"I try, I do": Child feeding practices of motivated, low-income parents reflect trade-offs between psychosocial- and nutrition-oriented goals.

Although there is increased focus on behavior change programs targeting parents to promote healthy child feeding, success of these programs has been limited. To close this gap, we sought to understand parents' goals for child feeding and their motivations, abilities, and contextual environment that challenged or enabled goal achievement, with a focus on parents' own childhood food experiences. We conducted semi-structured qualitative interviews (n = 21) with low-income parents of at least one child aged 3-11 years in three semi-rural counties in upstate New York to explore their emic perspectives on child feeding goals and practices. Transcripts were coded by at least two researchers using the constant comparative approach. Emergent themes were identified and interpreted in the context of the Motivation-Ability-Opportunity framework. Low-income parents articulated and were clearly motivated to achieve both nutrition- and psychosocial-oriented goals. Salient psychosocial goals (e.g., family meals to promote family relationships, help child feel secure), often led to different child feeding practices than indicated by parents' nutrition-oriented child feeding goals (e.g., nutritious diet, healthful relationship with food). Sometimes these psychosocial goals were in conflict with the nutrition-oriented goals; for example, some parents gave into child food preferences to avoid conflict or hesitated to introduce changes in diets of overweight children to preserve child self-esteem. Prominent contextual barriers included child preferences, life disruptions, and the inflexible time and financial restrictions of poverty. Parents exhibited awareness and motivation to achieve healthy eating goals but success was often thwarted by the salience of psychosocial goals that often motivated less-healthy practices. Thus, behavior change programs should acknowledge the value and relevance of both types of goals and help parents develop strategies to address the tensions between them.

Integrating Calcium Supplementation into Facility-Based Antenatal Care Services in Western Kenya: A Qualitative Process Evaluation to Identify Implementation Barriers and Facilitators.

BACKGROUND: In countries with low calcium intake, the WHO recommends integrating calcium supplementation into antenatal care (ANC) to reduce the risk of preeclampsia, a leading cause of maternal mortality. Current WHO guidelines recommend women take 3-4 calcium supplements plus 1 iron-folic acid supplement at separate times daily. There is limited evidence about implementing these guidelines through routine ANC. Through the Micronutrient Initiative-Cornell University Calcium (MICa) trial, we examined the effect of regimen on supplement consumption among ANC clients in western Kenya. A nested process evaluation examined factors that influence calcium supplementation delivery and uptake. OBJECTIVES: This process evaluation assessed ANC providers', pregnant women's, and family members' experiences with calcium supplementation, and investigated the feasibility and acceptability of engaging family members to support adherence. METHODS: We conducted semistructured interviews with 7 ANC providers, 32 pregnant women, and 20 adherence partners (family members who provide reminders and support), and 200 observations of ANC consultations. Interviews were transcribed, translated, and analyzed thematically. Observational data were summarized. RESULTS: ANC providers reported positive feelings about calcium supplementation, the training received, and counseling materials, but reported increased workloads. Women reported that providers counseled them on supplement benefits and managing side effects, offered reminder strategies, and provided supplements and behavior change materials. Women explained that reminder materials and adherence partners improved adherence. Most adherence partners reported providing reminders and other instrumental support to help with pill taking, which women confirmed and appreciated. Some women reported that comorbidities, concerns about being perceived as HIV positive, pill burden, unfavorable organoleptic properties, and lack of food were adherence barriers. CONCLUSIONS: Although integrating calcium into antenatal iron-folic acid supplementation was generally acceptable to ANC providers, pregnant women, and their families, calcium supplementation presents unique challenges that must be considered to successfully implement these guidelines.This trial was registered at clinicaltrials.gov as NCT02238704.