Modifying and extending Fit WIC materials to start obesity prevention in infancy: The WIC Baby Behavior Study

Background: In an earlier study, focus groups indicated that infant behavior was a trigger for inappropriate infant feeding behaviors among low income women participating in the Supplementary Nutrition for Women, Infants and Children Program (WIC). Mothers had unrealistic expectations of normal infant behavior resulting in premature cessation of breastfeeding, overfeeding, and early solid food introduction used to alter infant behavior. Educational interventions and materials are needed that directly address mothers' concerns about infant behavior and to improve mother-infant interactions. For this project, materials and methods were adapted and expanded from FitWIC obesity prevention projects that had been successful in many states. Methods: Using focus groups, qualitative interviews, cognitive testing procedures and pilot classes, educational and social marketing materials and methods were developed to create clinic environments that assist mothers to understand normal infant behavior and to more positively interact with their infants. Key messages were tested for acceptance and understanding prior to implementation in clinics participating in a controlled trial of the new approach. Results: Staff trainings resulted in improved knowledge related to infant behavior and maternal child interaction. Educational materials and classes were well accepted by WIC mothers and staff. Tested materials are currently being utilized in clinics participating in the year-long intervention project. Discussion: Qualitative methods are useful in developing and testing educational and social marketing materials. Education may be used to improve mothers' and staff understanding of normal infant behavior in the WIC environment as part of efforts to reduce inappropriate infant feeding practices in this population.