RESUMO
Alternative caregivers (i.e., someone besides the primary caregiver who also takes care of children) make food choices for children. This study investigated what alternative caregivers consider when making food choices for children and their perspectives on their role in making food choices to feed children. In-depth interviews were conducted with 16 alternative caregivers of children aged 1-5 years old in semi-urban and urban areas of the State of Mexico in Mexico. Interviews were recorded, transcribed, coded, and analyzed using constant comparative method. Alternative caregivers described spaces and situations that exposed children to food while under their care. Alternative caregivers who spent longer periods of time with the child described more involvement in what the child ate. Healthy or nutritious food, cost of food and affection for children were important considerations for alternative caregivers when deciding what to feed the child. Alternative caregivers had a substantial role in child feeding, decisions about cooking, and advising mothers on how to feed their children. Efforts to promote healthy food choices for children should include targeting of alternative caregivers.
Assuntos
Cuidadores , Preferências Alimentares , Criança , Feminino , Humanos , Pré-Escolar , Lactente , México , Mães , AlimentosRESUMO
Food choice for children has important implications in establishing early-life dietary habits and preferences. Food choice for children has been studied as parent-child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers' social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In-depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants' child-feeding practices, personal and local beliefs about child feeding and the individuals with whom they had conversations about food and child feeding. All interviews were conducted in Spanish, audio-recorded, transcribed verbatim, verified for quality and analysed using the constant comparative method. Five interconnected networks emerged, consisting of household family, non-household family, community, children's initial school and health and nutritional programme personnel. Each network had functions in food choice that ranged from shared food decision-making in the household family network to imparting formal dietary guidance in the health and nutritional programme personnel network. Across the networks, professionals, participants' mothers and mothers-in-law, community senior women and other women with children emerged as prominent figures whom participants would turn to for child-feeding advice. These findings provide empirical evidence that social networks, as an organized system of interconnected relationships, have vital functions in establishing social norms for food choices made for children that can be leveraged to promote healthy food choices.
Assuntos
Comportamento Alimentar , Preferências Alimentares , Pré-Escolar , Feminino , Humanos , Lactente , México , Mães , Rede SocialRESUMO
INTRODUCTION: The coexistence of food insecurity and excess body weight has been well documented in women. Both food insecurity and excess body weight have multiple consequences for physical and mental health. Concerns have been raised about interventions aimed to reduce food insecurity because these interventions might contribute to excess body weight, particularly in adult women. The purpose of this study was to develop, implement, and evaluate an intervention to simultaneously reduce food insecurity and body weight through alleviating discouragement-which women described as feeling sad, depressed, hopeless, and lacking drive to do important activities, such as finding a job or studying more-by increasing women's empowerment. STUDY DESIGN: This 2-armed cluster RCT was conducted from February to December 2017. Data were analyzed from January to July 2018. SETTING/PARTICIPANTS: Participants were food-insecure women with excess body weight in the Central Canton of the province of Alajuela, Costa Rica. INTERVENTION: The intensive intervention arm consisted of activities at the individual (12 sessions lasting 2 hours each, 3 follow-up monthly sessions, and 1 closing session), household (1 workshop with the participants' household and community members and homework with family participation), and community (2 brochures and 1 workshop) levels. The nonintensive control arm consisted of 3 sessions about healthy lifestyles lasting 1 hour each. MAIN OUTCOME MEASURES: Outcome measures included BMI, waist circumference, and food insecurity. RESULTS: A total of 171 participants were enrolled (83 in intensive and 88 in nonintensive control arms). At 6 months, the intensive arm had greater decreases from baseline in BMI (-0.648, p=0.019), waist circumference (-2.21, p=0.002), and food insecurity (-1.35, p=0.009) compared with the nonintensive control arm. CONCLUSIONS: The intensive intervention was effective in simultaneously reducing food insecurity and excess body weight. Educational components should be added to interventions aimed to reduce food insecurity. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT03492619.
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Exercício Físico , Insegurança Alimentar , Comportamentos Relacionados com a Saúde , Educação em Saúde , Obesidade/terapia , Adulto , Índice de Massa Corporal , Costa Rica , Dieta/estatística & dados numéricos , Características da Família , Feminino , Humanos , Circunferência da CinturaRESUMO
BACKGROUND: Presidents with no possibility of re-election overvalue far-future rewards and succumb to terminal logic behavior (TLB), responding to end-of-tenure legacy concerns despite political context. Government authorities perceiving the outgoing government is losing power at the end of term behave under the logic of strategic defection (SD), dissociating from the outgoing government once it is perceived powerless. In countries where re-election is impossible and government turnover and inconstant political parties are concerns, governmental officials at all levels may show TLB and SD during transitions that affect policy sustainability. OBJECTIVES: This study aimed to understand the context during presidential transitions that makes TLB and SD relevant, whether TLB and SD affect sustainability of food and nutrition security policy (FNSP), and the tactics for navigating transitions that favor sustainability. METHODS: A case-study design was used with semi-structured qualitative interviews and document review of news articles in Guatemala. Purposeful criteria and snowball sampling were used to recruit 52 policy actors implementing an FNSP across 2 transitions; 252 news articles from the referenced period covering topics on policy programmatic areas were purposefully sampled. Interviews were analyzed using coding and thematic analyses. News articles were analyzed using a priori thematic coding for verifying themes in interviews and data triangulation. RESULTS: Governmental officials were replaced by others during transitions; political parties were perceived as inconstant. TLB and SD occurred at all levels and had consequences for sustainability of FNSP: implementation slow-down, dysfunctional collaboration, inefficient use of resources, benefits not reaching targeted groups, and loss of momentum. These occurred through individual, institutional, and political mechanisms. Civil society, international organizations, and government adopted tactics for maximizing sustainability. CONCLUSIONS: Understanding governmental officials' experiences and the extent to which TLB and SD occur and affect sustainability could be advantageous to develop compensatory actions for reaching long-term FNSP goals.
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BACKGROUND: Food assistance programs may alter food choices, but factors determining households' decisions regarding food acquisition, preparation, and consumption in the context of food aid are not well understood. OBJECTIVE: This study aimed to understand how the Programa Comunitario Materno Infantil de Diversificación Alimentaria (Mother-Child Community Food Diversification Program; PROCOMIDA), a food-assisted maternal and child health and nutrition program in rural Alta Verapaz, Guatemala, altered household food choices. METHODS: We conducted semistructured interviews and focus groups with 63 households in 3 participating (n = 32 households) and 3 control (n = 31) villages. A last-day food recall (without estimating quantities) and food-frequency questionnaire that used food cards assessed dietary choices. Qualitative analysis used thematic a priori and emergent coding; food group consumption frequencies were analyzed by using 2-level, logistic, mixed modeling, and chi-square testing while accounting for community clustering. RESULTS: Compared with control households, PROCOMIDA changed household food choices through a combination of providing food resources (with monthly food rations) and new knowledge and skills related to health and food (in the program's behavior change communication component) while reinforcing existing knowledge and beliefs. PROCOMIDA families consumed rice, red beans, and oil more frequently than did control families (differences of 2.20 (P < 0.001), 2.68 (P < 0.001), and 1.64 (P = 0.038) times/wk, respectively); these foods were in the rations. PROCOMIDA families also ate chicken, local plants, and some vegetables more frequently. The importance of these foods was emphasized in the behavioral change communication component; these foods may have been more accessible because provision of food rations freed resources. CONCLUSION: Our findings suggest that if a program provides food free of cost to rural indigenous families in the context of a maternal and child nutrition and health program, it may be important to include a well-designed behavioral change communication component to improve household food choices.
Assuntos
Comportamento de Escolha , Comunicação , Dieta , Características da Família , Comportamento Alimentar , Assistência Alimentar , Promoção da Saúde/métodos , Adulto , Terapia Comportamental , Saúde da Criança , Feminino , Guatemala , Conhecimentos, Atitudes e Prática em Saúde , Serviços de Saúde do Indígena , Humanos , Lactente , Recém-Nascido , Masculino , Saúde Materna , População Rural , Adulto JovemRESUMO
OBJECTIVE: This mixed methods study sought to understand who makes decisions about whether preschool-aged Mexican American children engage in eating, outdoor play, sleep, and screen time behaviors. METHODS: Forty Mexican American mothers of children ages 3-4 participated in two interviews, during which both closed- and open-ended questions elicited perceptions of who made decisions for the four behaviors, as well as who was present, mealtime rules, and food choice values. Interviews were transcribed, coded for emergent themes, and compared across participants. RESULTS: Participants generally perceived themselves to be primary decision makers for all four behaviors; however, food decisions often seemed to be made collaboratively with the child. Fathers were most likely to participate in evening television decisions. Other family members were rarely mentioned. Selecting foods that children liked was a strong food choice value, while cost was rarely mentioned. Participants appeared to have low perceived control over their child's behaviors relative to their perceived roles in decision making. CONCLUSIONS: Mothers may be the primary audience for obesity prevention messages for preschool-aged, Mexican American children; however, health promotion programs may need to increase mothers' awareness of their control over children's behaviors. Understanding how children's behaviors are regulated is an important aspect of obesity prevention for low-income, Mexican American children.
Assuntos
Comportamento Infantil/psicologia , Tomada de Decisões , Comportamentos Relacionados com a Saúde , Relações Mãe-Filho/psicologia , Mães/psicologia , Obesidade Infantil/psicologia , Adulto , Peso Corporal , Pré-Escolar , Comportamento de Escolha , Dieta , Exercício Físico , Feminino , Assistência Alimentar , Preferências Alimentares/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Americanos Mexicanos , Obesidade Infantil/prevenção & controle , Pobreza , Fatores de Risco , Sono , Televisão , Jogos de VídeoRESUMO
This article critically examines federal, state and facility-level policies, as well as clinical practice guidelines regarding postnatal depression in Mexico. Thirteen documents including national health plans, national action plans, federal and state laws and regulations, clinical practice guidelines, and public-sector healthcare facility policies were collected and evaluated according to whether they included a statement of intent and/or actions related to the care of women at risk for or experiencing postnatal depression. While postnatal depression is included in several policies in Mexico, it is not addressed in ways that guide actions to manage postnatal depression. Specific direction on postnatal depression in policies would bridge a gap in maternal mental healthcare given that medication, treatment, and timing of interventions is unique in the postpartum context.
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Depressão Pós-Parto/terapia , Política de Saúde , Saúde Mental , Saúde da Mulher , Governo Federal , Feminino , Prioridades em Saúde , Promoção da Saúde , Humanos , México , Política Organizacional , Guias de Prática Clínica como Assunto , Governo EstadualRESUMO
In this article we describe the knowledge frameworks that 61 physicians, nurses, social workers, and psychologists from five public-sector health care facilities in Mexico used to conceptualize postpartum depression. We also demonstrate how providers applied social and behavioral antecedents in their conceptualizations of postpartum depression. Using grounded theory, we identify two frameworks that providers used to conceptualize postpartum depression: biochemical and adjustment. We highlight an emerging model of the function of social and behavioral antecedents within the frameworks, as well as the representation of postpartum depression by symptoms of distress and the perception among providers that these symptoms affected responsibilities associated with motherhood. The results provide a foundation for future study of how providers' conceptualizations of postpartum depression might affect detection and treatment practices and might be useful in the development of training materials to enhance the quality of care for women who experience any form of distress in the postpartum period.