Consent to participate in the 3 phases (pre,
Response Rate
Consent to participate in the study was received from 48 child care providers; 38 providers (23 in the intervention group and 15 in the control group) filled out the on-line pretest survey. After grouping the knowledge, attitude, and behavior questions into their appropriate scales as described earlier, there were no significant differences between the intervention and control groups' answers at the pretest time period (Table 1). Eighty percent power was achieved at the pre- and posttest time
Discussion
This is the first study of its kind known to the authors. Few studies have been published regarding infant feeding knowledge, attitudes, and behaviors of child care providers.5, 13, 14 Between the pretest and posttest, the intervention group did have more positive changes (statistically significant) in desired attitudes and behaviors related to infant feeding and providing a “breast-feeding–friendly” environment. Knowledge scores did not improve drastically; this finding could be because the
Implications for Research and Practice
An area of need appears to be in child care providers' ability to identify infant hunger cues. Providers in both groups answered incorrectly when asked if crying was a good sign of hunger in infants. Even though crying is considered a late hunger cue in infants, the recommendations are to offer breast milk or formula before crying occurs.16 Researchers have also found that overfeeding an infant can occur if care givers consistently respond to crying by feeding the infant and do not learn to
Acknowledgments
The funding for this project was provided by the Colorado Department of Public Health and Environment–Colorado Physical Activity and Nutrition Coalition, Colorado Breast-feeding Task Force, and the Medela Corporation. The authors acknowledge John W. Wilson for his assistance with the website. This research project was completed as part of Alena Clark's dissertation.
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(2005)United States Department of Health and Human Services, Office on Women's Health. Benefits of breastfeeding
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Colorado Pregnancy Risk Assessment Monitoring System (PRAMS) Breastfeeding Report
(2002) Centers for Disease Control. Breastfeeding Practices – Results from the 2005 National Immunization Survey
Position of the American Dietetic Association: benchmarks for nutrition programs in child care settings
J Am Diet Assoc
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Breastfeeding rates in the United States by characteristics of the child, mother or family: the 2002 National Immunization Survey
Pediatrics
(2005)
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2020, American Journal of Health PromotionEducational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under
2018, Cochrane Database of Systematic ReviewsA breastfeed-promoting mobile app intervention: Usability and usefulness study
2018, JMIR mHealth and uHealthMeasuring implementation behaviour of menu guidelines in the childcare setting: Confirmatory factor analysis of a theoretical domains framework questionnaire (TDFQ)
2017, International Journal of Behavioral Nutrition and Physical Activity
Funding for this project was provided by the Colorado Department of Public Health and Environment – Colorado Physical Activity and Nutrition Coalition, Colorado Breast-feeding Task Force, and the Medela Corporation.
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At the time research was conducted and completed, Alena Clark was a PhD candidate at Colorado State University, Department of Food Science and Human Nutrition, Fort Collins, Colorado.