Daily Challenges for Teen Moms: Strategies to Enhance Infant-Centered Feeding to Reduce Infant Obesity Risk

Saturday, 7 November 2015

Mildred A. Horodynski, PhD, MN, BSN, RN, FAAN1
Kami Silk, PhD, MA, BA2
Gary Hsieh, PhD, BS3
Alice Hoffman, BS1
Mackenzie Robson1
(1)College of Nursing, Michigan State University, East Lansing, MI, USA
(2)Department of Communication, Michigan State University, East Lansing, MI, USA
(3)Department of Human Centered Design and Engineering, University of Washington, Seattle, WA, USA

Purpose: Rapid weight gain in the first six months of life is associated with a sharply increased risk of obesity later in life and subsequent health consequences. Unhealthy mother-infant feeding practices contribute to rapid/excessive infant weight gain Lower-income, adolescent, first-time mothers are also less likely to engage in infant-centered feeding (shared regulation of feeding within the mother-infant dyad) characterized by maternal responsiveness (positive maternal recognition and responses to infant cues), positive feeding styles (maternal guided approach to infant feeding), and healthy feeding practices as recommended by the American Academy of Pediatrics. Infant-centered feeding is needed to reduce rapid/excessive gain in the first six months of life. Infant-centered feeding fosters infant feeding self-regulation, which is associated with healthy growth (weight and length) and is crucial in reducing childhood obesity risk and adverse health conditions later in life. Few published intervention studies on the prevention or reduction of obesity in infants exist. Practical early intervention strategies must be developed to promote infant-centered feeding among adolescent mothers. The proposed intervention addresses a deficit in the literature on infant-centered feeding to reduce rapid/excessive infant weight gain that exists for this high-risk population. Adolescent mothers’ feeding behaviors are most directly related to infant weight gain in the first year of life. Compared to adult mothers, adolescent mothers are less knowledgeable, less responsive, more controlling, and less skilled in infant feeding, which interferes with infants’ self-regulation, natural weight trajectory, and healthy growth during the first year of life.  The purpose of this study is to test a new social media intervention (Tools 4 Teen Moms [T4TM]) and to determine the preliminary efficacy and the feasibility, acceptability, and satisfaction of T4TM. This poster presents data on website usage, as means of acceptability and satisfaction with the social media intervention.

 Methods:  A two-group randomized control trial is being implemented with a targeted sample of 100 low-income, first-time adolescent mothers, ages 15 to 19 years old, with infants (0 to 6 months of age) to obtain evidence for efficacy, feasibility, acceptability, and satisfaction related to T4TM.  Participants are randomly assigned to the intervention group (n = 50) or control group (n = 50).  Adolescent mothers must be a primary caretaker of the infant who feeds her infant at least once a day. Adolescent mothers are recruited from Maternal Infant Health Programs, a program for pregnant women and infants who are Medicaid-eligible, promotes healthy pregnancies, positive birth outcomes, and healthy infants through home and office visits during the first year of life. The intervention consists of six weeks of daily challenges via the T4TM website within four urban, Michigan counties. Tools4Teen Moms challenges are being delivered for six weeks starting when the infant is four to six weeks old. T4TM includes cell phone text message reminders, an infant feeding website, and a Facebook interface to increase infant-centered feeding.  Participants perform daily behavioral challenge activities, which consist of daily challenges for six weeks via the T4TM website. Daily challenges focus on promoting maternal-infant feeding interaction and healthy feeding practices. Data are collected at three time points (baseline, when the infant is 10-12 weeks old, and six months old), using self-report and anthropometric measures. Data analysis for challenge feasibility: For those in the intervention group, the number and percent of participants who completed all the challenges will be determined. Acceptability and Satisfaction: The results of the satisfaction survey will be summarized and evaluated for overall satisfaction. Open-ended questions will be transcribed to identify key reasons for satisfaction levels and suggestions for improvement.

 Results (Preliminary):  Currently, the participant age range is 16 to 19 years with a mean of 18 years; 33% of participants identify themselves as Hispanic/Latina, 27%, identify as Black/African American, 20% White, 7% Asian, and 13% as multiracial. Most participants (87%) are not currently employed. At the time of data collection 33% of participants were currently breastfeeding, while 67% were not; of the 67% who were not currently breastfeeding, 50% had breastfed their baby at some point.  Birth weight of babies in the study ranges from 5.58-9.19 lbs (mean = 7.29 lbs).

Preliminary results indicate engagement with the T4TM website and challenges. Participants visited the website an average of 28/42 days. Many participants have retroactively completed challenges, meaning they visited the “Past Challenges” to complete challenges that had been posted earlier that week.  The average minimum challenge exposure for completed participants thus far is 31/42. Preliminary results show that participants engage with quizzes available on the T4TM website; participants have completed an average of 3/4 quizzes.

Feedback from participants indicates enjoyment of the intervention.  All participants agreed that they found the website helpful, they learned a lot about infant feeding from this program, and they would recommend T4TM to a friend for infant feeding advice. Participants agreed that they were satisfied with the challenges presented in the T4TM intervention. One participant expressed her opinion of the program: “It’s a good program; I like it because it teaches me new things about becoming a great mother, and I really appreciate this program. Thank you so much!”

Conclusions: This study is in progress. Preliminary evidence supports use of text messaging and daily challenges to engage adolescent mothers in healthy infant feeding practices. Nursing can augment education with skill application via social media.