Sharing knowledge about immunisation (SKAI): An exploration of parents' communication needs to inform development of a clinical communication support intervention.

INTRODUCTION: The SKAI (Sharing Knowledge About Immunisation) project aims to develop effective communication tools to support primary health care providers' consultations with parents who may be hesitant about vaccinating their children. AIM: This study explored parents' communication needs using a qualitative design. METHODS: Parents of at least one child less than five years old were recruited from two major cities and a regional town known for high prevalence of vaccine objection. Focus groups of parents who held similar vaccination attitudes and intentions were convened to discuss experiences of vaccination consultations and explore their communication needs, including preferences. Draft written communication support tools were used to stimulate discussion and gauge acceptability of the tools. RESULTS: Important differences in communication needs between group types emerged. The least hesitant parent groups reported feeling reassured upon reading resources designed to address commonly observed concerns about vaccination. As hesitancy of the group members increased, so did their accounts of the volume and detail of information they required. Trust appeared to be related to apparent or perceived transparency. More hesitant groups displayed increased sensitivity and resistance to persuasive language forms.

When parents won't vaccinate their children: a qualitative investigation of australian primary care providers' experiences.

BACKGROUND: Increasingly, the experiences and perceptions of parents who decline vaccination are the subject of investigation. However, the experiences of clinicians who encounter these parents in the course of their work has received little academic attention to date. This study aimed to understand the challenges faced and strategies used when general practitioners and immunising nurses encounter parents who choose not to vaccinate their children. METHODS: Primary care providers were recruited from regions identified through the Australian Childhood Immunisation Register (ACIR) as having higher than national average rates of registered objection to childhood vaccination. Interviews began with an exploration of provider experiences with parents who accept, are hesitant towards, and who decline vaccination. Participants were asked specifically about how they addressed any difficulties they encountered in their interactions. Thematic analysis focused on encounters with parents - challenges and strategies. RESULTS: Twenty-six general practitioners (GPs), community and practice nurses (PNs) were interviewed across two regions in NSW, Australia. Providers' sense of professional identity as health advocates and experts became conflicted in their encounters with vaccine objecting parents. Providers were dissatisfied when such consultations resulted in a 'therapeutic roadblock' whereby provider-parent communication came to a standstill. There were mixed views about being asked to sign forms exempting parents from vaccinating their children. These ranged from a belief that completing the forms rewarded parents for non-conformity to seeing it as a positive opportunity for engagement. Three common strategies were employed by providers to navigate through these challenges; 1) to explore and inform, 2) to mobilise clinical rapport and 3) to adopt a general principle to first do no harm to the therapeutic relationship. CONCLUSIONS: Many healthcare providers find consultations with vaccine objecting parents challenging and some, particularly more experienced providers, employ successful strategies to address this. Primary care providers, especially those more junior, could benefit from additional communication guidance to better the outcome and increase the efficiency of their interactions with such parents.

Health and nutrition content claims on websites advertising infant formula available in Australia: A content analysis.

The use of health and nutrition content claims in infant formula advertising is restricted by many governments in response to WHO policies and WHA resolutions. The purpose of this study was to determine whether such prohibited claims could be observed in Australian websites that advertise infant formula products. A comprehensive internet search was conducted to identify websites that advertise infant formula available for purchase in Australia. Content analysis was used to identify prohibited claims. The coding frame was closely aligned with the provisions of the Australian and New Zealand Food Standard Code, which prohibits these claims. The outcome measures were the presence of health claims, nutrition content claims, or references to the nutritional content of human milk. Web pages advertising 25 unique infant formula products available for purchase in Australia were identified. Every advertisement (100%) contained at least one health claim. Eighteen (72%) also contained at least one nutrition content claim. Three web pages (12%) advertising brands associated with infant formula products referenced the nutritional content of human milk. All of these claims appear in spite of national regulations prohibiting them indicating a failure of monitoring and/or enforcement. Where countries have enacted instruments to prohibit health and other claims in infant formula advertising, the marketing of infant formula must be actively monitored to be effective.

It's not the contents, it's the container: Australian parents' awareness and acceptance of infant and young child feeding recommendations.

Adherence to public health recommendations around infant and young child feeding is poor amongst Australian parents. This study aimed to investigate Australian parents' awareness and acceptance of public health recommendations about infant feeding. A cross-sectional design was used to survey a convenience sample of Australian parents. A total of 439 surveys were collected by intercept over 2 days from parents of children less than 5 years old, including those expecting a first baby, at the Pregnancy, Babies and Children (PBC) Expo held in Sydney in May 2008. Only 58.3% were aware of the WHO and NHMRC recommendation of 6 months exclusive breastfeeding. Fewer than 70% of respondents indicated that they thought breastfeeding should continue to 12 months or later, in accordance with the NHMRC guidelines, and only 12.3% thought breastfeeding should continue to 24 months or later, in accordance with WHO recommendations. This research suggests that awareness and acceptance of infant feeding recommendations in Australia is poor.

Circumventing the WHO Code? An observational study.

BACKGROUND: This study compares the formula milk advertisements that appeared in parenting magazines published in two countries that have enacted measures to restrict the advertising of infant formula products in response to the international code with two that have not. METHODS: Content analysis was used to compare the type and frequency of formula milk advertisements that appeared in parenting magazines collected from the USA, Canada, the UK and Australia during 2007, and to examine whether there was a relationship between these frequencies and advertising regulations. FINDINGS: Advertisements that promoted formula products or brands occurred in all of the magazines sampled but the type of product advertised differed. Follow-on formula advertisements occurred more frequently in titles from the UK, where infant formula advertising is prohibited (RR 3.82, 95% CI 2.65 to 5.50, p<0.0001) than they did in titles from the USA/Canada where infant and/or follow-on formula advertising is permitted. Toddler milk advertisements appeared more frequently in titles from Australia, where infant and follow-on formula advertising is prohibited, than they did in titles from countries where direct-to-consumer infant and/or follow-on formula advertising is permitted. Rate ratios were as follows: UK only 0.03 (95% CI 0.01 to 0.11, p<0.0001); USA/Canada only 0.02 (95% CI 0.01 to 0.06, p<0.0001). INTERPRETATION: Bans on the advertising of infant formula products do not prevent companies from advertising (follow-on or toddler formula). These products are presented in ways that encourage consumers to associate the claims made in them with a group of products (a product line) that includes infant formula.

Emergency preparedness for those who care for infants in developed country contexts.

Emergency management organisations recognise the vulnerability of infants in emergencies, even in developed countries. However, thus far, those who care for infants have not been provided with detailed information on what emergency preparedness entails. Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants. Those who care for formula fed infants should be provided with detailed information on the supplies necessary for an emergency preparedness kit and with information on how to prepare formula feeds in an emergency. An emergency preparedness kit for exclusively breastfed infants should include 100 nappies and 200 nappy wipes. The contents of an emergency preparedness for formula fed infants will vary depending upon whether ready-to-use liquid infant formula or powdered infant formula is used. If ready-to-use liquid infant formula is used, an emergency kit should include: 56 serves of ready-to-use liquid infant formula, 84 L water, storage container, metal knife, small bowl, 56 feeding bottles and teats/cups, 56 zip-lock plastic bags, 220 paper towels, detergent, 120 antiseptic wipes, 100 nappies and 200 nappy wipes. If powdered infant formula is used, an emergency preparedness kit should include: two 900 g tins powdered infant formula, 170 L drinking water, storage container, large cooking pot with lid, kettle, gas stove, box of matches/lighter, 14 kg liquid petroleum gas, measuring container, metal knife, metal tongs, feeding cup, 300 large sheets paper towel, detergent, 100 nappies and 200 nappy wipes. Great care with regards hygiene should be taken in the preparation of formula feeds. Child protection organisations should ensure that foster carers responsible for infants have the resources necessary to formula feed in the event of an emergency. Exclusive and continued breastfeeding should be promoted as an emergency preparedness activity by emergency management organisations as well as health authorities. The greater the proportion of infants exclusively breastfed when an emergency occurs, the more resilient the community, and the easier it will be to provide effective aid to the caregivers of formula fed infants.

Relax, you're soaking in it: sources of information about infant formula.

Although the advertising of infant and follow-on formula products in Australia is prohibited by the Marketing in Australia of Infant Formulas: Manufacturers and Importers Agreement (1992), toddler milk is advertised without restriction. Recent research suggests that Australian mothers perceive advertisements for toddler milk to also be advertisements for infant formula. Furthermore, they tend to accept the messages they encounter in these advertisements uncritically. This study used established qualitative market research strategies to investigate what mothers, and those who influence mothers, know about formula milk products. This included exploration of commonly used sources of information, how toddler milk advertisements are interpreted and how the claims made in these advertisements are evaluated. Eight interviews were conducted: two individual interviews (involving a General Practitioner and a Community Dietitian) and six discussion groups (two groups of two mothers, two groups of two grandmothers, one group of two child and family health nurses and one group of five Child and Family Health Nurses). The results suggest that mothers seek advice about formula milk products from health professionals, their friends and their own mothers. The responses also suggest that all of these groups understand toddler milk advertisements to be advertising formula milk products and tend to rely on the messages contained in them to inform their decisions or advice about infant feeding products. It may therefore be difficult for mothers to access independent information upon which to base their decisions about infant feeding products. Further research is needed on whether sufficient independent information about infant feeding products is available to health professionals and mothers.

It's all formula to me: women's understandings of toddler milk ads.

This study utilised semi-structured interviews to investigate how women expecting a first baby perceived print advertisements for 'toddler milks' in order to determine whether they function as indirect advertising for infant and follow-on formula. Examination of the marketing literature, analysis of the advertisers' websites and the advertisements themselves provided sources of triangulation. Fifteen women expecting a first baby were recruited from antenatal classes conducted by staff of the Northern Sydney Central Coast Area Health Service. These respondents clearly understood toddler milk advertisements to be promoting a range of products that included infant and follow-on formula and accepted their claims quite uncritically These claims contradicted public health messages about breastfeeding and the evidence of health risks associated with formula feeding. Toddler milk advertisements appear to function as indirect advertising for infant and follow-on formula. The Marketing in Australia of Infant Formula: Manufacturers' and Importers' Agreement is failing to protect the Australian community from the advertising of breastmilk substitutes as required by World Health Assembly Resolution 33.47, the International Code of Marketing of Breastmilk Substitutes. Further research is recommended to determine whether the responses of this group of primiparous women from a single area in NSW are representative of the wider population of Australian mothers.

Breast is no longer best: promoting normal infant feeding.

The recent release of new growth charts by the World Health Organization (WHO) heralds a fresh understanding of what constitutes normal infant growth and development. The Multicenter Growth Reference Study that underpins these new growth standards 'establish[es] breastfed infants as the normative model for growth and development'. This is in contrast to past practice, which treated breastfeeding as the optimal, rather than the normal, way to feed babies. This idealization of breastfeeding has been counterproductive, because it has reinforced a perception that formula feeding is the standard way of feeding babies. It is, therefore, suggested that breastfeeding promotion and education programmes should abandon the 'breast is best' message in favour of messages that normalize breastfeeding, and that future research ought to use infants breastfed according to WHO recommendations as the norm reference or control group in every instance.