Developing Educational Messages: A Qualitative Study with Asian Indian Mothers to Understand their Attitudes, Barriers, and Facilitators in Practicing Child Feeding BehaviorsA dramatic increase in the prevalence of childhood overweight has been observed among all ethnic and racial groups. The risk of overweight for Asian Indian children increases with longer residence and acculturation to the US. In addition, a shift to a higher proportion of Asian Indians born in the US is likely to result in higher rates of overweight in Asian Indian children. Parents, particularly mothers, are key in developing a home environment that fosters healthful eating among children via use of specific child feeding behaviors. Positive feeding behaviors such as regular family meals, parental modeling of healthy eating, and availability and accessibility of healthy foods at home are shown to have healthy nutrition outcomes in children. Negative behaviors such as letting children watch TV while eating may lead to overconsumption of energy. Negative behaviors which are also controlling such as pressuring children to eat, offering one food as a reward to eat another, and restricting children's consumption of certain foods may increase children's risk for overweight by disrupting their natural ability to self-regulate energy intake. This study was conducted into two stages: 1) assessment stage and 2) message development and testing stage. Using the Theory of Planned Behavior as a conceptual framework, the first stage used qualitative methodology to assess how Asian Indian mothers' underlying beliefs about expected outcomes of feeding behaviors, perceived behavioral control, and subjective norm influenced their feeding behaviors. In-depth interviews were conducted with 27 Asian Indian mothers (of children 5-10 years old) using projective techniques. The findings revealed that Asian Indian mothers were highly motivated by nutrition outcomes when practicing all feeding behaviors. Cultural beliefs related to religion, ethnic identity, and traditional foods also influenced the practice of feeding behaviors. Pressuring to eat was often practiced despite the perception of ineffectiveness. Use of food rewards and TV to control children's food intake despite the clear understanding of undesirable nutrition outcomes was found. In stage two, nine nutrition education messages were adapted from those developed by the United States Department of Agriculture and 29 new messages were developed based on behavioral beliefs, facilitators, and barriers unique to Asian Indian mothers identified in stage 1 of this research. These messages were tested using cognitive interviews with ten AI mothers for comprehensibility, agreeability with the information, and feasibility of acting on the message. Mothers were receptive to 31 messages, with minor revisions made to five messages to improve clarity and increase acceptability. Two messages that received strong negative responses were deemed inappropriate for this population. Nutrition professionals working with Asian Indian families may use the final messages in education materials to help mothers develop healthy child feeding practices.
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