Background Infancy is a significant disease prevention and health promotion stage in life. There is a need to examine factors influencing complementary feeding among Native Hawaiians through an indigenous framed lens. Objective To identify Hawaiian complementary feeding practices through in-depth interviews with kūpuna (grandparents) from across the state of Hawai‘i. Methods The chain-referral-sampling method was used to identify Native Hawaiian kūpuna knowledgeable in Hawaiian complementary feeding practices from across the 4 counties in Hawai‘i. Interview question topics included sharing about their formative years, infant health, infant feeding, transgenerational knowledge, and opportunities and barriers related to traditional food consumption. Interviews were recorded and then transcribed. 3 coders used NVivio12 to code transcripts using a priori and emergent themes. IRB approval was received prior to data collection. Results Fourteen kūpuna interviews were included in the analysis. A majority of the kūpuna were female. Most kūpuna shared that complementary feeding practices in their childhood and when their children and grandchildren were being raised reflected aspects of the traditional Hawaiian diet. Poi or steamed mashed taro root was the most common traditional Hawaiian dietary staple of infancy. However, kūpuna shared that traditional dietary practices evolved to reflect contemporary dietary practices such as the mixing of poi with infant cereal or milk. Female family members were prominent influences on kūpuna complementary feeding practices. Lifestyle and lack of knowledge were the most commonly shared reflections by kūpuna on the supports and barriers, respectively, to promoting and engaging in traditional Hawaiian complementary feeding practices. Conclusions Complementary feeding practices have evolved over generations but aspects of traditional Hawaiian feeding practices have remained. These findings are important when working with Hawaiian families as kūpuna play a prominent role in feeding infants.
The ability to comprehensively assess the diet of infants is essential for monitoring adequate growth; however, it is challenging to assess dietary intake with a high level of accuracy. Infants rely on surrogate reporting by caregivers. This study aimed to determine if surrogate reporters (e.g., caregivers) could use an image-based mobile food record adapted (baby mFR) to record infants’ eating occasions, and via caregiver feedback, could assess the usability and feasibility of the baby mFR in recording infants’ diets. This was a cross-sectional study in which surrogate reporters (e.g., caregivers) recorded all food and beverage intake (including human milk) of the infant over a 4-day period. Trained research staff evaluated all images submitted during data collection for different indicators of quality. All surrogate reporters were asked to complete a usability questionnaire at the end of the 4-day data collection period. Basic descriptive analyses were performed on the infants 3–12 months of age (n = 70). A total of 91% (n = 64) of surrogate reporters used the baby mFR to record their infants’ eating occasions. The mean number of images submitted daily per participant via the mFR was 4.2 (SD 0.2). A majority of submitted images contained the fiducial marker and the food and/or beverage was completely visible. The mFR was found to be easy to use; however, suggestions were provided to increase utility of the application such as the inclusion of a bottle button and reminders. An image-based dietary assessment method using a mobile app was found to be feasible for surrogate reporters to record an infant’s food and beverage intake throughout the day.
Objectives The objective of this study was to describe the first feeding behaviors (breastfeeding and complementary feeding timing) of Native Hawaiian, Pacific Islander, and Filipino infants 3 – 12 months of age. Methods A convenient sample of Native Hawaiian, Pacific Islander, and Filipino infants ages 3 – 12 months were recruited for this study examining dietary diversity and the feasibility of a mobile phone food record. Eligible participants resided on the island of O‘ahu and had a caregiver who was 18 years of age or older with access to an Apple mobile device. This abstract provides a description on the first feeding practices collected via online questionnaire (RedCap) for the sample collected as of December 2018. This study was deemed exempt by the Institutional Review Board. Results A total of 67 infants had completed the study between March and December 2018. Only 64 infants had complete data and were included in this analysis. A majority of the sample were boys (n = 37, 58%) and were identified as Native Hawaiian (n = 45, 70%). The mean age was 7.6 months with a majority of infants being over 6 months of age (n = 52, 81%). Only 28% of the sample (n = 18) were exclusively breastfed. The mean timing of complementary food introduction was 5 months with a little more than half of the infants receiving their first food before 6 months (56%, n = 36). The most common first food introduced infant/rice cereal (n = 19) followed by poi (mashed taro root, n = 16). Conclusions The number of exclusively breastfed infants is significantly less than the Healthy People 2020 target of 60.6%. In addition, the timing of complementary feeding in this convenient sample of minority infants seems to occur earlier than the recommended guideline of 6 months. Examining first feeding practices is especially important due to its connections with health later in life and the significant health disparities that exist within these minority populations. Funding Sources NIMHD.
The aim of this study was to investigate caregivers’ experiences of complementary feeding (CF) among the Native Hawaiian and Other Pacific Islander (NHPI), and Filipino populations. Research focused on the timing of CF commencement, and the influence of transgenerational experience on feeding practices. The experiences and practices of those who fed human milk exclusively (HME), were compared to those who included infant formula (F&HM). Caregivers of a subset of 32 infants who were participating in a larger longitudinal study relating to CF and diet diversity, took part in voluntary in-depth interviews relating to CF practices. Interviews were recorded and transcribed. Two researchers analyzed interview transcripts. Interrater reliability and saturation were established. Institutional Review Board exemption was confirmed prior to study commencement. Interviews with 29 caregivers of infants were included in this study. Only infants of the F&HM group had an early introduction to complementary foods (<4 months of age). Caregivers reported receiving conflicting advice from healthcare professionals (HCPs) in relation to timing of the introduction of complementary foods. Nonetheless, the majority of caregivers reported following the advice of HCPs. Extended family (including grandparents) played less of a role in infant feeding, compared to previous generations. While transgenerational practices were valued and included, ultimately, the perceived health and safety of the practice for infants influenced decisions.
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